White House Environmental Justice
Advisory Council
Public Meeting Summary
Virtual public meeting
February 24, 2022
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Contents
Preface 1
Welcome, Introductions, and Opening Remarks 1
Public Comment 3
WHEJAC Scorecard Workgroup Update and Discussion 18
WHEJAC Business Meeting 27
Appendix 1. Public Announcement 29
Appendix 2. Agenda 31
Appendix 3. Attendee List 33
Appendix 4. Comments and Documents Submitted by March 10, 2022 47
Appendix 5. Draft Letter to CEQ Under Discussion 48
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Preface
The White House Environmental Justice Advisory Council (WHEJAC) was established in 2021
through President Biden's executive order 14008 to advise the Council of Environmental Quality
(CEQ) and White House Environmental Justice Interagency Council (IAC) to increase the
federal government's efforts to address current and historic environmental injustice.
As a federal advisory committee, the WHEJAC is governed by the provisions of the 1972
Federal Advisory Committee Act.
This brief summarizes the WHEJAC public meeting convened via Zoom on Wednesday,
February 24, 2022. The public announcement may be viewed in appendix 1.
Please see appendix 2 for the agenda.
Welcome, Introductions, and Opening Remarks
Karen L. Martin, Designated Federal Officer (DFO), opened the meeting.
WHEJAC Co-Chair Richard Moore greeted members and attendees and acknowledged those
involved in the struggle who have now passed. He said there is a long list of individuals whose
shoulders they stand on. He thanked the regular participants from federal agencies who joined
the call and said he looked forward to a fruitful meeting.
WHEJAC Co-Chair Peggy Shepard greeted members and said that the WHEJAC has been
working hard to fulfil its mandate to make recommendations on the scorecard that will evaluate
the Administration's progress on implementing the Justice40 Initiative and advancing
environmental justice in all government policies. She noted the purpose of the present meeting is
to hear from the public about methods and metrics that the WHEJAC should consider in
developing its recommendations. She thanked everyone for their engagement on the issues.
Catherine Coleman Flowers, WHEJAC Vice Chair, welcomed everyone and said she looked
forward to discussing how to measure which communities are impacted by funding and how that
can be improved upon.
Roll Call
WHEJAC members
LaTricea Adams - Black
Millennials for Flint
Jade Begay - NDN
Collective
Robert Bullard -
Department of Urban
Planning & Environmental
Policy Texas Southern
University
Tom Cormons -
Appalachian Voices
Catherine Coleman
Flowers - Center for
Rural Enterprise and
Environmental Justice
Kim Havey - City of
Minneapolis, Office of
Sustainability
Angelo Logan - Moving
Forward Network
Maria Lopez-Nunez -
Ironbound Community
Corporation
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Harold Mitchell -
ReGenesis
Richard Moore - Los
Jardines Institute
Michele Roberts -
Environmental Justice and
Health Alliance for Chemical
Policy Reform
Ruth Santiago - Comite
Dialogo Ambiental and El
Puente, Latino Climate Action
Network
Nicky Sheats - Kean
University
Peggy Shepard - WE ACT
for Environmental Justice
Carletta Tilousi -
Havusapai Tribal
Viola Waghiyi - Alaska
Community Action on Toxics
Kyle Whyte - University of
Michigan
Beverly Wright - Deep
South Center for
Environmental Justice
Government participants
Karen Martin, DFO
Paula Flores Gregg, EPA
George Ward, EPA
Corey Solow, CEQ
Julie Drucker (interpreter)
Jacqueline Moore (interpreter)
Brenda Mallory, Chair, Council on Environmental Quality: Thanks so much, everyone.
Appreciate you all being here, as usual. I should start off by saying good afternoon, and thank
you, as usual, for inviting me to join the meeting. I also want to just welcome everyone else from
the public who is attending the White House Environmental Justice Advisory Council. As
always, I begin by expressing my immense gratitude to the WHEJAC members for the incredible
work that is going on that you all are doing and making towards these efforts in delivering
environmental justice to communities across the country. Your dedication in the public meetings,
but also in the workgroup meetings that occur late at night, I just can't thank you enough for that
commitment to all of us. Today's meeting will focus on a critical set of recommendations for the
environmental justice scorecard, an important accountability and transparency measure that is an
important element of President Biden's environmental justice agenda. So, I'll start off by sharing
a few thoughts on this scorecard to kick off the discussion but really look forward to learning
what you all discuss today and your views on this topic.
But before I turn to that, let me just reflect on a couple of things that have really struck me over
the past few weeks that are connected to other work that's going on in CEQ. First, as we are
coming to the end of Black History Month, I've had several opportunities in the past few weeks
to consider and discuss what it means to be the first Black person to serve in a position in this
administration at this moment. And I usually note the sense of purpose and pride that I feel, as
well as the added responsibility to advance the President's agenda, particularly on issues relating
to justice and equity more broadly. I felt that same sense of purpose last week as I traveled to
Mississippi with our Secretary of Interior Deb Haalland. And together we were visiting the home
of the civil rights leaders Medgar and Myrlie Evers, and we visited the sites associated with the
kidnapping and murder of Emmett Till, including the Tallahatchie courthouse where the
murderers of a 14-year-old boy were swiftly acquitted. Secretary Haalland, a 35th-generation
New Mexican and an enrolled member of the Laguna Pueblo, speaks about generational trauma,
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how the oppression and struggles and violence and tragedy that have come before us affect who
we are, even as we work towards a more just society. And that really resonated with me as we
visited the Civil Rights sites and I think about my own story and the way that my ancestors,
known and unknown, found ways to continue moving forward as they endured the injustices of
the time. And that's why when I think of Black history, I think of resilience. I think of a people
who, in the face of the unspeakable, find a way to persist and to keep pushing forward to build
communities that are better for themselves and their children. That enduring spirit, that grit, that
tenacity, and ultimately that resilience is what it will take to overcome the environmental
injustices that have plagued our communities for far too long. Clean air and clean water are basic
human rights, and we must fight for them every single day. And for those of us in roles helping
to develop and implement environmental policy, it is a particular responsibility to put the
interests of the overburden and underserved communities at the center of everything that we do.
That's why I am proud that last week we were able to release the beta version of the Climate and
Economic Justice Screening Tool. The Climate and Economic Justice Screening Tool is an
interactive map, but it's a lot more than that. It is a key element to helping us identify which
communities have been marginalized, underserved, and overburdened by pollution so that the
federal government can do a better job of delivering the benefits of programs and investments to
the places that need them most. In particular, the Climate and Economic Justice Screening Tool
is critical for implementing the President's Justice40 initiative because it provides federal
agencies with a clear and consistent definition of disadvantaged communities so that agencies
can ensure that the benefits of climate, clean energy, affordable housing, and other
environmental investments are reaching these communities.
The WHEJAC's recommendations have already been immensely helpful in developing the
screening tool, and we hope that over the course of the next 60-day comment period we will
receive additional feedback to ensure that the tool is capturing the reality on the ground. I also
hope that you will share the beta tool with your networks, analyze the data, explore the map,
click on the census tracts that you know, and let us know what looks right and what doesn't.
That's the kind of input that's really going to be helpful in refining and improving the tool as we
move forward to finalize it as quickly as we can. I wanted to just touch on those two things
because both are on my mind. I think that it feeds into what the environmental justice scorecard
is all about and the importance of having a mechanism like a scorecard to really track whether
we are succeeding at what we are trying to accomplish. The WHEJAC is obviously a critical
partner in the development of this first-ever scorecard, so I was pleased to see that it's a major
focus of today's meeting. We all know that it's one thing to set an ambitious environmental
justice agenda, but that ambition has to be accompanied by transparency and accountability. So,
I'm looking forward to hearing more about the vision, your vision and recommendations for the
scorecard and how we can ensure that it serves the purpose that ultimately we want.
But let me start just telling you about a couple of the things that I think are important and that
we're striving for as we are talking within CEQ and in the agencies in general. And first and
foremost, it's that the environmental justice scorecard should track progress and work across the
entire federal government and across the full breadth of our environmental justice agenda. That
will include evaluating whether we're reducing environmental burdens, delivering clean energy
and climate benefits, and undertaking institutional reforms that can ensure that the voices of
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communities are reflected in the decision making. In other words, the scorecard is a way that
we're going to be able to hold ourselves accountable for the progress that we're making. And I
say that understanding that the scorecard itself will evolve over the next couple of years because
what we're able to measure in the first scorecard is not as broad as what we'll be striving to be
able to accomplish when we do subsequent versions of the card.
A second priority for the scorecard is to provide information that is accessible and usable to
anyone and everyone. It shouldn't be—and we're aiming not to have it be—a website that is
really only of value to other government entities. We want it to be something that students or
community members can use to understand how their government is advancing environmental
justice and find out where there is more work to be done.
And then third is to make sure that the environmental justice scorecard is something that we can
build on and improve on year after year, which is what I said at the top. I think that's a really
important element of thinking about how the scorecard is going to work. The scorecard we
release this year will be a starting point and a foundation for that building. We'll take some time
to digest the recommendations that we receive from you all. But we'll then be publishing this
initial and first scorecard shortly thereafter. To be effective tools for accountability, each of these
annual scorecards will need to get more and more detailed about the progress the federal
government is making on the implementation of Justice40, in delivering meaningful change on
the ground and embedding environmental justice in all the work that we do. I'm excited that we
are at this juncture, and that we're going to have the benefit of your recommendations today.
With that, let me close where I started, which is to express my appreciation again for the work
that you're doing. There's a lot going on at CEQ right now that's very important, but there's really
nothing as important as the work that you all are helping us with. I thank you for that. And I turn
it back over to you, Richard.
Richard Moore: Thank you, Chairwoman. And we realize that you have another appointment
that you must move on to. I just wanted to, before we move on, say that—what you said—that
the historical significance of the White House Council has been extremely crucial to the work
that this council has been engaged in. And I know you realize, and other staff at CEQ and within
the White House also realize what I'm referring to as that political significance. Because many of
our grassroots communities, both urban and rural, have been asking for many, many years for
environmental and economic justice to be lifted to the highest level within the administration.
And the Biden-Harris Administration has made a commitment to do that. Each of these pieces of
work thus far that the council has done—the screening tool, the scorecard of the Justice40, the
implementation of the interim guidance, and the executive order—each one of those, along with
other pieces, are somewhat connected to each other. We appreciate your commitment, your
contribution, and the other staff at CEQ for the work that everyone has been able to do thus far.
And we'll be discussing other issues today regarding several of those pieces. And then in our
business section, we'll be diving into two other pieces of the work. Thank you very much for
those opening remarks. And we're going to let you go to your other appointment. Thank you.
Richard Moore: Take care. Thank you. Karen, I think we're ready to proceed with public
comment.
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Karen Martin: Yes, thank you, Richard. Just a couple of announcements before we get started.
We will only hear from our pre-registered public commenters in this meeting today. The
deadline to speak was 11:59 p.m. on Monday, February 21. We will hear from as many public
commenters as possible in the time we have on the agenda today. We will continue to accept
public comments in writing through March 10, 2022. And all comments we receive, we will
share them with WHEJAC members in the Scorecard workgroup. Kurd Ali is on the call with us
today helping us with the public comment period. So please listen for your name. He's going to
call three public commenters at a time, and he'll also send you a note in the chat. So please pay
attention. Please remember to state your name and your organization. You'll have three minutes
to speak. We'll have a timer on the screen to remind you of the time that you have remaining.
And Kurd, I think we're ready to get started.
Richard Moore: Thank you. Kurd, if you could name those three that are up so we get them on
board. And then before that testimony, I'd like to make a comment.
Kurd Ali, WHEJAC support: Okay. Thanks, Richard. Our first three public commenters today is
Alyssa Garza; the second one is Claire Barnett; and the third is Mario Atencio. Go ahead,
Richard, if you'd like to make a comment.
Richard Moore: Yes, a very brief comment. I've been receiving text messages and so on from
some of our folks that have registered for public comment. And I just wanted to mention this
because this is what we've been able, thus far, to put in place. And some would think that they
registered early, for example, but they're 55—or whatever the number is—and I just wanted to
make a comment while we open it up. One of the things that we've been looking at is who has
made previous comments in the past because in several different moments in public comment,
some have testified two or three times, and so we've asked the staff to watch the registration and
then to, in some cases, move the other folks up that haven't had the opportunity to make public
comment before, and so I wanted to make that comment before we opened it up. So, Kurd, we're
ready to proceed.
Public Comment
Eighty-one individuals registered to provide verbal comments; 25 individuals provided
comments. See appendix 3 for a list of pre-registered public commenters. See appendix 4 for
information on how to access the summary of written comments submitted by the March 10,
2022, deadline.
Alyssa Garza, public commenter: One of the things that I wanted to mention and touch up on
is that I live in the borderline region; El Paso, Texas, to be specific. And one of the things that I
would just like to emphasize is how our community continues to be marginalized by refineries
and people who pollute our city continuously. And I think it's important that the southwest
region has a seat at the table, especially when we're advancing environmental justice, and what
that looks like. So, making sure that this region is included in the climate justice movement, and
making sure that our community is heard as well, because we are also located in the Permian
Basin area, which is known for fracking and oil. And that is creating earthquakes. They're not
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extreme earthquakes, yet, but it has led to an increase in small earthquakes. So, I just wanted to
emphasize that, and thank you.
Claire Barnett, public commenter: What we're hearing is just, really, an amazing amount of
work over many years, which has led to the political impact that this particular Advisory Council
is having. I was very taken by CEQ Chair Mallory's comments about clean air and clean water
and having rights to those, only to bring up the children in schools who don't have those rights.
And it's very significant. The conditions of schools have always been a profound environmental
justice and civil rights issue going back decades. Today, we know just from the past two years
that schools have never been pandemic ready, and they certainly are not climate ready. There
98,000 public school buildings in the country; 95% of the occupants are women and children.
More than half of all the children in public schools today are children of color; 40% of school-
aged children, according to CDC, have pre-existing chronic health conditions, obviously
impacted by problems like indoor air and ventilation and sanitation and drinking water and so
forth. These are profound topics. So, in terms of the scorecard, which is a terrific idea, I hope
there's a way for the scorecard to develop methods and metrics around the environmental
conditions of schools, where the poorest children in the poorest communities must attend on a
regular basis. These are not new subjects. For us, if you're looking at how well the
Administration has done on this topic, aside from the COVID bailout money, it has not done
nearly enough. Most schools were—by a number of different local surveys—were unable to
meet or to even implement CDC reopening guidance. That's extraordinary. Why weren't they
able to? Who tried to figure that out? Very few people did. We hope you will join us as the
White House council on environmental justice, calling on this administration to establish and
fund a permanent Healthy Schools initiative within EPA, also to address the elimination of
legacy toxics within all those schools, PCBs, lead, mercury, whatever. And finally, we also hope
that there will be funding to rebuild America's schools, particularly in the lowest income
communities. There is not nearly enough money and time to be able to do that in very short
order. But the design and construction and repair of America's schools should be done with very
strict federal guidelines that prioritize children's health and the ability to learn. Anything less is
more injustice. We thank you very much and look forward to learning more about the methods
and metrics of a scorecard. Thank you.
Mario Atencio, public commenter: My name is Mario Atencio. I am the Vice President for the
Torreon/Star Lake chapter of the Navajo Nation government and part of the Protect Greater
Chaco landscape coalition. I'm really thankful that this group is taking on the work to develop a
scorecard. The scorecard really needs to take into the new guidance out of the White House
regarding tribal consultation. Local chapters of government like Torreon/Star Lake really need to
be involved in the environmental justice analysis. Because they are at times consulting parties on
federal actions such as Resource Management Plan and Resource Management Plan
amendments. Greater Chaco is incredibly sacred landscape. And in the EJ guidance, it says
NEPA, and NEPA specialists need to have a complete cultural understanding of federal actions
being taken place in the landscape. And so, these cultural impacts can only be fully realized and
understood by NEPA specialists if they communicate with local governments such as chapters of
Navajo Nation government. And so all of the Navajo Nation chapters in the Farmington Field
Office of the Bureau of Land Management are considered environmental justice communities,
and as a local leader, we have never been communicated as this being so and all of the rights and
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privileges therein, and ability to properly weigh in on federal actions such as increasing oil and
gas drilling into the Greater Chaco landscape. We have yet to really engage on that level. And so
this behooves, that, you know, from the White House, the Bureau of Indian Affairs can't be the
main lead agency; there needs to be a clear initiative that pushes this idea forward. And so co-
chairs and members of the advisory committee, I just really wanted to recap that this process
needs to follow a different level of tribal consultation, and possibly even thinking about free and
prior informed consent for these communities to properly engage and weigh in on highly
impactful federal actions that may or may not affect communities. Thank you.
Kathy Andrews, public commenter: My name is Kathy Andrews, and I am director of the Blue
Ridge Environmental Defense League. I'm calling from Myrtle Beach, South Carolina. But we
cover six states, South Carolina, Georgia, North Carolina, Alabama, Tennessee. And I'm calling
because I'm not sure what to do with Biden and the scorecard. Maybe he's trying, but we don't
see it. In the southeast, we don't see any type of penalties for companies like Dominion Energy,
that Dominion Energy was just defeated with the Atlantic Coast pipeline, and Virginia, North
Carolina. Now they're in South Carolina, trying to do the same thing. They're trying to put up
pipeline in Ayers property, predominantly a Black area. They're intimidating people. And the
only reason they're giving for this pipeline is development. They are offering people $300 and
some $1,000. And they pay off legislators; they've given legislators in Virginia over a million
dollars. So what we need the Biden Administration to do is penalize these companies like
Dominion Energy, trying to put a pipeline through a predominantly Black area in South
Carolina—it's called the River Neck to Kingsburg Project—and penalize them with fines and
executive orders. And if there is a community that's already compromised, stop these industries
from coming there. That's why they target places like Pamplico, South Carolina, where there's
also a cancer alley, which Michael Regan didn't come to, he went to Louisiana, but we've got
cancer alleys all across the southeast. And we're being inundated with industries that want to
pollute to profit. And these industries are already—people there already have cancer and other
problems. And so now they're going to have more cancer, more kidney disease, more respiratory
problems. So we need real legislation to stop these industries from coming to places like
Pamplico, South Carolina, and Augusta, Georgia, and putting landfills and huge chicken and hog
industries down here. We need real legislation. So when it comes to a scorecard, I can't give
them anything in the southeast. Nothing, absolutely zero. And we'll be sending a full report so
that you can understand what I'm talking about.
Laurene Conteras, public commenter: My name is Laurene Conteras. I am a member of the
Confederated Tribes of the Yakima Nation located in central Washington State. I am the
Program Administrator for Yakima Nation Environmental Restoration Waste Management,
which deals with the Hanford Nuclear reservation cleanup. We work in coordination with
Department of Energy. And I guess my comment today is, you know, the frustration as a tribal
member that lives in close proximity to the Hanford Nuclear reservation, which is 580 square
miles. And our tribe has been instrumental in obtaining a voice to deal with cleanup at the
Hanford site. The Hanford Nuclear reservation is the most contaminated site in the nation. And
so my concerns, recent, are the high-level waste redefinition in that Department of Energy and
GAO has supported because of cost savings. And the contamination, which was created by the
Manhattan Project back in the 1940s, basically impacts the ceded territory of the
recommendation that guarantees us rights through the Treaty of 1855. And contamination has
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left a huge impact on the environmental footprint in the area. The areas there are sacred to the
Yakima Nation because of the natural resources, cultural resources, burial sites that are there,
that we continue to try to do our best to protect. Hanford has over 56 million gallons of
contaminated waste, and I guess what we would like to see is that the Biden Administration take
measures to clearly protect the safe health and sustainability of this area for the Yakima nation
and surrounding communities. The Tri Cities area has a huge population. So it's not just about
the Yakima Nation. I mean, it's primarily our concern because that's our ceded territory. And
we've been here since time immemorial, and we're not going anywhere. So, the impacts of the
contamination are going to impact future generations for millions of years. And so my time here
on Earth, I'm spending my time working towards trying to protect and preserve what is there and
clean it up to the standard that will prevent future impacts to health in our environment and our
natural resources, religious resources there. So, thank you for allowing me to speak today. And
I'm hoping that a small voice can be heard throughout the nation, here in Washington State.
Thank you.
Syrah Scott, public commenter: I appreciate the new council and its willingness to make sure
that federal agencies are operating at their fullest potential when addressing environmental
injustices. My name is Sierra Scott, as mentioned, and I'm the founder and Executive Chairman
of the National Clean Water Collective. We're a grassroots organization that's helping to provide
short- and long-term relief to communities across the nation experiencing a water crisis. We
started in Flint, Michigan, and have since expanded our efforts into New Jersey, Newark,
Houston, Dallas, Austin, Jackson, Mississippi, and the Bahamas.
I believe that the federal agencies should be graded on the following: how well they are
disseminating information to the public and the community that they are serving? Do the
residents know what's happening in their community? Before and after they complete a project,
are they getting feedback from organizations like myself and even local organizations? Or are
they hosting focus groups in the community to make sure that they're getting honest feedback
from the participants in the community? And are they holding municipalities accountable when it
comes to a maintaining the water, the lead levels, and the copper levels? I know that there has
been a recent push to make sure that these municipalities are making sure that they're within the
federal guidelines. But are they going back to check to see if these cities and municipalities are
basically doing what they're supposed to be doing? Because to be quite honest, there is no level
of lead that's safe for human consumption. How well are they assessing the pipe replacements
that are done in communities like Newark and Flint, for instance; have they checked to see that
the work is being done? There are residents in New York and even Flint that are complaining
that the work has not been done and that they're just digging up the ground and they're not really
doing the work. I know that Vice President Kamala Harris went to Newark, but has she really
checked to see that the work was done? Also, when performing the pipe replacements, how are
they containing the area so that people are not really exposed to all the contaminants and
particulates that are in the air? Because we know that that causes cancer and other harmful
issues, like, even asthma. And then, are we going to include race because I saw the article about
how it was going to be excluded. That is concerned because, as Miss Mallory said, it's very
important. And we're marking a very important historic time. So, it's important for me to include
race. And then lastly, how well are they sharing grant and funding opportunities to grassroots
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organizations like myself, that are led by black and brown people? Thank you so much. I
appreciate the time.
Wig Zamore, public commenter: I want to focus on highways and airports and the primary
exposures to ultrafine particles and noise from those sources. I'm part of two grassroots groups in
Somerville; we have no paid staff. We have caused very large local land-use changes that have
advanced dense, mixed-use, transit-oriented, built the first subway station in Massachusetts in 30
years. And then we moved on to consideration of environmental epidemiology at near-source
scales and started a program with Tufts, two professors who had never worked together, had
never studied ultrafine or cardiovascular inflammation. And we were able to show with a series
of studies, a significant relationship between inflammatory biomarkers of cardiovascular disease
and our near-highway residents, as opposed to residents more than a kilometer away. Our studies
have been done with five doctorates who have moved on and several postdocs as well as Doug
Brogy, John Durant and others at the research universities in Boston. We do those studies at 500
million times the spatial temporal density of the Harvard six-city study. But because the
populations are so small, we are not able to drive regulatory progress at national and state levels.
In other words, the difficulty of the research is preventing focus on primary exposures, as
opposed to regional PM 2.5 exposures, which are flat in our spatial temporal domains. And I
understand that we are now moving with great speed into climate and protecting the planet and
people who are in vulnerable places on the planet, but we are not yet framing protection for the
people who live next to big highways, live next to large airports or under the flight paths. And
those health effect gradients are roughly 10 times the health effect gradients in our PM 2.5
variants within the US and in normal metropolitan areas. I know my time is about to go. I just
would plead with you to work with grassroots groups and USEPA to actually do the research that
at regional metropolitan level can show statistically significant relationships between primary
ultrafine and large transportation sources of noise and health outcomes. Those are the
populations which are most intensely environmental justice, most intensely immigrant in the US,
and most intensely affected now by our pollution levels. Thank you very much.
Peter Williams, public commenter: I'd like to comment about the Executive Order 14008,
which I've seen over the last year in regulations that on HFC phase down, that is a "wink wink,
nod nod" in the preamble and has nothing behind it. Since 2013, I've worked and gotten the
attention of the NAACP and other minorities in this space to try and get minority black and
brown people involved in the rule and to benefit from trying to straighten out some of the issues
that we faced with HFC and refrigerant releases. I'd like to note that I'm asking the council to try
and put greater emphasis on the use of this executive order, whereby we engage HBCUs to do
the research and development on things such as air conditioning units, disposal, different
elements of the HFC use, which has not been there. We look at the financial benefits that large
white enviro groups extend to large organizations in the air conditioning and refrigeration
industry and find that there's very little if any, Black-, brown- or female-owned businesses that
benefit from these types of rules that are that are going into place. We keep on struggling with
this issue. We look at the way that EPA has—you know, they talk about fenceline communities
and the effects, but there's not a full accounting of it. So essentially, I'm wondering if the council
would, in its report card, look at how this executive order is placed into and incorporated for real
time impact on environmental policy.
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Dr. Arnold Wendroff, public commenter: I'm going to talk about the failures, intentional
failures of EPA, etc. And I'm going to read this. I'm taking this opportunity to inform you of the
hypocrisy, nonfeasance, and rejection of the hallowed precautionary principle by EPA Office of
Environmental Justice and children's health protection, as well as the CDC ATSDR, and a
plethora of governmental and nongovernmental organizations and individuals all aware of
domestic mercury contamination resulting from the magical religious sprinkling of elemental
mercury on floors of homes as practiced in several Caribbean and Latinx racial, ethnic, and
religious minorities communities. These ritualistic mercury spills semi-permanently contaminate
dwellings with toxic—especially developmental^ neurotoxic—levels of mercury vapor, which is
inhaled by all current and future occupants, most problematically maternal-fetal pairs. The
domestic mercury vapor evacuation level is 10 micrograms per cubic meters, or a portable
biomarker level is only 20 micrograms per liter of urine. The cost of decontamination of these
homes is great, but the cost of the damage to the developing brains of exposed fetuses, infants,
and children is far greater, as is the case of pediatric lead exposure—the latter as American as
apple pie—to address and label an environmental injustice when the source of the toxin is
exogenous to the impacted minority. However, in this case of magical religious mercury
contamination, minority community members are themselves directly, albeit unwilling,
unwittingly, the source of the contamination. And government has fostered their ignorance of the
damage that they have caused and the danger they incur from occupying mercury-contaminated
dwellings. The elites of these communities, including many of you who are on the line there
now, your environmental justice advocates are exquisitely embarrassed by this problematic
practice and have individually and collectively acted to suppress any action to assess and address
the problem, thereby keeping their communities in ignorance of secondhand exposure from prior
ritualistic mercury spills. Manifold government agencies, including CDC ATSDR, and IHS, EPA
and city and state agencies and NGOs for decades have all participated in this cover up.
Information on the issue is readily available online using the keywords mercury and Santeria in
your favorite search engine or Google Scholar. And in 1999, ATSDR wrote, "There is an urgent
need to obtain information on the levels of exposure from these practices to determine if children
or adults are at risk." But to date, the government has refused to gather the data. And Karen
Martin and Peggy Shepard know all about it and have refused to do anything to lift a finger to
assist in getting the data.
Ayesha Franklin, public commenter: Thank you. I'm Ayesha Franklin Covington, and I'm with
Brooklyn Neighborhood Association. I live in Duval County, in Jacksonville, Florida. And I'm
calling as a concerned citizen and community activist regarding the Forest Street Incinerator site.
We currently have a project where the City of Jacksonville has entered into an agreement with a
private entity to clean the McCoy Creek; it's called the McCoy's Creek Restoration Project.
However, as I watched them engaged in this process, they are re-exposing the community to
contaminants. And as I had the conversation with the stakeholder, Groundwork Jacksonville, I
was told that the area was not that contaminated; it wasn't that bad. They built a new school over
here by us on the original site. Also, the Fairfax area, it was still contaminated with lead and with
different contaminants that we found in the soil, which when the EPA cleaned it up, the soil was
re-contaminated again. My concern is with these new projects that the city wants to undertake,
and old areas that had once been cleaned up by the Environmental Protection Agency. Who is
giving them oversight to ensure that the public is not re-affected or contaminated due to their
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lack of following EPA guidelines? We will observe them not using water, openly carrying
contaminants out in trucks, and we were being told, oh, it's not their truck.
I would like to see on the scorecard, if the city engages in opening an old area of contamination,
that someone gives them direct oversight on how to not contaminate another area, another
generation. We've had a lot of cancers that occurred as of the exposures. And there were no
medical studies done. But the only thing that we had in common was we lived in the direct area
of exposure. So, I don't want to see another area exposed. How do we make sure that these areas
are being protected in the future? And I would like to see that addressed by the Biden
Administration. I would like to see these cities held accountable because they allowed us to live
in these areas for years. And then they did not settle these agreements until the federal
government came in to assist with the cleanup. And I was one that sat at the table, and they
ignored all of our concerns. And now they're building new concrete dwellings; those children are
still being exposed to those contaminants that are seeping into the concrete. Thank you.
Brian Ansari, public commenter: One of the things that I noticed is the omission of the
businesses in these communities that have not had an opportunity to be able to add value to the
projects. And when I think about workforce, and I think about community benefits, the thing that
leaps out at me as a disadvantaged business owner myself, is how can we contribute to the
advancement or implementation of this expectation, as businesses; the path to be able to do that
is not clear at all in the criteria for environmental justice, And, frankly, there's a lot of
applications and solutions that are going to be developed. And, as businesses, there's a lot of
other vendors that are going to be coming into our communities and designing what success is
going to look like and intimating that success, and continuing a pattern of behavior, or at least
conduct that's sponsored by public policy, that prevents vendors in that community from being
able to provide services in a tangible way that is defined as a value, as a cultural value and as an
expectation that agencies are going to examine and then integrate into their response.
But also, with respect to any new technologies or new infrastructure that's going to be developed
to respond to these things, if there's no clear path defined for the participation of firms like mine
in the governance, then most assuredly we're going to be excluded both from economic benefits
and we'll be excluded from the knowledge transfer that could have occurred that would have
stayed in the community. My headquarters is in Newark, New Jersey. And we've seen their
significant issues with lead pipes and other vendors. The fact of the matter is that those are
turned into a crisis that have disproportionately benefited firms outside the community and
adversely impacted firms like mine, and many others that would like to participate in the
remediation of these issues, both from a policy standpoint, as well as an implementation
standpoint. So, I would encourage those who are looking at this to, when they think about
disadvantaged communities, do not omit the disadvantaged businesses that are specifically
identified in statute as being disadvantaged. And so, they represent a community as well that are
often embedded within the larger communities that, if given a voice to participate, would be
active in making sure that they were workforce value adds and that communities are being
engaged, and there would be opportunities to be able to hire union labor by firms that are going
to be a participant in the supply chain. But without an intentional stakeholder engagement plan or
other kinds of considerations identified in Section C of the guidance, and even the structure of
the grants—I mean, when you're putting out the NOFOs, you guys have made provisions for
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being able to give scoring benefits for certain considerations, but to the degree that there's a
scoring benefit that can be provided or incorporated that allow businesses that have invested in
these communities and that are invested in those community outcomes to participate in these
projects, that's a significant value add, as well. And that also reinforces a lot of the community's
small business or local business activities, and I know many municipalities and communities are
hoping that this will be an opportunity for them to be able to meaningfully engage members of
their business community to support things in their supply chain. Thank you.
Felipe Franchini, public commenter: I am a whistleblower. I was employed by a federal
contractor for the Department of Energy. I worked for eight years from 2000 to 2008.1 was
exposed to lead for a period of eight years. As I became ill and started getting sick, I attempted to
get a medical evaluation from our medical department. I was told that I was crazy, that I was
dreaming things, and that if I wasn't happy, and if I felt in danger, that I could find another job.
As I reported, I became a victim of racial harassment; constant efforts to be disposed of forced
me to quit. So, I blew the whistle to the Department of Energy Office of Inspector General. I was
told that they were similar to the FBI, they'll take complaints and do nothing about it. As my
harassment intensified, I contacted them again. They sent the case to the internal investigator.
My case was pretty much—she pretty much swept me under the table, under the carpet, and
made my work environment unbearable.
During this time, I recorded my interactions, I have a total of 50 recordings addressing my
issues. I have a total of close to 10,000 pages of documents that prove that I was exposed to lead.
I have never received one minute of training in lead handling. At the time of my employment.
When I began my employment, my wife was pregnant with my last daughter. I worked there for
a period of eight years. After working long hours plus the 12 [inaudible], I came home, carry my
infant child not knowing that I was contaminated with not just lead but radioactive contaminated
lead. When I addressed the issue, they claimed that I never worked with lead. And I said I
brought the issues and filed a complaint with OSHA and Department of Labor. They doctored
my file to make it appear as if I have received lead training when they have claimed that I did not
work with them. It's sad how the Department of Labor and OSHA further victimized the
whistleblower such as me. I became a victim repeatedly. And up till this day, I have not been
heard by anyone. I had attempted to contact Congress in our local area. Unfortunately, congress
members get bought by these federal contractors that contribute to their political campaigns. And
they look the other way, and we continue to be victimized. I dumped the contaminated waste that
I removed from floors into the storm sewer. I have documents that prove that I rented a machine
to remove such contamination. And yet they claim it never happened. My recordings will prove I
have filed for disability, and even with my medical conditions I plan on moving to Washington
to advocate for the whistleblowers who have not been heard and have been victimized by the
system time after time. I have traveled to Washington on several occasions. I have participated
and Whistleblower Recognition Day only to sadly look at how the little whistleblowers get
ignored and only those whistleblowers who are paying high dollars to the attorneys are heard.
Thank you for giving me the opportunity to be here. And I think you need to do more for
employees who become victims of your federal agencies all across the board, not just the EPA,
but the Department of Labor, Department of Energy, and Human Service. It's sad, and I hope
you do what [inaudible] doing each time. Thank you.
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Pamela Mullens, public commenter: My name is Pamela Mullens. I am a resident of
Covington, Kentucky. I'm speaking today about environmental injustice regarding landfills and
water seeping into disadvantaged communities, which is a community that I live in. We call it
the East Side of Covington. We are located adjacent to a levee flood wall. We are in—I believe
it's correct—to be region number four, as far as the district, when it comes to watershed and part
of the Ohio River Basin. I am serving on a committee this time that involves volunteers. And we
have listed some priorities that we believe that you should be paying attention to and held
accountable for when funds are giving to communities to help eradicate any of the injustice that
has been done to it from an environmental perspective, particularly to the soil. We want to be
sure that public engagement happens before decisions are made. And that's at the local level. But
also, with your level when you are granting dollars to these entities to be sure that there's some
type of cleanup. We also want to be sure that you are accountable with the reporting back to the
local entities and to the local residents so that we stay informed about what are the results of
these testing, and that someone is accountable to be sure that meetings are held, and that you
come back to the communities that are impacted so that we have a clearer understanding of what
these tests mean.
Some of these tools that are being provided to use to try to determine where there are areas of
disparity, there are not very easy to use. Technical assistance needs to be provided to
communities who get grants for these different projects. But even more than that, adequate
funding needs to be provided because many of these communities after the federal funds for
whatever must be done as far as cleanup, they are strapped with trying to figure out how to raise
some local funds many times to finish up projects that have not been totally brought to closure.
So, I would like to see that adequate funding be provided to these communities beyond whatever
you're currently doing now to eradicate, you know, what's been left behind from brownfield
damage, so that the communities, when they come back and apply again to do more and to clean
up more, they've got a good opportunity to get more dollars and it's going the right way, and it's
tracked appropriately. And the appropriate authorities are held accountable for tracking and
knowing where those dollars went. I see my time is about up. I thank you so much for the
opportunity to provide this public comment.
David DiGiacomo, public commenter: I am David DiGiacomo. I'm talking to you from St.
John and the United States Virgin Islands, where today it's 84 degrees and every day it's 84. I'm
not speaking to you on behalf of a number of boards that I'm on, but I am on the Friends of the
Virgin Islands National Park Board. I am on the Unitarian Universalist Fellowship Church board
here. I am on the School for the Arts Board, and I had previously been on an environmental
board, a board called Island Green Living, focused on a number of environmental issues. I
wanted to alert you all to the uniqueness of the Virgin Islands. We are citizens of the United
States, but we have no voting representative in Congress. And we have no United States Senator.
There are millions of people in the Virgin Islands and Puerto Rico who have similar interests and
challenges, but limited access to government and government resources. We also have
populations who are descended from slaves and Taino peoples who emigrated from Central
America over 3000 years ago. Whatever system that you ended up devising should seek a true
representation of all the peoples, including the peoples of our territory. Our rate of poverty is
higher than almost all the US, and the people who live here are overwhelmingly people who are
black and brown. We have unique data collection problems here in the territories. We have areas
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that are geographically unique. We have endangered species, including turtles. We have
problems obtaining accurate information from the territorial government regarding
environmental problems or issues. We also have a lack of enforcement of environmental laws
that has resulted in toxic wastes and dump sites that are not in compliance with federal laws. And
there's been failures to remediate those known hazardous waste sites, including the largest, what
was recently the largest single refinery in the world located on St. Croix, which is one of the US
Virgin Islands. We also want you to design a system that will address the fact that we have
limited resources here to address environmental conditions. Whatever scorecard that you create,
we hope will reflect the special interests of ours, which, while not entirely unique, are unique in
many ways. And thank you for the opportunity to speak today.
Kathy Yuknavage, public commenter: I'm a board member of our Commonwealth 670, a
grassroots organization on the island of Saipan in the Commonwealth of the Northern Mariana
Islands. Our primary concern is substandard EIS review processes by the Department of
Defense. This has allowed increasing US military expansion in the region, and DOD's constant,
flippant responses to Commonwealth concerns. We have had five EIS reviews from the late
1990s to present, which state their purpose is meeting military training requirements in the
western Pacific. Their need was using the CMIs location for this purpose. This purported need
precludes consideration of other alternative sites with existing installations on larger land masses
elsewhere in the Pacific that can provide this training and are less susceptible to impacts as our
small archipelago of less than 184 square miles. World War Two and current exercises have left
military debris, unexploded ordnance, and contamination of our islands. DOD is now proposing
new lease designs despite the acknowledgment within the CMI covenant with the US that no
additional lands would be leased for such purposes. This disregards Indigenous sovereignty.
Allowing live fire training on leased lands that will be returned even more polluted than after
World War Two is problematic from both a socioeconomic and environmental justice
perspective.
DOD has made clear that removing unexploded ordnance and contaminants of leased lands is not
a requirement or a priority. DOD should be required to complete baseline studies of [inaudible]
and biota contamination to demonstrate past and current levels to ensure accountability for
remediation and restoration of leased lands. Activity should support cultural norms, incorporate
best practices to meet local environmental requirements, and abide by local laws and regulations.
DOD has foregone attaining coastal management permits. Although allowed legally, it doesn't
offset socioeconomic impacts for underserved and Indigenous populations when their proposed
actions are inconsistent with their interest in resource protection. All pertinent research must be
considered in the EIS process, not just those studies that DOD have funded or that support their
preferred activities, and they cannot just disregard other peer reviewed research cited by local
agencies that does not support these activities. Public hearings should have knowledgeable
panels capable of answering substantive questions posed by participants. Should a panel not be
able to answer most questions, then this should not be considered a public hearing or engaged
public discourse for comments. DOD continues to offer higher salaries to entice experienced
local professionals that used to review the EISs on behalf of the CMI to now make assessments
for them. Federal agencies should provide proportionate funding to local governments to hire
experienced experts and make necessary purchases to enable thorough reviews or adjust
assessment of environmental concerns. I see that my time has run out. I do have a few other
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comments. Federal resources should provide in [inaudible] broad participation in public
hearings, including social media and radio and provide pertinent information and plans and
accessible and timely manner in the responses to comments. There should be translation services.
Federal agencies should provide pertinent information on plans in an accessible and timely
manner. And in their response to comments, there should be translation service and Indigenous
people should be given time to express themselves consistent with and respectful of local culture.
Consent should always be a primary goal before consultation. We thank you for this opportunity
to reach out to the Advisory Council.
Audrey Adams, public commenter: I'm Audrey Adams in Renton, Washington, and I'm one of
eight plaintiffs suing the EPA to ban fluoridation on behalf of my son Kyle who has autism and
severe chemical sensitivities. I discovered fluorides harmed Kyle when he was 14, and he's now
36. He suffered profound pain that resulted in wild, erratic behaviors. His chronic headaches
affected both home and school and I'd already put him on an organic diet. When a mom of a
child with autism suggested I try eliminating fluoridated water, we switched to fluoride-free
water. Kyle's pain diminished in three days, the screaming, jumping, and wild racing was no
longer the norm. With the pain of fluoride gone, I could identify other toxins he reacted to. By
his early 20s, Kyle's ability to detoxify decreased and his reactivity to chemicals increased. The
severe headaches had gradually returned mostly following his morning shower. Then another
autism mom told me about her terrible reactions to bathing and fluoridated water and her son's
pain, too. I hadn't even thought of skin exposure. We had a filter on the shower that remove
chlorine but not fluoride. When I switch Kyle shower to the evening, the screaming headaches
followed that shower. After installing a shower filter that removed most of the fluoride his pain
vastly diminished. Kyle's sensitivity to fluoride is well documented by the state DDD, his two
doctors, and his dentist. A 2019 study reports 60% of those with autism are hypersensitive to
chemicals. It is an unconscionable injustice to put a toxic chemical in public water, drugging
everyone regardless of medical differences. Most families coping with autism never discovered
that their child's pain is literally in the water. It took me 14 years, and I didn't fully understand
for another nine while Kyle suffered terribly. The CDC says one in 44 kids have autism. More
than half of those have chemical sensitivities. Fluoride is a presumed neurodevelopmental
neurotoxin, according to the National Toxicology Program. Seventy-four studies, including 11 at
amounts of fluoridated water show lowered IQ and higher rates of ADHD. How does a mom
without a car carry her baby, food, plus gallons of bottled water on a bus? Fluoride's toxicity
gram for gram sits between lead and arsenic. Those most harmed by fluoridation are low-income
families trying to avoid fluoride for their babies for those who have children with autism.
Fluoride is more than an injustice. It's an environmental crime against the most vulnerable. And I
thank you very much for listening to this and for doing the work that you do.
Kyle Kajihiro, public commenter: My name is Kyle Kajihiro. I'm a Japanese settler in the
occupied Hawaiian Kingdom on Kanaka Maoli lands. I'm a lecturer at the University of Hawaii
at Manoa in geography and ethnic studies. And we work with Hawaii Peace and Justice and a
group called the O'ahu Water Protectors. We have an environmental justice crisis in Hawaii at
this moment. The Navy's giant Red Hill fuel tanks have leaked into our aquifer, affecting about
93,000 users of the Navy water system, and about 4,000 families have been displaced from their
homes. But this is only a small warning shot of what could happen. There are about 200 million
gallons of fuel in these 80-year-old fuel tanks sitting 100 feet above the aquifer, which supplies
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77% of O'ahu's drinking water. It's a ticking time bomb that could destroy life on our island as
we know it. And communities have become united to demand that the Navy defuel the tanks
immediately and permanently decommission them. They have fought the emergency order of the
state and refused to abide by these orders. And so, we're appealing to the Biden Administration,
the President, to order the Navy to defuel the tanks and to decommission these tanks
permanently. But the Red Hill issue is only one of thousands of military contamination sites in
Hawaii. One of the issues that we have—and this is a legacy of the history of settler colonialism
here—the military leases about 30,000 plus acres of Hawaiian trust lands for $1 for 65 years.
These leases expire in 2029. And many of these lands are contaminated with unexploded
ordnance and other contaminants. So, we are pushing for the military to begin cleaning up and
restoring these lands so that they can be returned to the Hawaiian people. Regarding the
scorecard, a couple points I want to make. EJ issues have been typically weakly enforced in
Hawaii because we're blessed with a diversity in our community where there's no majority,
typically, environmental justice gets overlooked. Second, cumulative impacts are never
adequately addressed. Third, the military has been a bad actor, consistently polluting our
environment and trying to get exceptions whenever they get caught, as in this case, where they
are refusing the order to defuel. And finally, I think that free, prior, and informed consent as
defined in the UN Declaration on the Rights of Indigenous Peoples should be the standard for
any kind of environmental review and consultation. Thank you for this opportunity to share my
thoughts.
Wilda Anagal, public commenter: My name is Wilda Anagal, and I'm with the Grand Canyon
Trust. The Colorado Plateau is a region with enriched cultural and natural resources, home to
generations of Native American communities expanding across the plateau. These communities
are at the frontlines of the climate crisis and the transition away from a fossil-fueled dependent
based economy. The mining and combustion of Black Mesa coal created jobs and revenue for the
Navajo and Hopi tribes for several decades. The shuttered closure of Navajo Generating Station
in 2019, along with the mine that supplied coal left behind lingering environmental, social, and
cultural impacts. At Kayenta Mine, there are years of reclamation that needs to be addressed, and
there needs to be federal oversight. The community members and community-led organizations
are concerned about ongoing environmental impacts, including the process of reclamation, water
resources, and the commitment for foregoing a significant permit revision. The land needs
restoration and healing, as well as the community. An all-of-government approach to a just
transition should be carried forth with the inclusion of reclaiming lands and restoring tribal and
local economies. And thank you for the opportunity to provide a comment.
Diana Umpierre, public commenter: My name is Diana Umpierre; I'm in Florida. I am coming
to you in a very vulnerable moment. I'm going to try not to cry. At the last WHEJAC meeting,
Dr. Bullard highlighted the importance to organize, to mobilize to build the justice framework, to
be laser focused so that we don't keep getting what we're getting: nothing. So, it was with that
sentiment of "stay on it" that I am here back again today because I didn't get to speak last time. I
did send a comment letter to each of you, and I want to appreciate Catherine Flowers who
responded and acknowledged receipt and made me feel seen. I have a dear coworker that just a
few days ago was wrongfully arrested from her home, treated like a murderer by the police,
imprisoned for 26 hours, deprived of her prescription eyeglasses and publicly attacked by the
city of Brownsville mayor for opposing SpaceX environmental and gentrification injustice in in
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her community where he's building this spaceship in Boca Chica. And all of that because of the
[inaudible] charge that she spray painted "Gentrified, stop SpaceX" on a wall. Okay, the Musk
and SpaceX cult is hurting people. It's hurting the entire planet, or like all the other injustices and
all the other forms of pollution, it hurts some communities more than others. And it is happening
all over again. And I don't know what else to do, and that's why I'm pleading to you. I don't know
how you fit this in the scorecard. All I know is that I hope that at the end of my quick three
minutes, one of you will get to somebody in the White House and say we cannot allow the rush
to commercialize into industrialized space to give us the same of nothing and this time to hurt far
more communities. I asked in my comments to you to imagine the future in your children's own
lifetime, where we could no longer launch an Earth observation satellite, that we could no longer
even know the weather, that there's a hurricane coming, that we can no longer even launch GPS
satellites to know the location and to know where to send rescue resources. And I mentioned that
just to make you realize the reality of what is happening. All this is happening because basically
the US government as well as other governments on the planet don't have the policies in place to
make sure that they properly regulate the commercialization of space. So, this future is really not
fiction. The FCC is categorically excluding data constellations of commercial satellites. The
FAA is barely doing any environmental assessments of spaceports such as what's happening in
Boca Chica. And I have a friend right now who was being ridiculed just for speaking up. So, I
am pleading this. I don't know what else to do. And I'll be glad to provide more information as
much as you want or as little as you want, because I'm begging for help. We're begging for help.
Thank you.
Will Patterson, public commenter: Thank you to the WHEJAC, to the committee, to everyone
listening in, to the public listening in today. I just want to first say that my heart goes out to the
previous speaker, and to those that are struggling with looking for answers to the various
environmental injustice issues that have taken place. On somewhat of a different note, what I'd
like to say is there are organizations—first, let me let me back up; sorry. I represent a number of
faith-based and community-based organizations more along the faith-based side of things. We're
out here in region nine in Northern California, in the San Francisco, Oakland Bay Area, mostly
East Bay, on the Oakland side of the bridge. And there are organizations that are really doing
some great work. And one of those is East Bay MUD, East Bay Municipal Utility District; they
are responsible for the water delivery in our geographic location. And one of the things that
would be great in the development of your scorecard would be that there's an effort within that to
reach out to the organizations that are doing the good work, not just the—you know, there is lots
of good work, there's lots of good work being done as far as bringing the environmental justice
efforts to the forefront. But organizations, for example, like East Bay MUD that have really gone
out of their way to be at the forefront of looking out for environmental justice, while they're
providing good quality water to both residents of underserved communities and those that fall
outside of underserved communities. And so that's a lot of times the struggle when you're an
agency or municipality responsible for these services is being able to provide them in a quality
way for underserved communities as well as those that live, reside, outside underserved
communities. So not just with the development of your current scorecard, but we want to be able
to be an example that the overall Administration's national scorecard to point to as far as this
success is, so just something within your scorecard, and along the lines of a national scorecard, if
you will, really reaching out to organizations that are making an effort, forward thinking, looking
at really engaging and providing services that better work, that are really working, for example,
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in the area of water. Organizations like East Bay MUD, they're providing one of the, you know,
among the top-quality water in the nation, while adhering to the environmental standards, the
highest environmental standards. Thank you very much.
William Patterson, public commenter: I'm William B. Patterson. I'm a board member of the
East Bay Municipal Utility District, and our district is a special district. It encompasses both
water that is clean, the cleanest drinking water in the nation, and it also does the wastewater
services. What I want to just to engage the WHEJAC in is that I would like to encourage you to
work along with agencies like East Bay MUD. We serve 3.6 million people in water, and about
780,000 people in wastewater services. We're already hooked up with projects that we've done in
the upcountry, Calaveras County, where our water comes from. We had to do cleanup from the
old gold mining that was threatening our water supply coming off the Mokelumne River. And we
did that; cost millions of dollars to dig it out and work with Department of Federal Lands in
making that happen. That was in the interest of all the people in the water component of our
department and bringing them the best water. In the wastewater end, we've been given many
awards for our protection of the Bay. We are currently working with EPA, and we are involved
in a project called a consent decree of 2010-2014. And that is all the water that is draining off
the surface of the East Bay within our jurisdiction, seven or eight cities and all the agencies
therein, in making sure that water goes back into the bay in pristine conditions. So, these are
some examples of things that we are doing. And we'd like to encourage EPA through the
WHEJAC to work with the larger agencies, and you can get miles down the road from what
we've already done. And I want to just thank you for the continuous support and working
relationship over the years. That's my story this morning, and it's very positive. Thank you.
Dan Solitz, public commenter: I'm from the northwest. But I'm calling regarding the
Department of Energy Environmental Management sites restoration of the legacy Cold War
effort to develop more bomb material, particularly Hanford, which is the largest and most
contaminated site. It's complicated, but we need a place for the wastes from those sites that is
suitable for their final deposition. And that doesn't seem to be happening on a national scale,
which is where it needs to be happening. Reactor spent fuel at this point is supposed to be mixed
with high-level waste from legacy Cold War plutonium production sites. There needs to be an
effort to revive the effort in Congress to get this this geologic disposal matter further down the
road after what's happened with Yucca, and I'm hoping that the White House can apply some
leverage to move this down the line not only for the generations now, but for the generations in
the future and also to do it in a way that is fair to all of the different regions in the country.
Thank you.
Brandi Crawford-Johnson, public commenter: I feel like the EPA needs to do a lot more
enforcement. And everyone should just be going down to these disadvantaged communities. We
have all of them labeled on the new climate justice tool and start doing enforcement on these
polluters, start revoking permits so that these disadvantaged communities can stop suffering
these severe health risks and start living healthier lives. I just don't see a lot of action happening.
WHEJAC's put their plan through, last May, and there's just not any action happening. CEQ
needs to get in here and start implementing these plans that are being put forth to help these
environmental justice communities. We don't have a lot of time. Our earth is on fire for God's
sakes. Climate change and environmental justice go hand in hand. And we can say that, you
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know, all these false promises, saying, we're going to do this, or we're going to do that—if we
don't see action that's happening right now, then everyone's screwed. We need to get these
actions implemented as soon as possible. Any recommendation that WHEJAC has put forth has
got to be implemented right now. We cannot wait for this. We have to have actions, and
environmental justice. Thank you.
Rachel Makleff, public commenter: Thank you so much. My name is Rachel Makleff, and I
volunteer to work for clean, renewable energy as well as the prevention and remediation of
environmental justice communities. In renewing the Paris Agreement, the United States pledged
to reduce emissions in environmental communities worldwide. It was a group effort; the
agreement is an agreement with a group. But looking at the Advisory Council, and its scorecard
Working Group—which is terrific, really terrific—neither seems to pay attention to the strange
lack of logic in the US trade agreements. And I'm talking about things like NAFTA. If reduction
in a factory abroad hurts the factory worker in some permutation of NAFTA, the product is
prohibited to be imported into the United States under fair trade, the Fair-Trade concept. But
when the health and safety of people living near the factory occurs, there may be no such refusal.
And I talked last time about a project here in New York City to import electricity from Canada.
The people living in Canada who are who are First Nation people are harmed by all of this
production process. And I won't go on and on because last time I did, but there's something very
weird about it, because we're also helping other countries. I just read something in the news
about John Kerry helping other countries. So, here's my challenge to WHEJAC and to the
Scorecard Working Group: please announce, have President Biden announce, that the whole
system that creates EJ communities abroad needs to be brought into the vision of what we're
doing here. Certainly, we can't clean up, we can't pay. But we certainly should be able to say, this
project creates an environmental justice community abroad by the process, and therefore we will
not give a trade permit to this project. Thank you very much.
Vincent Martin, public commenter: My name is Vincent Martin and I'm calling from Detroit,
representing 48217 community, one of the most polluted areas of in Michigan. And I'm really
concerned about all this money being invested in these new green screening tools. And we
already know the information of where the worst areas are. Spending money that could be going
for action. Again, let's see some solution on the ground where it counts. And we do not need any
more data extracting information from our communities because it has not been helping us. So,
what I want to talk about now is we have two Riverside docks that collapsed into the Detroit
River. And our research has found out that our areas were pegged for the creation of the atom
bomb. And we will try to get some information on what was done with the nuclear waste while
the radiation was being pulled out the area. Well, I got information from the Department of
Energy that says they don't have no information. Now, radiation is something that has a life span
of millions and millions of years, and radiation waste being hauled off and placed where we
cannot find it is a big problem. So, do we have environmental justice from the EPA and
Department of Energy in our government, or are we just another specimen in a petri dish? So, we
need to actually get our act together because I've been at this now for a lot of years, and we've
been getting a lot of talk, rhetoric, and no action from our government. And we need solutions
now. We can't wait for tomorrow like the previous caller said. We need some actions today. And
thank you for your time.
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Kurd Ali: thanked commenters and said that anyone interested in providing public comments
can send it to the WHEJAC via email to wheiac@epa.com.
WHEJAC Scorecard Workgroup Update and Discussion
Richard Moore: Again, on behalf of all of us, thank to those that made public comment. And
the struggle continues, and stories continues, the issues continue, the lives in some cases of
people don't continue, and we just keep on keeping on going. And so, we just wanted to thank
those that made public comment, and then just say that we take public comment very seriously.
And as you listen into the rest of the next couple of hours, that public comment is something
that's very, very important to this council. And believe me, at the end of the day that we totally
understand the issues that have been discussed during public comment. For many of us, we're
living those issues on a day-to-day basis. So, I'm going to pass it on to Dr. Kyle, and to Peggy
are who are co-chairs of the scorecard workgroup. So, I will turn it over at this particular point.
Thank you to both of you.
Kyle Whyte: I respect greatly everybody that took their time to make public comments. And this
part of the meeting is going to be a discussion regarding the scorecard. So just very, very briefly,
we are submitting recommendations in two different phases regarding the scorecard. The first
phase we completed last public meeting. And those were base, foundational recommendations
about what a scorecard should be, what it should do, the scale and scope of the scorecard. Those
recommendations will be transmitted to CEQ next week. I appreciate and respect greatly all of
the revisions that WHEJAC members provided in that last public meeting, and all revisions were
made to the final recommendations for phase one.
Phase two, which we'd like to discuss right now, has to do with getting to the specifics of very
particular scoring measures and metrics, actual things that need to be scored and how to score
them, affecting almost all agencies given the mandate of the of the White House for
environmental justice work.
And so, for the next few minutes, we'd like to open things up to WHEJAC members, and we
requested everybody make comments about two different things. One, we would really like to
hear your comments regarding what our tremendously valued colleagues in the public comments
period shared about the scorecard. If you have further comments or ideas or things that you want
to lift up about what was shared in the public comments, this is the time to or at least one time to
do that. The second thing is if you do have ideas or comments to share just regarding the
scorecard, and again, the specifics, the particularities what needs to be scored how, we'd like to
have that conversation and hear from you as well in this time period. So, before we move into the
to this discussion, period, I just wanted to see if chairperson Shepherd wanted to make further
comments or share anything further at this point.
Peggy Shepard: I would just like to say that I really appreciated the remarks that Chair Mallory
made in addressing the scorecard. She referenced an across-agencies scorecard that would
address government-wide how environmental justice and Justice40 was being advanced. And I
just want to put a pin on that, that the summary card can only be done if there's a card done for
every agency. And so, I just want to put that clarification there that we cannot do a summary
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without understanding the scorecard for every single agency that is subject to the executive
order. So just want to make that point. And as many of the members of the scorecard group
know, we have only met with maybe two or three of the agencies to really understand what they
are beginning to do. So, again, without meeting with the Interagency Working Group, which we
have put in a request for, I believe some time ago, without meeting with those people who are
representing every federal agency, it becomes very difficult to finalize our work without that
information and expertise.
Kyle Whyte: Thank you, and, Karen, I believe we can go ahead and open it up. So, I look
forward to discussing and learning from the WHEJAC members about the topics that myself and
chairperson Shepherd opened up for discussion.
Karen Martin: If members could use the raise your hand feature. Please remember to state your
name when you're speaking and remember to speak slowly for our interpreters. Do you want to
call names, Kyle, or you want me to help you with that? Or Richard, you want to do that?
Richard Moore: I think on my end, not speaking for Dr. Kyle or for Peggy, I would appreciate
some backup on the hands raising.
Peggy Shepard: I can see them. I see Dr. Bullard, Ruth Santiago, Vi, and I'm not sure which
order. So forgive me if I go in the wrong order. I'll start with Ruth Santiago.
Ruth Santiago: I think that, as it has been stated before, we certainly need a lot more
information from the agencies and hopefully meetings with the Interagency Council in order to
have an idea about the specific kinds of metrics for each of the agencies. But there is one
crosscutting metric, I think, that we can use, which was alluded to in the public comments that
have to do—I think it's sort of an engagement metric, a public engagement metric of the agencies
to reach out and I guess, and I think they're saying, work with community-based organizations
that are doing really beneficial work in those communities. So, one commenter emphasized that,
or a couple of them emphasize that quite a bit. I totally agree that agencies should be evaluated
on the basis of how they are doing this engagement, this outreach in the communities. And
further than that, actually working and partnering with and providing resources to community-
based organizations that are addressing as the commenters mentioned, water supply. And of
course, there are many other areas and other services that community-based organizations
provide that should be supported by the respective agencies, depending on their area of expertise.
Thank you.
Peggy Shepard: Okay, Vi.
Viola Waghiyi: We heard some very moving comments. I understand the urgency that we heard
from some of the callers. I can relate to that, personally, of what is happening in my community
with the climate crisis. We heard over and over the climate change, but I just wanted to say—I
believe it was one of the last commenters talking about no more data, and that there's an urgency
for action. However, there is no data in some instances, there is no data, like no data on what is
happening in my community. You know, as far as health disparities, the cancer registry does not
work for communities small like mine, and they blame cigarette smoke for all our cancers with
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the cancer crisis we're facing. There's no data on persistent organic pollutants that are
sequestered in permafrost, ice, and glaciers that are melting. And, you know, I understand the
urgency; however, it's important that we identify and seek from grassroots and community-based
organizations that are doing science collection on the ground. It's so important; the existing data
doesn't have all that we need to identify these EJ communities.
And the other I heard about that stood out was the injured worker, trying to get help for to
himself, you know, with the Department of Energy. This is shameful. And we need to find ways
to hold federal agencies accountable for the health harms caused by their actions. And to sweep
it under the rug, shame on them. And also, legacy pollution. As we heard today, yet another war
has erupted, right? We still have legacy military toxics harming the health and well-being of my
people, and globally. And we call them Superfund sites. But we need to call it out as it is military
toxics, their occupation and activities. We heard about Cold War era, but also unexploded
ordnances; we heard about underground tanks in Hawaii at the Red Hill, and the Pentagon not
willing to take responsibility. And these are people and individuals who have a human right to
health and human rights to free and prior informed consent. We heard—we've been hearing
about it over and over. And the other scorecard I would like to bring awareness to is with the
Department Health and Human Services, agencies who are supposed to look out for our health
and well-being; they should be going to Congress to make sure that any new development or any
new industry or plant or permits that there's money put aside for impending health harms because
it won't be a matter of time, too many lives have been lost already. And health harms we hear
about over and over. And because, federal agencies are not addressing their health harms, there
needs to be proper screening, treatment, and diagnosis of environmental health effects. Thank
you.
Robert Bullard: I had a question and more of a critique. The scorecard is going to get sent up;
there are comments going to be made. And how the scorecard will be used within the various
agencies and within the culture of those agencies, and the priority programs and the agencies and
the different mandates that the agencies have—and so my question and concern is, to what extent
will this tool—even in a beta form—be looked at in a way that can garner interagency
collaboration? And viewing how the various programs within the various departments can use a
scorecard like this to assist and supporting targeting monies that, when you put them together,
will have a multiplier effect, as opposed to one agency setting priorities and using the scorecard
to just—I'm not saying this will happen, but it could happen—just blindly target their programs
in a way that may not have any kind of assessments done or plans to partner or to make
companion kinds of funding so that you get the biggest bang for the buck. I'm looking at, for
example, communities that have legacy pollution, communities that have historically had
infrastructure needs that have not been met. And these are the same types of communities,
communities that have energy poverty. So that's EPA and as, for example, transportation
infrastructure, that's DOT. Communities that have high energy, poverty, energy insecurity, I
would say that's DOE. And so, when you start targeting the resources, and having the agencies
talk to each other and talk about their programs, HUD is housing and, and CDBG monies,
community development block grant monies, that's for dealing with housing issues for low-
income families. And if you talk about issues around communities that have been hit hard with
disasters, like flooding and droughts, heat waves, you name the climate disasters, that's FEMA.
And so, FEMA involves housing, it involves a whole lot of things. When you start scoring these
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things, are the agencies going to be talking to each other so that the FEMA dollars that would go
to an area—and that money goes to the state, and then the state dolls it back out—will the
scorecard for housing, transportation, workforce development, that's Department of Labor—and
other kinds of elements that create this advantage that you're calling the community that's being
targeted? Will there be an analysis done to talk about how the monies that these six agencies
could put toward targeting these communities in a way that you could hit a lot of the areas, and
you could get, you know, if you're talking about the multiplier effect of this when you start
evaluating and assessing what this would mean? And I'm thinking about a program in the
Department of Labor, which could be a training program, a program that's in NIEHS, a training
program, a program that's in DOE, a training program, are all of these training programs aligned
in a way that you're thinking about jobs, sustainability, livability, health, et cetera? And I would
hope that there would be thinking along the lines of, that interagency working to maximize
where the problems are so that you can get the programs with the money—we're not talking
money, we're talking benefits—can align with those communities, those neighborhoods, those
areas that have maybe a bunch of those highly ranked factors that would make them eligible for
the programs. I know, I was rambling, but I have thought about this. And I've seen too often
where these agencies really don't talk. You know, there's one program that's over here. And you
say, well, why don't you work together? Why isn't the job training program, the weatherization
program, the program for green jobs, programs for health, blah, blah, blah, working on these
things together and talking? And they said, well, that's our money, and we don't work—that's our
money. Departments are very— When you talk about jurisdictions and that kind of thing. So that
was my question and comment.
Peggy Shepard: I just want to remind you, as well as the members, that the scorecard is not just
about Justice40 benefits of investments; it's about how the administration has advanced
environmental justice. And so, your thought about how agencies are collaborating to advance
effectiveness is one of those generic environmental justice metrics that we can use. So, we need
to be thinking about some of those environmental justice metrics, not just Justice40. And, of
course, thinking about the EJ metrics really allows us to be much more expansive and to talk
about dollars, and to talk about—a young man in the public session talked about disadvantaged
businesspeople. We can figure out that if DOE's putting forward a lot of contracts about
weatherization or energy efficiencies, will those go to those big-time contractors? Or will the
smaller folks who generally just get a subcontract, will we be able to lift them up to be primes?
So those are also metrics that we need to be thinking about. So, Thanks, Bob, on that. Dr. Nicky
Sheats.
Nicky Sheats: Oh, thanks, Peggy. I thought what you said starting out the session was really
interesting, Peggy, and I was just going to ask for clarification. So, is the workgroup thinking
that there should be a separate scorecard for each agency? And then maybe an overall scorecard
somehow that brings them together? And if that's the case, then should the workgroup and
WHEJAC be commenting on scorecard giving recommendations for a scorecard on each agency
then and on the overall scorecard? I was just interested in what you were saying, Peggy. Excuse
me if I got it wrong.
Peggy Shepard: No, that is correct, Nicky. I don't see how we score the administration if we
aren't scoring each agency that is subject to the executive order, especially given how different
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many of them may be from each other in terms of their mission, in terms of their programs. I
don't know how we would do one generic scorecard that really reached into the operations of
each agency. But certainly, I'd love to hear more discussion about that point. So those are my
thoughts on Nicky. Dr. Beverly Wright. And then Angelo Logan.
Beverly Wright: I wanted to make certain that I wouldn't be redundant with my concerns that
just recently, a large study came out that showed the connection between redlining and PM 2.5
and pollution. And all the questions that people ask me about this, I basically tell them it's not
surprising, because the communities that are redlined are mostly African American or other
people color. So African Americans and other people of color live with more pollution, then of
course, all these things are correlated. So, when I think about the scorecard, I'm thinking about
things like that, how do we capture that? Would redlining be something that we would even
think about? And certainly, we need to think about, if you're talking about environmental justice,
things like PM 2.5, especially the way we see it being connected to COVID-19 and health. So, if
you're looking at the health of a community, if you're looking at housing, and redlining certainly
ought to be something that's involved in it. All these things are so connected. And I'm trying to
figure out, like, to me, at some point, I think that as Bob was trying to also talk about the
connectivity of all of this as it relates to environmental justice communities, and climate
impacted communities and protecting them, or improving their quality of life, there are things
that are interconnected, and it all goes back to race.
So, I still say, you know, I don't want to bring this up, and I know that Administrator Mallory
was really speaking to this whole issue that those of us specifically who are African American
are upset about race not being included in the screening tool. So how do we deal with race in
scoring? And our committee member who's very smart in dealing with this, Rachel, said to us,
that we would be able to use race as a metric in the scoring card. My question is, how are we
going to use it, and I don't just mean race with Black people. Native Americans, I think there's
special circumstances, with Latinos there's special circumstances. We must use race in the
scorecard to be able to show what's happening with different racial and ethnic groups, as it
relates to the programs that they have coming out. So I want to make certain because I think that,
you know, scorecard discussions—and when I finally calmed down about the point of not
including race in the screening tool and asking the question: if you have a program that was put
in place to deal with race, and disproportionality, and all these things because of race, how in the
world do you score race without saying race? I think it's impossible, especially now looking at
this latest study with some things like redlining being connected to PM 2.5. And, you know, the
connectedness of all of this is the same people by race. You know, I'm very interested in us
figuring out on a matrix where we will place race to be in that scorecard. And I haven't figured it
out; I think Rachel has. And so, I was hoping I get a response. I don't know if she's on now. But
this is something that's really important to me. I want us to get it right in all the ways that
everybody's been talking about. But if we don't include race, what did we get right? When that's
why we're here?
Peggy Shepard: I just wanted to go back to a question that Vi asked; she asked what redlining
is. Redlining has been the procedure that banks have used to reject loans in certain
neighborhoods, and generally, that was in Black neighborhoods where Black applicants could
not get a loan to buy a home or to renovate a home, and they kind of redlined certain
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neighborhoods that were generally Black neighborhoods. And that's what redlining is. That's
how you defined redlining.
Robert Bullard: Banks, insurance companies, and businesses; it's not just mortgages. It's also
insurance companies redline. If you do get insured, it costs more, exorbitant. They don't put the
infrastructure in. They don't build the parks and the other infrastructure in terms of trees, in terms
of flood protection and other kinds of what people call amenities, they don't put that stuff in our
communities. And it was planned that way. And that's how you ended up having all kinds of
urban heat islands and flooding, et cetera.
Viola Waghiyi: Food deserts can be used like in gentrification.
Beverly Wright: You went right to it, Vi; that is the point. It creates communities that are ready
for gentrification. And they are usually in coveted areas within the city limit.
Peggy Shepard: And you also won't see grocery stores in some areas because the insurance
companies want to charge so much if it's, you know, a Black or community of color. There are
many ways that that plays out.
Viola Waghiyi: Racism.
Peggy Shepard: Yes, exactly. Our next speaker is Angela Logan.
Angelo Logan: I wanted to comment on the multi-agency approach. So, I wanted to just voice
my support for the scorecard to apply to multiple agencies and departments across the
administration, both individually and as a blanket, so maybe one blanket scorecard as well, that
has criteria that reaches across all the different departments. But I think drilling into each of the
departments will be very important as well. If this this particular scorecard is to assess the
effectiveness of the administration, you know, at best we have, like, what, another six years or
something like that, right? And we've been kind of accumulating this problem for over 500 years.
So, we're not going to resolve this issue within the next four to six years. And so, I think that it's
important for us to really institutionalize the scorecard across all the departments. So, to the best
of the administration's ability, institutionalize it into the function of each of the departments and
agencies, so that it can exist over a long period of time, so that we can have long-term
assessments, along with short-term assessments. So, we have the four-year assessment to
understand the existing administration. But what happens in 20 years? I started doing this work
over 20 years ago, I thought, by 20 years, we're going to see some progress. We have the
assessment tool in place, we might see very little progress in the overall issue of environmental
racism. So, I wanted to place support and consideration for those two types of approaches within
the scorecard.
Peggy Shepard: I think at one of our last public meetings, the issue of how we evaluate senior
staff at agencies came up, that they should be evaluated based on diversity, equity, and such. And
so, as you said, Angelo, if we institutionalize the scorecard into agency functions and operations,
we will also see the directors of some of those programs and departments perhaps being
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evaluated based on what happens with the scorecard for their department or their operations. So
that would be another way to get to the personnel issue, as well. Dr. Kyle White.
Kyle Whyte: Thank you. I just wanted to add a further response to the question line that Dr.
Sheats began and that, Chairperson Shepherd, you'd responded to and then also Angelo and
others made very relevant comments on the topic of the individual agency scorecards and
interagency scoring. I was going to mention that in our base recommendations and Phase One
that go to CEQ next week, we did state that when we refer to the EJ scorecard, what we're
referring to is all the different individual agency scorecards, but we also said that that includes
the need for whole-of-government interagency scoring for issues that we need to advance
through interagency coordination. And so, in our future discussions, including this discussion,
we should be developing metrics and scoring that speak to the type of interagency collaborations
that are needed both in relation—Peggy made a good point in response to Dr. Bullard—both in
relation to Justice40, but also for all of the other EJ issues that require that coordination. So,
given our base recommendations, all of these points that you all have been making, I think are
very, very critical. And the more we can specify and particularize and get to the bottom of this, I
think we'll be able to make some compelling recommendations.
Tom Cormons: Yes, this is such a critically important conversation. And as those of us in the
Justice40 workgroup are thinking about forthcoming sets of recommendations on Justice40, one
of the biggest considerations, I think, for us is what the accountability mechanisms are going to
be to incentivize agencies to do their very best under Justice40. And, you know, I think
accountability is helpful, not just in cases where your entities or individuals may not want to do
the right thing, but also where they really do want to do the right thing. And it's extremely
helpful to be evaluated for the right things one is doing, and to include the right things that we
want to prioritize in how individuals are evaluated. And, you know, on up the chain to how full
agencies are evaluated.
There are two areas I want to lean in on in relation to that, certainly not the only two that are
important, but two that have come up a lot in conversation with community members and are not
always traditionally emphasized as much as I think that the Biden Administration wants to, and
we all want the administration to. The first is local economic benefits. And this goes to a point
made by one of the public commenters that if we're really going to be transformative, we need to
look at investing in businesses and building wealth in impacted disadvantaged communities
themselves. It's very easy to make investments for projects in disadvantaged communities that
may go to outside companies or even large corporations. And you know, even if they're hiring
local folks, are they really building wealth in those places? So, I'm really interested in thinking
from an accountability standpoint on how actually building wealth in local communities—as
opposed to just employing people in local communities—is accounted for in terms of the
accountability metrics. The other area that really deserves to be underscored here is effectiveness
of public outreach and grassroots engagement. Because the way to do things impactfully is in a
way that's informed by sensitivities on the ground, and wisdom on the ground, and people who
are impacted on the ground. So, I'm interested in thinking about accountability metrics that look
not only at strictly the outputs of agencies in relation to public engagement—you know, did you
hold a public hearing or not? How many public hearings did you hear? —but the outcomes of
that public engagement. Because if you're looking at the outcomes in terms of how many people
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were actually engaged, how many constructive comments were received, and considered and
influenced the project, I think that provides a greater incentive to do public engagement in the
most impactful way to make sure that you've got the best people on staff who are really great at
doing it and not just jumping through hoops in a rote way, but really striving for impact. So,
thinking about, you know, outcome-based metrics for public engagement, community
engagement, I think is really important. Thank you.
Michele Roberts: I'll make my comments very brief. I just want to echo what everyone else has
said. And you know, it seems we're able to see some of this in real time as we speak right now, I
won't go into the specifics. But one thing is important to making sure that we look at. . . make
sure that we have scorecards, as everyone has said, for the various agencies and then an
overarching one. The reason being is continuous use, as we all said, continue to help us really
look at these metrics and identify them. But one of the things that we're doing in some of our
work right now is taking it back to the tuberculosis epidemic. So thereby looking at those who
have been left behind with TB, as we're speaking about the disparity with COVID-19. So, this
gives us one of those baseline examples and reasons why, even with the onset of that, of legacy
communities, redlining, and flat-out racial segregation, it helps us to track as best we can to see
the spikes and numbers and consistencies thereof from epidemic to pandemic, and all our other
legacy issues in between. I'll just leave it there. But I just want to echo what everyone said and
say that it is very important for us to have various measures of making sure— and then last, have
some type of tracking mechanism within those processes that tracks the community input.
Therefore, the communities constantly see themselves in this [inaudible]. In addition to that, the
agencies themselves can even see where they're making strides of efforts, or the lack thereof, and
it gives a deeper level of accountability and transparency, as well as engagement for everyone
around. I'll leave it there. Thank you.
Nicky Sheats: I just wanted to comment on what Dr. Wright brought up, what Beverly brought
up about indicators you could use to track race. Where you don't specifically use percentage of
people of color in the census track. And redlining could be one of them. Another one that people
talk about is there a history of racially restrictive land covenants? There are some measures of
segregation. That gets tricky though, because then you're not only talking about people of color.
And then also you can think about other indicators that are not race-conscious but that also may
track the impacts of race, like PM 2.5 concentrations themselves might, or you could also think
of unemployment, or maybe educational attainment. And I think we're probably going to have
our next screening tool workgroup meeting soon. And I anticipate that's going to be a hot topic
of discussion. And I think that the two workgroups should have a lot of cross-pollination
between the scorecard workgroup, and the screening tool workgroup about this particular topic,
in particular, and we should talk about how to how to make that happen, I think.
Kyle Whyte: Just quickly given Dr. Sheats and others, and I believe Dr. Wright had mentioned
the race-conscious data, and I just wanted to clarify that for the scorecard, we can use race-
conscious data. And so, I just wanted to clarify that and so I appreciate Dr. Sheats your point
about what that means for the coordination between the screening tool's work and the scorecard
work.
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Beverly Wright: I was going to say the same thing, Peggy. My hand was up. We're talking
about using race for the scorecard because it's not being used in the screening tool, and the
screening tool coming up with other measures that better get at race if that's the way this is going
to go, which I still stand in disagreement on. I don't know how many times I have to say it but
yeah, I just—
Nicky Sheats: Because in the scorecard you're not giving out benefits, but you're actually
analyzing something. So that's very different.
Beverly Wright: But the whole reason for the screening tool is to get to problems that exist
because of race. So you we will never agree on this, Nicky. I think that is a wimpish approach. I
think we should stand up for what's right and fight. But that's me.
Nicky Sheats: I don't think we disagree. I think the question is how to do it.
Peggy Shepard: Okay. I don't know if that's the last word. Kyle? I'm not seeing any more hands
up.
Kyle Whyte: Neither am I. Chairperson Shepherd, should we request to move to the next
segment the business meeting?
Richard Moore: I think it was a very, very important discussion. And we may necessarily not
agree about everything. But the question at the end of the day, is how we are going to deal with
the concerns of our people, and not only those that have made public comment, but the hundreds
and hundreds upon hundreds of others to be able to get the job done that we want to get done.
And so, I think with that said, that we're ready to move to the business section.
I'm going turn it back over to Peggy in just in a second. But just let me just make this comment.
Again, it's extremely important that we maintain quorum, so I need to keep bringing that up.
Because we're going to go into the business section now, again, and we need to have quorum.
So, what we'll do is we'll use this time to do a couple of things. One is, is reflect on the
proceedings and public comment period, you'll see that when Peggy gives us some guidance of
how to move forward, and then we'll provide workgroup updates. And we'll discuss action items
and finalize next steps. So, Peggy, that's how we're going to tighten up this piece and run through
it, and I will turn it back to you.
Ruth Santiago: All right. I don't want to hold it up or anything. But I just wanted to say that, in
this discussion of the scorecard, I wanted to mention that the data collection in the territories is
especially deficient. It's been documented many times here in Puerto Rico. We heard from the
Virgin Islands. So that is, I guess, crucial, right? The inputs that you might have for a scorecard
depend on what kind of data that an agency is or is not collecting. And we have a real problem
with that in the territories. And also wanted to mention and highlight that during the public
comment. There was a lot of reference in the territories as well and in the [inaudible] areas about
military pollution and unwillingness of the military to decontaminate properly, etc. So, the
WHEJAC Public Meeting February 24,2022, Summary | 26
-------
scorecard, the specific scorecard for DOD needs to reflect those criteria. And sorry to wait till the
last minute for that comment.
WHEJAC Business Meeting
Peggy Shepard introduced the two key actions under discussion:
1. Finalize WHEJAC Action on Public Comments
2. Finalize WHEJAC Letter
WHEJAC Action on Public Comments
Peggy Shepard said the group had discussed the public comment process in the November 2021
and December 2022 public meetings but did not vote on an action at those times, so that vote is
on the agenda. The issue is that, although the WHEJAC is not required to respond to individual
public comments, they would like to ensure the government is more responsive to public
comments offered at WHEJAC meetings.
Members were asked to vote for one of the three following options (which were shared with
members before the meeting):
1. Request CEQ/IAC to establish a point of contact for each agency to attend public
meetings to hear public comments, and prepare to follow up with the WHEJAC at the
next public meeting on actions taken on public comments received
2. Request CEA/IAC to develop a process on how they will respond to public comments
and report back to the WHEJAC. Set a timeframe for CEQ/IAC to report back to the
WHEJAC on the process
3. Set up a WHEJAC workgroup to draft recommendations for a system for following up
and tracking public comments
Several members immediately voiced their opposition to option 3, establishing another
workgroup.
Peggy Shepard called for a vote on Option 1. Option 1 passed.
Peggy Shepard raised the issue of the time frame within which agencies will need to respond,
and suggested three weeks. Karen Martin said the next public meeting is a month out. Peggy
Shepard said she would prefer if there were a response by the next business meeting, and then
the agency representatives could attend the public meeting. Peggy Shepard clarified that the
process would start at the March 30 meeting.
Next step: The WHEJAC will notify CEQ that they will have to establish a point of contact for
agencies and prepare to follow up with the WHEJAC.
WHEJAC Letter
Peggy Shepard explained that this action item is to request resources for WHEJAC workgroups,
such as contractors, writers, editors, graphic designers, and expertise around federal agencies.
WHEJAC Public Meeting February 24,2022, Summary | 27
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The letter requests timelines for key deliverables and recommends an increase in CEQ budget
and staff. A draft of this letter was shared with members the evening before (see appendix 5).
Ruth Santiago suggested a minor edit.
Peggy Shepard called for a vote on the letter with edits. Karen Martin confirmed there was
consensus.
Next step: The letter will be sent to CEQ.
Next Public Meeting
March 30-31, 2022
Closing Remarks
Closing remarks were delivered by Peggy Shepard, Corey Solow, Richard Moore, and Catherine
Coleman Flowers.
Karen Martin adjourned the meeting.
WHEJAC Public Meeting February 24,2022, Summary | 28
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Appendix 1. Public Announcement
Federal Register /Vol, 87, No. 32/Wednesday, February 16, 2022/Notices
8835
phone, and webform. For further
information about the EPA s public
docket Docket Cental semces and the
current status, please visit us online at
https //mm epa go\ /dockets Thn
telephone number for the Docket Ontei
is 2U2—506—1744.
Abiticirt This mfoimation collection
request pertains to trade secrecy claims
submitted under section 322 of the
Emergency Planning and Community
Right-to-Know Act of 1988 (EPCRA).
EPCRA contains provisions requiring
facilities to report to state and local
authorities, and EPA, the presence of
extremely hazardous substances (section
302), inventoi^ of hazdidous chemicals
(sections 311 and 312) and manufacture,
process and use of toxic chemicals
(section 313). Section 322 ot EPCRA
allows a tdcihty to withhold the specific
chemical identity fiom these EPCRA
reports if the facility asserts a trade
seciet claim for that chemical identity.
The provisions in section 322 establish
the requirements and procedures that
facilities must follow to request trade
seciet treatment ol chemical identities
as well as the pioceduies loi submitting
public petitions Jo the Agency toi
reuewntthe sufficiency ottiade
secret claims.
Tiade seciet piotectiun is pio\ided for
specific chemical identitu s rontdint d m
lepoits submitted undei p
-------
8836
Federal Register/Vol. 87, No. 32/Wednesday, February 16, 2022/Notices
during the meeting, and whether you
are submitting written comments at. the
time of registration.
A. Public Comment
The WHEJAC is interested in
receiving public comments specific to
the development of an annual public
performance scorecard and the types of
indicators or data that would be useful
in a scorecard. This scorecard will
provide a method for evaluation and
accountability to assess progress on
agencies' progress in addressing historic
environmental justice. Every effort will
be made to hear from as many registered
public commenters during the time
specified on the agenda. Individuals or
groups making remarks during the
public comment period will be limited
to three (3) minutes. Please be prepared
to briefly describe your issue and what
you want the WHEJAC to advise CEQ
and IAC to do. Submitting written
comments tor the lecoid aie sLmngly
encouraged. You can submit your
written comments m thie^ different
ways, (1.) by creating comments in the
Docket ID No. EPA-HQ-OA-2022-0050
at http://www.regulations.gov, (2.) bo-
using the webform at https://
www. epa.go v/en vironm entalju s ti ce/
white -house-en vironm en tal -ju stice-
advisory-counciMwhejacrneeting, and
(3.) by sending comments via email to
wheja@epa.gov. Written comments can
be submitted through March 10, 2022.
B. Information About Services for
Individuals With Disabilities or
Requiring English Language
Translation Assistance
For information about access or
services for individuals requiring
assistance, please contact Karen L.
Mai tin \ id email at uhefacf*epa go\ m
contact bv phone at (202) 5b4-0203, lo
request special acmmmoddtions foi i
disability or other assistance, please
submit your request at least seven (7)
working days prior to the meeting, to
give EPA sufficient time to process your
request. All requests should be sent to
the email listed in the FOR FURTHER
INFORMATION CONTACT section.
Matthew Tejada,
Director for the Office of Environmental
Justice.
[FR Doc. 2022-4)3262 Filed 2-15-22; 8:45 am]
BILLING CODE 6560-50-P
ENVIRONMENTAL PROTECTION
AGENCY
[FRL-9564-01-R6]
Clean Air Act Operating Permit
Program; Petitions for Objection to
State Operating Permit for ETC Texas
Pipeline, Ltd, Waha Gas Plant, Pecos
County, Texas
AGENCY; Environmental Protection
Agency (EPA.).
ACTION: Notice of final Order on Petition
for objection to Clean Air Act title V
operating permit.
SUMMARY: The Environmental Protection
Agency (EPA) Administrator signed an
Order dated lanuary 28. 2022. granting
a Petition dated March 10. 2U20 trom
the Em uonmental Integrity Pinicct,
Siena Club Emuonment Texas and
Texas Campaign toi the Fmuonment
(the Petitioners). The Petition requested
that the EPA nb]ert to a Clean Air Act
(CAA) title V operating permit issued by
the Texas Commission on
Km liunmentai Quality (TCEQ) to ETC
Te\ds Pipeline Ltd (ETC) for its Waha
Gas Plant located in Pecos County,
Texas,
ADDRESSES: The EPA requests that you
contact the individual listed in the FOR
FURTHER INFORMATION CONTACT section to
view copies of the final Order, the
Petition, and other supporting
information. Out of an abundance of
caution tor members of the public and
our staff, the EPA Region 6 office is
cunenth closed tu the public to reduce
the nsk of tidnsmitting COVID-1M
Please call en email tht contact listed
below if you need alternative access to
the final Order and Petition, which are
available electronically at: https://
www.epa.gov/title-v-operating-permits/
title-v-petition-database.
FOR FURTHER INFORMATION CONTACT:
Aimee Wilson. EPA Region 6 Office, Air
Permits Section, (214) 665-7596,
wilson. aim ee@epa.gov.
SUPPLEMENTARY INFORMATION: The CAA
affords EPA a 45-day period to review
and object to, as appropriate, operating
permits proposed by state permitting
authorities under title V of the CAA.
Section 505(b)(2) of the CAA authorizes
any person to petition the EPA
Administrator to ob]ect to a title V
operating permit wrthm 6U days after
the expiration of the EPA s 45-day
review period it the EPA has not
objected on its own mmaove. Petitions
must be based only on objections to the
permit that were raised, with reasonable
specificity during the public comment
period provided by the state, unless the
petitioner demonstrates that it was
impracticable to raise these issues
during the comment period or unless
the grounds for the issue arose after this
period.
The EPA received the Petition from
the Petitioners dated March 10, 2020,
requesting that the EPA object to the
issuance of operating permit no. 02546,
issued by TCEQ to the Waha Gas Plant
in Pecos County, Texas. The Petition
claims the proposed permit must
include a schedule addressing
noncompliance at the Waha Gas Plant,
fails to identify any emission unit(s)
authorized by one Permit by Rule (PBR)
and three Standard Exemptions
incorporated as applicable
requirements, fails to establish
monitoring, testing, and recordkeeping
provisions that assure compliance with
PBR and Standard Exemption
requirements, falls to include specific
enforceable terms and conditions for
applicable NSPS requirements, and the
proposed permit's incorporation of
ETC's PBR registrations is deficient.
On January 28, 2022, the EPA
Administrator issued an Order granting
the Petition. The Order explains the
basis for EPA's decision.
Dated: February 9, 2022.
David Garcia,
Director, Air and Radiation Division, Region
e.
[FRDoc, 2022-03265 Filed 2-15-22; 8:45 am]
BILLING CODE 6560-50-P
ENVIRONMENTAL PROTECTION
AGENCY
[EPA-HQ-SFUND-2005-0008; FRL-9582-
01-OMSJ
Information Collection Request
Submitted to OMB for Review and
Approval; Comment Request;
Emergency Planning and Release
Notification Requirements (EPCRA
Sections 302, 303, and 304) (Renewal)
AGENCY: Environmental Protection
Agency (EPA).
ACTION: Notice.
SUMMARY: The Environmental Protection
Agency (EPA) has submitted an
information collection request (ICR),
Emergency Planning and Release
Notification Requirements (EPA ICR
Number 1395.11, OMB Control Number
2050-0092.) to the Office of Management
and Budget (OMB) for review and
approval in accordance with the
Paperwork Reduction Act. This is a
proposed extension of the ICR, which is
currently approved through April 30,
2022. Public comments were previously
requested via the Federal Register on
WHEJAC Public Meeting February 24,2022, Summary | 30
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Appendix 2. Agenda
The Council on Environmental Quality
White House Environmental Justice Advisory Council Virtual Public Meeting
February 24, 2022
3:00 P.M.-7:30 P.M. ET
3:00 p.m. -
3:15 p.m.
WELCOME, INTRODUCTIONS & OPENING REMARKS
• Karen L. Martin, Designated Federal Officer - U.S. Environmental Protection
Agency
• Richard Moore, White House Environmental Justice Council Co-Chair - Los
Jardines Institute
• Peggy Shepard, White House Environmental Justice Council Co-Chair - WE
ACT for Environmental Justice o Catherine Coleman Flowers, White House
Environmental Justice Council Vice Chair - Center for Rural Enterprise and
Environmental Justice
• Carletta Tilousi, White House Environmental Justice Council Vice Chair -
Havasupai Tribal Council
3:15 p.m. -
3:30 p.m.
WELCOME & OPENING REMARKS
Brenda Mallory, Chair - The Council on Environmental Quality
3:30 p.m. -
5:00 p.m.
PUBLIC COMMENT PERIOD
Members of the public will be given three (3) minutes to present comments relevant to the
development of a scorecard to assess the progress of federal agencies in addressing
environmental injustice.
5:00 p.m. -
5:15 p.m.
BREAK
5:15 p.m. -
6:15 p.m.
WHEJAC SCORECARD WORKGROUP UPDATE & DISCUSSION
• Dr. Kyle Whyte, Scorecard Workgroup Co-Chair - University of Michigan
• Peggy Shepard, Workgroup Co-Chair - WE ACT for Environmental Justice
6:15 p.m. -
7:15 p.m.
WHEJAC BUSINESS MEETING REFLECTION & CONVERSATION
The WHEJAC will use this time to reflect on the meeting proceedings and public comment
period; provide workgroup updates; discuss action items and finalize next steps.
• Karen L. Martin, Designated Federal Officer - U.S. Environmental Protection
Agency
• Richard Moore, White House Environmental Justice Council Co-Chair - Los
Jardines Institute
• Peggy Shepard, White House Environmental Justice Council Co-Chair - WE
ACT for Environmental Justice
• Catherine Coleman Flowers, White House Environmental Justice Council
Vice Chair - Center for Rural Enterprise and Environmental Justice
WHEJAC Public Meeting February 24,2022, Summary | 31
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• Carletta Tilousi, White House Environmental Justice Council Vice Chair -
Havasupai Tribal Council
7:15 p.m. -
7:30 p.m.
CLOSING REMARKS & ADJOURN
• Corey Solow, Deputy Director for Environmental Justice - The Council on
Environmental Quality o Richard Moore, White House Environmental
Justice Council Co-Chair - Los Jardines Institute
• Peggy Shepard, White House Environmental Justice Council Co-Chair - WE
ACT for Environmental Justice
• Catherine Coleman Flowers, White House Environmental Justice Council
Vice Chair - Center for Rural Enterprise and Environmental Justice
• Carletta Tilousi, White House Environmental Justice Council Vice Chair -
Havasupai Tribal Council
• Karen L. Martin, Designated Federal Officer - U.S. Environmental Protection
Agency
WHEJAC Public Meeting February 24,2022, Summary | 32
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Appendix 3. Attendee List
First Name
Last Name
Organization
Gilbert
Sabater
Grow New York Renewables - NO Hydro Quebec
Chris
Moore
Eastman Chemical
Angela
Berry-Roberson
WSP USA
Jason
Poe
U.S. EPA
Joan
Vanhala
Hennepin County
Feleena
Sutton
Aera Energy
Erin
Broussard
Arizona Electric Power Cooperative
Pamela
Winston
US DHHS/ASPE
Ana Isabel
Baptista
Tishman Environment & Design Center
Kim
Lambert
U.S. Fish and Wildlife Service
Katherine
Mlika
US Digital Service
Jill
Harrison
University of Colorado Boulder
Krista
Mantsch
GAO
Sharunda
Buchanan
CDC/ATSDR
Ann
Stephanos
U.S. Environmental Protection Agency
Adrian
Herder
To Nizhonf Am (Sacred Water Speaks)
Elliott
Rouillard
Virginia Department of Transportation
Chad
Whiteman
U.S. Chamber of Commerce
Claire
Williams
Stinson LLP
Brian
Ansari
BrianAnsari and Associates Inc.
Kathy
Sessions
Health and Environmental Funders Network (HEFN)
Annette
Hlnes
Appalachian Game Changers
Jess
Wallace
U.S. EPA
Danielle
Espiritu
Private Citizen
Vittoria
Totaro
UNM
Andrea
Thi
DOJ
Sara
Mar
Private Citizen
Karina
Castillo
Miami-Dade County
Victoria
Kurker
U.S. EPA
Sarah
Bishop Merrill
SAVERGV
Stephanie
Herron
EJHA
Kevin
Wickersham
Hudson Center for Community and Environment
Marilynn
Marsh-Robinson
EDF
David
DiGiacomo
Friends of the Park, Unitarian Church, School of Arts
Hazel
Choi
Green 2.0
Shane
Palmer
Peter Damon Group
Mikayla
Spencer
Ocean Conservancy
Derek
Rockett
Ecology
Pratima
Gangopadhyay
Toyota Motor North America
Florence
Parker
OKI Regional Council of Governments
WHEJAC Public Meeting February 24,2022, Summary | 33
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Nicole
Horvath
WSSC Water
Wilda
Anagal
Grand Canyon Trust
Andrea
Price
U.S. EPA
Catrice
Jefferson
U.S. EPA
Brandon
Morton
Dallas College
Gloria
McNair
Groundwork Jacksonville, Inc.
Naadiya
Hutchinson
Congressman Donald McEachin
Peter
Williams
New Era Group
Larissa
Mark
VDOT
Tom
Hollenhorst
U.S. EPA
Maria
Rahim
Chevron
Sacoby
Wilson
University of Maryland College Park
Lauren
Thie
North Carolina Department of Health and Human Services
Reginald
Butler
DHEC's Bureau of water
Melodie
Aduja
Environmental Caucus of the Democratic Party of Hawau
Giuseppe
Grillo
Sustainable Jersey, A NJ Nonprofit Organization
Erica
Le Doux
U.S. EPA
Brad
Sims
Exxon Mobil Corporation
Mary
Daly
Surrey Environmental Consulting, LLC
Brittany
Bianco
FDOT
Daniel
Doxzon
Deloitte
Bonita
Johnson
U.S. EPA
Scott
Petty
Webco Industries
Kristien
Knapp
Committee on Oversight and Reform
Janene
Yazzie
Sixth World Solutions
Stephanie
Hammonds
WVDEP-DAQ
Carisa
McLaney
Steptoe & Johnson LLP
Dylan
Ramos
Private Citizen
Kris
Rusch
Endyna
Enrique
Valencia
The New School
Ericka
Farrell
U.S. EPA
Traci
Baker
FHWA
Emily
Federer
Port of New Orleans
Nayyirah
Shariff
flint rising
Chanele
Holbrook
WA Dept of Ecology
Ariana
Gonzalez
NRDC
Caitlin
McHale
National Mining Association
Steve
Zuiss
Koch
Katasha
Cornwell
FDOT
Deirdre
Courtney Nieves
Education
Erin
Stanforth
Mecklenburg County
Theresa
Coffey
Private citizen
Pete
Doktor
Wai Ola Alliance
WHEJAC Public Meeting February 24,2022, Summary | 34
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Catherine
Capitman-
USDA Forest Service
Tania
Ellersick
USDA Forest Service
Vanessa
Lei by
WWEMA
Crystal
Upperman
AECOM
Sean
Joyner
HUD
Stacey
Murray
Webco Industries Inc., Stainless Division
Eric
Choi
GHGSat Inc.
Caleb
Beers
Webco Industries Inc.
Jennifer
Mccord
Alabama Dept of Environmental Management
Naomi
Yoder
Healthy Gulf
Joshua
Singh
Deloitte & Touche
Brandi
Johnson
EJ Activist
Winifred
Carson-Smith
WY Carson Company
Charles
Lee
US Environmental Protection Agency
Isabel G.
Trevino
Harris County Attorney
Catherine
Johnson
Department of Veterans Affairs
Jessica
Loya
Private Citizen
Shantha
Alonso
U.S. Department of the Interior
Lori
Dowil
Corteva
Perdita
Chavis
Houston City Council District K
Lara
Hakki
Hogan Lovells LLP
Ayako
Nagano
Private Citizen
Kimberly
Craven
Reno-Sparks Indian Colony
Rachel
Hanes
USBR
Rachel
Makleff
Grow Renewable New York: No Canadian Hydro
Yasmin
Yacoby
U.S. Department of Energy
Amanda
Aguirre
Rooted & Reimagined Strategies
Nia
Harper
Sage Futures CDC
Claire
Bergenholtz
University of Washington Bothell
Anahi
Naranjo
CEED
David
SYKES
Quiet Communities Inc.
Mike
Moltzen
U.S. EPA
Mary
McCullough
U.S. EPA
Cynthia
Peurifoy
Private Citizen
Megan
Smith
shift7
Susan
Alzner
shift7
Lori
Llewellyn
CDP North America
Denise
Sarchiapone
B&D Environmental Consulting LLC
Ngani
Ndimbie
Pennsylvania DEP
Ari
Lewis
Gradient
Nate
Curtisbrown
Advanced Energy Economy
Joi
Ross
APEX Direct Inc.
Michael
Snyder
Dow
WHEJAC Public Meeting February 24,2022, Summary | 35
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Xavier
Barraza
Valle de Oro EJLT
Rosalind
Moore
City of Forest Park Ohio
Anna
O'Driscoll
Partnership for Southern Equity
Amy
Witherall
U.S. DOI, Bureau of Reclamation
Abigail
Talboy
DOJ
Olga
Naidenko
ENVIRONMENTAL WORKING GROUP
Kristen
Haitaian
Freshwater Future
Adrienne
Bandlow
Washington State Department of Commerce
Sasha
Forbes
SPARCC
Jocelyn
Brannon
SCDHEC
Sheri
Deal-Tyne
Physicians for Social Responsibility-Iowa
Camille
Moore
Peter Damon Group
Sara
Jordan
CEQ
Emily
Gallo
HNTB
Maeve
Flynn
LSR
Matthew
Greene
U.S. Fish and Wildlife Service
Gretchen
Fitzgerald
Hudson Center for the Community and Environment
Laurie
Gelman
Department of Justice
Crystal
Lee Pow Jackson
RTI International
Joanna
Stancil
USDA-FS
William
Patterson
EBMUD (East Bay Municipal Utility District)
Nakiya
Clausell
Deloitte
Majidah
Cochran
Beveridge & Diamond, P.C.
Shem
Teya
Texas Tech University School of Nursing
Ngozi
Nwosu
City of Dallas
Louise
Kitamura
U.S. EPA
A
Sung
Greenbank Associates
Kay
Anderson
American Bottoms Regional Treatment
Yukyan
Lam
NRDC
Dewayne
Harley
General Services Administration
Kartik
Sheth
WH EOP/OSTP
Dawn
Reeves
Inside EPA
Steven
Nelson
Smithsonian Institution
Sarah
Jareczek
Intermountain Fair Housing Council
Stephanie
Herron
EJHA
Vernice
Miller-Travis
Metropolitan Group
Phillip
Washington
USDA
Alyssa
Garza
Green 2.0
Dan
Solitz
Private citizen
Leslie
Reed
Brightwater Strategies
Kelly
Crawford
DC Department of Energy and Environment
Aidan
Fife
U.S. EPA
Elizabeth
Mathis
The Chisholm Legacy Project
WHEJAC Public Meeting February 24,2022, Summary | 36
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Mario
Sengco
U.S. EPA
William
Charouhis
We Are Forces of Nature
William
Nichols
U.S. EPA
Greg
Lovato
Nevada Division of Environmental Protection
Monisha
Shah
NREL
Elliot
Blaufuss
University of Washington
Josephine
Mogeni
Texas Tech University school of Nursing
Vick
Mohanka
The Chisholm Legacy Project
Gloria
Vaughn
U.S. EPA
Justin
Thompson
NAACP
Clarence
Williams
Private Citizen
Syrah
Scott
National Clean Water Collective
Ryan
Bahnfleth
Esri
Justin
Dula
PA Dept. Of Enviro. Protection
Jamesa
Johnson Greer
Michigan Environmental Justice Coalition
Darien
Siddall
Federal Highway Administration (FHWA)
Nancy
Lui
DOE
Holly
Ravesloot
ACF
Devin
Araujo
Private Citizen
Kevin
Rosseel
U.S. EPA
Karen
Martin
Private Citizen
Aluanda
Drain
GSA
Kesha
Braunskill
Delaware Forest Service
Eric
Frankowski
Western Clean Energy Campaign
Nicole
Horseherder
To Nizhoni Ani
Joanie
Steinhaus
Turtle Island Restoration Network
Ali
Dominguez
Deloitte
Nicolette
Fertakis
U.S. EPA
Diana
Mendes
HNTB
Charissee
Ridgeway
CEQ
Gwen
Collman
NIEHS
Sonja
Favors
ADEM
Samantha
DiNatale
U.S. EPA
Betsy
Biffl
U.S. EPA
Angela
Harris
Southeast care
Erica
Brown
AMWA
Spencer
Keats
Deloitte
Brenda
Staudenmaier
CWAC
Melissa
Sturdivant
USDA - Rural Development
Janice
Horn
Tennessee Valley Authority
Dean
Scott
Bloomberg Environment
Tasha
Lo Porto
USDA Forest Service
Patricia
Iscaro
Politico Agency IQ
WHEJAC Public Meeting February 24,2022, Summary | 37
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Judy
Ackerman
Private Citizen
Dinesh
Senghani
U.S. EPA
Laurel A.
Royer
Private Citizen
Jenn
Alexander
U.S. EPA
Elizabeth
Berg
ORISE
Janelle
Anderson
Washington State Department of Ecology
Bria
Crawford
Environmental Protection Agency
C
Cunningham
DOI-USBR
Ariela
Zycherman
NOAA
Marva
King
Private Citizen
James
Haussener
CMANC
Cristina
Villa
Department of the Interior
Regan
Patterson
Congressional Black Caucus Foundation
Alanis
Allen
CT DEEP
Isa
Arriola
Our Common Wealth 670
Theresa
Yarber
DoD
Kathy
Andrews
Blue Ridge Environmental Defense League
Karen L
Williams
League of Women Voters of the Virgin Islands
Nona
Schaffner
FL Dept. of Transportation
Obrian
Murray
University of Guyana
Evelyn
Britton
U.S. General Services Administration
Aleah
Holt
U.S. EPA
Kelsey
Sisko
Maryland Department of the Environment
Lauren
Branum
Webco
Kate
Dowling
Department of Justice
Leslie
Vasquez
CEQ
Audrey
Adams
Private Citizen
Jamie
Banks
Quiet Communities
Douglas
Meiklejohn
Conservation Voters New Mexico
Gabriella
Mabayyed
EPIC
Kendra
Pinto
Earthworks
Rebecca
Truka
Hexion Inc
Lisa
Stuart
DOL
Kay
Jowers
Duke Univ
Kyle
Kajihiro
University of Hawai'i
Kristin
Gimbel
Metropolitan Group
David
Meierhenry
Tyson Foods, Inc.
Richard
Hamel
ALL4, LLC
Clark
Watson
Webco Industries
Vanessa
Gordon
USDA
John
Wiggins
U.S. EPA
Cyd
Curtis
U.S. EPA
Cara
Thuringer
The Chisholm Legacy Project
WHEJAC Public Meeting February 24,2022, Summary | 38
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Karmen
Robinson
ENRD
Coline
Bodenreider
Private Citizen
Felipe
Franchini
Private Citizen
Jane
Williams
California Communities Against Toxics
Kristin
Lehman
FEMA
Elizabeth
Small
CDP North America Inc.
Kathleen
Toolan
FDOT
Sherry
Pollack
private citizen
Kyle
Bryant
R4 EPA/ORA/SPO/EJCHS
John
Gardella
CMBG3 Law
Tyler
Jenkins
Senate EPW
Jake
Hesseling
OKI
Melissa
Kaminski
Ocean Conservancy
Pamela
Mullins
Private Citizen
Laura
Bretheim
Private Citizen
Olivia
Balandran
U.S. EPA
Suzanne
Yohannan
Inside EPA
Catherine
Villa
US Environmental Protection Agency
Brian
Parrish
CBP
Kelsey
Brugger
E&E News
Britney
Rithvixay
University of Washington Bothell
Roxanne
Welch
U.S. EPA
Judith
Kendall
U.S. EPA
Bridgitte
Prince
Independent African-American Woman Filmmaker
Carla
Walker
World Resources Institute
Carolyn
Slaughter
APPA
Vincent
Martin
V Martin Environmental Justice LLC
Marian
Rice
Salt Lake City Department of Public Utilities
Joe
Gallenstein
Kentuckians For The Commonwealth
Emma
Kurnat-Thoma
Georgetown University NHS
Lena
Epps-Price
U.S. EPA
Adam
Carpenter
American Water Works Association
JAROD D
DAVIS
Dow Inc.
Lew
Daly
Roosevelt Institute
Arsenio
Mataka
HHS
Kim
Carter
Fed
Krystal
Laymon
CEQ
Elyse
Salinas
U.S. EPA
Maisa
Tisdale
The Mary & Eliza Freeman Center for History and Community
Demi
Gary
Oak Ridge Institute/EPA
Olivia
Morgan
Private Citizen
Chelsea
Barnes
Appalachian Voices
Lea
Kosnik
University of Missouri
WHEJAC Public Meeting February 24,2022, Summary | 39
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Natalie
Rivas
The Chisholm Legacy Project
Janette
Marsh
U.S. EPA
Nikki
Saccoccia
Mystic Aquarium
Jenn
Tribble
TDEC
Morgan
Capilla
U.S. EPA
Richard
Falcon
United Latinos
Patricia
Duft
Medtronic
Venu
Ghanta
Duke Energy
Cheryl
Kelly
Department of the Interior
Mikyla
Reta
CAP
Katherine
Kane
USDOJ
Robert
Skoglund
Covestro LLC
Anil
Gurcan
Private Citizen
May
Bhetraratana
California Air Resources Board
Keyna
Cory
Public Affairs Consultants
Kathy
Yuknavage
Our Common Wealth 670
Sara
Adelsberg
Deloitte
Rebecca
Miserendino
Lewis Burke Associates
Bruce
Lum
Save Ala Moana Beach Park Hui
Molly
Updegrove
Relmagine Appalachia
Stacey
Callaway
Ecology
Sara
Miller
U.S. EPA
Robert
Dinterman
USDA
Mary
McCarron
Ohio EPA
Colonel Ann
Wright
O'ahu Water Protectors & Veterans for Peace
Stacy
Allen
Ameren
Gavin
Pauley
Environmental Protection Agency
Chris
Whitehead
ESI
Marisa
Hazell
US DOJ
Alfred
Saucedo
U.S. EPA
Brian
Holtzclaw
U.S. EPA
Lynn
Battle
ADEM
Carlyn
Petrella
Center for the New Energy Economy
Wig
Zamore
Somerville Transportation Equity Partnership
Kameron
Kerger
U.S. digital service
Elizabeth
Bradford
Michael Baker International
Elisabeth
Grinspoon
USDA Forest Service
Robyn
Rose
USDA FPAC BC
Bronson
Azama
Hawaiian Kingdom
Sean
Schrag-Toso
Department of the Interior
Steven
Menoff
Civil & Environmental Consultants, Inc.
John
Tolos
WaterProsper, Inc
Melissa
Muroff
Delaware County District Attorney's Office
WHEJAC Public Meeting February 24,2022, Summary | 40
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Doug
Brune
U.S. EPA
Charles
Alsdorf
Deloitte
Mario
Atencio
Dine Citizens Against Ruining our Environment (CARE)
Aurora
Aparicio Collazo
The Packard Foundation
Adriana
Reynolds
Ramboll
Taylor
Schoenhofer
University of Kansas
Laurene
Contreras
Yakama Nation
David
Smith
NASA/Leidos
Emily
Phillips
Georgia EPD
Janus
Herrera
Rocky Mountain Youth Corps
Paul
Lee
LA Mayor's Office
Emily
Brooks
USGS
Cynthia
Ferguson
US Dept. of Justice/ Environment and Natural Resources Division
Deborah
Cohen
U.S. EPA
Katy
Super
EJHA
John
Mueller
Supporter, Fluoride Action Network
L.
Watchempino
Multicultural Alliance for a Safe Environment
Jane
Kloeckner
Kansas University
Wesley
Watson
Michigan Sustainable Business Forum
Farrah
Court
TCEQ
Jumana
Vasi
Private Citizen
Yvonne
White-Morey
BIG, NFP
Sabrina
Johnson
U.S. EPA
Charles
Pearson
Syngenta Crop Protection, LLC
Andrea
Lauden
WA State Dept of Ecology
Timothy
Fields
MDB, Inc.
Jingsheng
Tuo
NIH
EFatimah
Hasan
MD-National Capital Park and Planning Commission
Beattra
Wilson
USDA Forest Service
Deborah
Cullins-Threets
U.S. GSA
Arnold
Wendroff
Mercury Poisoning Project
Nicole
Briggs
Nez Perce Tribe
Will
Patterson
Continuing Faith Center (Faith Based)
Benjamin
Nuvamsa
KIVA Institute, LLC
Jamie
Gobreski
U.S. EPA
Devon
Trotter
Institute for Sustainable Communities
Rachel
Turney-Work
ENERCON
Diana
Umpierre
Private Citizen
Kirsten
Cook
Partnership for Southern Equity
John
Kinsman
Edison Electric Institute
Sarah
Eisenlord
LanzaTech
Faith
Boyer
Steptoe & Johnson LLP
Laura
Betts
The CLEO Institute
WHEJAC Public Meeting February 24,2022, Summary | 41
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Anna
Chua
The Sierra Club of Hawai'i
Ayesha
Franklin
Brooklyn Neighborhood Association
Claire
Barnett
HEALTHY SCHOOLS NETWORK
Eric
Boyle
Department of Energy
David
Lonnberg
shift7
Carly
Sincavitch
Arnold and Porter
Chad
Gorman
USGAO
Katharine
Morris
CT Equity Now
Tiffany
Wallace
USDA
Chris
Espinosa
House Committee on Natural Resources
Marissa
Naranjo
High Watermark LLC
Margaret
Motheral
Skipping Stone Media LLC
Sean
McGinnis
COEFFICIENT
Alexis
Guibani
University of Washington
Andrew
George
UNC Chapel Hill Institute for the Environment
Sheila
Lewis
USEPA/Office of Environmental Justice
Kay
Nelson
Northwest Indiana Forum
Lydia
Heye
US Department of Justice
Oral
Sau Iters
Tribal TAB
Paige
Lieberman
U.S. EPA
Rebecca
McNaughton
University of Chicago
Roddy
Hughes
Sierra Club
Monika
King
NYS DOH
Brian
Chalfant
Pennsylvania Department of Environmental Protection
Mary
Raulerson
Kittelson & Associates Inc.
Adriane
Busby
Friends of the Earth, DC
Hiilei
Casco
Private Citizen
Center for
Communities
Center for Sustainable Communities
Louis
Zeller
Blue Ridge Environmental Defense League
Angela
Chalk
Healthy Community Services
Ryan
Hathaway
Department of the Interior
Lisa
Pellett
Washington Military Department
Rashida
Manuel
Institute for Sustainable Communities
Thomas
Regan-Lefebvre
Center for Latino Progress
Katherine
Wolf
University of California at Berkeley
Greg
Rose
Stellantis
Boris
Ricks
CSUN
Shea
Zwerver
PA DCNR
Aaron
Bell
U.S. EPA
Sheila
Babauta
22nd CNMI House of Representatives
Elizabeth
Perera
Sierra Club
C.
Liv
HHS
Lauren
Tamboer
WA Dept. of Ecology
WHEJAC Public Meeting February 24,2022, Summary | 42
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Ericka
Popovich
West Michigan Environmental Action Council
Shannon
Anderson
University of Illinois
Jade
Lu
Massachusetts Clean Energy Center
Ray
Hall
UNA-USA Bmforflint coosa nation
Michael
Jensen
Waste Management
Ronald
Moore
Cincinnati Children's Hospital Medical Center
Liza
Stern ik
US DOJ, ENRD, EES
Andrea
Vidaurre
Peoples Collective for Environmental Justice
Brian
Kristofic
Ardagh group
Patricia
Taylor
Environment and Human Health, Inc.
Salvador
Gandara
EPA Region 6
Felicia
Beltran
Arizona Department of Transportation
Christopher
Smith
Interstate Natural Gas Association of America
Jessica
Arika
Hennepin County
Connie
Dula
Private Citizen
Taylor
Mayes
Black Environmental Activist Movement
Jose
Almanzar
Private Citizen
Jason
Husveth
Human Beings Advocating for Native Plant Communities
Melinda
Downing
Department of Energy
Negin
Sobhani
National Academy of Sciences
Carl
Baker
Tri-city Democrats
Sara
Lips
Georgia EPD
Drue
Pearce
Holland & Hart LLP
William
Hsu
CDP
Marti
Townsend
Sierra Club
Karen
Campblin
Private Citizen
Atenas
Mena
CleanAirNow
Gregory
Mason
Defense Logistics Agency
Andrew
Patros
community citizens
Rachel
Vranizan
California Environmental Justice Alliance
Jorge
Acevedo
Ml EGLE
John
Quade
US HUD
Cynthia
Jennings
Connecticut Coalition for Environmental Justice
Jeffrey
Schub
Coalition for Green Capital
MacKensey
King
CDP
DARIA
GRAYER
AAMC
Charles
Garrison
Hogan Lovells
Zeno
Guerrero Jr
Our Commonwealth 670
Fona
Ou
UC Berkeley
Adamarie
Acevedo
University of Idaho
Pamela
Perez, PhD
California State University, Northridge (CSUN)
Reagan
Swaine
CDP North America
JL
Andrepont
350.org
WHEJAC Public Meeting February 24,2022, Summary | 43
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Cameron
Baker
Fortress Control
Carolyn
Yee
California Environmental Protection Agency, Department of Toxic
Substances Control
Kimi
Wei
The Wei LLC
Dannie
Bolden
Pioneer Bay Community Development Corporation
Marilyn
Elliott
Adrm
Tanya
Abrahamian
U.S. EPA
Ian
Pope
WM
Harry
Stone
Ohio River Basin Alliance
Annetta
Thompson
Private Citizen
Demitrous
Blount
Dept of Energy
Grant
Gutierrez
Dartmouth College
Francisco
Donez
U.S. EPA
Samyukta
Iyer
Wheeler High School
Donna
Chavis
Friends of the Earth/RedTailed Hawk Collective
Danilo
Morales
DOER
Jonathan
Cruz
Multnomah County Environmental Health
Lisa
Buglione
Association for the Improvement of American Infrastructure
Zoe
Gabrielson
Duke University
Rebecca
Huff
U.S. EPA
Matthew
Young
BeechWood Inc.
Stuart
Spencer
Tyson Foods, Inc.
Sarah
Si el off
Maul Foster Alongi
Katherine
Welty
DOJ ENRD
Allison
Zejnati
Private Citizen
Jenna
Mel
NCUIH
Claire
Woods
Greenfield Environmental
Virginia
Johnson
KFTC
Astrika
Adams
SBA OA
David
Magdangal
U.S. EPA
Annika
Gacnik
Hive Brands
Lauren
Owan
Black Millennial 4 Flint
Janie
Cisneros
Singleton United/Unidos
Nefeli Maria
Bompoti
University of Connecticut
Valerie
Amor
Private Citizen
Melissa
Kaminski
Ocean Conservancy
Hank
Fergerstrom
Na Kupuna Moku 0 Keawe
Alex
Guillen
POLITICO
Bud
McAllister
Partners in Healthy Communities
Ariel le
Benjamin
U.S. EPA
Linda
Belton
NOAA
Joanne
Chiu
Private Citizen
Sarah
Barr
U.S. EPA
WHEJAC Public Meeting February 24,2022, Summary | 44
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Leo
Goldsmith
ICF
Taylor
Gillespie
EPA
Mark
Fite
U.S. EPA
Maggie
Coulter
Center for Biological Diversity
John
Abbott
Syngenta
Denise
Bennett
Louisiana Department of Environmental Quality
Briana
Wendland
Private Citizen
Daria
Neal
U.S. Dept. of Justice
Lawrence
Friedman
American Institutes for Research
Kevin
Lambert
NPS
Brittany
McCubbin
Kentuckians for the Commonwealth
Trish
Porter
Resilient Virginia
Melissa
Brandenburg
UNM / student
Elizabeth
O'Nan
Protect All Children's Environment
Maya
Nye
Coming Clean
Sunny
Dooley
Private Citizen
Avery
Lavoie
Oakridge Research Institute for Science and Education
Nicki
Alexander
U.S. EPA
Kalauna
Carter
FAMU-SOE STUDENT
Crystal
Myers-Wilkins
Private Citizen
Jenny
Heeter
National Renewable Energy Laboratory
Jane
Mantey
Ceres
Deyadira
Arellano
People's Collective for Environmental Justice
Sheryl
Good
U.S. EPA
Edith
Pestana
CTDEEP
Dondre
Young
Office of U.S. Senator Debbie Stabenow
Reginald
Butler
DHEC's Bureau of Water
Brendan
Mascarenhas
American Chemistry Council
Gina
Hara
Oahu Water Protector
Rebecca
Spellissy
Ramboll
Kristin
Aldred Cheek
Stericycle
Hanaloa
Helela
Ka'ohewai
James
Courtney
Arnold & Porter, LLP
Rosemary
Ahtuangaruak
Nuiqsut
Rachel
Gonsenhauser
U.S. EPA
Sara
Schwartz
U.S. EPA
Cheyenne
Antonio
The Red Nation
Renee
Kramer
NCDEQ
Darcy
Sharp
FBI
Jessica
Bielecki
NRC
Katherine
Diaz
Private Citizen
Amy
Turner
ODOT
Teresa
Acuna
DOL
WHEJAC Public Meeting February 24,2022, Summary | 45
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Melissa
Horton
Southern Company
Carlos
Anchondo
E&E News
Amelia
McCall
U.S. EPA
Jessica
Borden
TVA
Jeffrey
Knishkowy
Federal Govt
Tamara
Freeman
U.S. EPA
Alan
Walts
U.S. EPA
Kate
Friedman
Louisiana Dept. of Health Env. Epi.
Kimberly
Wilson
U.S. EPA
Donald
Ami
DOE/NNSA/Los Alamos
Cara
Cook
Alliance of Nurses for Healthy Environments
Hilda
Nieves
Private citizen
Briana
Garcia
Temboo
Virginia
Necochea
NMELC
Leilani
Lindsey-Kaapuni
Hui Aloha Aina
Millie
Piazza
Dept. of Ecology
Ashley
James
Private Citizen
Sarah
Kleypas
Lone Star Legal Aid
Gail
Orendorff
DOT/FAA
Caitlin
Macomber
WRI
Charles
Mason
Pacific Gas and Electric
Anjuli
Jain Figueroa
DOE
Maureen
Munoz
U.S. EPA
Dean
Alonistiotis
MWRD
Lara
Spader
VA
Megan
Kohler
ADEC
Lin
Nelson
Evergreen State College
Jahi
Wise
WHO
Samantha
Beers
U.S. EPA
Ann Marie
Chischilly
Institute for Tribal Environmental Professionals
Luciana
Paz
USDA
Courtney
Rutledge
Legal Aid of Western Ohio
Jordan
Creed
DOI/BSEE
Leila
Heidari
Boston University School of Public Health
Nancy
Beck
Private Citizen
Shelby
St u Its
Advanced Energy Economy
WHEJAC Public Meeting February 24,2022, Summary | 46
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Appendix 4. Comments and Documents Submitted by March 10, 2022
WHEJAC Public Meeting February 24,2022, Summary | 47
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Appendix 4. Documents and Comments Submitted by March 10, 2022
ADA Letter to NTP2-7-2022 A4 3
Alaska Community Action on Toxics Public Comments to WHEJAC 2-9-22 A4 5
Andrew Young Foundation 10-6-2016 A4 7
Arnold Paul WendroffVita 03 01 19 A4 9
Ashgar, A conceptual framework of EJ based on shared but differentiated responsibilities EJ 2001 A4 19
Atsdr Children's Hg Exposure 2009 Excerpts A4 77
AtsdrTox Profile 1999 Excerpts A4 83
Audrey Adams EPA Declaration Final PDF A4 88
Audrey Adams WHEJAC Testimony Environmental injustice of water fluoridation 2-24-22 A4 95
Benjamin H. Nuvamsa et al. Comments to WHEJAC w Exhibits A4 96
Beyond Extreme Energy WHEJAC letter Feb 2022 A4 143
Brannan, Su, & Alverson 2012 Mercury poisoning A4 146
C. Johnson paper on Merury 1999 A4 149
Charles Schumer letter to B. Mojica 1997 A4 160
Charles Schumer letter to B. Mojica 1998 A4 161
Charles Schumer letter to Dr. Arnold Wendroff 1994 A4 162
Citizens Resistance At Fermi Two (CRAFT) Mi healthy climate plan comments A4 163
Coal Ash Pile HEIC (image) A4 177
Coal Ash Report Mirant Dec. 2011 A4 178
Coalition for Healthier Schools email to President Biden 2022 A4 185
CofAwit Mosaic tabulation A4 187
CVNM Comments to WHEJAC A4 189
Deed map CHPE Property in Stony Point NY 2018 A4 194
Diana Umpierre Comments to WHEJAC A4 201
Dr. Sacoby Wilson WHEJAC Scorecard Recommendations A4 203
Dr. Sarah Bishop Merrill Comments to WHEJAC A4 205
EJTF Washington State Report_Final 2020 A4 207
Emma Kurnat-Thoma, PhD, MS, RN, FAAN Comments to WHEJAC A4 348
Encyclical letter A4 358
Enid Sisskin PhD Comments to WHEJAC A4 542
EPA RARE Grant Proposal 2010 A4 545
Ferrer Bronx BP 04 07 00 A4 549
Ferrer Bronx BP 07 23 97 A4 550
Flouridation Annotated Biblio 90+ docs A4 551
Flouride Action Network report-9-25-15 A4 568
Flouride in Drinking Water 2006 Exec Summ National Academies A4 713
Fluoridated Water and ADHD A4 735
Garetano et al. 2006 A4 755
Garetano Thesis Excerpts 2006 A4 759
Grand Canyon Trust Comments to WHEJAC Docket ID No. EPA.HQ.OA.2022.0050 A4 765
Hailey N. Williams et al. Comments to WHEJAC A4 770
Hanmer letter to Leslie Russell 1983 A4 774
Hydrofluosilicic Acid-Mosaic-7-13-15 A4 775
John Mueller Comments to WHEJAC 1-2627-2022 A4 782
John Mueller Comments to WHEJAC 2-24-2022 A4 784
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Kathy Yuknavage, Our Common Wealth 670s Comments to WHEJAC A4 786
LULAC Civil Rights Violation Regarding Forced Medication statement A4 788
Lynne Bonnett Comment to WHEJAC Feb 27, 2022 A4 790
Merer et al. Acrodynia and Hypertension 2012 A4 791
Michael Greenberg article on Mercury 1999 A4 794
Nita Lowey Letter to Col. Paul Owen A4 796
NRDC Report Excerpts 2004 A4 798
NYCDOH Hg for providers 12 99 A4 803
NYCDOH Hg Poisoning 12 99 A4 821
OMB Memorandum Interim Implementation Guidance for the Justice40 Initiative July 20 2021 A4 829
Ozuah et al. Mercury Exposure Article 2003 A4 842
Ramos Lehman Coll 2005 A4 845
SATCON2 CEWG Excerpts A4 848
Smith et al WHO Performance Measurement A4 868
Sodium fluorosilicate solvay A4 896
Steinemann Article International Prevalence of chemical sensitivity, 2019 A4 905
Testimony to WHEJAC, addressing ecocide against the Hawaiian Kingdom A4 914
The Chisholm Legacy Project A4 916
Theresa Arriola, et al. Our Commonwealth 670 A4 920
Towboat and Harbor Carriers Assoc. of NYNJ 2020 A4 923
TSCA-lawsuit complaint 4-18-17 A4 930
UN-Space-Sustainability-Stakeholder-Study Rpt Excerpts A4 955
UNEP Module 5 2008 condensed A4 958
Velaquez letter to A. Waxman 1997 A4 970
Velaquez letter to A. Wendroff 1997 A4 971
Velaquez letter to A. Wendroff 2000 A4 972
Wendroff article 1990 A4 974
Wendroff article Environmental Review 2005 A4 975
Wendroff Comments and corrections to Brannan et al. 2012 A4 985
Wendroff Lancet article corrected 2014 A4 987
Wendroff letter to the editor 1995 A4 993
Wexler article 2016 A4 994
Written Public Comments from the WHEJAC Public Meeting on February 24, 2022 A4 999
Zayas & Ozuah Letter to the editor 1996 A4 1015
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American "11 14th Street, MM T 202.898.2400
* " "IIV.I1VUII Suite 1200 F 202.898.2437
Dental Washington, DC 20005 www.ada.org
Association®
February 7, 2022
RickWoychik, Ph.D.
Director
National Toxicology Program and the
National Institute of Environmental Health Sciences
111 TW Alexander Drive
Durham, NC 27709
Re: State-of-the-Science Report on Fluoride Exposure
Dear Dr. Woychik:
On behalf of our 162,000 members, we would like to express our concern about the
National Toxicology Program's forthcoming state-of-the-science report examining whether
there is a causal relationship between fluoride exposure and potential neurodevelopmental
and cognitive effects. Specifically, we ask you to exclude—or carefully consider how to
characterize—any neurotoxin claims lingering from NTP's now-abandoned monograph,
even if placed in a forward or executive summary.
For the last several years, NTP has been examining the literature to determine whether
there is a causal relationship between fluoride exposure and neurocognitive health. The
work culminated in a proposed monograph titled Systematic Review of Fluoride Exposure
and Neurodevelopmental and Cognitive Health Effects. Both the first and revised drafts
contained the unqualified statement that fluoride is a "potential" neurotoxin at any exposure
level,1"2
The National Academies of Sciences, Engineering and Medicine issued scathing peer
reviews of both drafts, questioning whether the claim could withstand scientific scrutiny.
NASEM noted that NTP failed to provide adequate scientific evidence for its conclusion,
noting difficulty following the review methods, inability to find key data, "worrisome"
inconsistencies, and concerns about the wording of some conclusions.3"4
NTP's blanket claim about any level of exposure was based on a "low-to-moderate level of
evidence" examining exposure to abnormally high levels of fluoride (>1.5 mg/L). Those
levels are more than double of what Centers for Disease Control and Prevention and the
U.S. Public Health Service recommends for community water fluoridation (0.7 mg/L). It
prompted NASEM to write in its second peer review:
"NTP did not conduct a formal dose-response assessment that could inform a
discussion on water fluoridation. NTP needs to state clearly that the monograph is not
designed to be informative with respect to decisions about the concentrations of fluoride
that are used for water fluoridation. That point should be reiterated at the end of the
monograph with some indication that... [the monograph] does not draw any conclusions
regarding drinking-water fluoridation or other fluoride sources, such as toothpaste or
other dental treatments... [T]he context into which the monograph falls calls for much
more carefully developed and articulated communication on this issue."
A4 p.3
-------
Dr. Rick Woychik
February 7, 2022
Page 2
The ADA is concerned that the monograph's risk biased claim about fluoride being a
"potential" neurotoxin at any exposure level will resurface in NTP's state-of-the-science
report. An unqualified claim of this nature would only add to the many myths and
misperceptions about community water fluoridation (0.7 mg/L)—and undermine national,
state, and local efforts to expand the practice.
The CDC hailed community water fluoridation as one of ten great public health
achievements of the 20th century.5-6 It is an inexpensive way to reduce tooth decay by at
least 25 percent in the population.7 It would be a shame to distract from over 75 years of
public health success over a simple matter of communicating the science, which is often
more nuanced than a sound bite can convey.
We would welcome the opportunity to meet with you to discuss our concerns. In the
meantime, we ask you to exclude—or carefully consider how to characterize—any
neurotoxin claims lingering from NTP's now-abandoned monograph, even if placed in a
forward or executive summary.
If you have any questions, please contact Mr. Robert J. Burns at 202-789-5176 or
burnsr@ada.org.
Sincerely,
/s/ /s/
Cesar R. Sabates, D.D.S. Raymond A. Cohlmia, D.D.S.
President Executive Director
CRS:RAC:rjb
cc: ADM Rachel Levine, Assistant Secretary for Health
1 National Toxicology Program. 2019. Draft NTP Monograph on the Systematic Review of Fluoride
Exposure and Neurodevelopmental and Cognitive Health Effects. Office of Health Assessment and
Translation, Division of the NTP, National Institute of Environmental Health Sciences, National
Institutes of Health, U.S. Department of Health and Human Services.
2 National Toxicology Program. 2020. Revised Draft NTP Monograph on the Systematic Review of
Fluoride Exposure and Neurodevelopmental and Cognitive Health Effects. Office of Health
Assessment and Translation, Division of the NTP, National Institute of Environmental Health
Sciences, National Institutes of Health, U.S. Department of Health and Human Services.
3 National Academies of Sciences, Engineering, and Medicine. 2020. Review of the Draft NTP
Monograph: Systematic Review of Fluoride Exposure and Neurodevelopmental and Cognitive Health
Effects. Washington, DC: The National Academies Press.
4 National Academies of Sciences, Engineering, and Medicine. 2021. Review of the Revised NTP
Monograph on the Systematic Review of Fluoride Exposure and Neurodevelopmental and Cognitive
Health Effects: A Letter Report. Washington, DC: The National Academies Press.
5 Centers for Disease Control and Prevention. Ten Great Public Health Achievements - United
States, 1900-1999. MMWR 1999; 48 (12): 241-243.
6 Vivek H. Murthy, Surgeon General's Perspectives: Community Water Fluoridation—One of CDC's
10 Great Public Health Achievements of the 20th Century, Public Health Rep 2015; 130(4): 296-298.
7 American Dental Association, Fluoridation Facts, 2018.
A4 p.4
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Alaska Community Action on Toxics
Alaska Community Action on Toxics
Comments to the WHEJAC
February 9, 2022
Alaska Community Action on Toxics (ACAT) is an environmental health and justice research and
advocacy organization based in Anchorage, Alaska, USA. We are a participating organization of
the International Pollutants Elimination Network (IPEN) and endorse the IPEN submission. We
will focus our submission on the particular vulnerability of Arctic ecosystems and Indigenous
peoples related to the toxic lifecycle of plastics, impacts on health, and implications for human
rights.
Alaska and the circumpolar Arctic are warming at least twice as fast as the rest of the planet as a
whole. Climate warming is exacerbating the mobilization and transport of persistent and toxic
chemicals as well as plastics/microplastics within and into the north/Arctic. Accelerated melting
of sea ice, permafrost, and glaciers is mobilizing sequestered contaminants and microplastics,
threatening the health of our oceans, fish, wildlife, and peoples of the north. The north/Arctic is
a hemispheric sink for persistent industrial chemicals and microplastics that are transported into
the north on atmospheric and oceanic currents from lower latitudes through global distillation.
Arctic Indigenous Peoples have some of the highest levels of persistent pollutants of any
population on earth because of their reliance on traditional foods from the sea. Plastics and
microplastics convey toxic substances that are additives or absorbed into the plastics into the food
web, thus presenting a hazard to the health of fish, wildlife, and people. Microplastic particles
have been revealed in the placentas of developing babies for the first time, which the researchers
said was "a matter of great concern." Scientists said they could carry chemicals that could cause
long-term damage or upset the baby's developing immune system.1
Delbert Pungowiyi, a Yupik tribal leader from Savoonga on Sivuqaq (St. Lawrence Island)
highlighted the threats to health and human rights in the Arctic caused by the interconnected
issues of chemicals, plastics, and climate change: "We are overwhelmed with concern about the
health harms associated with climate change, the loss of sea ice and melting permafrost and the
mobilization of chemicals and plastics — these are all interconnected. We are running out of
time!"
The petrochemical industry projects exponential increases in production of chemicals and plastics
over the next three decades, as they see transition to renewable energy reducing the demand for
oil as an energy source. Thus, petrochemicals are becoming a huge driver of global oil and natural
1 Ragusa etal. 2021. Plasticenta: First evidence of microplastics in human placenta. Env. Int'l.
https://doi.Org/10.1016/i.envint.2020.106274
A4 p.5
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gas production and use and major sources of climate-altering emissions. Investments in
renewable energy must be accompanied by phase out of classes of persistent and toxic chemicals;
investments and innovations in green chemistry and safe alternatives; as well as curbing the
production and use of plastics.
Production of plastics exacerbates climate warming: 99% of plastics are derived from fossil fuels.
The lifecycle of plastics will add more than 850 million metric tons of greenhouse gases to the
atmosphere in the current year, an amount equal to the emissions from 189 five-hundred
megawatt coal-fired power plants.2
Plastics in the Arctic:
¦ A recent study on the global microplastic transportation patterns revealed that the
concentrations of microplastics were higher in the Arctic Basin compared to any other
ocean basin in the world.3 As all plastic persists for hundreds of years, in the Arctic, the
lifespan of plastic is dramatically longer due to colder water and the low concentration of
oxygen combined with an absence of sunlight.
¦ "Thousands of particles of microplastic were in nearly every sample from the Arctic; a
single liter of snow contained 14,000 grains of the stuff." "A recent study found more than
12,000 microplastic particles per liter of sea ice. That amount is similar to the highest
reported concentrations floating off polluted urban coasts. And it's surpassed by the
14,000 particles per liter recently found in the snow on top of Fram Strait sea ice. Arctic
sea ice is a major global sink for microplastic particles."4
¦ 100% of beluga whales hunted in the Arctic had microplastics in their stomachs and
intestines.5
¦ Arctic seabirds are exposed to hormone disrupting chemicals by eating plastics.6
Plastics and associated toxic chemicals threaten the health, well-being, and food security of Arctic
Indigenous Peoples. Urgent action is needed to curb fossil fuel, chemicals and plastics production
and to prevent these threats and further harm, protect health, and human rights. Climate
warming, toxic chemicals, and plastics are interconnected and existential threats to the health and
safety of northern and Arctic Indigenous peoples.
2 https://theintercept.com/2019/07/20/plastics-industry-plastic-recvcling/
3 https://wyyyy.scjencedirectxom/science/article/abs/pii/S0269749117349400?via%3Dihub
4 httPsi/Zwyyvy.nationalgeographic.com/science/article/remote-arrtic-contains-more-plastic-than-most-places-on-
earth
5 https://pubmed.ncbi.nlm.nih.gov/31733906/
6 https://pubmed.ncbi.nlm.nih.gov/32753218/
A4 p.6
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ANDREW YOUNG
FOUNDATION
October 6, 2016
Georgia Governor Nathan Deal
206 Washington Street
111 State Capitol
Atlanta, Georgia 30334
House Speaker David Ralston
332 State Capitol
Atlanta GA 30334
Copy to: American Water Works Association
RE: Fluoridegate Scandal Documents and Repeal of GA's Water Fluoridation Law
Dear Governor Deal and Speaker Ralston:
As a person deeply involved in civil and human rights, I am writing to ask for a written response from you in light of
the Fluoridegate scandal developing here in Georgia. What's clear to me is that we need a repeal of Georgia's water
fluoridation law, and hearings to look into how fluoridation has continued all these years, long after there were
plenty of reasons to end it. This is a civil rights issue, and the people have a right to have the full story given to them,
rather than highly edited, misleading talking points.
When someone's story keeps changing, there are quite often motivations behind their changed stance that may not
be aligned with the best interests of the public. The story offered by water fluoridation promoters keeps
changing...and changing...and changing. There are key groups such as seniors, kidney patients, diabetics, communities
of color, thyroid patients and people who drink a lot of water due to their occupation that are especially affected by
Fluoridegate.
Consider how the story has changed, repeatedly.
• Dentists said there has been extensive research for 60 years on the safety of fluoridation. Now a document
from the American Dental Association has surfaced, calling for very basic research on how kidney patients,
diabetics, seniors and other groups are affected — topics that should have been settled before fluoridation
commenced. So, no, fluoridation was not extensively researched.
Communicating Possirii ities
Developing Leaders
Andrew J.Young Foundation, Inc. • 260 14™Sreet,NW * Atlanta, Georgia 30318
Phone: (404) 685-2786 Fax: (404) 685-2774 • www.andrewjyoungfoundation.org
-------
J
ANDREW rOUNG
FOUNDATION
• Discoloration of teeth by fluoride was called a pathologic condition in the American Dental Association's
journal. Now it's dismissed by dentists as just a "cosmetic" issue and "barely visible." Strange, isn't it, to go
from pathology to inconsequential?
• Dentists said we need to ingest fluoride systemically for it to help prevent cavities, so this was the
justification for putting it in drinking water. Now dentists tell us that the primary way fluorides work is
topical, when they touch teeth in the mouth. They also said the concentration of fluoride in saliva resulting
from fluoride in water is too weak to do much. So why is fluoridation continuing? Are we sacrificing the
health and safety of our communities simply because dentists don't want to be embarrassed, or sued?
• Dentists said fluoridation would help level the playing field for minority communities, but now we see in
documents publicized by The Lillie Center that African Americans and other groups are actually
disproportionately harmed by fluorides causing all forms of dental fluorosis teeth disfigurement. Plus we
have more diabetics and kidney patients in African American communities, and they deserve to not be kept
in the dark and forced to drink fluorides because the state mandates it.
• Dentists led us to believe fluoridation is highly effective, but dental journals admit that fluorides do very little
to prevent cavities where more than 80% occur, in the back molars. Dental journals say it: tooth sealants are
dramatically more effective. So, no, once again, we don't need fluoridated water.
I am calling for Fluoridegate hearings, here, in Georgia. And I am calling for a repeal of Georgia's fluoridation law,
immediately. I look forward to your written response. I am copying this letter to the American Water Works
Association, because I would also like to know what their response is, given the ever-changing story offered to
continue fluoridation and the documents that have come to light. Water fluoridation clearly has not stemmed the
cavity epidemic in our cities, and millions of people don't know the ways that uncontrolled dosing of fluorides in
drinking water can impact them.
Thank you for your help.
CC. CEO David B. LaFrance, American Water Works Association, 6666 West Quincy Avenue, Denver CO 80235-3098
Sincerely,
Communicating Possibilities
Developing Leaders
Andrew J. Young Foundation, Inc. • 260 14'" Sreet,NW • Atlanta, Georgia 30318
Phone: (404)685-2786 Fax: (404)685-2774 • www.andrewjyoungfoundation.org
-------
Curriculum Vitae
ARNOLD PAUL WENDROFF
Born: January 31, 1942
544 Eighth Street
Brooklyn, NY 11215-4201 USA
(718) 499-8336 Phone & Fax
mercurvwendroff@mindsprina.com
Education
CUNY Graduate Center Ph.D. (Sociology of Medicine) October 1985
CUNY Graduate Center M.Phil. (Sociology) June 1981
Brooklyn College, CUNYM.Sc.Ed. (Education) February 1971
Brooklyn College, CUNY B.A. (Biology) February 1964
Erasmus Hall High School, Regents Diploma, June 1959
Employment
Visiting Scientist, Chitedze Agricultural Research Station, Ministry of Agriculture, Malawi. April-May 1998, May-June 2002.
Co-Principal Investigator, Woodhull Medical and Mental Health Center, Department of Pediatrics, Mercury Absorption Study. 1999 -
2001. (Pro bono)
Co-Principal Investigator, EPA Environmental Justice / Pollution grant to Medgar Evers College/CUNY. October 1998 - October
2000
Research Associate, Geology Department, Brooklyn College/CUNY, 1997-2002
Consultant, Mercury Poisoning Project, EPA Office of Environmental Justice Grant to Puerto Rican Family Institute, Queens, NY.
1997- 1998 (Pro bono)
Science Teacher (various Brooklyn junior high schools) NYC Board of Education, 1970-1996. Retired.
Adjunct Lecturer, Department of Rehabilitation Medicine (Occupational Therapy) Columbia University, College of Physicians and
Surgeons, 1985-1991.
Assistant to the President, CUNY Academy for the Humanities and Sciences, 1980.
Adjunct Lecturer, Sociology Department, Brooklyn College/CUNY, 1975.
Primary School Science Curriculum Developer, Domasi Science Centre, Malawi (U.S. Peace Corps) July 1967-December 1968.
Secondary School Science Teacher, Livingstonia Secondary School, Malawi (U.S. Peace Corps) January 1967-June 1967.
Biology Laboratory Assistant, Erasmus Hall High School, Brooklyn, NY 1964-5.
Science Laboratory Technician, Berriman Junior High School, Brooklyn, NY 1963.
A4 p.9
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Publications
"Undervalued, Overdue: Handcarts And Food Security." Friends of Malawi Newsletter, October, 2017 p. 11
"Handcarts for Transporting Water in Sub Sahara Africa — A Neglected Technology." Comment, on line PLOS one June 22,
2016. http://journals.plos.org/plosone/article/comment?id=info%3Adoi%2F10.1371%2Fannotation%2F8742elb4-204b-4292-993c-
0fa5e31 lbcac
"Preparedness for Public Health Emergencies Improving." Comment, on line Medscape Family Medicine. April 29, 2016.
https://www.medscape.com/viewarticle/862471?nlid=104393_2581&src=WNL_mdplsnews_160429_mscpedit_obgy&uac=48881DX
&spon=16&impID=1078935&faf=l
"Neurodevelopmental toxicity: still more questions than answers" July 2014 THE LANCET Neurology 13:7:646-647 Letter
"Is there really a causal relationship between mercury exposure and autism? Some evidence to the contrary!" Our Health and
Environment Blog from the Collaborative on Health and the Environment. October 23, 2013.
https://ourhealthandenvironment.wordpress.com/2013/10/23/is-there-really-a-causal-relationship-between-mercury-exposure-and-
autism-some-evidence-to-the-contrary/
"Comments on "Assessment of prenatal mercury exposure in a predominantly Caribbean immigrant community in Brooklyn,
NY" Journal of Environmental Monitoring 2012,14, 2815-2816 Letter
"Handcarts: The Most Appropriate Transportation Technology for Transfer to Malawi." Malawi T2 Newsletter Malawi
Transportation Technology Transfer Centre Vol. 1 No. 2 Blantyre, Malawi January 2006
"Magico-Religious Mercury Use in Caribbean and Latino Communities: Pollution, Persistence, and Politics" Environmental
Practice 7:2: 87-96 June 2005.
"The Malawi cart: An affordable bicycle-wheel wood-frame handcart for agricultural, rural and urban transport applications
in Africa." Workshop Report. Vol. II - International Workshop on Modernising Agriculture: Visions and Technologies for Animal
Traction and Conservation Agriculture. Jinja, Uganda. 19th - 25th May 2002. U.N. Food and Agriculture Organization, Rome, Pp. 189-
197. 2005.
"The AfriCart's Role in Malawi's Agricultural Economy" Business Voice Malawi Confederation of Chambers of Commerce and
Industry, First Issue July/August 2004 pp. 26-27
"The Toxicology of Mercury." New England Journal of Medicine 350:9:945 February 26, 2004 Letter
"Public Health Crisis in the Low-Income Community: Domestic Mercury Poisoning." Vital Signs Coalition of Concerned
Medical Professionals. New York, 27:1:3,18-19. Winter 2003 [actually late 2002]
"Handcarts in Malawi and Sub-Sahara Africa." Anthropology News. Association for Africanist Anthropology. Guest Column. Pp.
38-39 Jan. 2003.
"Healthier Transport Options" The New York Times. March 19, 2002. Letter.
"IOM Scrutinizes Link Between Vaccines, Neurological Problems." Medscape Pediatrics July 2001 Letter
http://www.medscape.com/Medscape/pediatrics/journal/200 l/v03 ,no4/.. ,mpe0731 .wend.htm
"Domestic Mercury Contamination in Hispanic and Caribbean Communities in New York City." BCC Science & Technology
News. 2:2:1,4,5. Bronx Community College. May 2001.
"Excerpts and Comments [on EPA's] Mercury Research Strategy in: Report on the Peer Review of EPA's Draft Mercury
Research Strategy. Final Report. Appendix G, Written Comments by Observers, pp. 1-25. 2/3/00 Eastern Research Group, Lexington,
MA. EPA Contract No. 68-C-98-148.
"Mercury Contamination Risk for Certain Residential Properties." Environmental Times pp. 1,8,16 Fall 1999 (with D.A. Jetter,
MPH)
A4 p.10
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"Ritual Poisons" The New York Times. August 2, 1997. Letter.
"Magico-religious Mercury Exposure." Environmental Health Perspectives, 105:3:266. March 1997. Letter.
"Magico-Religious Mercury Poisoning and Cultural SensitivityAmerican Journal of Public Health, 85:3:409-410. March 1995.
Letter.
"More on EPA Mercury Warning." The Nation's Health 25:6:2. July 1994. Letter.
"Human Powered Garden Carts; Appropriate Farm Transportation." in Human and Draught Animal Power in Crop Production.
Workshop proceedings, Harare, Zimbabwe. Abridged. 130-31 Food and Agriculture Organization, UN, Rome, 1993.
"Bodies at Rest: Rousing Officialdom to the Peril of Domestic Mercury Pollution." Research poster abstract. Journal of Health
Care for the Poor and Underserved, 3:1:256-257. Summer 1992.
"El envenenamiento con mercurioMedico Interamericano, 10:11:64,66,68. Nov. 1991. (Translation by Dr. H. Carasquillo)
"Bringing Attention to Mercury Threat." Society for Applied Anthropology Newsletter, 2:1:3-5 Feb. 1991.
"Domestic mercury pollution." Nature, 347:6294:623 Oct. 18,1990. Letter.
Trouble-Shooters and Trouble-Makers: Witchfinding and Traditional Malawian Medicine. Dissertation, CUNY Graduate
Center, 1985.
"Health Care and Social Change: The Case of Northeastern Malawi." in Third World Medicine and Social Change, pp.253-267
John H. Morgan ed. University Press of America, Lanham MD 1983.
"The Role of traditional Divining Healers in Northeastern Malawi." Paper, African Studies Association, ASA #81-131, 1981.
Conference Panel, Paper, Poster Sessions, Lectures, etc.
"Environmental Health Effects of Magico-Religious Mercury Use in Caribbean and Latino Communities, & Social factors
precluding its assessment." Lecture: Environmental & Occupational Health Sciences Institute, Rutgers University, Piscataway, NJ
03/01/19
"Magico-Religious Mercury Use in Caribbean & Latin American Communities: Another Inconvenient Truth, & Why Social
Scientists Should Investigate It." Metropolitan Medical Anthropology Association. CUNY Graduate Center 02/07/18
"Neurotoxic Sequelae of Magico-Religious Mercury Use in Caribbean and Latino Communities: A Latent Epidemic of
Mercury Poisoning?" Grand Rounds, Institute for Neurosciences, New York Methodist Hospital, 11/24/14
"Environmental Health Issues Surrounding Magico-Religious and Ethnomedical Mercury Use in Caribbean and Latino
Communities" Grand Rounds: Department of Obstetrics & Gynecology, Brookdale Medical Center, 04/23/14
"Environmental Health Effects of Magico-Religious Mercury Use in Caribbean and Latino Communities & Factors Impeding
its Assessment" Lecture: Environmental & Occupational Health Sciences Institute, Rutgers University, Piscataway, NJ 01/07/14
"Magico-Religious Mercury Use Contaminates Latino Homes and Poisons Their Occupants." Latino Health: Social Justice &
Latino Health, 4th Annual Conference. N.Y.U. School of Medicine Centers for Health Disparities Research. New York, 10/28-29/05.
"Magico-Religious and Ethnomedical Mercury Use in the Caribbean Communities." Caribbean American Medical and Scientific
Association. Conference on "Impact of Environment on Health: A Caribbean Perspective." Methodist Hospital, Brooklyn, NY
"Mercury and Birth Defects: What You Should Know." Presentation. Combined Meeting of the Brooklyn Healthy Start Initiative
Project and Comprehensive Prenatal Perinatal Services Network. Brookdale Medical Center, Brooklyn, NY 12/3/03.
A4 p.11
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"Cultural Uses of Mercury-An Update." Panel Session. Eighth Annual Conference On Environmental Issues: Safety from the
Environmental Hazards in the Home, School and City. Medgar Evers College/CUNY Brooklyn, NY 3/8/03.
The AfriCart: Conference presentation and handcart and handcart building demonstrations: Workshop on Improving Mobility for
Rural Poor: Achieving Sustainable Motorised and Non-Motorised Transport. Organized by the International Forum for Rural
Transport and Development. Morogoro, Tanzania. January 20-23 2003.
Pediatric Magico-Religious Mercury Exposure. Poster Session, Children's Environmental Health II: A Global Forum for Action.
Children's Environmental Health Network & Canadian Institute of Child Health. Washington DC 9/9/01.
Hearing (held at my request) on the Ritualistic Mercury Problem. Congresswoman Nydia Velazquez. I submitted written and oral
testimony. Brooklyn, NY 2/9/01.
New York City Council, Housing & Buildings Committee. Invited to testify and submit a written statement at hearing on Int. 832 to
ban the testing of gas piping systems with gauges that use mercury. 11/09/00.
Demonstration of bicycle-wheel handcarts to the President of Malawi, H.E. Dr. Bakili Muluzi at Mzuzu Stadium, during the 125th
Anniversary Celebrations of the founding of the Livingstonia Mission. 7/29/00.
Radio Program: "Radio House call," Gerald Deas, MD Moderator, WLIB New York, 119.0 AM. Six five-minute interviews to be aired
daily on 3/20-3/24 and 3/27/00 (Taped 3/13/00) [aired 3/14/00]
Environmental Justice Implications of Magico-Religious Mercury Use. Seminar, Ramapo College, NJ 2/23/00
"Dangers of Magico-Religious Mercury Use." Cable television interview, SUNY Health Science Center at Brooklyn. Gerald Deas,
M.D., interviewer. 9/15/99.
Lecture/Grand Rounds: "Reproductive Effects of Magico-Religious Mercury Exposure." Department of Obstetrics and
Gynecology, Woodhull Hospital. [Invited: 5/21/99],
Religious and Mystic Uses of Mercury. Presentation to Southern States Mercury Task Force. DestinFL. 5/6/99
"Magico-Religious Mercury Use in Caribbean & Hispanic Homes." Presentation to , New Jersey D.E.P. Mercury Task Force,
Trenton, NJ 4/9/99
"Toxicology and Sociology of Magico-Religious Mercury Exposure in Caribbean and Hispanic Homes." Lecture Woodhull
Medical Center, Brooklyn NY 3/11/99.
"Magico-Religious Mercury Use in Caribbean & Hispanic Homes: Why Have Governmental Agencies, Community and
Environmental Justice Groups Failed to Address This Issue?" Community-Based Research for Environmental Justice: Conference.
The Community/University Consortium for Regional Environmental Justice. Rutgers University, Newark, NJ 2/27-28/99. Poster.
"Neuropsychological Effects of Magico-Religious Mercury Use." Lecture, Brooklyn Psychiatric Centers, Inc. 2/9/99.
"Religious Mercury Use: Implications for Environmental Health" Panel discussion. Third Annual Conference on Environmental
Issues. Medgar Evers College. 3/14/98.
"Magico-Religious Mercury Use." Lecture, CUNY Language Immersion Program, Manhattan. 3/2/98.
"Magico-Religious Mercury Use." Lecture, Wolfe Institute, Brooklyn College / CUNY 2/26/98.
Panelist: "Toxics in Your Homes." Harlem Environmental Impact Project, Inc. 2/20/98.
Panelist: "PCB/Mercury Poisoned Fish From the Hudson/East Rivers." Harlem Environmental Impact Project, Inc. 3/11/98.
"Magico-Religious Mercury Exposures." Lecture to Environmental Toxicology Class, Hunter College / Health Sciences Campus.
3/4/98.
A4 p.12
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"Toxicology and Sociology of Magico-Religious Exposure to Mercury in Caribbean and Hispanic Homes." Faculty
Development Program, Department of Occupational Therapy, SUNY Health Science Center at Brooklyn. 1/29/98.
Lecture to Health & Nutrition Science Club, Health and Nutrition Science Department, Brooklyn College / CUNY on the Mercury
Poisoning Project. 12/1/97.
"Health Implications of Magico-Religious Mercury Use." Health and Nutrition Sciences Seminar, Center for Health Promotion,
Brooklyn College /CUNY 11/12/97.
"Toxic Cures." Videotaped television shoot for Strange Universe Productions. (Not aired) 7/15/97.
"Magico-religious mercury use in Hispanic homes: a novel but significant exposure route." International Conference on Human
Health Effects of Mercury Exposure, Torshavn, Faroe Islands, 6/22-26/97.
"What are the Neurodevelopmental Sequelae of Magico-Religious Mercury Use in Hispanic and Caribbean Homes?" 1st
National Research Conference on Children's Environmental Health. Washington, DC 2/22/97. Poster.
"Mercury Exposure from Magico-Religious Use in Latino Homes." Poster presentation, American Public Health Association,
124th Annual Meeting, New York City. 11/19/96.
"Mercury Poisoning in Haitian Homes." Poster presented at The Health of the Haitian Community conference, Arthur Ashe
Institute for Urban Health, SUNY-Health Science Center at Brooklyn, NY 4/27/96.
"Mercury Exposure from Magico-Religious Use in the Home: Research and Policy Issues." Lecture presented at the
Southeastern United States Mercury Conference, University of Miami, Coral Gables, FL 2/24/96.
"Traditional Health Beliefs: Implications for Healthcare Policy in Africa." Paper presented at the Institute on African Affairs,
Third Annual Conference on African Policy Issues. Carnegie International Conference Center, Washington DC 2/24/93.
"The Garden Cart: An Appropriate Technology for African Health and Welfare." Poster presented at the Institute on African
Affairs, Third Annual Conference on African Policy Issues. Washington DC 2/24-26, 1993.
"Human Powered Garden Carts: Appropriate Farm Transportation." Workshop: Human and Draught Animal Power in Crop
Production: Experiences, Present Status and Research Priorities. Harare, Zimbabwe. 1/20/93. In absentia.
"Pediatric Mercury Poisoning: An Unrecognized Epidemic?" Poster. Conference on The High Risk Child: Environmental Issues
in Developmental Delay. Albert Einstein College of Medicine, New York, NY 6/3/92.
"Toxics and Children." Panelist, Northern Manhattan Environmental Health Conference. Hunter College School of Health Sciences,
Community Environmental Health Center. New York, 4/25/92.
"Bodies at Rest: Rousing Officialdom to the Peril of Domestic Mercury Pollution." Poster. Fourth National Conference on Health
Care for the Poor and Underserved. Meharry Medical College, Nashville, TN 10/7-8/91.
Articles / Books / Radio / Television Citing My Work
Setting Out (Again): Ethnographic Deliverance in Malawi Jason J. Price. Doctoral Dissertation, Anthropology, University of
California, Berkeley. Fall, 2017
"When Religion Pollutes- How Should Law Respond When Religious Practice Threatens Public Health?" Jay Wexler. in: Law
Religion, and Health in the United States Chapter 29, pp. 414-415. Cambridge University Press, July 2017.
"An Analysis of Water Collection Labor among Women and Children in 24 Sub-Saharan African Countries" Jay P. Graham ct
al. PLOS ONE June 1, 2016. Lightening the Water-Carrier's Load" Comment by Ed Austin: Posted June 8, 2016.
https://journals.plos.org/plosone/article/comment?id=10.1371/annotation/59532852-0dd3-490b-bd79-ebbd0f17f519
Weekly Newsletter: April 22.2016 - APHA Environment Section. Emailed Newsletter (re Wexler book & articles cited below).
A4 p.13
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When God Isn't Green - A World-Wide Journey to Places Where Religious Practice and Environmentalism Collide Jay
Wexler, Beacon Press, Boston, 2016 pp. 5, 11, 16-18, 198-199
"Is Religion Wrecking Our Air?" Jay Wexler, Religion Dispatches 03/04/16
http://religiondispatches.org/is-religion-wrecking-our-air/
"End indifference and bureaucratic inertia" Akwete Sande The Daily Times [Malawi] 04/15/13
http://www.bnltimes.com/index.php/sunday-times/headlines/columns/319-hard-tackle/14730-end-indifference-and-bureaucratic-inertia-
"Head-loading: An old habit that restricts efficiency" Akwete Sande The Daily Times [Malawi] 03/27/13
http://www.bnltimes.com/index.php/daily-times/headlines/features/14356-head-loading-an-old-habit-that-restricts-efficiency
"An unfinished take of the handcart" Akwete Sande The Daily Times [Malawi] 02/28/13
http://www.bnltimes.com/index.php/daily-times/headlines/features/13981-an-unfinished-tale-of-the-handcart
"EPA Weighs Threats Posed by Mercury Used in Religious Rituals" Emily Yehle, Greenwire / The New York Times 05/18/11
Children's Exposure to Elemental Mercury: A National Review of Exposure Events Agency for Toxic Substances and Disease
Registry/CDC 02/09
"Thousands of kids exposed to dangerous liquid mercury in schools, homes. Contamination can last years, and cleanups are
costly" Jessica A. Knoblauch Environmental Health News / Scientific American (on line) 5/5/09
Rural transport and traction enterprises for improved livelihoods Peter Crossley, Tim Chamen, Josef Kienzle. Rural
Infrastructure and Agro-Industries Division, Food and Agriculture Organization of the United Nations, Rome 2009. CASE STUDY 8
"Wheelbarrows vs hand carts in sub-Saharan Africa" p. 33 http://www.fao.Org/3/a-i0525e.pdf
Mercury: A priority of action. Module 5 - Cultural Uses of Mercury United Nations Environment Program 2008
"Mercury vapor in residential building common areas in communities where mercury is used for cultural purposes versus a
reference community" Gary Garetano, Alan H. Stern, Mark Robson, Michael Gochfeld Science of the Total Environment 07/08
pp. 131-139
"His study on ritual use of mercury is out of Africa" Clem Richardson Daily News (Brooklyn edition) 05/30/08
"Side effects of Santeria" Darryl R. Isherwood & Eva Loayza The Times of Trenton 12/17/07
"Mercury scare: Santeria, and other religions in UC, WNY[Union City, West New York] can employ toxic rituals " Jessica Rosero
Hudson Reporter 12/17/06
"Mercury Use and Exposure among Santeria Practitioners: Religious versus Folk Practice in Northern New Jersey, USA" C.
Alison Newby , Donna M. Riley , Tomas O. Leal-Almeraz Ethnicity and Health 08/06 pp. 287-304
"Comparison of Indoor Mercury Vapor in Common Areas of Residential Buildings with Outdoor Levels in a Community
Where Mercury Is Used for Cultural Purposes" Gary Garetano, Michael Gochfeld, Alan H. Stern Environmental Health Perspectives
01/06 pp. 59-62
"It's Traditional. It's Religious. It's Poison." Anthony DePalma, The New York Times 12/7/05
"Mercury Found In Tower." Ariella Cohen, The Brooklyn Paper, pp. 1, 13 11/12/05
"Mercury Brings High Anxiety in Brooklyn." Paul H.B. Shin [N. Y.] Daily News 11/9/05.
"Tiptoeing Around Mercury: Why Your Religious Ceremony May be Dangerous to Your Health." Ozzie Ramos, The Bronx
Journal Spring 2005 Pp. A1-A3 Lehman College, CUNY.
"Religious Use of Mercury Endangering Latino and Caribbean Communities." BushGreenwatch /Environmental Media Services
March 29, 2005
A4 p.14
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"Mercury's Menace: Use of mercury in religious rituals seen as health danger." Franziska Castillo, The Journal News
Westchester County NY pp. 1-2 10/25/04.
Hidden Danger: Environmental Health Threats in the Latino Community A. Quintero-Somaini et al. Natural Resources Defense
Council, 10/20/04
"Subcutaneous Injection of Mercury: Warding Off Evil." Venkat Prasad. Environmental Health Perspectives 112:13:1326-1328
09/04.
"Religious use of mercury persists even after health warnings." David Fleshier, South Florida Sun-Sentinel June 30, 2004
"Mercury in rituals raises alarms." Leonora LaPeter & Paul De La Garza St Petersburg Times, Florida, January 26, 2004.
"Mercury Beads Couldn't Come From Broken Bulb, Critics Say." Seth Slabaugh The Star Press Muncie, Indiana October 3, 2003
"Get burdens off your head" Christian Chronicle, March 2003 http://www.christianchronicle.org/article/get-burdens-off-your-head
"Mercury Rising." Smita Paul City Limits (New York City) February 2003 pp. 26-30, 42.
"Non-motorized transport viable for rural communities." Judica Tarimo The Guardian (Dar es Salaam, Tanzania) January 22,
2003.
Task Force on Ritualistic Uses of Mercury Report OSWER 9285.4-07 EPA/540-R-01-005 December 2002 xiii, xv, 3, 15, 16, 20,...
Nchimi Chikanga: The Battle against Witchcraft in Malawi B. Soko, G. Kubik. A Kachere Text. Christian Literature Association
in Malawi. Blantyre, / University of Malawi, Zomba. 2002.
"Cultural Uses of Mercury in New Jersey: Final Report December 2002." New Jersey DEP, Trenton.
"Magic Mercury Monster" CUNY Honors College Class of 2005 at Brooklyn College/CUNY. Web site on magico-religious
mercury use.
"Network Africa" radio news program. BBC Africa Service. Coverage of the Malawi Handcart Project. Interview by Leslie Goffe on
9/21/02 Broadcast week of 9/24/02.
"Everywoman" radio news program. BBC World Service. London. Host Anna Umbima covers the Malawi Handcart Project.
Interview 9/17/02. Broadcast week of 9/23/02.
"The World" radio news program. BBC/WGBH Boston. Host Lisa Mullins covers the Malawi Handcart Project. Interview and
broadcast 9/17/02.
"A Brooklyn Inventor Eases an African Headache: An Inexpensive Handcart Catches On in Malawi, Where Women Have
Long Used Their Heads." Robert F. Worth The New York Times p.Bl-2 9/14/02
"Ritual Mercury: Bad for What Ails You." C.B. Gaines, J. Motavalli. EMagazine XIII:3:32. May/June 2002.
"I chose the oft-maligned Superfund program "fellowship focus American Association for the Advancement of Science. Donna
Riley Letter. 2:6:1 April 2002
Health Issues in the Latino Community. Eds. M. Aguirre-Molina, C. W. Molina, R.E. Zambrana. Chapter 4 "The Health of Children
and Youth." G. Flores, R.E. Zambrana. P. 95. Jossey-Bass, SanFrancisco. 2001.
"Assessing Elemental Mercury Vapor Exposure from Cultural and Religious Practices." D M. Riley, C. A. Newby, T O. Leal,
V.M. Thomas. Environmental Health Perspectives 109:8:779-784 8/01
"Studying Mercury, Children." Margaret Ramirez Newsday p.A18 7/19/01
A4 p.15
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"Primer Impacto" news program coverage of botanica mercury sales and contamination. Univision TV Network. Cenia Alvarado
reporter. Sunday, 3/25/01.
"Sin resloverse el problama del mercurio" Marco Vinicio el diario/La Prensa p.6 2/12/01
"Planean estrategia el mercurio" Marco Vinicio el diario/La Prensa p.6 2/10/01
"Urge descontaminar hogares de Mercurio" Marco Vinicio el diario/La Prensa p.5 2/8/01
"Urge la education sobre el mercurio" Marco Vinicio el diario/La Prensa p.5 2/1/01
"Un problema sin solucion definitiva" Marco Vinicio el diario/La Prensa p.3 1/31/01
"Una bomba de tiempo" Marco Vinicio el diario/La Prensa pp. 1-3 1/30/01
"City may ban mercury gas gauges after spill forces family from home." Ken Valenti The Journal News Westchester NY 11/
23/00 p. 3b
"A Little-Known Threat" Robert Worth The New York Times (Westchester edition) [Discusses mercury spills from plumber's
manometers.] p.6 10/8/00.
"Cart for all seasons." Chinduti Chirwa. The Nation [Lilongwe, Malawil August 25, 2000. Full page story with four photographs.
Toxicological Effects of Methvlmercurv. Committee on the Toxicological Effects of Methylmercury, Board on Environmental
Studies and Toxicology, Commission on Life Sciences, National Research Council. National Academy Press, Washington DC 2000.
Cites my 1995 article in American Journal of Public Health, pp. 33, 59.
"The Week in Review" news program, Television Malawi (TVM), coverage of my meeting with President of Malawi demonstrating
bicycle-wheel "Livingstonia-Carts" at Mzuzu Stadium, 7/29/00. Aired 8/5/00.
"Morning Basket" interview program, Malawi Broadcasting Corporation (MBC), hostess Ms. Siphiwe Banda. Interview on Malawi
Handcart Project on 7/21/00. Aired 7/27/00
"Hand cart to ease workload." The Nation" [Lilongwe, Malawil 7:137:7 7/24/00. Story supplied by Malawi News Agency, Mzuzu,
[Interview of 7/21/00, Ziba Muyanga, reporter],
"Good-luck capsules carry lethal liquid." Paula Lugones The Bronx Beat ColumbiaGraduate School of Journalism 5/8-14/00
"Mercury Use in the Hispanic Community of Chicago." Sciammarella E. Lllinois Morbidity and Mortality Review 4:2:7-10 Spring
2000
Report on the Peer Review of EPA's Mercury Research Strategy. 2/3/00 p.2-17; pp.F-3-F-4.
"Magic Potions spell trouble." Francescani, C. New York Post, 11/30/99.
"Peligroso el uso casero del mercurio de botanicas." Vinicio, M. el diario/la Prensa 8/24/99.
"Mercury Hazard Widespread in Magico-Religious Practices in U.S." Emergency Medicine News. Greenberg, M., XXI:8:24-25.
8/99.
Toxicological Profile for Mcrcurv(Ui)date). March 1999. Agency for Toxic Substances and Disease Registry, pp.430, 431, 459, 460,
473, 474, 475, 480, 485.
"Mercury Exposure in French Guinea: Levels and Determinants." Cordier, S, et al. Archives of Environmental Health 53:4:299-
303
A4 p.16
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Religion in Malawi: An Annotated Bibliography. Eds. J.C. Chakanza & K.R. Ross. Kachere Text No. 7. Christian Literature
Association in Malawi, Blantyre 1998. Cites my doctoral dissertation under "Health and Healing, Witchcraft and Witchfinding" p. 44.
"Mercury." Evans, HL. Environmental and Occupational Medicine. Third Edition WN. Rom ed. Lippincott-Raven, Philadelphia.
1998. (Chapter 69, p. 1000)
The Promise and Peril of Environmental Justice. 1998. Foreman, C.H., Brookings Institution Press. 88-89, 171.
"Ritual Use of Mercury Prompts Testing of Children for Illness." Ojito, M., The New York Times 12/14/97.
"Ritual Uses of Mercury May Place Minority Communities, Kids at Risk." Environmental Health Letter 11/97.
"Faith in mercury stymies government." Levinson, A., Associated Press The Times-Record (Middletown, NY 10/31/97.
"Mercury Poisoning Project Addresses Magico-Religious Uses." Closing The Gap, Office of Minority Health, U.S. Department of
Health and Human Services, 10/97.
"Hispanos ignoran advertencias sobre peligrosidad del mercurio." Gomez, J. el diario/La Prensa. 8/31/97
Toxicological Profile for Mercury. (Update, 8/97)) 1994 Agency for Toxic Substances and Disease Registry, pp. 340-341, 363, 477.
"Impregnation de la population guyanaise par la mercure." Cordier S et al Bulletin Epidemiologique Hebdomadaire No. 14,
April, 1997
"Mercury Use in Espiritismo: A Survey of Botanicas" Luis H. Zayas & Philip O. Ozuah American Journal of Public Health 01/06
pp. 111-112
Neuropsychological Toxicology: Identification and Assessment of Human Neurotoxic Syndromes. 2nd Ed. Hartman, D.E.,
Plenum Press (Introduction p. 1 and Chapter 3 Metals, Mercury pp. 132-133. 1995.
RM2 Assessment Document For Cultural Uses Of Mercury US Environmental Protection Agency, Office of Pollution Prevention
and Toxics. June 9, 1993 p. 3.
"Dangerous Spirits: Concern rises over religion's use of mercury." Rauch, K.D. New York Newsday, Brooklyn edition 9/15/91
"The Spiritual Use of Poisonous Mercury." Rauch, K.D. Washington Post, Health Section, 8/13/91
"Children face mercury danger." Gee, H. The Times [London] Science & Technology 10/18/90
"Vudu provoca intoxicacoes de mercurio." Antonio Granado. Journal Publico, Lisbon, Portugal. 10/22/90
Research and Development Experience Overseas
Extensive fieldwork in traditional medicine and allied topics in Malawi (19 field trips totaling 33 months) and Nepal (4 months).
Invited by Malawi's Minister of Agriculture to demonstrate feasibility of handcarts for smallholder farmers. Worked with Department
of Research and Technical Services to design, fabricate and evaluate handcarts at Chitedze Agricultural Research Station, Lilongwe,
Malawi.. April - May 1998; May-June 2002, June-July 2003, June-July 2004. Development and demonstration in Malawi of the
"Malawi-Cart," handcart-goat cart-bicycle trailer fabricated from wood and bicycle wheels. The only handcart to be developed in sub-
Sahara Africa using locally available materials and capable of being made by local carpenters, at a cost affordable to significant
numbers of the population. Trained carpenters to build handcarts. Carts demonstrated to representatives of CARE, World Bank,
National Smallholder Farmers' Association of Malawi and Malawi Rural Travel and Transport Programme, FAO, GTZ, etc.. Carts
demonstrated in Uganda and Tanzania. AfriCart assessment by Millennium Villages Project/Earth Institute - Columbia University.
Honors & Miscellany
Peer Reviewer, Environmental Health, 4/15
A4 p.17
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EPA Region 2 Environmental Quality Award, April 24, 2003
Peer Reviewer, Environmental Health Perspectives, National Institute of Environmental Health Sciences, 9/00, 8/03
One of the "Twenty Brooklyn Heroes." Brooklyn Center for the Urban Environment. 5/7/99.
Member, EPA Ritualistic Uses of Mercury Task Force 1/99-8/01
Sigma Xi, The Scientific Research Society, Associate Member, Brooklyn College Chapter, 1987.
New York State Regents Scholarship, 1959
Grants
U.S. Environmental Protection Agency, Office of Environmental Justice. Mercury Poisoning Project: Exposure in Hispanic Homes
(Grant to Puerto Rican Family Institute. Approval Date 7/24/97) Consultant.
U.S. Environmental Protection Agency, Office of Environmental Justice. Preventing Mercury Pollution from Magico-Religious Uses
in Brooklyn's Crown Heights and Sunset Park Neighborhoods. (Grant to MedgarEvers College, CUNY.) Co-Principal Investigator.
Current Research, Development and Advocacy Activities
Advisor to the Dedza East Trust [Malawi] 2014 -2016.
Appropriate Transportation Technology Project: Introducing inexpensive handcarts to African peasant farmers. I am currently
sponsoring assessment and dissemination of handcarts for use in Malawi, working with the Agricultural Engineering Department of
Bunda College, LUANAR. (1989 - present).
Poisoning from elemental (magico-religious) mercury exposure: Clinical and environmental research and advocacy. (1990 - present)
Ethnomedicine, Magic and Traditional Religion in Malawi. (1972 - present)
Websites
Mercury Poisoning Project www.mercurypoisoninqproiect.org
Malawi Handcart Project http://mercurvpoisoninqproiect.org/malawi
VITA.APW 10/25/18
A4 p.18
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AN, Asghar
Working Paper
A conceptual framework for environmental justice
based on shared but differentiated responsibilities
CSERGE Working Paper EDM, No. 01-02
Provided in Cooperation with:
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Suggested Citation: AN, Asghar (2001): A conceptual framework for environmental justice
based on shared but differentiated responsibilities, CSERGE Working Paper EDM, No.
01-02, University of East Anglia, The Centre for Social and Economic Research on the Global
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A CONCEPTUAL FRAMEWORK
FOR ENVIRONMENTAL JUSTICE
BASED ON SHARED BUT
DIFFERENTIATED RESPONSIBILITIES
by
Asghar Ali
CSERGE Working Paper EDM 01-02
A4 p.20
-------
A CONCEPTUAL FRAMEWORK
FOR ENVIRONMENTAL JUSTICE
BASED ON SHARED BUT
DIFFERENTIATED RESPONSIBILITIES
by
Asghar Ali
School of Environmental Sciences
and
The Centre for Social and Economic Research
on the Global Environment
University of East Anglia
Norwich NR4 7TJ, Norfolk UK
telephone: (44)(0)1603 592542:
email - Asghar.Ali@uea.ac.uk
Acknowledgements
The support of the Economic and Social Research Council (ESRC) is gratefully
acknowledged. This work was part of the interdisciplinary research programme of the ESRC
Research Centre for Social and Economic Research on the Global Environment (CSERGE).
The author wishes to thank Tim O'Riordan for his support and comments on an earlier
version of this paper.
ISSN 0967-8875
A4 p.21
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Abstract
Environmental justice has become a major issue in the discourses of
environment. The calls for environmental equity and justice are now part of
major environmental negotiations like the UNFCCC and the Kyoto Protocol, to
give some examples. In this paper I locate the issues of environmental justice
within the broader framework of environmental sustainability and the
contemporary debates about theories of justice. The environmental justice
movement in the USA, which has gained popular momentum in recent years, is
briefly studied. This particular grassroots movement appears to be redefining
the sustainability agenda with a strong social justice content. It has similarities
with environmentally informed social justice movements in the developing
world, the so- called 'environmentalism of the poor'. Employing a critical
discursive methodology I briefly and critically review some of the well-known
theories of justice based on different principles of justice like need, desert and
entitlement. These are looked at within the contemporary debates of
universalism versus particularism or the 'abstract' liberal versus communitarian
theories and some other critical perspectives on justice. I argue for a broader
conception of environmental justice that takes into account particularities but is
also sensitive to the global nature of many of the environmental problems that
are spread and have impacts across regions, territories and even countries. In
such situations it becomes necessary as a matter of justice to take into account
differentiated impacts arising out of disproportionate contributions to
environmental harms or 'bads'. I further argue that a theory of justice, which
will recognize this fact, will also have to consider differentiated responsibilities.
Key words: Sustainability, sustainable development, equity, justice, distributive
justice, vulnerabilities, responsibility.
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1. Introduction
Justice seems to be an ever-present societal issue. It is often seen as a foremost
desirable social virtue. The universal presence of the calls for justice is evidence
that there are unresolved issues at different levels of human interaction and
sociality. There are conflicts and disagreements, which tell us that society and
its institutions have to keep grappling with matters that provide the bases and
the reasons for these complaints and for the cries for justice. These are issues
that define and often legitimize justice claims; grievances that are voiced by
those to whom injustice - as understood by them but not necessarily endorsed by
others - has been done. Justice is therefore, a historically present phenomenon
that in turn signifies the societal presence of harm, exploitation and oppression
on the one hand and a quest to rectify these failings on the other hand.
When we talk of justice, it is almost always about justice among human beings.
Justice as we know it is typically as a human affair, involving human-human
interactions and relationships. As such, in a broad and general sense, it is under-
stood as a social concept. It is a claim put forward by some members of society
about or against the actions, or intentions, of others. A sense of (z«)justice arises
out of a situation of competing, often rights-based, claims. The struggles for
justice are reflections of problems both old and new and the way these are
understood, experienced and defined by different actors. Every era's concerns
have had influence on, or more importantly influenced by, the way justice has
been understood, demanded and achieved. The concept of justice, because of its
very nature and because in the way it is being defined and redefined in the
context of complex, diverse contemporary societies has become the subject of
intense debates and disagreements in recent decades. There are always differing
perspectives and actors involved in these contestations. Contemporary issues of
economic and political significance are bound to have influence on, or be
influenced by, such inherently political and contested issue like justice. One
such area is the environment and the discourses that shape the way environment
is defined, understood and used or abused.
As the nature of risks and harms changes with the transformations in science
and technology and the social and economic polarizations both within and
across societies influencing a new understanding and redefinition of problems,
for example, the calls for justice are also being framed in new ways.
Environmental justice is one such area where the focus is now on the
distribution of environmental quality; a focus on harms caused and aggravated
by anthropogenic environmental bads and well being protected and enhanced by
environmental goods. Here, justice is demanded by or on behalf of 'environ-
mental victims'. Environmental victims are 'those who are harmed by natural
processes, by anthropogenic processes mediated by the natural environment,
l
A4 p.23
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and by restrictions in access to the environment' (Penz 1998, p.42). Justice in
its narrower sense is, therefore, about the distribution or maldistribution of or
access to environmental quality - just like any other commodity - among
different groups who question and protest these distributions, because they have
real consequences on the quality of their lives and on their environments. In a
broader sense, environmental justice may well connect with broader issues of
social justice that questions socio-political and economic institutional arrange-
ments of societies, or even of the world as a whole. An important feature of
these (mal)distributions is that they often have both spatial and temporal
features. On a different level, there are indeed some big ontological questions or
big picture issues, for example our relationship as species with other species and
with nature. Distinct but not totally unrelated from these are the specific
situations, which have immediate consequences and impacts upon people's lives
in their neighborhoods and communities; situations reflecting lived and
experienced instances of injuries and victimization than being theoretical
speculations.
Justice as concerned with the interaction and relationship of human beings with
each other, as a social concept, is still, correctly so, the primary focus of
attention and study for many theorists and activists. But now there is a
realization of another relational aspect to the struggles for justice; that of our
relationship as species - as human beings - to the rest of the natural world. Low
and Gleeson (1998) term the first as 'environmental justice' and the latter as
'ecological justice' but point out that 'They are really two aspects of the same
relationship' (p.2). In this paper, following this distinction, which also stresses
the significant interrelated and interdependent nature of the two aspects of
justice, I will mainly focus on 'environmental justice'; justice as concerned with
human-human relationships. I accept that stressing this kind of dichotomy too
much and too far can be misleading and may even be unnecessary. This is
because eventually all environmental and ecological problems have their roots
in social problems as also suggested by a 'social ecology' perspective that
rejects a dualistic thinking whereby nature and society are often seen as
antagonistic towards each other. Thus, 'The divisions between society and
nature have their deepest roots in divisions within the social realm, namely
deep-seated conflicts between human and human that are often obscured by our
broad use of the word "humanity"' (Bookchin 1990: 32). The injuries done to
the non-human world has a close relationship to the injustices in the human
world. An ecological sensibility developing out of such understanding and
based on a dialectical view of self, history, nature and society that enriches and
broadens thought and action does not see aspects of a phenomenon exclusively
and in isolation from other phenomenon.
2
A4 p.24
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Given the scope and limitations of this work, I will attempt to focus on
environmental justice within a broader framework of environmental sustain-
ability and in doing so hope that the connections between the two forms of
justice (human-human and human-non human) also become visible to a certain
extent. After a brief critical review of some prominent theories of justice, their
principles and bases and focusing on the ensuing debates that have taken
different, often clashing forms, I will argue for a broader conception of
environmental justice based on the notion of shared but differentiated
responsibility which is sensitive to particularities as well as supportive of a new,
truly democratic universalism which will have to be debated and established
dialogically through fair, active and meaningful participation of different actors
and/or stakeholders with their equally different and diverse cultures, traditions
or worldviews.
3
A4 p.25
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2. Justice and Sustainable Development
In a now cliched and much quoted paragraph, Lele says that sustainable
development
is a "metafix" that will unite everybody from the profit-minded
industrialist and risk minimising subsistence farmer to the equity seeking
social worker, the pollution-concerned or wildlife-loving First Worlder,
the growth-maximising policy maker, the goal-oriented bureaucrat, and
therefore, the vote-counting politician (1991, p.613).
If one follows Lele, then it becomes evident from such a view of sustainable
development that it is inherently a political and 'contested concept' (O'Riordan
1988; Jacobs 1999). This is, primarily, because the stakes around which the
concept revolves, and is often constructed, are very high. Ever since the term
was elevated by events such as the publication of the Brundtland Report
(WCED) in 1987 and the Earth Summit of 1992 in Rio de Janeiro, this catch
phrase has become one of the most talked about ideas of contemporary times.
For example, among contemporary issues of universal importance the concept
of a sustainable society is second only to the idea of an information society as
the most prominent image of the future (McKenzie-Mohr and Marien, 1994
cited in Olson 1995, p. 19).
The rise of environmentalism and many green movements since the 1960s
around the world but especially in the North, have all, to one degree or another,
rallied around the different forms and varieties of this concept. The concept has
also been embraced by big commercial interests who are in turn, accused by
many green groups for being the very cause of much of environmental degrad-
ations. From grassroots and local level groups to international organizations,
transnational corporations and national governments all equally claim this
concept as their 'vision' and guiding philosophy. While often it is seen as an
isolated, single issue, end-of-the-pipe pollution problem, some radical
perspectives understand environmental unsustainability as a symptom of a wider
and much deeper malaise. Thus, we get different prescriptions for the differently
diagnosed problems. The politics of sustainable development in such a
contested environment is, therefore, very complex and at the end of the day is as
much in need of critical political and ethical considerations as of technical and
managerialist issues of say, efficiency, best practice and improvement in
resource use etc., themselves political issues.
But most often these accounts and reviews of sustainable development have
been narratives and according to Dobson (1998) these have been 'bought at the
cost of a degree of analytical weakness' (p.8). In such analyses, it is often the
4
A4 p.26
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multiplicity of the meanings of sustainable development which are hinted at but
the narrow generalizations leave out some very specific questions unanswered
and the linkages, for example, between issues like justice, equity and environ-
mental protection remain sketchy if not at all ignored. Because of the fact that
the term is so open and easily co-opted by different interests, confusions can be
created easily and issues central to the discourse get glossed over.
It is argued here that because sustainable development (SD) embodies a human,
social dimension, it needs to be understood in a broader sense. In fact, its open-
ness to interpretation and vagueness may well be its strength. The vague-ness
so characteristic of sustainable development, despite a steady proliferation of
definitions, allows for dialogue and participation in discussing environmental
issues and herein lies its political strength and also its analytical weakness
(Cohen et al., 1998). The human dimension means taking into account world-
views, perceptions, rights and choices and their accompanying responsibilities
about environmental change and impacts at different scales and by different
actors involved although how some perceptions and choices become dominant
over others and acquire legitimacy, often through systematic institutionalization,
is a more specific and critical issue that needs to be understood. Human choice
could be viewed at different levels; individual, communal, societal, national and
global. These are interrelated and all have consequences not only for the present
but also for the future of life on this planet. But what is clear is that there are
some 'core ideas' that feature in most, if not all, explications of sustainability,
however tinged they may be with different ideological hues.
Some of these core issues stem from the seminal document that is very much
responsible for the popularization of the term. Among other things, the
Brundtland Report's affirmation that 'inequality is the planet's main "environ-
mental" problem' (WCED 1987, p.6) has given rise to different interpretations
and understanding of sustainable development that often link issues of social
justice with unsustainability. The Report's observations, for example, that
'poverty itself pollutes the environment, creating environmental stress in a
different way. Those who are poor and hungry will often destroy their
immediate environment in order to survive' (p.28) and that 'It is futile to
attempt to deal with environmental problems without a broader perspective that
encompasses the factors underlying world poverty and international inequality'
(p.3) may be controversial and even seen as superficially concerned with
symptoms rather than causes by some radical perspectives1, but has,
1 Some of these perspectives are, for example, social ecology and the works of social
ecologists like Murray Bookchin, 'The Ecology of Freedom', 1991, Montreal: Black Rose
Books, Re-enchanting Humanity, 1995, London: Cassell, Remaking Society, 1990, Boston:
South End Press, and numerous articles in Green Left Weekly), ecosocialism and the works of
ecosocialists like James O'Connor (ed.), 1994, Is Capitalism Sustainable ? Political Economy
5
A4 p.27
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nevertheless, made it possible to talk about social justice and environmental
sustainability as related issues.
But is sustainable development the same as sustainability? Dobson (1998) views
the first as a narrower, second-level focus while the latter as a broader issue:
...sustainable development amounts to one conception or theory of
environmental sustainability rather than the two things being
synonymous. It is a conception of sustainability in that it contains views
on what is to be sustained, on why, on what the object(s) of concern are,
and (often implicitly) on the degree of substitutability of human made
capital for natural capital... .It is a theory of environmental sustainability
in that it argues that a particular interpretation of the causes of
unsustainability leads to a determinate view of the remedies for it (p. 60,
original emphasis).
While this may be a better way forward, given the highly ideological and
contested nature of sustainable development, the problem is not much solved.
'Sustainability' itself is amenable to the same kind of disagreements and has at
least as much potential to become a 'metafix' and therefore, contested, as its any
'theory'. For example, sustainability even though understood scientifically and
'objectively', something that Dobson seems to be suggesting, could potentially
become yet another contestation depending on different deeper ontological and
epistemological understanding of 'environment', 'nature', or society-nature
relationship, out of which stems conceptions of self, other, freedom, needs,
justice, contentment or happiness etc.
Many justice discourses in the environmental sustainability debate, as in other
debates outside the sustainability discourse, appear to be primarily concerned
with distribution; distribution of something. This is perhaps because many
discourses of justice still remain within the distributive paradigm. Given the fact
that there are all sorts of disparities and asymmetries not only within societies
but also between societies, the cry for distributional justice remains the
dominant form of protest. But justice exclusively seen in the context of a
and Political Ecology, New York: Guilford, David Pepper , 1993, Eco-socialism, from deep
Ecology to Social Justice, London: Routledge, and numerous articles in the journal 'Capital-
ism, Nature, Socialism, and some Third World perspectives like Shiva, V., Staying Alive:
Women, ecology and development, London: Zed, Ramachandra Guha with Juan Martinez-
Alier, 1997, Varieties of Environmentalism, London: Earthscan. For a brief and useful
comparison of some of these perspectives with other sustainable development (SD) dis-
courses like 'Market Environmentalism' and 'Ecological Modernization' see Nicholas Low
and Brenden Gleeson, 1998, 'Justice, Society and Nature, London: Routledge, chapter 7.
6
A4 p.28
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distributive paradigm is reductive and problematic2, and may actually deter or
distract us from other ways of looking at justice. This theme will be taken up in
the following sections. Also, what is often counterpoised to this paradigm itself
has its limitations, another aspect of my discussion of the issues in the sections
that follow.
2
In recent years a strong critique of the distributive paradigm has been carried out by some
feminist and communitarian writers arguing for different, more concrete, contextual and less
abstract approaches to issues of justice. See, especially, Iris Marion Young, 1990, ' Justice
and the Politics of Difference', Princeton University Press, New Jersey; Carol Gilligan,
1982, 'In a Different Voice: Psychological Theory and Women's Development, Harvard
University Press, Cambridge, Massachusetts; Seyla Benhabib, 1987, 'The generalized and the
concrete other: The Kohlberg-Gilligan controversy in Feminist Theory', in Feminism as
Critique: On the Politics of Gender, edited by Seyla Benhabib and Drucilla Cornell,
University of Minnesota Press, Minneapolis; Amitai Etzioni, 1993, 'The Spirit of
Community', Simon and Schuster.
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3. Distribution of What?
An important question, therefore, arises 'what is to be distributed?' if justice is
to be done. This is perhaps the most important question in the sustainability-
social justice nexus. At the Earth Summit in 1992 and following that, at almost
all other major international events related to development and environment for
example, the Cairo Conference, Habitat II, Beijing Conference on Women, the
question of fairness and justice remain as central issues for many of the voices
especially those of the developing world, although it is articulated in different
vocabularies of justice. There and elsewhere, for the poor and marginalised
distribution is as much about resources as about fair access to these resources.
Issues of trade, rules of trade, investment, development credits, loans and aid
etc. as incorporated in the international governance regime consisting of
institutions like The World Trade Organization (WTO), IMF, The World Bank,
NAFTA are often found unjust and discriminatory by these dissenting voices.
Moreover, the contemporary globalized tendency of production systems that
concentrate not only benefits of modernised development but also its harms is
often the core target of many of these criticisms. It is in this area, particularly
the claims about the unfair or potentially unfair, disproportionate spreading and
sharing of harms or risks that the distributional demands seem to have taken a
new turn within the environmentalist discourse of justice. This new form of
understanding of maldistribution is somewhat different from the old ones
whereby the focus was mainly on access to resources, wealth etc. This is not to
say that they are not connected. Of course, the distribution of wealth and power
has got a lot to do in determining the distribution of social and environmental
goods and harms (Boyce 1994). But what is notable is that with a change in the
nature of injustices, there seems to have been a parallel shift, or rather a
broadening, in the conception and language of distributive justice.
Inside the distributive perspectives of justice the question 'what is to be
distributed?' cannot be seen in separation from 'what is to be sustained?'.
Within the politics of environment, claims of distributive justice often are bound
to come face to face with the claims of sustainability. This seems unavoidable
because of the fact that the very concept of sustainable development, or even
sustainability, has an important normative feature and unless one talks about
this feature, the concept does not make much sense unless one wants to reduce
the whole notion to pure technical matters. Such an encounter seems inevitable
as concern for environment become a major, if not the most important, driving
force and arena of power politics, struggles and conflicts. While to some
quarters it is increasingly becoming clear that it is no longer rational and
desirable to talk of development, progress, resource use, security and stability,
in short, environmental sustainability, without talking about equity and social
justice, to others such as the narrow techno-managerialist and purely
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economistic perspectives equity and justice appear to be less important issues at
best and non-issues at worst.
In a very general sense, it can be said that, 'On any account of
sustainability...something or other is supposed to be kept going, or at any rate
not allowed to decline, over time' (Holland 1994: 169). The problem seems to
be that there are different understandings of this 'something or other' and how it
must be 'kept going' or sustained. One idea suggests the sustainability of a
scarce natural 'capital' which can be termed as 'critical natural capital'. Similar
to earlier definitions of 'critical natural capital'3 Dobson (1998) defines it as
'Critical natural capital is capital critical for the maintenance of human life' and
that "'critical natural capital" is radically indeterminate, of course, and it might
refer us (in the detail) to any number of features of the non-human world' (p.
43, emphasis added). These, according to Dobson are mostly understood and
argued for in the industrialized world in terms of overarching 'ecological
processes' (Norton 1992: 97), 'biogeochemical cycles' (Pearce 1993: 16), or
'global life support systems' (Bowers 1990: 8), ecological 'glue' (Pearce 1995:
52) and 'ecosystem health' (all cited in Dobson 1998: 43-44). This kind of a
radical understanding of a 'critical natural capital', meaning that it is the very
scarce foundational base on which all life depends and on which all life activity
is carried out can indeed have very deep implications for any discussion of
sustainability and social justice. The implication in such arguments is that this
understanding of 'criticality' is born out of the very scarcity and limited nature
of that which is crucial for life, human or otherwise, and because of this, some
form of preservation and/or conservation is imperative if humanity in particular
or life in general is to survive.
A further complication in such an understanding of 'critical natural capital' is
that whether it is always substitutable in any way by other things or not. This is
also at the heart of the debates that have been going on recently among
economists and philosophers of different schools of thought and ideological
persuasions. The reference here is especially to the complementarity versus
substitutability debate. This means that complementarity or substitutability of
"3
See R.K. Turner and D. Pearce, 1993, 'Sustainable Economic Development: Economic and
Ethical Principles' in E. Barbier (ed.), Economics and Ecology: New Frontiers and
Sustainable Development, London: Chapman and Hall, and English Nature, 1994,
'Sustainability in Practice: Planning for Environmental Sustainability, Peterborough: English
Nature. English Nature defines "critical natural capital" as 'those assets, stock levels or
quality levels that are highly valued; and also either essential to human health, essential to the
efficient functioning of life-support systems, or irreplaceable or unsubstitutable for all
practical purposes', quoted by A.Holland, 1999, p. 286, Note. 15, in A. Dobson (ed.),
Fairness and Futurity: Essays on Environmental Sustainability and Social Justice, Oxford:
Oxford University Press
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natural capital by human made capital. Among other things, the arguments have
mostly got knitted around the concepts of 'weak' and 'strong' sustainability.
Daly who champions the 'strong' sustainability and complementarity position
has argued: 'weak sustainability assumes that manmade and natural capital are
basically substitutes....Strong sustainability assumes that manmade and natural
capital are basically complements' (1995: 49) or 'the basic relation of man-
made and natural capital is one of complementarity, not substitutability' (1994
in Sagoff 1995:613). Elsewhere it is argued: 'Capital cannot ultimately
substitute for resources...labour and capital complement the material resources
that are transformed into a product' (Daly and Cobb 1989: 409).
On the other side of the debate is the substitutability school, so to speak, to
which the 'weak', the 'very weak' sustainability positions, or the so-called
'mainstream economists' subscribe in one form or another with different
degrees of affiliations. Sagoff (1995) claims that a typical argument belonging
to such a position says:
The standard model of economic growth assumes that human knowledge
and ingenuity can always alleviate resource shortages so that natural
capital sets no limit on economic growth' (p.613) and,...if there is a
limiting factor in economic production, it is knowledge, and that as long
as knowledge advances, the economy can expand (1995: 610).
Holland (1999) is critical of the economic natural capital approach to
sustainability and suggests a 'physical stock' approach. It is an inventory
approach whereby 'informed judgments' are made 'to decide whether and in
what sense there has been any depletion' (p.63). This approach, it is claimed,
will overcome the problems of measurement and economic valuation, often
identified with the former approach and that 'it is to lay stress on a different
kind of valuation' (p.64). Norton (1999), in turn, identifies 'keystone natural
resources', as a form of capital that is not interchangeable with other forms of
capital and that are distinctive and defining features of a place and culture.
These should be sustained because they are crucial for regional development
and also because 'their loss erodes the distinctiveness of the landscape and the
diversity of available habitats in the region' (p. 146).
On a different level of analysis one can ask as to how and why 'nature' or what
constitutes 'nature' and 'environment' have become 'capitalised' or become to
be seen as 'stocks' and 'assets'. Nature as 'capital', 'stock', 'assets', 'resources'
are all one or another type of valuations based on and informed by different
conceptions of self, nature, and the relationship of society with nature. Some
valuations are more quantitative while others are qualitative and still others as
mixtures of quantitative and qualitative approaches. There are problems with
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measurements of nature especially as 'natural capital'. Since measurement has
always been a first stepping-stone towards control, prediction and exploitation
of resources as well as peoples, it may be asked that once nature has been
inventoried, stocked, counted or measured and capitalized, what is there to stop
its exploitation and abuse? In other words, why would it be safe to assume that
there would be no overexploitation of those parts of nature that are
commercially viable and profitable in a now globalized capitalist economy that
thrives on a short term future-discounted exploitation with profit as its central
axiom and which is hostile to all non-market understanding of these 'stocks'
upon which all life depends? It may be useful and even necessary to 'inventory'
nature for the sake of sustainability in such a manner but these must be
complemented by other, essentially non-instrumental and non-capitalised
conceptions of nature in order to be in tune with the essence of 'criticality'
mentioned above.
The underlying commonality of all these approaches is the problematic notion
of scarcity; something 'critical', something scarce, a 'keystone resource' that
needs to be counted/inventoried, measured, sustained and passed on, often as a
rationale for intergenerational justice. The worry and concern is often to be
responsible and to do justice to the future generations. Compared to such needed
and understandable concerns for the future generations there is rather a critical
scarcity of similar resources (in the form of research studies, for example) that
scrutinize similarly from every nook and cranny and analyse in detail for
example, issues of international justice or justice among the present generations
across societies and nations. The moral and economic concerns for the future
generations' well being is relatively overemphasized and overtheorised, often at
the cost of concerns for justice here and now. Low and Gleeson (1998: 19)
argue this to be rather inconsistent:
It seems more than a little inconsistent to show moral concern for future
generations when the worst environmental conditions imaginable are
already present in places on this planet.
Now, given the high degree of concern for 'critical natural capital' conception
of sustainability, and for the future generations, how can, or should, these
critically scarce resources be understood from a justice perspective? How they
are to be reconciled with justice claims made by groups of presently living
generations as opposed to the yet unborn and therefore yet to make justice
claims? There are many problems with the whole idea of critical natural capital
and many difficult questions lurk beneath the concept of criticality. For
example, Owen (1994) argues that 'who decides what is critical and why...to
designate natural assets as critical requires someone to judge what is so
important that it should be preserved intact, whatever the weight of other
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considerations' (p.449 original emphasis). It is worth noting that claims to
preserve and sustain some scarce or 'critical natural capital' for the sake of
future generations can also easily mutate into justifying calls for sustaining
present inequalities and injustices; inequalities which are already so visibly
marked and extreme that place a fourth of humanity in absolute conditions of
poverty. Since the very idea of scarcity is so 'radically indeterminate' and
therefore, challengeable4, it can be argued that even if there is an 'objectively'
established 'criticality', then perhaps such 'criticality' or access to it should be
distributed, or distributing scarcity ought to become the absolute and even
radical focus of discourses of environmental justice.
4 Mark Sagoff (1995), for example appears to be against such a notion of 'critical natural
capital' or, in general, against a 'limits to growth' concept conceding that 'the thesis that
there are significant natural limits to growth remains intuitively appealing', 'Carrying
capacity and ecological economics', Bioscience, 45(9) p.612, (emphasis added). This
skepticism may well be objectionable but at the same time there are other perspectives that
challenge such scarcity theories by questioning the very conception of nature and nature-
society relationship that inform them. For example, from a social ecology perspective,
Murray Bookchin (1996) argues that based on a dialectical and ethical understanding of self,
nature and society-nature relationship (as opposed to an instrumental one), nature may well
be a realm of abundance and freedom. He argues: 'One of the most entrenched ideas in
Western thought is the notion that nature is a harsh realm of necessity, a domain of
unrelenting lawfulness and compulsion. From this underlying idea, two extreme attitudes
have emerged. Either humanity must yield with religious or "ecological" humility to the dicta
of "natural law" and take its abject place side by side with the lowly ants...or it must
"conquer" nature by means of its technological and rational astuteness, in a shared project
ultimately to "liberate" all of humanity from the compulsion of natural "necessity" - an
enterprise that may well entail the subjugation of human by human' {The Philosophy of
Social Ecology: Essays in Dialectical Naturalism, Montreal: Black Rose Books, p.71). The
conceptual contrast between such views and the atomist, cost-benefit calculus view of self
and nature could not be sharper and profound; a contrast that will inform and eventually
influence discourses of environmental politics and justice.
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4.
The Environmental Justice Movement
The Brundtland Report (1987) on numerous occasions claims causal type
linkages between poverty, inequality and environmental degradations. It does
attempt, however inadequately, to bring a wider focus on these issues which are
often absent from the discourse of the mainstream environmentalism and the
numerous conservation movements. For example, sustainable development as
advocated by international organizations like the International Institute for
Environment and Development (IIED) and especially, by the IUCN's World
Conservation Strategy (WCS) is a clearly narrow concept that lacks some of the
more social and political insights. The overemphasis for more conservation and
preservation, necessary as they are, nevertheless, come at the cost of a holistic
analysis of the situation. Adams has pointed to this weakness and writes that the
WCS was " pious, liberal and benign, inevitably ideological and disastrously
naive " (1990, p.51 in O'Riordan 1993, p.50). Here, environmental issues are
usually taken as single issue problems and relatively seen in isolation from their
broader social milieus. The claims about the linkages between poverty and
environmental degradation not only shift the focus but also complicate issues of
justice. Such claims are repeatedly made in the Brundtland Report (WCED
1987), for example, that 'poverty itself pollutes the environment, creating
environmental stress in a different way. Those who are poor and hungry will
often destroy their immediate environment in order to survive' (p.28) and that
'It is futile to attempt to deal with environmental problems without a broader
perspective that encompasses the factors underlying world poverty and
international inequality' (p.3). To what extent poverty 'pollutes' the environ-
ment and why so, is an open question. But in the context of justice claims it is
not only this question but also who pollutes whose environment that matter
equally if not more. These issues while themselves reflective of distinct under-
standings of the environment and their social and political discourses, have been
influential in shaping the agendas of many sustainable development movements
with strong social justice character around the world. In the United States the
'environmental justice' movement can be seen as a similar social justice move-
ment which is not exclusively concerned with conservation and preservation
causes that otherwise make up the agendas of so many other influential
Northern sustainability groups. The apparent absence of a strong conservation
element in such justice movements is at the heart of the growing suspicion that
the agendas of social justice and sustainability may not be the same.
This points to the importance of social justice, democracy and human rights, for
a more broader and inclusive discourse of sustainability meaning that the
environmental cannot be seen in isolation from the social and the political. The
environmental justice movement emphasizes the same. It asserts that 'social
justice and environmental issues are inseparable, both conceptually and politic-
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ally' (Grass 1995). The cost of ignoring these linkages, no matter how much
un- or under-explored, both at local, national, regional and even international
levels can only result in the aggravation of the situation, both environmental and
social. This concern also appears to be behind the WCED arguments cited
earlier. The environmental justice movement in the USA is the outcome of the
'struggle of low-class, often black communities against the incinerators and
toxic waste dumps that, by accident and frequently by design, come to be sited
near them (and away from affluent neighborhoods)' (Guha and Martinez-Alier,
1997, p. 19). The movement is often seen to be in contrast to the more well
known environmentalism of the middle class Americans who have showed less
concern with the disproportionate burden of toxic wastes and risks on minority
communities (Hofrichter, 1993; Low and Gleeson, 1998). Hofrichter (1993) has
argued that these minority communities have been unfairly at the receiving end
of 'unregulated, often racist, activities of major corporations who target them
for high technology industries, incinerators and waste' (p.2). Although the
contexts and their historical development are different, the grassroots, activist
nature of this movement has much in common with many similar movements
for social justice in the developing world, whether prefixed by sustainable
development or not.
Environmental justice as a movement has mainly been a US based phenomenon.
The term 'environmental racism' is also sometimes used interchangeably with
environmental justice and environmental equity. In the context of US some have
claimed that, 'statistics show that race is a better indicator than income in
determining the probability that a community is polluted' (Collin, 1993:41).
'Environmental racism' was coined by Benjamin Chavis, then head of the
United Church of Christ's Commission on Racial Justice (Mushak, 1993 cited
in Cutter 1995, p. 112). The Commission carried out a study, Toxic Wastes and
Race in the United States that concluded that 'race was consistently a more
prominent factor in the location of commercial hazardous waste facilities than
any other factor examined' (quoted in Collins 1993, p. 41). Environmental
racism in this case is seen 'as an extension of racism in household, land use,
employment, and education policies and therefore as part of the larger web of
institutionalized racism' (Collins 1993, p.41). Reverend Chavis who headed the
Commission on the toxic waste study states:
Environmental racism is racial discrimination in environmental policy-
making and enforcement of regulations and laws, the deliberate targeting
of communities of color for toxic waste facilities, the official sanctioning
of the presence of life threatening poisons and pollutants in communities
of color, and the history of excluding people of color from leadership of
the environmental movement (quoted in Cutter 1995, p. 112).
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Other authors and activists prefer the term environmental justice because they
see environmental racism as 'too restrictive a term' and also because
'environmental justice...moves beyond racism to include others (regardless of
race or ethnicity) who are deprived of their environmental rights, such as
women, children and the poor' (Cutter 1995, p. 113). Some have challenged this
notion on methodological grounds (Been, 1993, Boerner and Lambert, 1995).
However, these studies, funded by risk producing industries have been
questioned by Goldman (1996). Robert Bullard is one of the main activist and
theorist of the environmental justice movement and he has identified equity
issues that are procedural, geographic, and social (Bullard 1994). According to
Bullard (1994) environmental justice 'is a more politically charged term, one
that connotes some remedial action to correct an injustice imposed on a specific
group of people, mostly people of color in the USA' (quoted in Cutter 1995, p.
112). Bullard (1994) goes on to suggest five principles of environmental justice
to promote procedural, geographic, and social equity and it must be said here
that these have remarkable similarity with those proposals that are often put
forward by the developing countries, for example, regarding potential disasters
from toxic wastes or climate change and their effects on the vulnerable and the
poor:
1. guaranteeing the right to environmental protection;
2. preventing harm before it occurs;
3. shifting the burden of proof of contamination to polluters not the
residents;
4. obviating proof of intent to discriminate; and
5. redressing existing inequities (p. 15).
As with so many other social issues to which attention is often drawn by social
justice movements and which are expressed in a vocabulary of protestation so is
the case with the environmental justice movement. In the US case the environ-
mental justice movement clearly has strong civil rights character. It has
attempted to connect with or incorporate broader social justice vocabulary from
outside the conventional conservation movements that often either ignore these
issues in their quest for 'wilderness' or pristine nature preservation or subsume
and collapse all differential impacts and burdens in abstractions like 'human
beings', 'homo sapiens' or 'we'. It may well be that in such latter instances the
concern is with the macro level, a concern with what will happen to the planet
and its life forms as a whole, but that need not come at the cost of these
localized, concrete, micro level situations of struggles that are more visible
definitions of the human condition; conditions of disproportionate and un-
deserved harm and injury, of deprivation and suffering, which are equally, if not
more, important and urgently in need of redress. Dowie (1995) makes a similar
point:
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During the early years of the movement, in an understandable attempt to
build the broadest possible constituency, environmentalists often des-
cribed the issues as one that affected everyone equally. We all live in the
same biosphere, said the gospel, breathing the same thin layer of air,
eating food grown in the same soil. Our water is drawn from the same
aquifers, and acid rain falls on the estates of the rich as forcefully as on
the ghettos of the poor. On closer examination, however, massive in-
equities in environmental degradation and injustices in the policies used
to correct them became evident. While created equal, all Americans were
not, as things turned out, being poisoned equally (p. 141, quoted in
Dobson 1998: 19).
What is so remarkable is that the environmental justice movement is based in
the richest country (in terms of aggregate incomes and GDP, although a society
where wealth and resources are highly concentrated in few hands), in the world.
What would it be like in more materially deprived societies with highly
polarized groups in terms of wealth and its ubiquitous adjunct, power? Or since
many environmental problems do not respect regional and national boundaries,
what would it be like in a highly polarized world? A world where inequalities of
everything from wealth to knowledge are the dominant defining features as also
witnessed by the critical discourse of globalization and the figures of poverty
published year after year by international agencies like the different UN
organizations, the World Bank and others?
It becomes obvious that the claims for equity and justice are about the
distribution of real as well as perceived environmental benefits and burdens or
of the mechanisms and means of protection from the burdens or harms; claims
made by the poor who also want prevention of and protection from the
deleterious effects of environmental degradation. One aspect of the claims are
that to these spatial and temporal dislocations their contribution is often meager
compared to those who live more wasteful lifestyles and who have the 'ability
to pay' for protection from these harmful effects. These claims make clear 'the
environmental justice belief that the "environment" is no more - and certainly
no less - than a particular form of goods and bads that society must divide
among its members' (Dobson 1998: 20).
There are similarities between the environmental justice movement in a country
like the USA and other environmentally oriented protests and struggles in the
developing world. The latter can collectively be called as the 'environmentalism
of the poor'. Some authors, in comparing the two types of environmentalism -
that of the 'rich' and of the 'poor' - have taken a view according to which the
'environmentalism of the rich' is seen as a partial shift from a materialist to a
'post materialist' or 'post industrial' society and the 'environmentalism of the
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poor' mostly concerned with 'nature/resource based conflicts' (Guha and
Martinez-Alier, 1997). It is argued:
Origins and political style notwithstanding, the two varieties of
environmentalism perhaps differ most markedly in their ideologies. The
environmentalism of the poor originates as a clash over productive
resources: a third kind of class conflict, so to speak, but one with deep
ecological implications. Red on the outside, but green on the inside.... In
contrast, the wilderness movement in the North originates outside the
production process. It is in this respect more of a single-issue movement,
calling for a change in attitudes (towards the natural world) rather than a
change in systems of social production or distribution (p. 18).
The different conflicts that occur in such situations as referred to in the quote,
have strong ecological basis. Perhaps this is because the 'environment' has a
radically different meaning and implication in such situations. In the South, for
example, 'forests are not wilderness areas but habitats for the poorest of the
poor' (CSE 1992: 265). The issues are complex with a highly social and
political content than just aesthetic or technical matters of protecting and
preserving the wild flora and fauna. At the core of these conflicts are the
historical, as well as, contemporary issues of equity, access and distributional
justice at all levels from the local to the global. An example of India:
The inequities in contemporary India relate not only to control over land,
water, fish, forest or minerals, but also to access to education, jobs in the
bureaucracy, and the process of political decision-making. There are
growing social conflicts focused on each one of these concerns. Conflicts
grow primarily because the gulf between omnivores and the dispossessed
is continually widening (Gadgil and Guha, 1995, p.96).
Distribution then takes the form of 'ecological distribution' which refers to 'the
social, spatial and temporal asymmetries or inequalities in the use by humans of
environmental resources and services, i.e. in the depletion of natural resources
(including the loss of biodiversity) and the burdens of pollution' (Guha and
Martinez-Alier, 1997, p.31). The ensuing discontent and conflicts often suggest
a strong linkage between resource use and the social and economic disparities.
Environmental injustices from such a perspective are therefore, first and
foremost, equity and access issues implying a broader and better understanding
of these historical and structural disparities as crucial pre-requisites for any
ameliorative or mitigation measure that claims to be just, inclusive and non-
coercive. This kind of thinking has wider implications for the understanding of
environmental justice, especially in the global context, because they import and
emphasize the socio-political, in addition to the economic dimension.
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The environmental justice movement, although a localized, country specific
protest movement not only reflects structural arrangements of that particular
society but also gives legitimacy to the voices and concerns of the less
privileged and environmental victims - or potentially vulnerable to such
victimization - of the world at large; a world where the economic and political
order resembles the same structures in its exclusion, marginalization and
oppression of its lower one fifth population. For the message of the movement
to have any real impact and meaning in its truly globalized sense, it has to show
awareness of and solidarity with the big pictures of injustices and will have to
transcend the 'politics of place' (Low and Gleeson, 1998). Without doing that,
there is a real danger that it can itself become a net contributor to injustices
beyond the borders of its particular community of justice. This already happens
through the displacement of hazardous facilities to other lesser influential and
powerful communities both within and outside state borders. The movement is
also a much needed correction to the worldview of the 'environmentalism of the
rich'. Like its counterparts in the peripheral world, the environmental justice
movement may be theoretically unsophisticated in making its case to the powers
that be, but its real strength is its grassroots nature, its closeness to real life
experiences of injustice and its bearing of disproportionate burdens of (ab)use of
environmental resources and functions. These experiences and realities do
signify situations of injustice calling for an ethical and moral concern by any
humane and rational account or theory of justice; a call for a historically
informed new understanding and ways of coming to terms with these issues.
These situations not only call our attention to our moral faculty but also to our
rational capacities to act differently and collectively since never before the
world, its peoples and resources have been faced with situations with potential
for disasters of enormous proportions. The responses to make just the unjust are,
however, very much varied and the perspectives cover a broad spectrum of
thinking as will be discussed in the next sections.
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5. A Brief Critical Review of Some Principles of Justice
Justice or international justice especially in the context of environment and
related issues for example international trade, is often interchangeably used with
the concept of equity, both intra- and intergenerational. Because equity and
justice issues are often intertwined and in a complementary relationship, there-
fore, associated with the demands for equity are the demands for justice. Equity
in its broadest sense, means 'the quality of being fair or impartial' or 'something
that is fair and just'. The meaning of justice is often not far from that of equity
or from the idea of fairness. As the 'first of social virtues' (Bullock et al., 1988)
it also means 'the quality of being right and fair' (Oxford Advanced Learner's
Dictionary 1985).
However, beyond the simple dictionary definitions, justice is now a much more
complex issue and the subject of intense arguments. Justice has many
dimensions. For example, many accounts of justice as a desirable social virtue
aspire towards and demand, although to different degrees and through different
means, the establishment of appropriate political institutions and giving
consideration to a shared public ethos that result in a social order that is
acceptable and enjoyed by the majority if not all. An order where people's
safety and liberties are maximized and social evils are kept at a minimum if not
totally eradicated. Achieving these pose enormous challenges for any theory of
justice, environmental or otherwise; challenges that have become more pro-
found with the recent critiques of some of the more dominant justice theories. In
the following brief critical discussion of these theories we shall see how these
theories grapple with justice issues and in doing so, how they agree and disagree
with each other.
It is perhaps the principles of justice, or the bases of justice which are often at
the core of most discussions about distributive justice, for example need, desert,
rights, entitlements and a range of virtues depending on the overall view of
justice. These are also the central feature of the political philosophies and/or
traditions like liberalism and socialism for example. In recent times, some of the
most influential works on justice have been those by John Rawls (A Theory of
Justice, 1971, Political Liberalism, 1993), Robert Nozick (Anarchy, State, and
Utopia, 1974) and in recent years, Michael Walzer {Spheres of Justice, 1984).
In the case of Rawls, it can be said that his major attempt has been at the formu-
ation of a theory of justice which proposes the idea of a kind of 'well ordered'
society which is so not because the aggregate figures about that society present
a healthy picture which is what conventional utilitarian measures of progress
and development often do but, a society where the well being of each and every
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individual is a concern of justice, although based on an 'abstract' understanding
of the individual5.
Rawls' "difference principle" is at the center of his theory of justice. In its
stricter meaning 'the difference principle is satisfied by a given economic
system only if those who are worst off under it are not more badly off than the
worst off would be under any alternative to it' (Cohen 1986: 133). Defining
'Justice as Fairness' Rawls based his theory on the following two principles:
First, each person participating in a practice, or affected by it, has an
equal right to the most extensive liberty compatible with a like liberty for
all; and second, inequalities are arbitrary unless it is reasonable to expect
that they will work out for everyone's advantage, and provided the
positions and offices to which they attach, or from which they may be
gained, are open to all (1976: 30)
Rawls (1976) further enunciates the second principle by stressing that:
It should be noted that the second principle holds that an inequality is
allowed only if there is reason to believe that the practice with the
inequality, or resulting in it, will work for the advantage of every party
engaging in it. Here it is important to stress that every party must gain
from that inequality (p. 32, original emphasis).
In fact, it was in his earlier seminal work, A Theory of Justice (1973) that Rawls
first enunciated his principles of justice in much more detail. The second
principle there reads like this:
... social and economic inequalities are to be arranged so that they are both:
5 The literature on these theories of justice is monumental, especially those that either support
or critique Rawls' theory. I shall, therefore restrict my discussion to some salient and relevant
features of these theories. The critique of Rawls' theory has been carried out by feminists as
well as communitarians (See note 2). From another perspective, there are also critics who
criticize the overall dominant framework of liberalism, individualism and secularism within
which Rawls formulates his theory. See, for example, William Galston, 1991, Liberal
Purposes: Goods, Virtues and Diversity in the Liberal State, Cambridge: Cambridge
University Press; Veit Bader, 'The Cultural Conditions of Transnational Citizenship: On the
Interdependence of Political and Ethnic Cultures', Political Theory 25(6), 1997, 771-813; For
a criticism of the liberal states' myths of 'difference blindness' and 'neutrality' see Veit
Bader, 'Religious Pluralism: Secularism or Priority for Democracy?', Political Theory 27(5),
1999, 597-633; For a critical perspective on secularism see, T. Modood, ed., 1996, Church,
state and religious minorities, London: Policy Studies Institute; R. Bhargava, ed., 1998,
Secularism and its critics, Delhi: Oxford University Press.
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a), to the greatest benefit of the least advantaged, consistent with the just
savings principle, and
b). attached to offices and positions open to all under conditions of fair
equality of opportunity (Rawls 1973: 302)
Rawls's 'difference principle' and his overall theory appears to be emphasizing
the principle of need especially through his concept of 'primary goods'. Primary
goods are, 'things it is supposed a rational man wants whatever else he wants'
including, 'the basic liberties', 'freedom of movement and choice of
occupation', 'powers and prerogatives of office and positions of responsibility',
'income and wealth' and 'the social bases of self-respect' (1971: 61-65, in Sen
1988: 277). In his later work, Rawls (1993) defines primary goods as,
things which is supposed a rational man wants whatever else he wants.
Regardless of what an individual's rational plans are in detail, it is
assumed that there are various things which he would prefer more of
rather than less (p.92).
If Rawls's 'primary goods' is understood to have the quality of something that
is required as a condition of survival or for the sustenance of human life, then it
is rather hard to conceive what principle of justice other than basic need could
be more legitimate for the distribution of those primary goods. Indeed, 'basic
needs', the kind that is conditional or prerequisite for life has to figure strongly
in any discussion of poverty alleviation and in theories of equality and distrib-
utive justice. The most famous articulation of justice based on the principle of
need is of course, the Marxist notion of "to each according to his needs"
whereby in a free and egalitarian society, as the culmination of human reason
and ethics, there will be no need for a principle of distributive justice.
Desert as a principle of justice seems to be very much prevalent although not
often explicitly expressed in modern capitalist and individualist societies. The
overriding emphasis on individualism suggests a rational entity who possesses
capacities, talents and skills for the contribution of which he/she expects to be
justly rewarded. Also, because there are differentials in each individual's
capacities and abilities out of which will result 'just differentials', this notion of
desert does make sense, although very superficially. This is also referred to in a
similar vein as the 'merit principle' or the meritocratic view of an ideal society;
to do justice is to distribute something in accordance with ability and hard work
etc. A criticism of this view objects that while it points to individual qualities,
talents and potentials, it ignores their 'social origins'. It also claims that
"'merit" is not a neutral and objective criterion for settling which of several
candidates should be given sought-after position, but instead socially con-
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structed notion that works in favour of those already entrenched in positions of
power' and that 'it replaces a concern for equality of outcome with a concern of
opportunity' (Miller 1999, p. 197-80). The reductionist tendencies that are so
much a hallmark of contemporary industrialized societies can and in fact do
view 'merit' in a very narrow sense and therein lies the danger with this view of
justice and an ideal society. Miller rightly criticizes this tendency in the talk
about the justice of meritocracy:
The danger inherent in meritocracy is that one dimension of merit will be
given too great an emphasis, both in terms of the esteem that attaches to
it, and in terms of the material rewards that it commands. Someone who
has the skill to make arts and crafts, say, that people want to buy gets
recognized and rewarded; someone whose skills are less tangible but
from a wider social point of view just as valuable... is liable to have her
merits ignored' (1999, p. 199).
One can think of a situation where an enthusiastic, if not outright predatory,
financial speculator is given more 'merit' points for his 'contribution' than a
devoted teacher or social worker, a scenario not too much far away from
contemporary reality.
In an extreme version of such an individualist/atomist perspective (already a
feature of many advanced societies) each individual sees himself/herself as an
island, capable of surviving on his/her own and because of this, nobody has any
obligation to anybody else. The notion of individual here is often that of the
economically rational consumer, the so-called rational homo economicus, with
preferences rather than a social and public being say, a whole citizen whose
'developed capacities and their value owe something to society' (Taylor 1986:
60) a society, to which his/her relationship is complex and mutually
developmental, in a dialectical sense. Taylor (1986) calls this desert based
concept of justice the 'contribution principle' and argues that:
This is not a doctrine that is anywhere spelled out. Rather what I am
trying to do... is sketch what I think is the implicit background to a widely
held principle of distributive justice in our society, which we can call the
contribution principle. This is (at least partly) what lies behind the widely
felt intuition that highly talented people ought to be paid more than the
ordinary, that professions requiring high skill and extensive training
should be more highly remunerated, and in general that complete equality
of income, or distribution according to need, would be wrong (p. 53).
Taylor sees this 'contribution principle' as a prominent feature of what he calls
the 'atomist' view of western industrial society which has brought about a
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"privatization" of life and that this privatization 'naturally makes us tend to look
at society as a set of necessary instruments rather than as the locus in which we
can develop our most important potential' (1986: 51). However, his conclusion
is that
Justice involves giving appropriate weight to both of these principles
[equalization/ principle of equal sharing and "differentials" or the
contribution principle]... in any society that is inter alia an enterprise of
economic collaboration, and in which the economic contributions are not
equal, as they cannot be in an advanced technological society, some form
of the contribution principle is valid (p. 63 original emphasis)
This seems to be the kind of approach that is advocated by many other justice
theorists although in different formulations and with mixtures of principles. For
example Galston (1986) argues on similar lines and proposes two principles that
according to him typifies modern liberal societies:
First, goods and services that fall within the sphere of basic needs are to
be distributed on the basis of need, and the needs of all individuals are to
be regarded as equally important. Secondly, many opportunities outside
the sphere of need are to be allocated to individuals through a competition
in which all have a fair chance to participate (p.89).
For his part, Michael Walzer in his seminal work Spheres of Justice (1983) has
argued that 'Desert does not have the urgency of need and it does not involve
having (owning and consuming) in the same way', and that, 'it is a strong claim,
but it calls for difficult judgments; and only under very special conditions does
it yield specific distributions' (p.24-25)
While the equality of opportunity, as implied by the second principle in the
above quote by Galston (1986), should not be confused with equality of
endowment (individuals with similar naturally endowed capacities etc. rather
than unique ones with varied natural capacities) and/or equality of outcome
(similar and equal outcomes), it can however, be argued that there is a sub-
stantial relationship between equality of opportunity and equality of outcome in
modern societies many of which are far from egalitarian and are in fact,
increasingly becoming polarized. For example, in such modern societies the
contemporary available opportunities have a causative relationship to and
depend upon the outcomes of the previous ones or, as an egalitarian perspective
would argue opportunity in a hierarchical society depends 'not only on an open
road but also upon an equal start'.
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It is thus, the "equality of conditions", the background conditions, or the
equality of circumstances which influence the opportunities and the outcomes
and which are then evaluated in a manner that makes the equality of opportunity
concept relevant and meaningful. From the emphasis that an "equal start is also
important in addition to an open road" or that because of the injustices or
barriers and obstacles created by previous outcomes, the implication is that
some sort of corrective measures (compensation?) will be needed if distributive
justice is to mean anything. A clearer version of the same view can be found in
Walzer (1986) who says:
Today's inequalities of opportunity derive from yesterday's victories and
defeats; they are inherited from the past, carried not by genetic but by
social structures, by organized power, wealth, and professional standing
(p. 144).
These and other similar observations are at the center of the disagreements in
the discourses of not only domestic but also of international justice. For
instance, regarding greenhouse gas emissions in particular and other
environmental goods and bads in general (the waste trade or the 'traffic in risk')
an important bone of contention between the states at international fora is that of
demand for responsibility based justice, especially, both contemporary and
'historical responsibility'. The concept of 'natural debt' also refers to history
and the historical patterns of use of nature and global natural commons.
Another perspective on justice is that which focuses on the principle of
entitlement and its most well known advocate is Robert Nozick through his
well-known work Anarchy, State, and Utopia (1974). Nozick's theory is
basically a defense of private property rights. The justifications of ownership
are reflected in Nozick's entitlement view in the following quotes (all cited in
Dobson 1998: 77, 144):
'Things come into the world already attached to people having
entitlements over them'
'The general outlines of the entitlement theory illuminates the nature and
defects of the other conceptions of distributive justice. The entitlement
theory of justice is historical, whether a distribution is just depends upon
how it came about' (original emphasis)
'Justice in holdings is historical; it depends on what actually happened'
'Whatever arises from a just situation is itself just'
and
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In a free society, diverse persons control different resources, and new
holdings arise out of the voluntary exchanges and actions of persons.
There is no more a distributing or distribution of shares than there is a
distributing of mates in a society in which persons choose whom they will
marry. The result is the product of many individual decisions which the
different individuals are entitled to make (Nozick, 1974: 149-150, cited in
Low and Gleeson 1998: 79).
Nozick and before him Fredrick Hayek have argued for a property-based
approach to justice meaning entitlement to property. Justice is about the
acquisition and transfer of private property. In their view justice is frequently
seen in its procedural sense; the justice of the outcomes are not relevant as long
as the procedures have been just. Moreover, if the 'original' acquisition and the
subsequent transfers of property was just, then claims made on other principles
of justice like need for example, are less important or irrelevant. This 'original'
acquisition of property draws from a 'Lockean proviso' according to which an
acquisition should not worsen the position of others by preventing them from
acquiring the same.
The entitlement approach to justice has its fair share of critics6. An obvious
problem arises with its claims regarding the legitimacy of the initial 'original'
acquisition of property. The Lockean proviso that it draws upon may hold true
for certain situations where resources are in abundant supply but where
resources are scarce and are of vital nature, such 'original' acquisitions can
become monopolistic, with no concern for vital and basic human needs and can,
therefore, be deemed unjust and unethical. Furthermore, the kind of accurate
and 'just' information needed to make such a claim may not be always
available. The element of uncertainty and distortion, therefore, creep in as
regards the legitimacy of much of existing private property. Cohen (1985)
makes a seemingly insignificant point but which has validity if one takes into
account recent centuries of world history which is full of stories of exploitation,
plunder and coercive occupations of land and other resources:
Take, for example, the shirt that I am wearing. Superior force, nothing
more, is the likely means whereby whoever first privatized the land from
6 6. Among others, see the works of the Marxist writer G.A. Cohen especially his essay,
'Self-ownership, world-ownership and equality', in F.S. Lucash, ed., Justice and Equality:
Here and Now, Ithaca NY and London: Cornell University Press, 1986, and G.A.Cohen,
'Nozick on appropriation', New Left Review, 150, March/April 1985, 89-107; Amartya Sen's
work is also critical of the entitlement theory of justice. See, 'Poverty and famines : an essay
on entitlement and deprivation', Oxford : Clarendon, 1981.
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which came the cotton out of which it is made secured his title to it
(p.92).
The economist Amartya Sen's work on famines and his observation regarding
entitlements critically shows that how under such "justly held" or "unrestricted"
or "inalienable" property rights famines can and have occurred and have left a
track of detrimental consequences for the victims of starvation. In a situation of
hunger and starvation 'there was no overall decline in food availability at all,
and the famines occurred precisely because of shifts in entitlement resulting
from exercises of rights that are perfectly legitimate' (Sen, 1984: 311-2). But
while entitlements can result in certain terrible and undesirable outcomes, in
terms of global commons or 'environmental space' like the emissions of
greenhouse gases it is often the choice principle of justice for those who demand
'equal rights of all individuals on earth to the use of the atmosphere' (CSE
1992: 276). For example, the Indian non governmental organization the Center
for Science and Environment (CSE) one of the most vocal NGOs from South,
argued for such entitlements in their statement issued prior to the UNCED
sponsored Earth Summit in Rio in 1992. In proposing an equal rights to the
atmosphere, the CSE argued - and still insists on such a principle - that the
'South should be demanding compensatory measures from the north for errant
behaviour as a question of its right over global resources' (p. 278). Further, it
maintains, among other things, that its proposed scheme should be attractive to
all parties because:
1. it is consistent with the norms of human rights and equality, [and that]
2. it is a system built on rights, not on aid or charity or undue and
unequal obligations (CSE 1992, p.278).
An exclusive insistence on entitlements or rights may well be disadvantageous
for those who do not possess the necessary capacities and tools either because of
'historical barriers' or previous injustices, or because of naturally unequal
endowments, which are often made even more unequal because of the existing
structural and systemic unequal arrangements. It is also important to note that,
given the fact that the principle of 'poor sell cheap' is a prominent feature of the
rapidly globalizing capitalist world economy, there is no good reason to think
that the environmental resources and their associated functions that the poor
would come to own as a result of property rights (in itself unlikely the way
things stand at present), will be sold or exchanged at socially just and
'ecologically correct' prices. There will always be incentives for abuse of these
'rights' as long as there are no mechanisms against exploitation in an
economically polarized and unequal world. The weaker parties' acquiescence to
sell cheap to the powerful (because there are immediate survival needs or
because there is a lack of information and knowledge about the nature of the
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agreements and the long term consequences of such selling) could itself be a
reflection of background injustices (Shue, 1992). It is these background issues
that compound the discourses of justice. Or in other word, a historical and
inherently political understanding and theorizing about justice stand in sharp
contrast to a narrowly rational and 'pragmatic' approach to justice. For example,
from a game theoretical perspective leverage in negotiations depend exactly on
how justice is viewed and, more importantly, on how issues are linked to arrive
at definitions and perspectives on justice. While history matters, it can be
argued that historical type arguments can well be amenable to abuse by
entrenched interests parading as the voice of the poor.
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6. Environment, International Justice and the Universal/Particular Debate
Jamieson (1994:203) has suggested: 'Perhaps the most important idea of global
environmental justice views the environment as a commodity whose distribution
should be governed by principles of justice'. But can there be such a justice?
This is a very contentious issue and some think it is impossible to talk about
such a thing as 'international justice'. One such view is that identified with the
'realist school' of international relations that deny the application of any kind of
ethical or moral principles across societies and on a global scale. This pers-
pective remains the dominant normative view of international relations (Baylis
and Rengerr 1992, p.9). The idea is that since there is no global 'community',
there cannot be international justice and that politics should be seen separately
from ethics. It stresses order and survival (often seen as the 'morality of states')
and not justice, national interests and security and not moral and ethical
considerations. The perspective is supported by a Hobbesian and Machiavellian
state-centric worldview with narrow, inadequate and essentially egoistical
assumptions about human nature. This kind of view especially in relation to
matters of inter-state justice, although with different political commitments and
ethical foundations, is also reflected in many other theories of justice especially
those that have now come to be known as the 'communitarian' theories. These
perspectives critique universalist and 'abstract' idea and 'seek to derive justice
from "history, tradition or local context'" (Attfiled and Wilkins, 1992:6). For
example, Michael Walzer's influential Sphere of Justice (1983) is one such
theory. Walzer who is one of the most radically liberal and pluralist
communitarians, puts forward a 'pluralistic' approach that argues for different
'spheres' and principles of justice:
I want to argue.. .that the principles of justice are themselves pluralistic in
form; that different social goods ought to be distributed for different
reasons, in accordance with different procedures, by different agents; and
that all these differences derive from different understandings of social
goods themselves - the inevitable product of historical cultural
particularism (1983: 6).
For Walzer (1983:5) 'Justice is a human construction, and it is doubtful that it
can be made in only one way'. Goods have different social meanings and they
are all social in nature. 'Goods in the world have shared meanings because
conceptions and creation are social processes. For the same reason, goods have
different meanings in different societies. The same "thing" is valued for
different reasons, or it is valued here and disvalued there' (p.7). Also:
A single necessary good, and one that is always necessary - food, for
example - carries different meanings in different places. Bread is the staff
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of life, the body of Christ, the symbol of the Sabbath, the means of
hospitality, and so on (p.8).
Walzer is correct as regards the different social meanings and values of goods in
different places. But if one may ask why in certain concrete situations
something as necessary, a "staff of life" like bread, has different value and
meaning in different places or, why a starving person sees bread in a different
light from someone else who is not faced with the same predicament? It is then,
not difficult to see that it is basically the circumstances, some of then life
threatening, that produce these different understandings of the otherwise same
thing. In such extreme cases most ethical positions and systems would suggest
that need be the choice principle of distribution. But Walzer casts doubts: 'If the
religious uses of bread were to conflict with its nutritional uses - if the gods
demanded that bread be baked and burned rather than eaten - it is by no means
clear which use would be primary' (p.8). While Walzer is certainly not implying
this, an ironic meaning could be read into the 'religious uses' of basic
commodities or resources to mean as those uses which are dictated by the
instrumental and narrow calculus of capitalist market economy that see nothing
wrong in channeling critical resources into non-basic needs investments and by
'gods' to mean as the powerful terrestrial entities that have vested interests in
such investments! After all, according to this kind of rationality, it indeed
becomes very much clear which use would be primary because it makes much
more sense to invest in producing 'nutritious' food for the pets of the wealthy
that will bring more returns to the investor(s) than to invest in food crops or in
other ventures that may not bring the same kind of profits but will surely save
starving lives and reduce human misery.
The recent debates between liberal and the communitarian theorists of justice is
of particular interest here regarding international justice. Liberal theories have
recently been accused of being too 'abstract' not grounded in social reality, not
context sensitive and that they avoid taking into account the differences among
communities, societies and states etc. Their apparent attempt to look for a single
principle or single set of principles of justice is particularly criticized. In this
way, its communitarian critics are increasingly questioning the 'universalism' of
liberal theories of justice. Rawls' 'impartiality' and 'justice as fairness' and
liberal secularism's apparent 'neutrality' have come under critical scrutiny.
Moreover, most liberal theorists are accused of being too staunch advocates of
the secular 'wall of separation' between say, religion and public affairs at the
cost of undermining cultural, religious diversity and democratic pluralism
(Bader, 1999). Bader (1999) suggests that liberal theorists should be concerned
more with the 'priority for democracy' rather than with the myths of 'neutrality'
and a 'hands-off approach to justice. Carens (1999) argues on similar lines and
thinks that a better approach to issues of justice would be one of 'immersion'
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rather than abstraction and 'neutral' distance. The similarities of this view with
some feminist perspectives like the 'ethics of care' (Gilligan 1982) are striking.
'Immersion' or inclusiveness is a feature of Iris Young's (1990) conception of
justice, which is also very critical of the 'neutrality' and 'impartiality' thesis.
Young's argument can be seen as a standard critique of the strict 'impartiality'
position like that of Rawls :
Rawls presents us with not so flashy a fiction, but the original position
which he constructs as the point of view of impartiality
is...Utopian....The ideal of impartiality is an idealist fiction. It is
impossible to adopt an unsituated moral point of view, and if a point of
view is situated, then it cannot be universal, it cannot stand apart from
and understand all points of view (1990: 104).
Among other things, the communitarian perspectives seem to be attempting to
bring back a substantial ethical outlook into conceptions of justice; a virtue
based outlook on issues of justice. This is particularly visible in the work of
Alasdair Maclntyre (1981) which argues for a 'virtue ethic'. For Maclntyre
cultural traditions, their vocabularies and narratives are indispensable and
cannot be discarded if we want to conduct a meaningful discourse of justice and
rationality. Communitarian theories appear to be reluctant to talk about
universal justice based on a theory that will have a universal descriptive and
prescriptive reach. While the idea of international justice seems to be
unattractive to communitarian theorists they do, however, express their concerns
and call for international charity and aid.
What is often being suggested is that while there should be international
concern in the form of charity and humanitarian action, there can be no inter-
national justice. But is it possible, to achieve ends of justice through charitable
means and if it is, should it be? What is the normative and substantive
difference between the two and how they relate to and affect the dignity or the
sense of that dignity of a person, a group or community to whom a charitable
'justice' is done? Is charity and aid the way to go in addressing the cumulative
products of past injustices which are, ironically, so well captured in a previous
quote by Walzer (1986) himself?
Today's inequalities of opportunity derive from yesterday's victories and
defeats; they are inherited from the past, carried not by genetic but by
social structures, by organized power, wealth, and professional standing
(p. 144).
Belsey (1992) replies with an example of famine:
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It is a truth, though a depressing one, that even if the immediate and
desperate crisis of famine and starvation could be solved, the underlying
problem of widespread absolute poverty would remain, and with it the
constant threat of breakdown into further famines. Famine relief is of
course vital, but because it is treating the symptoms rather than tackling
the underlying causes, it is only amelioration and not a cure (p. 36).
George (1992) who has explored the politics of food and hunger also argues for
justice because charity as a 'stop-gap' does not address structural and systemic
causes of injustice.
There is something disturbing when the two are conflated and confused with
each other. Although in a sense justice cannot be separated from virtues like
care, concern and compassion for instance, it cannot be replaced with them
either without changing its substantial meaning and its intrinsic essence radical-
ly; the kind of essence that is constitutive of these virtues yet is something more.
A similar sense permeates, for example, the Kantian notion of 'moral equality'
of all persons. Perhaps this is what substantive theories of justice also argue for,
that is, to have some general concept of the good, the ethical and the rational as
one dialectically synthesized concept which would guide justice essentially
because as 'morally equals' humans are ends in themselves and when these ends
are intentionally violated by some, anywhere and at any time, injustice is done.
But what the 'recipients', if not the victims, deem unjust because of the circum-
stances that they find themselves in - circumstances which are not 'natural' or
'inevitable', which are 'carried not by genetic but by social structures' - solution
has to come through a framework or theory of justice and not charity. It is
always possible that in such situations charity, however necessary and desirable,
could actually legitimize injustice. Moreover, and perhaps more relevant here, it
is perfectly possible - in fact a feature of certain strands of environmentalism -
to talk passionately and benevolently about 'care' and 'concern' for the
environment, for 'wildlife' preservation, even about sustainability, without ever
talking about social justice in any substantial and meaningful sense.
Another objection made to the universalist views of justice is that by the
dominant 'realist' school on the grounds of reciprocity which, in a nutshell,
means that because there is no real reciprocity (of power and not moral)
therefore, there are and can be no obligations of the powerful towards the weak.
Nielsen (1992) has argued that instead of such a reciprocity there is a need for
'moral reciprocity' based on the Kantian conception of moral equality. The
'realist' school is realist in that it takes for granted, even justifies, contemporary
power structures and power-relations often in an ahistorical framework. But
history matters and historical contexts matter. It matters everywhere. Claims
based on conceptions of histories matter. It (the realist position) discounts all
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this and it fails to see how the dialectic of power has developed through the ages
and in that development process who and how some were systematically
trampled down and disempowered through unjust practices and abusive exercise
of power. Justice is not just about 'here and now' but equally about 'there and
then'. But for such perspectives it appears that justice is not an issue to be
argued from grounds with such implicitly judgmental orientations, as if there
was such a thing as 'ethical neutrality' or some imagined view from nowhere to
talk about such inherently normative issues. This kind of outlook with its own
logic of reciprocity of power might as well disregard all claims of justice and
obligation towards the weak (therefore, all) non-human life forms because just
like their weak and oppressed human counterparts, they are also unable to
reciprocate enough to counter 'real' and existing power.
The dominant reductionist views about international relations, politics and the
deafening silence about historical, structural nature of oppression, exploitation
and discrimination makes any talk of international justice irrelevant. The state-
centric conception of world politics with obsolete and particularistic political
forms refuses to acknowledge new, complex and dangerous problems that
potentially threaten the possibility and the character of life forms not just within
confined borders but also on the planet as a whole. But this refusal in itself
becomes an injustice because it ignores the changed nature of the interaction of
states and non-state actors in the global arena and the resulting benefits and
burdens that are produced and shared, often disproportionately and undeserved-
ly, by the parties. The very word 'interdependence' has taken a new meaning. A
world in which states are seen as autarkic with exclusive concern for what
happens within the domestic borders is a world blind to injustices at other supra-
state levels. Beitz (1979) while criticizing the passing concern shown by liberal
theorists for international justice has argued that 'In an interdependent world,
confining principles of social justice to domestic societies has the effect of
taxing the poor nations so that others may benefit from living in "just" regimes'
(p. 150). In the context of migration and border controls in liberal/democratic
societies Bader (1995) has termed this kind of attitude as 'collective welfare
chauvinism' (p.215).
The realist state-centric position with its over-emphasis on the twin principles of
territoriality and sovereignty while suitable for the management of more local-
ized natural resources is dangerously at odds with many areas of the biosphere
that needs collaboration or joint action. These areas are commonly known as the
global 'commons' or within the theoretical constructs of social science as
'collective goods' (Rowlands 1992, p.290). This kind of understanding of global
resources and their management calls into question the conventional
unilateralist attitude towards global issues. In recent years this critical challenge
has been partially gaining some acceptance, as also evident in certain environ-
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mental treaties and agreements, but it has a long way to go in order to replace
the entrenched worldviews that dominate global politics of international
relations. If such issues cut across national boundaries and there is growing
degree of interdependence, then with each interaction complexity of issues is
bound to grow and within each interaction there are normative issues involved
that defy isolationist and reductionist disciplinary thinking. The proper tools of
analysis needed must then be diverse and cross-or trans-disciplinary. For
example, Rowlands (1992), in pointing out the growing interest in 'trans-
boundary material flow' has argued that 'this issue has increased the challenge
to our traditional interpretation of international relations by clearly revealing the
true "interdependence" of the global environment: trans-boundary actions can
effect another state' and that 'it further illustrates the permeability of the
realist's billiard ball by demonstrating that international issues can have their
origins in domestic concerns' (p.295).
Returning to the universal/particular debate, if it appears that the circumstances
of justice are plural and complex then it would be rather futile to argue for a
single principle to be valid universally and for all situations. But this complexity
and diversity need not lead us to a silence and surrender in the face of pervasive
issues of oppressions and injustice with global reach and effects. Regarding the
now much dissected incompatibility thesis of universal 'abstraction' and par-
ticular 'sensitivity to context', O'Neill (1992) using the example of poor women
in impoverished economies, who she identifies as the 'impoverished providers',
has cogently and convincingly suggested that this dichotomy is unnecessary and
can be avoided. She distinguishes between 'idealization' and 'abstraction' and
argues that abstraction is possible and perhaps necessary for an international
theory of justice without idealization: 'Abstract principles can guide context-
sensitive judgment without lapsing into relativism' (p.53). She argues:
Idealizations may privilege certain sorts of human agent and life and
certain sorts of society by covertly presenting (enhanced versions of) their
specific characteristics as true of all human action and life. In this way
covert gender chauvinism and an exaggerated view of state sovereignty
can be combined with liberal principles. Idealization masquerading as
abstraction yields theories that appear to apply widely, but which covertly
exclude those who do not match a certain ideal, or match it less well than
others. Those who are excluded are then seen as defective or inadequate
(p.58).
Moreover,
Idealized conceptions both of state sovereignty and of state boundaries
limit discussions of international distributive justice....The only way to
find theories that have a wide scope is to abstract from the particularities
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of agents; but, when abstraction is displaced by idealization, we are not
led to theories with wide scope but to theories that apply to idealized
agents (O'Neill 1992, p.61).
Whether this kind of 'abstraction without idealization' remains an open
question. But it does hint towards a way forward to establish general human
interests, for example, in the context of global environmental issues and the
situations of justice arising therein. The particularistic corrections to strict
'neutrality', 'impartiality' or 'difference-blind' positions of liberalism should be
welcomed but without creating a false dichotomy that sees all types of universal
conceptions as impossible at best and totalitarian or oppressive at worst. The
other extreme that puts too much emphasis on the particular and the specific at
the cost of the universal and the general, may itself become an obstacle to the
elaboration of an inclusive and immersed conception of justice at all levels,
which is so much needed to address the contemporary human condition.
Oppression and injustice have many faces as Young (1990) has argued. They
affect at different levels, their victims live in different places and the
victimizers, either people or institutions are sometimes different and at other
times the same. While some of these faces are easily visible and recognizable,
others, more pervasive and structural ones are not. Harvey (1999) calls these
subtle, non-violent but deeply damaging forms of oppressions as 'civilized
oppression'. Harvey argues that 'Western societies generally and specific
institutions within them may pride themselves on being examples of civilization
in practice, yet oppressive relationships may pervade some of these institutions,
even though the absence of force and of overt denials makes their analysis
challenging and their recognition a matter of skill' (p. 180). If one ignores, or
fails to talk about one kind of oppression and protest against another, then one is
not doing much justice after all. Moreover, one should always try to keep the
big and historical picture of injustice in mind while at the same time being
critically aware of the local and particular forms and of all the other faces,
sometimes changing faces, of oppressions and injustices. The big picture
injustices are those that are reflected in the contemporary world in the form of
oppressive neo-imperialist institutions and relationships.
The universalist-particularist debate about justice issues has implications for any
discourse of international (environmental) justice. For example, whether the
liberal/communitarian debate can lead us to a new understanding of a rapidly
changing world throwing up complex and complicated social and environmental
problems with deep ethical implications, remain to be seen. So far, it seems that
these debates are not adequately engaged with these issues but have been more
focused on methodological and philosophical arguments. Some of the
implications will become clear in the following sections.
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7. Towards a 'Shared but Differentiated Responsibilities' Conception of
Environmental Justice
7.1 Vulnerabilities, capabilities and environmental victims
The Brundtland Report (WCED) claims that "inequality is the planet's main
environmental problem" (1987:5). One could as well think of it as a social and
historical 'problem', as a cumulative end-product of historical events and
processes. A more deeper view would think of it as an ethical problem. But one
must ask, 'inequality of what ?' Or more precisely, 'Equality of what?,' as
Amartya Sen has done. Sen's work on capabilities, freedom of choice and
alternatives and their effects on well being and quality of life are major
contributions to moral philosophy and welfare economics. In addition to his
contribution to the understanding of famines and how and why they occur, Sen
has also significantly added to the ethical basis of justice which he 'locates not
so much in needs, interests or rights but in human capabilities and their
facilitation' (Attfield and Wilkins 1992:2). In a series of publications and
lectures Sen has tried to establish the relationship between freedom and
capabilities and their overall influence on and relationship with people's quality
of lives and well being. On the one hand, Sen makes a distinction between
'negative' and 'positive' freedoms based on Isiah Berlin's concepts of the two
terms and, on the other hand, between 'instrumental' and 'intrinsic' freedoms.
Negative freedom is understood as the non-interference of others in an
individual's affairs whereas positive freedom has a more substantial meaning
and is understood as a person's actual capacities to do something or to be. Sen
defines the latter set as:
In the 'instrumental' view, freedom is taken to be important precisely
because of its being a means to other ends, rather than being valuable in
itself. In contrast, the 'intrinsic' view of the importance of freedom
asserts that freedom is valuable in itself, and not only because of what it
permits us to achieve or do. The good life may be seen to be a life of
freedom, and in that context freedom is not just a way of achieving good
life, it is constitutive of the good life itself (1995:92).
Sen has particularly been concerned with positive and intrinsic freedoms
because in his work on poverty and famines he has shown that a focus on
negative freedom is inadequate. Recently, Sen (1999) has stressed upon the role
of freedom as the determinant of the quality of our lives and that this quality in
particular and development in general should not only be measured with
narrower indicators but by our freedoms to do and be. This means that not only
the inequality of wealth but also that of freedom and capabilities be of concern
to us, although there are important linkages between the two. If there is a
positive relationship between quality of life and quality of environment, it can
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be argued that the range and quality of one's freedoms, particularly positive
freedom, may also be measured by one's environment - especially when it
directly and critically supports subsistence. That is, where there is better
environment there is more freedom, or vice versa.
This kind of relationship has also been shown by the Environmental Kuznets
Curve, the EKC7 although that quality and therefore, the freedom that makes it
possible, may be "imported" or appropriated. Such ecological appropriations for
example, have been shown in studies like 'ecological footprints', 'appropriated
carrying capacity' and 'environmental space' which give estimates of how
much one region depends and appropriates resources of other regions (Rees and
Wackernagel, 1994). Ecological footprints simply means 'resources consumed
per person'. For example, Rees estimates that 4-6 hectares of land are needed to
maintain the average consumer lifestyle in the North ore the developed
countries. Yet in 1990 the total available productive land globally was only 1.7
hectares per person. Giving the example of Netherlands, Rees estimates that it
consumes the output equivalent to 14 times as much productive land as is
contained within its own borders (figures cited in New Internationalist 1996, p.
19). The deficits in this case and most other similar ones are usually
expropriated for example, from the resources of lower-income countries usually
through 'free' trade in primary products.
Before exploring the implications of all this for a proposed theory of environ-
mental justice let us turn to some other similar findings regarding differential
impacts. According to Boyce (1994), 'environmental degradation per unit
consumption is not necessarily constant across income classes....Indeed, it is
conceivable that degradation per unit consumption is greater for the rich;
compare, for example, bicycles and automobiles' (original emphasis, p. 173).
This kind of observation is also similar to the claims of environmental justice
movement. Boyce introduces a 'political-economy framework' in the argument
by pointing to the important big divider - power. For instance, since, in the real
world, power more often than not, correlates positively with wealth, Boyce
(1994) believes that 'situations in which the winners are powerful can be
expected to occur more frequently than situations in which the losers are
powerful' and that 'the greater the inequality of power, the greater the extent
1
EKC describes 'the relationship between some pollutants and income as an inverted-U
increasing levels of pollution for people living in lower income countries and declining levels
of pollution for higher per capita incomes', (Rothman and de Bruyn, 1998, 'Probing into the
environmental Kuznets curve hypothesis' Ecological Economics 25, p. 143). The relationship
derives its name from the works of Simon Kuznets who first proposed a relationship between
income and economic growth. See S. Kuznets, 1955, 'Economic growth and income
inequality, American Economic Review, 45, pp: 1-28.
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and social cost of environmental degradation' (p. 173). He therefore, concludes
that 'democracy and equity are important not only as ends in themselves, but
also as means to environmental protection' (Boyce 1994:178).
Torras and Boyce (1998) who have carried out a critical reassessment of the
Environmental Kuznet's Curve (EKC) argue that 'changes in the distribution of
power are central to the connection between the two phenomenon [income and
pollution in the EKC]' (p. 149). The authors make an important observation in
their conclusion that, 'as average income in a given country rises, pollution-
intensive production may be relocated to lower income countries. If so, this may
reflect power inequalities among countries, as well as within them' (p. 158).
Since the capitalist world economy is very much infused with risk, and there is a
growing hostility of communities in the industrialized world towards the siting
of risk-producing land uses an 'efficient' 'traffic in risk' is just a logical out-
come. Low and Gleeson (1998) have argued that 'given these centrifugal social
and regulatory pressures, it should be no surprise that environmental
organizations are reporting a flourishing trade in toxic wastes, exported mainly
from developed countries to developing countries' (p. 122). Today many of the
persistent environmental harms and risks are not 'solved' but the impacts are
simply shifted from one locality to another. Dryzek (1987) has shown this
tendency of 'displacement' using the case of acid rain in USA. It is solved by
building tall smokestacks: 'Instead of polluting areas adjacent to copper
smelters in Utah or coal-burning power stations in Ohio, the sulfur dioxide ends
up in the form of acid rain in rural areas such as the Rocky Mountains or the
Adinrondacks' (p. 16).
Dryzek notes three forms of displacement:
1. Spatial displacement. For example shifting waste dumps from one place
to another
2. Displacement through shifting the problem to another medium. For
example dumping in the sea instead of on land
3. Temporal displacement; Problem is delayed and displaced into the future.
For example the long-term effects of nuclear testing (cited in Low and
Gleeson 1998, p.35).
What makes these situations more problematic and unjust is the difficulty in
attributing responsibility for ecological disasters. The tragic incidences like the
one that happened in Bhopal in India is a good example to see how risk-
producing entities can get away without shouldering responsibility for their acts.
Multinatonal capital in this particular case was able to solve the issue outside
court and cheaply: 'Indeed, as the Indian government argued when seeking to
have Bhopal case heard in a US court, multinational capital is able to use its
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deterritorialised organizational structure to maximize the advantages of the
"organized non-liability'" (Low and Gleeson 1998, p. 127).
But there is a more pernicious form of ecocide that is not all too visible; a kind
of slow death that occurs through sustained poisoning and degradation of
environments and life support systems. More than 100 million people are
displaced every year from their local environments by mega-development
projects in the developing world. Valleys are flooded, villages drowned, land
appropriated for more commercial projects the fruits of which are not justly
shared. There are numerous small, unreported but equally lethal Bhopals that
happen in many of these places. Weir (1987) notes:
Bhopal is being repeated, not just as explosions, infernos, and deadly
clouds heard, felt, and seen, the world over, but as 'mini-Bhopals -
smaller industrial accidents that occur with disturbing frequency in
chemical plants in both developed and developing countries. Even more
numerous and deadly are the 'slow-motion Bhopals' - unseen and chronic
poisoning from industrial pollution that causes irreversible pain,
suffering, and death (p. xi-xii).
Returning to Sen (1988), if 'The freedom to choose between alternative
functioning bundles reflects a person's "advantage" - his or her "capability" to
function' (1988: 279), then, conversely, it can be argued that the unfreedom, or
the lack or absence of freedom to choose between alternatives will reflect a
person's 'disadvantage' - his or her 'incapability' to function or function
properly. This incapability will also be a reflection and a cause of the person's
vulnerabilities. A major share of these vulnerabilities could well be due to
social-political, institutional/structural constraints, which incapacitate and dis-
empower. Moreover, due to ecological dislocations both of local and global
nature - themselves reflections of these arrangements - these vulnerabilities
could further be worsened.
A good example of this kind of scenario has been presented by Onora O'Neill
(992) whose focus on the poor women in poor countries, the 'impoverished
providers', raises crucial issues of justice. It is argued:
Women's lives are not well conceived just as those of idealized
individuals. A world of such individuals assumes away relations of
dependence and interdependence; yet these are central to most lives
actually available to women... .These women may depend on others but
lack the supposed securities of dependence....They are powerless, yet
others who are yet more vulnerable depend on them for protection
(O'Neill 1992:51)
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There are similarities between demands for gender and international justice. In
the global context, the vulnerabilities of the 'impoverished providers' and those
of the 'impoverished' in general are similar in the sense that while the
difference certainly exist in degree, it may not exist so much in kind under
certain circumstances. It is possible to think of a situation in which while those
who are not the most vulnerable 'impoverished providers' in the domestic
sphere are, nevertheless, absolutely vulnerable and 'impoverished' on a
different scale, in a different bigger circle or sphere to which they also belong
and depend upon in addition to the smaller ones. This comparison is not meant
to belittle the experiences and the predicaments of the former and it should not
be seen as a condonation or justification of the existence of domestic or local
structures of oppression. But that these local spheres of injustice are also
situated in and are part of a wider, bigger unjust sphere the workings of which
affect all the impoverished - impoverished to different degrees, but nevertheless
impoverished. O'Neill (1992:51) argues:
They may find that they are relegated to and subordinated within a
domestic sphere, whose separate and distinctive existence is legitimated
not by appeals to justice but by entrenched views of family life and
honour. They may also find that this domestic sphere is embedded in an
economy that is sub-ordinate to distant and richer economies...their
rewards fluctuating to the beat of distant economic forces.
A serious and just account of justice cannot ignore the plight of O'Neill's
'impoverished providers' in marginalized and developing economies but that
account of justice cannot also gloss over the predicaments of the impoverished
in general, who may be the oppressors in one sphere but the absolutely
vulnerable and oppressed in another and who may suffer equally in the wake of
ecological disasters not necessarily, and more important, not equally of their
own making. Such a conception of justice needs, perhaps, a kind of
'contribution principle', like the one discussed earlier, not only for environ-
mental 'goods' and the consequent rewards but also for environmental 'bads'
and the say, consequent penalties, to strike a fair balance.
Because the weak and vulnerable are not equal partners in power relations and
lack not only the resources that are the determinants of capabilities but also the
freedoms to exercise them or the power of agency to employ them, they are
always in a disadvantaged position. For example, in negotiations and
transactions the existence of such vulnerabilities cannot give rise to a legitimate
consent or agreement because of the disparities in access to information and
knowledge, the security to dissent and to have an equal say in the change or
modification of arrangements. If the present circumstances of justice are 'ethical
diversity' (O'Neill 1988:718), then it is important to note that this 'ethical
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diversity' is, however, shaped by the equally diverse universe of experiences
and encounters some of which are enabling and empowering while others
disabling and disempowering; some enhance capabilities and freedoms while
others restrict and stunt these capabilities which are potentially latent and reside
in every human being. The internal, local and domestic as well as the external,
universal relations, unequal exchanges and interdependencies contribute to these
circumstances of (injustice and inequity, environmental or otherwise. If such is
the contemporary state of affairs at local/national as well as global levels, then
what kind of a theory of justice is required? How can justice be deliberated and
established in an unequal world with such 'impoverished' vulnerable agents?
7.2 Responsibility: shared but differentiated
In our contemporary, rapidly globalizing world, in all spheres of commerce,
culture and communications, if one consider the nature, scope and reach of most
accompanying social and environmental influences and the impacts that arise
out of the pursuance of different interests through the complex mechanisms of
interdependencies and interactions, then one is faced with a rather novel
situation. This is a situation of mutual involvement of agents, be they
individuals, groups, states or multinational corporations, and their correspond-
ing mutual claims of rights and obligations. That these impacts can be, and
actually are, variable within and across boundaries and spheres both in degree
and in kind and which are coped with by agents with different vulnerabilities
and capabilities cannot be overemphasized. In such scenarios (which are not too
unrealistic but arguably contemporary and existing), while obligations to others
decrease in strength as one moves away from one's immediate circle, as we are
told (Wenz 1988)8, the impacts and consequences of actions of some may not
necessarily decrease with distance from the inner most core. In fact, the very
o
Peter Wenz writes: 'The closer our relationship is to someone or something, the greater the
number of our obligations in that relationship, and/or the stronger our obligations in that
relationship ... .My obligations toward a person increase with proximity to me of the circle on
which the person exists (Wenz 1988, 'Environmental Justice, New York: SUNY Press, p.
316). This has remarkable resemblance to Sidgwick's nineteenth-century 'common-sense
morality'. Sidgwick, long before Wenz's 'concentric circles' theory was formulated, said
(failings of gender aside):' We should all agree that each of us is bound to show kindness to
his parents and spouse and children, and to other kinsmen in a less degree: and to those who
have rendered services to him, and any others whom he may have admitted to his intimacy
and called friends: and to neighbors and to fellow-countrymen more than others: and perhaps
we may say to those of our own race more than to black or yellow men, and generally to
human beings in proportion to their affinity to ourselves', quoted in A. Belsey 1992, 'World
Poverty, justice and equality', in Attfield, R. and Wilkins, B. (eds.) International Justice and
the Third World, Routledge, London p.38). Belsey rightly objects to such views that it is
indeed true that most people's behaviors are exactly of that nature but is it justified to make a
virtue out of this kind of rationalization of self-centeredness and then base a theory of justice
on it especially in relation to issues and actions that have impacts, some of them very
harmful, across boundaries, territories - national or otherwise - and 'circles'?
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commonality of many environmental resources and services they provide gives
them a global reach. The extent of an action's impact therefore, can no longer
be restricted to a certain 'sphere' or 'circle' and this obviously creates an
'imperative of responsibility' among people who may or may not be the
inhabitants of same ecological space or geographical, or for that matter, of
emotional kinship 'circles'. As mentioned earlier, in Dryzek's view these
problems are merely moved around or 'displaced' rather than dealt with in a
meaningful way.
In the context of the contemporary patterns of social and economic change, if
the extent of an action's impact goes far beyond the conventional political units
and forms like the state, then what conceptions of community, justice and ethics
are needed? For example, instead of tinkering with the dominant logic of
international relations which precludes any attempt of expanding the notion of
community, should we not be asking more fundamental questions about these
issues? Linklater (1990) asks:
Does the state exhaust our political obligations, or are there wider and
more fundamental obligations that survive, so to speak, the fragmentation
of the human race into sovereign states? If there are surviving obligations,
are they the obligations that states owe one another as members of a
society of states? Are there duties that the individual owes to the whole of
humanity, and are there rights that individuals can claim to turn against
the human species and its political representatives? To what extent are
there universal obligations not just to uphold the rights of human beings
as far as possible within the current system, but to construct new global
institutions and practices capable of realizing higher levels of human
community and solidarity?' (p. 136-37).
Fain (1987) has argued for a 'task-theoretic' normative politics. Fain sees the
globalness of tasks as an appropriate defining category for these concepts of
community, moral obligations and global responsibility. Fain has argued against
'legal conceptualism' and sees a normative imperative behind global problems.
Since certain tasks cannot be solved by individuals and nation states, what we
need is a notion of belonging and responsibility to a larger community.
Similarly, Warner (1993) has suggested that 'The parameters of the community
to whom one is responsible...vary according to the issue' and that 'the
relationship between community and responsibility becomes crucial once we
leave the liberal individual/state' (p.441). But I would argue that the relationship
between the individual and the world - social as well as natural world - also
becomes crucial once we move away from the individualist notions of the self.
With the complex patterns of changes in the world today there must also come
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an expansion in the notions of self, community, belonging, responsibility and
the justice of these circumstances.
However, 'because engagement with the world is necessarily "global" in its
scope, but the world is characterized by a multiplicity of agents none of whom
can single-handedly bear the burden of global responsibility, the way in which
our ethical responsibility is to be acted upon has to be contested and negotiated'
(Campbell, 1993, p.99). These multiple agents with different capabilities to
cope and handle burdens may find themselves in a world that thrusts upon them
a disproportionate amount of risks and dangers. Because of the essentially
differentiated impacts on the common ecological resources and functions by
different agents with different capabilities and vulnerabilities, it is argued here,
a theory of justice, which is compatible with a critical conception of ecological
sustainability must be based on the principle of shared but differentiated
responsibilities. Responsibility as not merely shared but differently shared
because of differences and asymmetries that are the main, even definitive
feature of societies and of the world in large. This is also because
'responsibility... is a function of power and knowledge' (Jonas 1984:123) and it
is only too well known a fact that power and knowledge (already a determinant
of much power, the 'information gap') have never been so unequally and
disproportionately wielded as it is today. Jonas (1984) has argued that 'Power
conjoined with reason carries responsibility with it' (p. 138) or, that
...responsibility is a correlate of power, so that the scope and kind of
power determine the scope and kind of responsibility. When power and
its constant exercise grow to certain dimensions, then not only the
magnitude but also the qualitative nature of responsibility changes, with
the effect that deeds of power generate the contents of the "ought", which
thus is essentially in answer to what is being done (p. 128).
Jonas's concern was about the future, the future generations and future of the
planet itself but his thesis on the 'imperative of responsibility' and his
exploration of an 'ethics for a technological age' can equally well apply to the
contemporary world of impoverished and vulnerable agents; to the intra-
generational and international scene as well as to the intergeneration scenario.
He put his thesis by making the following basic distinctions:
The first and most general condition of responsibility is causal power,
that is, that acting makes an impact on the world; the second, that such
acting is under the agent's control; and third, that he can foresee its
consequences to some extent (1984:90).
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Jonas's generalizations can be zoomed in or viewed in a more detailed manner
whereby the asymmetries of power wielded by different agents, their
differentiated capacities, capabilities, the consequent disproportionate impacts,
and freedoms to control and foresee consequences become more visible. And
what will be revealed under the magnifying lens will have implications for a
theory of justice based on the principle of shared but differentiated
responsibilities.
In such a schema, justice requires that the vulnerable be at least capable and
have the freedom to cope and function, let's say, in an environmental
emergency. This may well require an unequal treatment, a biased and impartial
treatment in favour of the vulnerable. This kind of thinking about justice may
actually contradict with, for example, the often strictly and exclusively reward
(desert) based 'contribution principle', but it will be in agreement with a
compensatory principle of rational as well as ethical and responsible sharing of
both the benefits and costs of that which is global and common without
unnecessarily denying rewards for contributions of individuals and groups. This
kind of compensation - not to be confused with aid and charity - will be
legitimate given the fact that the contemporary injustices and inequalities, of
opportunities and freedoms are not sudden phenomena but are accumulations
that carry a historical baggage. This is not an entirely new insight. For example,
in many democratic societies the system of taxing (in an egalitarian conception
the more progressive taxing) of income and wealth, more or less, performs the
same function. It appears that among other reasons, it is done because there is a
public value system that demands it as a matter of justice. In historical terms,
most societies have functioned under similar principles of justice as Bookchin
has also argued. Bookchin (1991) refers to the principles of 'irreducible
minimum' (Radin 1960) and the 'equality of unequals' as inherent features of
many organic societies:
The principle of the irreducible minimum thus affirms the existence of
inequality within the group - inequality of physical and mental powers, of
skills and virtuosity, of psyches and proclivities. It does so not to ignore
these inequalities or denigrate them, but on the contrary, to compensate
for them... organic society tends to operate unconsciously according to
the equality of unequals - that is, a freely given, unreflective form of
social behaviour and distribution that compensates inequalities and does
not yield to the fictive claim...that everyone is equal (p. 144, original
emphasis).
But in modern liberal tradition the blindfolded Justitia and her scales must
dispenses 'equal and exact' justice. All competing and conflicting claims and
interests are equalized and must be resolved blindly in a balancing manner:
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Indeed, all scales can ever do is to reduce qualitative difference to
quantitative ones. Accordingly, everyone must be equal before Justitia;
her blindfold prevents her from drawing any distinctions between
[and]... from making any changes of measure due to difference among her
supplicants....But persons are very different indeed, as the primordial
equality of unequals had recognized. Justitia's rule of equality - of
equivalence - thus completely reverses the old principle. Inasmuch as all
are theoretically "equal" in her unseeing eyes, although often grossly
unequal in fact, she turns the equality of unequals into the inequality of
equals... .Accordingly, the rule of equivalence, as symbolized by the
scales in Justitia's hand, calls for balance, not compensation (Bookchin
1991:148 original emphasis).
Thinking in such a radical way about distributive justice 'demands more, not
less, to be just to the vulnerable' (O'Neill 1992:69 original emphasis). In the
context of environmental damages since these vulnerabilities are exacerbated
and capabilities and freedoms diminished variedly due to the differential
impacts on the commonly shared environmental goods and services, the so
called global commons and the 'services' they provide, distributive justice can
therefore be seen as the call for the distribution of responsibilities. It would also
be a call for the distribution of freedoms, the freedoms that are reflective of
advantages and capabilities as well as of the disadvantages and vulnerabilities to
cope with 'produced' ecological dislocations. Because these freedoms and
capabilities are infringed upon differently by these 'produced' environmental
bads, which are proportionately more detrimental to the vulnerable agents when
compared with their contribution to these environmental bads, this demand is
seen to be as fair and just. Justice is here, first and foremost, a matter of
responsibility, of shared but differentiated responsibility; differentiated in
proportion to the power of the agents and its reach and negative impacts upon
vulnerable others. To these vulnerable others one may as well add the non-
human life forms.
So where does all this leave us with a conception of sustainability that often
sees the protection of a limited or scarce 'critical natural capital' as essential if
humanity is to move towards a sustainable future which is also just? What kind
of a theory of justice can we pin our hopes to for such a sustainable future? A
particularism local, communitarian theory which while provides the required
correction to a strictly abstract 'contextually insensitive' stance but which
ignores other broader and wider contexts. Or a theory that has universal
concern; that abstracts without idealization as O'Neill has pointed out; that
while avoids collapsing all specific circumstances of injustice and diversity of
ethics, culture, tradition and identity into uniformity and standardization,
identifies not only everybody's shared and mutual general interests in the
44
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environment and its sustainability but also their differentiated responsibilities
towards those general interests? Perhaps this dichotomy, if emphasised too
much, itself is misleading. If one must play with geometric shapes then, one has
to ask whether a 'concentric circles', a 'spherical' type of a theory of justice
with their parochial orientations (important as they are in certain contexts but
rather less meaningful when it comes to other, global, transnational and trans-
communal issues like many of the ecological issues inherently are) makes sense
or one that has a big circle that encapsulates and encircles all the other circles
and spheres inside it. Some of these circles will be concentric while most others
eccentric and overlapping with each other but, nevertheless, all embedded in
and dependent on that one big circle.
This kind of an approach to reach to a theory of justice based on a general
human interest and such a conception of responsibilities is essential if
sustainability and social justice, not only within societies but also among
societies have to be achieved. This could be an essential element of an
'ecological sensibility', 'ecological rationality' and of'ecological virtue' as part
of a new reconstitution of human subjectivity. The suspicion that the agendas of
environmental sustainability and social justice may diverge may or may not
prove to be right. It will all depend upon what we eventually mean by
sustainability, social justice but more important, upon our understanding of self,
other and society-nature relationship. But, on another note, dealing with such a
substantially normative issue like justice one has to ask whether a sustainable
world where social justice is denied to the majority of its inhabitants would also
be desirable if it was possible, proven 'scientifically' or otherwise? This denial
could well be through ideological distortions as Kai Nielsn has pointed out:
'Ideological mystification leads us to believe that there is nothing significant
that could be done about these matters or nothing that could be done short of
impoverishing us all or undermining our civil liberties. But that is just
ideological mystification' (1992:32).
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8. By Way of Conclusion
There is no escape from ethical dilemmas in these times of complex
transformations and fragmentations. As Stanley Hoffman put it: 'the claims of
ordinary morality, the clamour for a kind of state conduct that does not almost
inevitably lead to deceit and violence, cannot be suppressed. We must
remember that states are led by human beings whose actions affect human
beings within and outside: considerations of good and evil, right and wrong are
therefore both inevitable and legitimate' (cited in Goulet 1992, p. 231).
The contemporary human condition demands our attention to justice. Justice is
important. It is important not only in its narrow, contractarian-legalistic and
distributive sense but also in its more substantially ethical and moral aspects.
Approximately a quarter of humanity is trapped into absolute poverty and
exclusion. We have entered the twenty first century with all of humanity's
achievements and glories but injustices of all kinds in all societies stare us right
in the face. But now there is a new twist to all these circumstances of injustice
in the form of ecological degradations that can potentially threaten - are already
threatening in some places - the very survival of all life including ours, on this
planet.
Justice is understood differently depending upon so many things some of which
I have briefly discussed in this paper. The principles or bases of justice are
diverse. The seemingly strict and opposing dichotomies like universal and
particular, abstract and concrete/context sensitive etc. not only criticize and
therefore, inform and correct each other but importantly, they also complement
each other in many ways although it may not appear so. Each can be enriched
and broadened by the critical stance taken by the other. In the context of
environmental justice I have tried to argue that it is not helpful to stick to one or
the other in a strict manner. For example, the postmodernist criticism of abstract
universalism and universal solutions to issues of justice should be welcomed but
with caution. If the so called 'grand narratives' of the old universalism were
faulty, as is often argued, and did not deliver as expected and hoped, then we
need a new universalism and alternative grand narratives. The critiques of
universalism should now focus more on what type of universalism rather than
universalism per se. Or, whose universalism? We must go through a pre-
universalistic period, with all its attending anxieties, disagreements, frustrations
before arriving to a truly inclusive universalism. There is no escaping, or
perhaps should not be, from grand narratives if there is to be a universal solution
to injustices that arise out of events, interactions and arrangements that
influence different peoples at different places some of whom are within the
boundaries of the nation-states and some without as in the case of many
environmental problems. There is some truth in Fredrick Jameson's observation
46
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that grand narratives merely go underground but they do not disappear
completely.
It may be objected, rightly so, that the differences - methodological, theoretical
and especially ideological, for example - are not trivial between positions
usually taken as we have already seen in this paper especially the universal/
particular debate about justice. But again, it can be argued that if the old
universalism and its baggage which many contemporary theorists, including
theorists of justice, are so critical of did not fulfill all promises, then perhaps it
is because it was not truly universal in the first place, some of the insistent
claims notwithstanding. For example, Bader (1995) argues that 'Historically, all
known forms of "liberal-democratic" or "republican universalism" up till now
are badly disguised versions of chauvinism' (p.232). For instance, these forms
did not include or at times even did not acknowledge the visions, hopes and
modes of thoughts of all peoples. It was flawed because it was built on some
wrong or distorted assumptions about all 'others', especially oppressive views
about the victims of history. It had a tendency to extend particular notions to
universal proportions and to insist that that particular was 'objective', 'neutral'
and 'impartial'. But what is more important is that this kind of new universalism
out of which a comprehensive and inclusive theory of justice will have a good
chance to emerge with new grand narratives will not be given; it will have to be
established through democratic deliberations and inclusive participation,
through a 'dialogue of visions'. In other words, these truly democratic narratives
will have to be established dialogically and discursively which may well mean a
radical revision, even inversion, of the old assumptions about self, society,
nature and particularly about the others of nature and society. This is one pre-
requisite, a crucial one, for a theory of justice, environmental or otherwise and
applicable at different levels. It is so, because after all is said and done,
sustainability, however defined, requires no less a definition of community than
one that includes humanity - all of it and all peoples - as its members. In a
discursively reached conception of justice the particular as well as the universal
is the planet itself.
The State, as it has developed from the European experience through the treaty
of Westphaplia in 1648 and onwards, along with all its monopolistic para-
phernalia of violence has historically 'sought to limit the scope of both sub-
national and transnational solidarities and identities' (Linklater 1990, p. 149).
Because of the fear of its internationalization, the idea of community has thus
remained limited to the boundary of the nation-state. As Linklater (1990) has
argued that 'states have sought a monopoly over the right to define political
identity, because 'their survival and their success have largely depended upon
it' (p. 149). If within this kind of framework moral and political inclusion
remains fixated with concern for human beings within state boundaries, it is
47
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almost impossible to imagine the inclusion of non-human species to make up a
'community' of life forms, a dominant concern of'ecological justice' (Low and
Gleeson 1998).
In the end we as human beings and as peoples are all responsible for what
happens to this planet. But since, as people, and groups of people, our
contributions, both historical and contemporary and both towards environmental
goods and bads, are not of the same order and kind, the corresponding
responsibilities especially for harms, must also not be the same and equal but
differentiated, justly differentiated if justice is to be done. The past of the
species was not shared responsibly and justly by all its members, but both
rationality and ethics demand that its future destiny, it there is to be one, a
sustainable one, must be shared responsibly.
48
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You can access a copy of this report at
http://www.atsdr.cdc.gov/mercurv/mercurv report.html#sec1
Children's Exposure to Elemental Mercury Title Page
CHILDREN'S EXPOSURE to ELEMENTAL MERCURY
A NATIONAL REVIEW of EXPOSURE EVENTS
The Agency for Toxic Substances and Disease Registry
Centers for Disease Control and Prevention
Mercury Workgroup
February 2009
Children's Exposure to Elemental Mercury:
A National Review of Exposure Events
Reported by: The Agency for Toxic Substances and Disease Registry and Centers for Disease Control and
Prevention Mercury Workgroup
Richard E. Besser, M.D.
February 2009
WORKGROUP MEMBERS
This report, titled "Children's Exposure to Elemental Mercury: A National Review of Exposure Events,"
was prepared by the Agency for Toxic Substances and Disease Registry (ATSDR) and the Centers for
Disease Control and Prevention (CDC). The members of the internally convened workgroup have
expertise in biomonitoring, environmental epidemiology, medicine, statistics, exposure investigation and
assessment, state-led initiatives, toxicology, and management of mercury contamination in the
environment.
1.1. Co-Chairs
Robin Lee, MPH - ATSDR/Division of Health Studies
Dan Middleton, MD, MPH - ATSDR/Division of Health Studies
1.2. Members
Kathleen L. Caldwell, PhD - CDC/Division of Laboratory Sciences
Steve Dearwent, PhD - ATSDR/Division of Health Studies
Steven Jones, MS - ATSDR/Division of Regional Operations
Brian Lewis - ATSDR/Division of Health Studies
Carolyn Monteilh, PhD - CDC/Division of Environmental Hazards and Health Effects
Mary Ellen Mortensen, MD, MS - CDC/Division of Laboratory Sciences
Richard A. Nickle, MPH - ATSDR/Division of Toxicology and Environmental Medicine
Kenneth Orloff, PhD - ATSDR/Division of Health Assessment and Consultation
Meghan Reger - ATSDR/Division of Health Studies
John F. Risher, MS, PhD - ATSDR/Division of Toxicology and Environmental Medicine
Helen S. Rogers, PhD - CDC/Division of Environmental Hazards and Health Effects
Michelle Watters, MD, PhD, MPH - ATSDR/Division of Regional Operations
A4 p.77
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p.8
The objectives of the workgroup were to:
1) identify the common sources of elemental mercury exposure in children; and
2) describe the location, demographics, and proportion of children exposed or
potentially exposed to elemental mercury in the United States.
p.10
4.6. Discussion and Conclusions
Review of the data sources and literature found three categories of exposure
scenarios. The first two categories are scenarios in the home and those at school, two
common locations for childhood elemental mercury exposures. The third category
includes exposures at other locations, such as medical clinics and property that was
not adequately remediated. The sources of exposure in the home include mercury-
containing devices, cultural or ceremonial uses of mercury, ...
p.12
5.2. Objectives
The objectives of the Mercury Workgroup were to:
1) identify the exposure sources associated with elemental mercury exposure in
children; and
2) describe the location, demographics, and proportion of children exposed or
potentially exposed to elemental mercury in the United States.
The Mercury Workgroup reported on elemental mercury exposures that typically
occur when children inhale mercury vapor related to:
• disposal or damage to mercury devices (e.g., thermometers or lightbulbs);
• off-gassing of mercury vapors from flooring materials;
• proximity to industrial sites or hazardous waste sites contaminated with
mercury;
• reuse of industrial property contaminated with mercury;
• residential contamination caused by religious or cultural practices; and
• release of mercury found in school science laboratories or health care
facilities.
p.13
Indoor mercury spills that are not properly cleaned up can release mercury vapors into the air
for weeks or even years [ATSDR 1999],
6.2. Toxicokinetics of Elemental Mercury
When human volunteers were exposed to mercury vapor, the estimated uptake rate through
the skin was approximately 2% of the uptake rate through the lungs [Hursh et al. 1989],
Even the small amount of mercury in a typical thermometer (0.5 to 3.0 g mercury or 0.04 to
A4 p.78
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0.22 ml mercury) can create hazardous conditions if spilled indoors and improperly cleaned
[Smart 1986; von Muhlendahl 1990],
p.14
Some Caribbean religions and folk healers use mercury for religious or ceremonial
purposes [Wendroff 2005], The ceremonial uses of mercury include applying it to the
skin, adding it to candles, or sprinkling it around the home. Elemental mercury is
easily dispersed into fine beads that sink into carpets, furniture, cracks in the floor, or
other porous materials (Figure la, lb). Mercury tracked from room to room produces
widespread contamination throughout the house. These practices can potentially
expose practitioners and their children. Following indoor spills, mercury can persist
for months and even years [Carpi and Chen 2001], Therefore ceremonial use of
mercury in the home could also expose future occupants and their children.
Occasionally, mercury contamination is so extensive that adequate cleaning is not
possible and the building must be demolished [Orloff et al. 1997],
In addition, school science laboratories may store elemental mercury and various types of
mercury-containing equipment, such as thermometers and barometers.
p.15
Mercury is also measurable in hair. However, these tests primarily measure organic
mercury [Aposhian et al. 1992; ATSDR 2001c; Cianciola et al. 1997; Kingman et al.
1998], and are not useful for assessing recent exposures to elemental mercury.
p.28
10.1. Exposure at Home
The sources of exposure in the home include ... cultural or ceremonial uses of mercury, ...
A mercury vapor absorbing filter system was used in the bedroom for 3 months to remove residual
mercury vapors.
p.29
Cultural or Ceremonial Uses. Some practitioners of certain Caribbean and Latin
American religions, such as Voodoo, Santeria, Palo, and Espiritismo, use mercury
ceremonially [EPA 2002; Johnson 1999; Newby et al. 2006; Wendroff 2005; Zayas
and Ozuah 1996], Ceremonial uses of mercury include applying it to the skin, adding
it to candles, or sprinkling it around the home. These practices can potentially expose
practitioners and their families. Because mercury contamination in the home can
persist for years, ceremonial use of mercury in the home could expose future
occupants and their children, contributing to health disparities in these populations.
Previous reports document the ceremonial use of mercury in neighborhoods whose
residents are largely Hispanic [JSI 2003; Ozuah et al. 2003; Rogers et al. 2008;
Rogers et al. 2007; Zayas and Ozuah 1996], The John Snow, Inc. Center for
Environmental Health Studies [2003] reported a survey of 898 persons, most of
whom had Latino or Caribbean backgrounds. In this survey, 344 of the 898 people
(38%) reported that they used or knew someone who used mercury for religious,
spiritual, or health purposes. Garetano et al. [2008] found that mercury vapor levels
were higher among residential common areas belonging to communities likely to use
A4 p.79
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mercury for cultural practices than control areas where cultural mercury use is
uncommon. However, all mercury vapor levels observed by Garetano et al. [2008]
were below the ATSDR minimum risk level for chronic inhalation of metallic
mercury [ATSDR 1999], An exposure assessment by Rogers et al. [2007] tested the
urine mercury levels of 306 children who lived in an area where elemental mercury
[p.30] was commonly sold for ritualistic use. Although no relationship between ritualistic
use and mercury exposure was evident, Rogers et al. [2007] concluded that potential
health hazards remain when mercury is readily available. In a similar study, urine
mercury levels were measured in 100 children that resided in an area where elemental
mercury was commonly sold for religious practices. Five percent of these children
had urine mercury levels above 5 |ig/L [Ozuah et al. 2003; Zayas and Ozuah 1996],
10.2. Exposure at School
The most common elemental mercury sources in schools are mercury stored in
science laboratories, mercury found in broken instruments, and mercury brought to
school from other locations.
p.31
10.3. Exposures in Other Locations
Prior Industrial Mercury Contamination. In most situations the reuse of industrial
property does not result in childhood mercury exposure.
p.33
11. LIMITATIONS
Concerns regarding personal responsibility for causing a spill or having to clean up a
spill may influence the quality and completeness of the information reported. Spills
in private residences may be under reported because the residents are unaware of the
health hazard and the need to report spills ... In addition, the published literature is
likely biased toward reporting worst-case scenarios, as opposed to the more typical
exposures that do not cause symptoms or attract attention.
Case reports from the literature provide more information about risk factors, exposure
scenarios, and associated health outcomes. The specifics relate to the individual cases
and are not representative of all exposure scenarios.
p. 34
12. DISCUSSION
p.35
12.2. Describing the Location, Demographics, and Proportion of Children Affected
Neither urine nor blood mercury levels correlate well with the presence or severity of
symptoms [Cherry et al. 2002; Gattineni et al. 2007; Tominack et al. 2002],
Although the extent of mercury use in the home for religious purposes is not well
characterized, such use may lead to chronic mercury exposure among those who use
it in this manner and for subsequent occupants of the contaminated homes. Some
A4 p.80
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evidence suggests that attempting to ban mercury could drive its use and sales
underground, making the risks of using mercury and the benefits of mercury-free
alternatives difficult for local health officials to communicate [Riley et al. 2001],
The individuals affected are most likely to be members of minority populations,
raising concerns about environmental injustice in these communities.
13. CONCLUSIONS
p.36
Although credibly estimating the frequency of elemental mercury exposures among
children in the United States is not possible, such exposures are occurring. These
incidents typically result from the misuse of mercury-containing equipment or a lack
of knowledge regarding the hazard.
Initiatives that affect the number of children exposed have focused on reducing or
removing mercury from consumer products, eliminating mercury from school science
laboratories, and educating the public and school officials about its toxicity.
p.37
14. REFERENCES
[ATSDR] Agency for Toxic Substances and Disease Registry. 1999. Toxicological
profile for mercury. Available from: http://www.atsdr.cdc.gov/toxprofiles/tp46.pdf
[accessed 3 December 2007],
p.39
[EPA] U.S. Environmental Protection Agency. 2002. Task force on ritualistic uses of
mercury report. Available from:
http://www.epa.gov/superfund/community/pdfs/mercury.pdf [accessed 26 June 2008],
Garetano G, Stern AH, Robson M, Gochfeld M. 2008. Mercury vapor in residential
building common areas in communities where mercury is used for cultural purposes
versus a reference community. Sci Total Environ 397(1-3): 131-139.
p.40
Johnson C. 1999. Elemental mercury use in religious and ritualistic practices in Latin
American and Caribbean communities in New York. Popul Environ 20(5):443-453.
[JSI] John Snow Inc. 2003. Ritual use of mercury (azogue) assessment and education
project. Available from:
http://www.jsi.com/Managed/Docs/Publications/EnviroHealth/MercuryAssessment_Repo
rt.pdf [accessed 11 February 2008],
p.41
Newby AC, Riley DM, Leal-Almeraz TO. 2006. Mercury use and exposure among
Santeria practitioners: Religious versus folk practice in northern New Jersey, USA. Ethn
Health ll(3):287-306.
A4 p.81
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Ozuah PO, Lesser MS, Woods JS, Choi H, Markowitz M. 2003. Mercury exposure in an
urban pediatric population. Ambul Pediatr 3(l):24-26.
p. 42
Riley DM, Newby CA, Leal-Almeraz TO, Thomas VM. 2001. Assessing elemental
mercury vapor exposure from cultural and religious practices. Environ Health Perspect
109(8):779-784.
Rogers HS, Jeffery N, Kieszak S, Fritz P, Spliethoff H, Palmer CD, et al. 2008. Mercury
exposure in young children living in New York City. J Urban Health 85(1):39—51.
Rogers HS, McCullough J, Kieszak S, Caldwell KL, Jones RL, Rubin C. 2007. Exposure
assessment of young children living in Chicago communities with historic reports of
ritualistic use of mercury. Clin Toxicol (Phila) 45(3):240-247.
p.43
Wendroff AP. 2005. Magico-religious mercury use in Caribbean and Latino
Communities: Pollution, persistence, and politics. Environ Pract 7:87-96.
Zayas LH, Ozuah PO. 1996. Mercury use in Espiritismo: A survey of botanicas. Am J
Public Health 86(1): 111-112.
A4 p.82
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[Verbatim excerpts relating to magico-religious mercury use.]
"There is an urgent need to obtain information on the levels of exposure from these practices to
determine if children or adults are at risk. Mercury vapor concentrations may be much higher after use
during the winter months when the heat is turned on and the windows are closed, so data that reflect a
variety of possible exposure scenarios are also needed." p. 480
TOXICOLOGICAL PROFILE FOR MERCURY
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Health Service
Agency for Toxic Substances and Disease Registry
March 1999
p.7
Some religions have practices that may include the use of metallic mercury. Examples of these
religions include Santeria (a Cuban-based religion whose followers worship both African deities and
Catholic saints), Voodoo (a Haitian-based set of beliefs and rituals), Palo Mayombe (a secret
form of ancestor worship practiced mainly in the Caribbean), and Espiritismo (a spiritual belief
system native to Puerto Rico). Not all people who observe these religions use mercury, but when
mercury is used in religious, ethnic, or ritualistic practices, exposure to mercury may occur both at
the time of the practice and afterwards from contaminated indoor air. Metallic mercury is sold
under the name "azogue" (pronounced ah-SEW-gay) in stores called "botanicas." Botanicas are
common in Hispanic and Haitian communities, where azogue may be sold as an herbal remedy or
for spiritual practices. The metallic mercury is often sold in capsules or in glass containers. It
may be placed in a sealed pouch to be worn on a necklace or in a pocket, or it may be sprinkled in
the home or car. Some people may mix azogue in bath water or perfume, or place azogue in
devotional candles. Because metallic mercury evaporates into the air, these practices may put
anyone breathing the air in the room at risk of exposure to mercury. The longer people breathe the
contaminated air, the greater their risk will be. The use of metallic mercury in a home or an
apartment not only threatens the health of the people who live there now, but also threatens the
health of future residents who may unknowingly be exposed to further release of mercury vapors
from contaminated floors or walls.
p. 20
If you use metallic mercury or azogue in religious practices, you may expose your children or
unborn child to mercury or contaminate your home. Such practices in which mercury containing
substances have traditionally been used include Santeria (a Cuban-based religion whose followers
worship both African deities and Catholic saints), Voodoo (a Haitian-based set of beliefs and
rituals), Palo Mayombe (a secret form of ancestor worship practiced mainly in the Caribbean), or
Espiritismo (a spiritual belief system native to Puerto Rico).
A4 p.83
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p. 227
Some religions have practices that may include the use of metallic mercury. Examples of these religions
include Santeria (a Cuban-based religion that worships both African deities and Catholic saints), Voodoo
(a Haitian-based set of beliefs and rituals), Palo Mayombe (a secret form of ancestor worship practiced
mainly in the Caribbean), and Espiritismo (a spiritual belief system native to Puerto Rico). Not all people
who observe these religions use mercury, but when mercury is used in religious, folk, or ritualistic
practices, exposure to mercury may occur both at the time of the practice and afterwards from breathing in
contaminated indoor air. Metallic mercury is sold under the name "azogue" (pronounced ah-SEW-gay) in
stores called "botanicas." Botanicas are common in Hispanic and Haitian communities, where azogue
maybe sold as an herbal remedy or for spiritual practices. The metallic mercury is often sold in capsules
or in glass containers. It may be placed in a sealed pouch to be worn on a necklace or carried in a pocket,
or it may be sprinkled in the home or car. Some store owners may also suggest mixing azogue in bath
water or perfume, and some people place azogue in devotional candles. The use of metallic mercury in a
home or apartment not only threatens the health of the current residents, but also poses health risks to
future residents, who may unknowingly be exposed to further release of mercury vapors from
contaminated floors, carpeting, or walls.
p. 378
In addition, unknown quantities of metallic mercury used in religious or ethnic ceremonies, rituals, and
practices (see Sections 5.4.4, 5.6, and 5.7) may reach municipal landfill sites by being improperly
disposed of in domestic garbage, or may reach POTWs by being improperly discarded into domestic
toilets or sink drains (Johnson [in press]). A survey was conducted to determine the use patterns of
elemental mercury in the Latin American and Caribbean communities in New York City (Johnson [in
press]). In a survey of 203 adults, about 54% used elemental mercury in various religious and ethnic
practices. Of these users, 64% disposed of the mercury in household garbage, 27% flushed the mercury
down the toilet, and 9% disposed of the mercury outdoors. It is commonly thought that the high mercury
load found in sewage and garbage in New York City comes from dental clinics; however, improper
disposal of mercury by religious practitioners in the Latin American and Caribbean communities may also
contribute to this load (Johnson [in press]).
p. 429
Metallic mercury has been used by Mexican American and Asian populations in traditional remedies for
chronic stomach disorders (Espinoza et al. 1995; 1996; Geffner and Sandler 1980; Trotter 1985). Most
recently, Perharic et al. (1994) reported cases of poisonings resulting from exposure to traditional
remedies and food supplements reported to the National Poisons Unit in London, England. From 1989 to
1991,elemental mercury was implicated in several poisonings following exposure to traditional Asian
medicines. In one case, the mercury concentration in the medicinal product taken orally was 540 mg/g
(540,000 ppm). The mercury was in its elemental or metallic form. Espinoza et al. (1995, 1996) reported
that while examining imported Chinese herbal balls for the presence of products from endangered species,
the authors detected potentially toxic levels of arsenic and mercury in certain herbal ball preparations.
Herbal balls are aromatic, malleable, earth-toned, roughly spherical, hand-rolled mixtures primarily
composed of herbs and honey that are used to make medicinal teas. These herbal balls are used as a self-
medication for a wide variety of conditions, including fever, rheumatism, apoplexy, and cataracts. Herbal
balls similar to those analyzed are readily available in specialty markets throughout the United States.
Mercury (probably mercury sulfide) was detected in 8 of the 9 herbal balls tested. The recommended
adult dose for the herbal balls is two per day. Ingesting two herbal balls could theoretically provide a dose
of up to 1,200 mg of mercury.
A4 p.84
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p. 430
Religious and Ethnic Rituals, Ceremonies, and Practices. While some of medicinal and
pharmaceutical uses of mercury compounds have been replaced in recent years, individuals in some
ethnic or religious groups may still use mercury in various religious or ethnic rituals, practices, and
ceremonies that can expose them to elevated mercury concentrations in room air. Metallic mercury has
been used in Latin American and Caribbean communities as part of certain religious practices (e.g.,
Voodoo, Santeria, and Espiritismo), predominantly in domestic settings (Wendroff 1990). This use of
mercury can contaminate a dwelling or automobile if the mercury is not completely removed from
flooring, carpeting, and woodwork in an appropriate manner. Metallic mercury (sometimes under the
name azogue) currently is sold in shops called botanicas which stock medicinal plants, traditional
medicines, incense, candles, and perfumes. Botanicas typically dispense mercury in gelatin capsules or
sometimes in small glass vials. Some religious practices involve sprinkling metallic mercury on the floor
of the dwelling or of a car, mixing metallic mercury with soap and water to wash the floor, or placing it in
an open container to rid the house of evil spirits. Other practices involve carrying a small amount of
mercury in a vial on the person, or mixing mercury in bath water or perfumed soaps, devotional candles,
ammonia or camphor. Any of these practices can liberate mercury vapor into the room air, exposing the
occupants to elevated levels of mercury vapors (ATSDR 1997; Wendroff 1990, 1991). In addition to the
individuals that intentionally use mercury in their dwellings, the opportunity exists for nonusers to be
inadvertently exposed when they visit the dwelling, or purchase or rent dwellings in which the former
tenants used mercury for religious purposes. The issuance of cautionary notices and information by health
departments to members of these user populations is appropriate.
p. 457
Children can be exposed to various forms of mercury in a variety of ways, including playing with
unsecured elemental mercury, inhalation of mercury vapors via the religious or ethnic practices of their
parents or unintentional spills of elemental mercury, oral ingestion of herbal or ethnic remedies or
mercury-containing consumer products, ...
p. 459
Children may be exposed to mercury vapors when they play with metallic mercury. Metallic mercury is a
heavy, shiny, silver liquid and when spilled, forms little balls or beads which fascinate children. ...
Metallic mercury is traditionally used in some religious rituals or remedies, including religions such as
Santeria (a Cuban-based religion that worships both African deities and Catholic saints), voodoo (a
Haitian based set of beliefs and secret rites), Palo Mayombe (a secret form of ancestor worship practiced
mainly in the Caribbean), or Espiritismo (a spiritual belief system native to Puerto Rico) (Wendroff
1990). If these rituals or spiritual remedies containing mercury are used in the home, children may be
exposed and the house may be contaminated with mercury (ATSDR 1997; Johnson [in press]; Wendroff
1990, 1991; Zayas and Ozuah 1996). Metallic mercury is sold under the name "azogue" (pronounced ah-
SEW-gay) in stores (sometimes called botanicas) which specialize in religious items and ethnic remedies
(Johnson [in press]; Wendroff 1990; Zayas and Ozuah 1996). Azogue may be recommended by family
members, spiritualists, card readers, and santeros. Typically, azogue is carried on one's person in a sealed
pouch, or it is ritually sprinkled in the home or car. Some store owners suggest mixing azogue in bath
water or perfume. Some people place azogue in devotional candles. Because metallic mercury evaporates
into the air, there is a potential health risk from exposure to mercury vapors in a room where the mercury
is sprinkled or spilled onto the floor, put in candles, or where open containers of metallic mercury are
present (ATSDR 1997; Wendroff 1990, 1991). Young children spend a lot of time crawling on the floor
A4 p.85
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and carpeting, so they maybe subject to a higher risk of exposure, especially when mercury is sprinkled
on the floors or carpets. Very small amounts of metallic mercury (i.e., a few drops) may raise air
concentrations of mercury to levels that could be harmful to health (ATSDR 1997). Metallic mercury and
its vapors are extremely difficult to remove from clothes, furniture, carpet, floors, walls, and other such
items. The mercury contamination can remain for months or years, and may pose a significant health risk
for people continually exposed (ATSDR 1997; Johnson [in press]; Wendroff 1990, 1991).
p. 473
Individuals Exposed to Consumer Products and Medicinal Products Containing Mercury.
Individual who use various consumer products containing mercury (i.e., medicinal herbal remedies, skin
lightening creams and soaps, laxatives, tattoo dyes, fingerpaints, and make-up paints) are also exposed to
higher mercury levels than the general population (Barr et al. 1973; Dyall-Smith and Scurry 1990;
Espinoza et al. 1995; Geffner and Sandler 1980; Lauwerys et al. 1987; Rastogi 1992; Wendroff 1990).
Metallic mercury has been used by Mexican American and Asian populations in traditional remedies for a
variety of medical conditions, including chronic stomach disorders. Several papers have been published
related to the use of metallic mercury as a folk remedy (ATSDR 1992, 1997; Department of Health 1997;
Geffner and Sandler 1980; Hartman 1995; Johnson [in press]; Trotter 1985; Wendroff 1990, 1991; Zayas
and Ozuah 1996). Some Mexican-Americans believe that disorders of the alimentary tract may be caused
by a bolus of food adhering to the stomach wall, a condition known as empacho. Geffner and Sandler
(1980) reported cases of two young patients with acute gastroenteritis who received traditional remedies
of oral administration of metallic mercury, presumably to dislodge the bolus. Both patients were
successfully treated and released from the hospital after 2 and 10 days of treatment, respectively. Trotter
(1985) reported that metallic mercury known as azogue is in common use in New Mexico and the
bordering areas for treating this gastrointestinal condition, empacho.
p. 474
Individuals that Use Mercury in Religious Ceremonies and/or Ethnic Practices or Live in
Dwellings where Intentional or Unintentional Elemental Mercury Spills have Occurred.
Metallic mercury has been used in Latin American and Caribbean communities as part of certain religious
practices (e.g., Voodoo, Santeria, and Espiritismo) predominantly in domestic settings (Wendroff 1990).
Metallic mercury is sold in shops called botanicas (sometimes under the name azogue) which stock
medicinal plants, magical medicines, incense, candles, and perfumes. Botanicas typically dispense
mercury in gelatin capsules or, sometimes, in small glass vials. Some practices involve sprinkling metallic
mercury on the floor of the dwelling or of a car, mixing elemental mercury with soap and water to wash
the floor, or placing it in an open container to rid the house of evil spirits. Other practices involve carrying
a small amount of mercury in a vial on the person or mixing mercury in bath water or perfumed soaps,
devotional candles, ammonia, or camphor. Any of these practices can liberate mercury vapor into the
room air exposing the occupants to unnecessarily elevated levels of mercury vapors (ATSDR 1997;
Wendroff 1990, 1991). The issuance of cautionary notices by health departments to members of these
user populations may be appropriate. While some medicinal and pharmaceutical uses of mercury
compounds have been replaced in recent years, individuals in some religious and ethnic groups may still
use mercury in various rituals. This use of mercury can contaminate the dwelling if the mercury is not
removed from flooring, carpeting, and woodwork in an appropriate manner.
A4 p.86
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p. 480
A unique exposure pathway that has received little research attention is the exposure to children from
religious and ethnic uses in homes and cars or in remedies containing metallic mercury (ATSDR 1997;
Johnson [in press]; Wendroff 1990, 1991). In some religious practices of Latin American or Caribbean
origin, there are traditional rituals or remedies that involve mercury. These include intentional sprinkling
of liquid elemental mercury on the floor, burning candles made with mercury, using mercury in baths,
adding it to perfume, or wearing small containers of mercury around the neck for good luck. There is an
urgent need to obtain information on the levels of exposure from these practices to determine if
children or adults are at risk. Mercury vapor concentrations may be much higher after use during the
winter months when the heat is turned on and the windows are closed, so data that reflect a variety of
possible exposure scenarios are also needed.
A4 p.87
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IN THE UNITED STATES DISTRICT COURT
FOR THE NORTHERN DISTRICT OF CALIFORNIA
SAN FRANCISCO DIVISION
FOOD & WATER WATCH, INC., etal.,
Plaintiffs,
v.
ENVIRONMENTAL PROTECTION
AGENCY, etal.,
Defendants.
I, AUDREY ADAMS, declare as follows:
1. I am over the age of eighteen years and am competent to make this declaration. All the
facts stated herein are within my personal knowledge.
2. I am the legal guardian and primary caretaker of my son, Kyle, age 33, who lives with me
and my husband at our home in Renton, which is located in King County, Washington. The
water has been fluoridated here ever since my husband and I purchased our house in 1978.
3. Kyle is severely hypersensitive to fluoride. I did not realize this for the first 14 years of
Kyle's life, nor did I know of his countless other chemical sensitivities. We've traveled a long
Case No. 17-cv-02162-EMC
DECLARATION OF AUDREY ADAMS
A4 p.88
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and painful road together, his pain physical (and profound), my pain emotional (when I can't stop
his suffering).
4. In 1999, when Kyle was 13 and 14 years old, he was in pain constantly, particularly in his
extremities (hands, feet, lips, and tongue) and back of his head. Kyle's pain had increased
considerably in the aftermath of a horrific reaction to a doctor prescribed "over the counter"
(OTC) treatment that is completely benign to most people. After this reaction, Kyle developed
incapacitating pain in his fingers that forced him to stop playing his beloved cello in the school
orchestra. His school sent him home repeatedly with horrific headaches during this time, and he
would scream and race around the house as if pursued by killer bees. At night the house shook
with Kyle's leg-pounding that was more like a grand mal seizure than "restless leg."
5. We went to numerous medical specialists during this time and not one of them could
diagnose the source of Kyle's pain, let alone help relieve it. We tried using Tylenol, but this
always seemed to result in a migraine the next day; other pain-relievers were ineffective.
6. During this time, I began experimenting with removing chemicals from Kyle's food and
environment. Among other things, I changed Kyle's diet to organically grown food, stopped
using chemical cleaners or scented products, and got Kyle's school to cooperate with providing
him a low-chemical environment. These changes improved Kyle's symptoms, but he still
manifested symptoms of intense pain each day and continued to report pain in the back of his
head, though less often and less severe.
7. In or about May 2000, a mom from Beaverton, Oregon, with two autistic teenagers of her
own, recommended that I stop Kyle's exposure to fluoridated water. Since Kyle's only beverage
was tap water and because I was willing to try anything that could help relieve Kyle's pain, I
followed her recommendation. Within three days of drinking filtered, fluoride-free water, Kyle
experienced a substantial improvement in his symptoms, including the pain he had been
A4 p.89
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suffering in his extremities. After eliminating fluoridated drinking water, Kyle was able to
resume playing cello in the school orchestra, and his remaining high school and transition school
years were more successful and productive than they otherwise would have been.
8. Having observed first-hand the dramatic improvement that Kyle experienced after we
eliminated fluoridated drinking water, I have gone to great lengths to ensure that he is never
again exposed to fluoridated drinking water. I consider this of paramount importance to
protecting Kyle.
9. In April 2007, after 7 years of hauling thousands of gallons of reverse osmosis and spring
water to my home for drinking and cooking, Kyle's improved quality of life enabled him to work
a part-time office job at Highline Community College, where he continues to work to the present
day, scanning and archiving documents to a computer. I am convinced that this would not have
been possible if we had not eliminated fluoridated drinking water.
10. To be clear, Kyle was not (and is not) free of all pain. Indeed, Kyle still regularly
experiences pain when he is exposed to a variety of chemical and food triggers; such as
chemicals, pesticides and toxins that are hidden in food; airborne fumes, such as auto exhaust or
perfumes; and certain allergic foods; as well as for reasons I cannot always identify. Kyle also
experienced pain as the result of Lyme Disease (diagnosed in 2007 but now resolved), as well as
gut dysbiosis and acute infections, including ear infections. But, by providing Kyle with fluoride-
free water, the severity, frequency and consistency of his pain was notably reduced. This allowed
me, in turn, to better detect other triggers of Kyle's symptoms.
11. In or about 2008/2009, I discovered that one of the triggers of Kyle's symptoms was
another source of fluoride that I did not previously appreciate: skin contact to fluoridated water
in the shower. The discovery was prompted after Kyle began experiencing regular morning
headaches. Each morning he woke up without a headache, but a headache would inevitably seem
A4 p.90
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to set in prior to leaving for work or starting his day. We had multiple conversations with his
doctor about it, and over several months, we investigated various possible causes, such as
possible mold or toxins in his bedroom, and experimented with his already organic, highly
specialized breakfast.
12. Prior to, and during the time when Kyle developed the morning headaches, I was not
filtering fluoride out of Kyle's shower water, as I did not believe at that time that skin contact to
fluoride could pose a problem. I did have a carbon filter on the shower to prevent chlorine
fumes, but this filter did not remove fluoride.
13. After hearing of Kyle's headaches, a mother of a child with autism from Snoqualmie,
WA persuaded me to limit Kyle's exposure to fluoridated water in the shower. The next day after
this conversation I had Kyle skip his morning shower and the morning headache that had become
a routine did not develop. That evening, I had Kyle shower before bed, and the headache
returned. Based on this initial "shower trial," I heated bottled water on the stove for Kyle to
sponge bathe over the course of the next week. There were no morning headaches at all during
this week.
14. These "trials," which included several more tests of the shower water (each of which
were followed by headaches), convinced me that Kyle was sensitive to fluoride in shower water.
For the next 8 to 10 months, therefore, I continued to heat bottled spring water on the stove for
sponge bathing, intermittently experimenting on ways to limit Kyle's exposure to fluoridated
water during showers. After many failed attempts with various filtering products, I finally
purchased a filter that removed enough fluoride to avoid Kyle's headaches if I do all of the
following four things: (1) Set a timer and limit the shower to 4 minutes; (2) Use warm water, not
hot; (3) Keep water pressure at the lowest possible, about I gal/min, for maximum filtration
contact; and (4) Change the filter at 3 months, not 6 as the manufacturer suggests..
A4 p.91
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15. Kyle has camped with our family in state and national parks for all of his 33 years,
usually 25 or more nights per year, showering daily in those campgrounds. After I became aware
of Kyle's pain from fluoridated water, I'd call ahead and ask about the fluoridation status. Based
on my experience, campgrounds almost never have water with added fluoride, but they do have
chlorine. Kyle does not get headaches when showering at campgrounds or when we visit
relatives near Portland (an area with no fluoridation). Likewise, when we stay at motels in areas
with chlorinated, but not fluoridated, water, Kyle does not report head pain and does not
demonstrate symptoms of headaches following a shower.
16. On one family camping trip, I wrongly assumed that the campground we visited did not
use fluoridated water. I let Kyle take a shower at the campground, assuming it was safe. To my
horror, he had a very painful reaction to the shower; with the manifestations of the pain lasting
over a day—which is longer than the pain used to last. I asked the park ranger about the water
and he informed me that the campground used fluoridated municipal water. This experience left
me concerned that Kyle's sensitivity to fluoride has increased over time.
17. Based on Kyle's longstanding sensitivity to fluoride, his two current treating doctors (Dr.
Charles Butler and Dr. Nooshin Darvish) have both advised that he continue refraining from
exposure to fluoridated water, and other forms of fluoride ingestion. (Exhibits A, B, C, D, E).
Consistent with this, the Washington State Department of Health & Human Services, in its
annual care needs assessments of Kyle, called Person Centered Service Plans (PCSP), has
recognized the need to limit Kyle's exposure to fluoride, including fluoridated water. (Exhibit
F).
18. Ever since 2000, I have incurred whatever financial expense is necessary to protect Kyle
from the fluoridation chemicals contained in the tap water in our home; and most other
communities in King County, including the nearby cities where he works, attends medical
A4 p.92
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appointments and recreates in Special Olympics sports and other recreational activities with the
Renton Parks Department. He cannot leave the house without carrying an adequate supply of
fluoride-free water in his backpack. When we travel we must pack multiple gallons of fluoride-
free water and buy spring water at grocery stores during our trip. I will continue incurring these
expenses so long as fluoridation chemicals pose a risk to Kyle.
19. A small fraction of the financial costs I have incurred purchasing fluoride-free spring
water, and filtering fluoride from our home water, are reflected in the documents included in
Exhibit G.
20. The cost of my time and extraordinary inconvenience providing safe, fluoride-free water
for Kyle's drinking, cooking and bathing needs is incalculable.
21. Far more important to me than the financial costs and physical burden associated with
avoiding fluoridated water is the painful reactions Kyle experiences when exposed to fluoridated
water and other sources of fluoride ingestion. As Kyle's legal guardian and primary caregiver, it
causes me profound distress to see my son suffer, and I will continue to do whatever I can to
keep him out of harm's way.
22. I am concerned that the presence of fluoride in the tap water of nearly every community
in King County will jeopardize Kyle's future home care placement options. With the help of
Kyle's case manager, we are targeting a move in the next 2-3 years out of my home to a state
residential placement. However, the type of living arrangements available to Kyle are limited
because the Adult Family Homes that Kyle currently qualifies for are paid a flat rate and are not
paid extra to provide fluoride-free water for drinking, cooking and bathing. Moreover, the Adult
Family Homes do not have any allowances for special filtration equipment. Further, all
caregivers in any future living arrangement will have to become fluoride-avoidance experts—an
extreme expectation when that means tap water avoidance—and will expect to be paid for the
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complex fluoride-removal tasks that I currently do. Obtaining the state funding for such a high
level of care, which is exacerbated by wide-spread water fluoridation in our area, is very
challenging.
23. I am a supporting member of the Food and Water Watch, Fluoride Action Network, and
Moms Against Fluoridation. Examples of my membership contributions are attached as Exhibit
H.
I declare under penalty of perjury, under the laws of the United States of America, that the
foregoing is true and correct. Executed this day of , 2018 in Renton,
Washington.
AUDREY ADAMS
A4 p.94
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Thank you for allowing me to speak with you about the environmental injustice of water
fluoridation.
I'm Audrey Adams, in Renton, Washington. I am one of 8 plaintiffs suing the EPA to ban
fluoridation on behalf of my son, Kyle, who has autism and severe chemical sensitivities.
I discovered fluoride's harm to Kyle when he was 14—he is now 36. He suffered profound pain
that resulted in wild, erratic behaviors. His chronic headaches affected both home and school.
I had already put him on an organic diet, then a mom of a child with autism suggested I try
eliminating fluoridated water.
Switching to fluoride-free water, Kyle's pain diminished in 3 days. The screaming, jumping and
wild racing was no longer the norm. With the pain of fluoride gone, I could identify other toxins
he reacted to.
By his early 20's, Kyle's ability to detoxify decreased and his reactivity to chemicals increased.
The severe headaches had gradually returned, mostly following his morning shower.
Then another "autism mom" told me about her terrible reactions to bathing in fluoridated
water and her son's pain, too. I hadn't even thought of skin exposure! We had a filter on the
shower that removed chlorine, but not fluoride. When I switched Kyle's shower to the evening,
screaming headaches followed.
After installing a shower filter that removed most of the fluoride, his pain vastly diminished.
Kyle's sensitivity to fluoride is well documented by State DDD, his two doctors and his dentist.
A 2019 study reports 60% of those with autism are hyper-sensitive to chemicals. It is an
unconscionable injustice to put a toxic chemical in public water, drugging everyone, without
consent, regardless of medical differences. Most families coping with autism never discover
that their child's pain is in the water. It took me 14 years and didn't fully understand for
another 9, while Kyle suffered terribly.
The CDC says 1 in 44 kids have autism. More than half of those have chemical sensitivities.
Fluoride is a presumed developmental neurotoxin, according to the National Toxicology
Program: 74 studies, including 11 at amounts in fluoridated water, show lower IQ and higher
rates of ADHD. How does a mom without a car carry her baby, food, plus gallons of bottled
water on a bus?
Fluoride's toxicity, gram for gram, sits between lead and arsenic. Those most harmed by
fluoridation are low-income families trying to avoid fluoride for their babies or those with
children with autism.
Fluoridation is more than an injustice—it's an environmental crime against the most vulnerable.
Thank you very much.
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TO: Members of the White House Environmental Justice Advisory Council
RE: Comments in Docket No. EPA-HQ-OA-2022-0050
DATE: March 10, 2022
Without proper remediation, the land devastated by the Black Mesa and Kayenta mines may
never fully recover. On that point, we believe OSMRE has been negligent in duties to hold
Peabody accountable for the damage they have done to our land and our people.
- Navajo Nation President Jonathan Nez and Vice President Myron Lmei
Letter to the House Subcommittee on Energy and Mineral Resources
June 29, 2021
I believe that the regulators have never really sought form the people themselves what
troubles them most. ... We live in fear that we are going to be left with no water, coal dust, mo
improved roads and the health problem we have suffered under all these years.
- The Honorable Herb Yazzie, Former ChiefJustice of the Navajo Supreme Court
January 2021
OSMRE can demonstrate its respect for the people of Black Mesa and the Hopi Tribe, and
ensure that the Hopi Tribe and others will have a fair opportunity to participate in the key
decisions that will impact our land and water resources long after Peabody is gone, by
designating Kayenta "s closure as a significant permit revision. We believe that after 50 years
of sacrifice, we are entitled to that respect.
- Former Hopi Tribal Chairmen Vernon Mosa^esva and Benjamin Numtma
Letter to OSMRE
June 10, 2020
Dear Members of the White House Environmental Justice Advisory Council (WHEJAC),
We are writing collectively to bring your attention to important environmental justice issues related to
federal oversight of coal mine reclamation activities on Black Mesa in northern Arizona, our home.
The two mines in question. Black Mesa and Kayenta - which are operated by Peabody Western Coal
Company, a subsidiary of Peabody Energy - encompass nearly 65,000 acres, spanning a hundred
square miles of both the Navajo and Hopi tribal nations, a land area bigger than the city and county of
Denver, Colorado.
After nearly a half century in operation, both mines are now closed, yet none of the lands and waters
mined by Peabody have been permanently reclaimed to a pre-tnine condition and there is currently no
timetable or meaningful plan for achieving this legal requirement. The federal Office of Surface
Mining, Reclamation and Enforcement (OSMRE) is responsible for overseeing mine cleanup at both
sites, but so far, the agency has not lived up to trust obligations owed to our tribes and tribal
communities, nor the environmental justice obligations included in Executive Order 14008.
1
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In the context of the WHEJAC scorecard, the Biden Administration warrants a failing grade for its
failure to ensure that the basic tenets of environmental justice set forward by the President are carried
forward and achieved, and that our tribal lands and waters, exploited by decades of coal strip-mining
by Peabody, are given back to the Navajo and Hopi in a condition that fosters the return and prosperity
of the tribal communities that once lived there.
We request your assistance in ending ongoing injustice and in aiding our communities with the
creation of a process for reconciliation, transparency and meaningful public and community
involvement in the recovery and restoration of mined land and waters on our tribal homelands.
We have raised these issues at the federal level in numerous ways and for many years. In the past year
alone, we've written twice to Interior Secretary Deb Haaland, once in January 20211 prior to her
appointment and again this past September.2 We addressed coal mine reclamation issues in a
Congressional subcommittee hearing in June of 2021.3 And we have raised detailed concerns about the
progress and adequacy of mine cleanup with officials at OSMRE in dozens of conversations and
written comments.4
All to no avail. The concerns we've raised for years about reclamation remain unaddressed. Despite
the fact that Peabody permanently ceased coal production at the Black Mesa Mine in 2005 and
Kayenta Mine in August of 2019, OSMRE has never provided our Tribes and tribal communities the
opportunity to have a meaningful voice in planning the reclamation and timely return of lands and
waters to our people in their pre-mine condition.
Instead, OSMRE decisions that affect the return of our land and water are made in consultation with
Peabody behind closed doors. Impacted communities are left out of conversations and decisions that
greatly affect their futures. The reclamation work that is being done is inadequate. Significant and
possibly permanent damage to one of the primary sources of water for our people is dismissed,
explained away and even blamed on the very communities that depend on this resource, even though
their water use amounts to a fraction of what was consumed by Peabody's strip-mining for coal.
Decades of environmental injustice are ongoing and fostered by OSMRE's bureaucratic intransigence
and cozy relationship with Peabody, which OSMRE's Western Regional Office treats like a customer
or client instead of a regulated entity. We raise these issues again with you in the hope that the
WHEJAC will be able to bring our concerns directly to the attention of the President and decision-
makers who can correct decades of injustice and make the Biden Administration's commitment to
equity, fairness and environmental justice more than empty words. More specifically, we seek your
assistance on the issues of:
Aquifer damage
For nearly a half century, Peabody drained millions of gallons of water a day from the pristine
Navajo Aquifer, the main source of domestic water on Black Mesa. The depletion is well
documented, with the water table in many areas now 100 feet or more below its historic levels.
1 See Exhibit A
2 See Exhibit B
3 Testimony of Nicole Horseherder and Ben Nuvamsa, House Subcommittee on Energy and Mineral Resources,
oversight hearing on "Environmental Justice for Coal Country: Supporting Communities Through the Energy
Transition." June 15, 2021. https://naturalresources.house.aov/download/testimonv -ms-nicole-horseherder-
and-mr-ben-nuvamsa—emr-ov-hrq-081521pdf
4 See, for example, Exhibits C, D, E. F
2
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Seeps and springs that once nourished corn and other crops and supported livestock and wildlife
have dried up and disappeared, as have wells that provided water for Navajo and Hopi families
living on Black Mesa. Yet, OSMRE has ignored and covered up the damage done to the aquifer by
using models - developed by Peabody - that manipulate data to minimize the impacts of mining.
We have no confidence that the OSMRE can objectively lead an analysis on the hydrological
impacts of mining and what is needed to restore the aquifer or mitigate the damage. An
independent expert is needed to conduct the much-needed assessment of the cumulative hydrologic
impacts of Peabody's half-century of strip-mining on Black Mesa.
Permitting injustice
The operating permit for Kayenta Mine expired in July of 2020. The last major update of the
reclamation plan was in 1990, meaning that cleanup work is now proceeding under an expired
permit that is more than 30 years out of date. But in lieu of conducting a comprehensive
assessment of what is needed to return land and water to our Tribes properly, OSMRE for the past
three years has been consistently signing off on numerous requests by Peabody for "minor permit
revisions" that do not require public notice and that are by default approved behind closed doors.5
Their approval negates the ability of communities that are directly impacted by reclamation
activities to participate in decisions that affect their future. These "minor" revisions include non-
minor activities like altering the five-year reclamation schedule to allow delays that put
reclamation work years behind where it should be. Cumulatively, these changes add up to
significant alterations to how reclamation is being conducted. True environmental justice would
mean treating the closure of the mine as a "significant mine permit revision" and initiating a
comprehensive review of mine reclamation as part of the permit renewal process.
Inappropriate reclamation standards
The mine reclamation work that is being conducted is wholly inappropriate for the arid landscape
of Black Mesa. Navajo and Hopi families once lived in the areas that were mined, yet the
benchmark for the return of these lands to the Tribes is only that they support "grazing" as the final
end use, not people returning home. On top of that, the grazing standards are based on reseeding
and vegetation criteria that are appropriate for the humid Midwest not the arid Southwest, and that
were put in place by non-Indian bureaucrats without any consultation with local communities
possessing traditional cultural knowledge of the region's ecology. The main vegetative cover being
used in Peabody's reclamation, for example, is non-native grass. Additionally, there is nothing in
Peabody's reclamation plan for long-term monitoring. Once OSMRE signs off on releasing
Peabody from its reclamation obligations, there will be no recourse if the reclaimed lands
deteriorate - as they almost certainly will given the mismatch between what is being utilized for
reseeding and the local climate, not to mention the decimation of the aquifer that can support a
healthy habitat. Resources for long-term monitoring must be an essential part of any reclamation
plan revision.
Lack of transparency and consultation
We already have noted the lack of transparency in OSMRE's decision-making around minor
permit revisions, but the issue is much deeper and more systemic than that. As a general practice,
the agency makes it extremely difficult to obtain documentation, data, reports and communications
that are critical to understanding what is happening on our lands. As an example, OSMRE has a
Kayenta-Black Mesa Initiative web page that could easily serve as a clearinghouse for the
voluminous information on the two mines. However, the most recent documents posted on it are
5 See Exhibit H
3
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from 2014.6 Since then, Peabody has gone bankrupt twice, Kayenta Mine has permanently closed,
numerous permit revisions have been enacted, and Kayenta Mine's operating permit has expired.
Yet none of the relevant information on these significant developments is publicly accessible.
More recently, Peabody applied to OSMRE to have more than $25 million in reclamation bonds
released. Under the federal Surface Mining, Reclamation and Control Act (SMCRA), in-person
meetings are supposed to be held in the impacted communities to discuss the bond release
applications, and a request was made for just such a meeting last July,7 well within the statutory
window. Follow-up requests were made again in October8 and in January,9 yet OSMRE outright
denied our request, saying it was made out the regulatory timeframe.10 Instead, it chose to host a
two-hour virtual meeting, all but locking out participation by the community members most
directly impacted, many of whom lack internet access and even electricity. This decision was a
textbook example of the environmental injustice that President Biden and Secretary Haaland have
vowed to confront.
Our Tribes and communities across Black Mesa have been living with the social and environmental
impacts from Peabody's coal mining operations for a half century. We deserve a plan that
meaningfully addresses when our land and water will be returned to us, explains how Peabody will
reclaim our land and water to its pre-mining condition, and adequately analyzes how much it will cost
to do the necessary reclamation work so we can be confident that clean-up operations are adequately
bonded. We deserve a transparent and public process that will ensure the people who live on Black
Mesa and continue to be directly affected by the impacts of decades of coal mining can understand and
meaningfully participate in efforts to reclaim and restore our lands and water.
The Interior Department, which oversees the OSMRE, has set as a priority playing "a central role in
how the United States.. .increases environmental protections, pursues environmental justice and
honors our nation-to-nation relationship with Tribes11 The agency also touts that "the President
knows that the intersecting health, economic, racial justice and climate crises disproportionately
impact American Indians and Alaska Natives, which is why he has directed the entire federal
workforce to take a whole-of-government approach to supporting Indian Country." 12
It is past time to put such words into action, and we trust that as appointed members of the President's
Advisory Council, you understand how profoundly important it is not to repeat the pattern of broken
promises to American Indians that litter our nation's history. At a minimum, we respectfully request
that you communicate to the Council on Environmental Quality the major shortcomings by OSMRE in
carrying out the Administration's commitment to environmental justice.
Given that there already is a regulatory pathway under existing federal surface-mining laws to correct
these deficiencies, we respectfully request that you additionally recommend the Administration make a
determination, as required by law, that the permanent closure of Kayenta Mine constitutes a
"significant mine permit revision" under SMCRA, which in turn will create a comprehensive,
6 See https://www.wrcc.osmre.qov/initiatives/kaventaMineComplex.shtm
7 See Exhibit D
8 See Exhibit E
9 See Exhibit F
10 See Exhibit G
11 See www.doi.aov/ourDriorities
12 U.S. Department of the Interior blog. March 2, 2021. www.doi.qov/bloq/endurinq-partnership-interiors-
commitment-honorina-our-nation-nation-relationshiptribes
4
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transparent and inclusive process for reviewing and revising the current state of affairs related to Black
Mesa and Kayenta Mine cleanup.
However, answering the bell on environmental justice must encompass far more than just conducting
government-to-government conversations. Any action to correct the injustices currently plaguing mine
reclamation on Black Mesa must, without compromise, give impacted Navajo and Hopi community
members a seat at the table. The President recognized the importance of local voices on his first day in
office, declaring through Executive Order that in order "to redress inequities in their policies and
programs that serve as barriers to equal opportunity," agencies in his Administration "shall consult
with members of communities that have been historically underrepresented in the Federal
Government and underserved by, or subject to discrimination in, Federal policies and programs." 13
After more than 50 years of mining at Kayenta and Black Mesa, it is time to repair the land, restore the
Navajo Aquifer, which is vital for the continued prosperity of our Tribal communities, and return
mined land and waters to the people of Navajo and Hopi in their pre-mining condition. The
commitment made by the Biden Administration to environmental justice is encouraging but
incomplete. We are eager to work with any and all agencies to see that the promise of meaningful
engagement, cooperation and an honoring of relationships - what we Dine call Hozho and we Hopi
call Siimi 'na 'gnwa - is put into practice on Black Mesa.
Thank you for your attention to these important issues.
Benjamin H. Nuvamsa
Former Chairman of the Hopi Tribe
b en @,ld vain sti tute. com
928-380-6677
Robyn Jackson
Dine C.A.R.E.
robvn. j ackson @di n e~care. or g
505-862-4433
Nicole Horseherder
To Nizhoni Ani
nhorseherder@ email. com
928-675-1851
Vernon Masayesva
Black Mesa Trust
Former Chairman of the Hopi Tribe
kuuvi@aol.com
928-255-2356
Copy: U.S. Secretary of Interior Deb Haaland
Jonathon Nez, President of the Navajo Nation
Timothy L. Nuvangyaoma, Hopi Chairman
Steve Feldgus, Deputy Assistant Secretary for Land and Minerals Management, U.S.
Department of Interior
Glenda H. Owens, Deputy Director, Office of Surface Mining Reclamation and
Enforcement
13 See Executive Order On Advancing Racial Equity and Support for Underserved Communities Through the
Federal Government, signed Jan. 20, 2021. https://www.whitehouse.qoy/briefinq-room/presidential-
actions/2021/01/20/executive-order-advancinq-racial-equitv-and-support-for-underserved-communities-
throuqh-the-federal-qovernment/
5
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EXHIBIT 1,1ST
• Exhibit A ----- Letter to then-Interior Secretary-designee Deb Haaland and the Biden Transition
Team, Jan. 14, 2020.
Exhibit B --- Letter to Interior Secretary Deb Haaland, Sept. 22, 2021.
Exhibit C ----- Letter to OSMRE, June 10, 2020.
Exhibit D ----- Letter to OSMRE, July 9, 2021.
Exhibit E ----- Letter to OSMRE, Oct. 6, 2021.
Exhibit F ----- Boycott Letter to OSMRE, Jan. 27, 2022
Exhibit G ----- OSMRE Letter to Nicole Horseherder and Ben Nuvamsa, Jan. 25, 2022
Exhibit H ----- Letter to OSMRE, March 10, 2022
6
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Exhibit A
7
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To: DOI Secretary-designee Deb Haaland
David Hayes, incoming Special Advisor to the President on Climate Policy
Cecilia Martinez, incoming Senior Director for Environmental Justice, CEQ
To: DOI Transition Team
Kevin Washburn; Clara Pratte; Bob Anderson; Bret Birdsong; Janie Hipp;
Amanda Leiter
To: EPA Transition Team
Patrice Simms
Cc: The Honorable Raul Grijalva, Chairman, House Natural Resources Committee;
The Honorable Tom O'Halleran; The Honorable Mark Kelly; The Honorable Kyrsten
Sinema; The Honorable Martin Heinrich; The Honorable Ben Ray Lujan
From: Benjamin Nuvamsa, former Hopi Chairman; Nicole Horseherder, Executive Director, To
Nizhoni Ani; Carol Davis, Executive Director, Dine C.A.R.E.; Vernon Masayesva, former
Hopi Chairman and Executive Director, Black Mesa Trust; Herb Yazzie, former Chief
Justice of the Navajo Nation Supreme Court; Percy Deal, former Navajo County
Supervisor and former Navajo Nation Council Delegate
Date: Jan. 14, 2021
Re: Navajo and Hopi Community Leaders ask for an "all-of-government" approach led
by the Interior Department for the Reclamation, Restoration and Revitalization of
the Lands, Waters, and Communities Impacted by Coal Mining on Black Mesa
What is required for both cultures to survive and prosper is a deepened regard for the spirit of
laws and trust responsibilities In order to successfully guarantee protection of indigenous
peoples' spiritual concerns. Furthermore, beyond scrupulous legal attention to the letter of the
law, simple justice demands that those in power attend the way these words are understood by
their legal charges: those most affected by them.
- The Honorable Vernon Masayesva, Former Hopi Tribal Chairman and Executive Director of Black
Mesa Trust. From the essay January 2021
I believe that the regulators have never really sought from the people themselves what troubles
them most,... We live in fear that we are going to be left with no water, coal dust no
improved roads and the health problems we have suffered under all these years.
- The Honorable Herb Ymiie, Former Chief Justice of the Navajo Supreme Court, January 2021
President-elect Biden has made the issue of environmental justice, overlooked for far too long, a
centerpiece of his platform and a central tenet of his policies and practices aimed at
accelerating efforts to combat the climate crisis. We trust that the members of his transition
team tasked with building the programs that will put the President-elect's priorities into action,
you understand how profoundly meaningful this commitment to environmental justice is, and
how important it is for his administration to walk the talk. Highlights of the Transition Plan that
focus on environmental justice include:
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• Rooting out systemic racism in our laws, policies, and institutions;
• Using an inclusive, collaborative and empowering AII-of-Government approach;
• Making decisions that are driven by data and science;
• Targeting resources in a way that is consistent with prioritization of environmental
and climate justice, and;
• Assessing and addressing risks to communities from the next public health
emergency.
These priorities have particular and immediate relevance to the reclamation of now-closed coal
mines that sprawl across thousands of acres of Navajo and Hopi lands in northern Arizona. For
nearly a half century, our communities and people have borne the direct impacts of operations
at Black Mesa Mine and Kayenta Mine. Now that these mines are closed, we are calling on the
Biden administration to make them shining examples of how environmental justice policies can
be meaningfully enacted by making the cleanup of both mines a priority.
Reclamation on Black Mesa is a distinct endeavor because of tribal land status, the removal of
human remains and artifacts, and the sacrifices made by our people to provide Arizona with
cheap water and cities across the Southwest with cheap power. Five decades of coal mining
have left indelible marks on the Navajo and Hopi, scarring not only our land, but also our water
and cultural resources.
Now, after over half a century of mining, deteriorating economics have ended the era of coal on
Black Mesa. Navajo Generating Station (NGS) - for nearly five decades the largest coal-burning
power plant in the Western U.S. - shuttered its doors on November 18, 2019. Coal for the plant
was supplied by Peabody Western Coal Company (Peabody) from Kayenta Mine, which closed
on August 26, 2019. Prior to that, Mohave Generating Station shut its operations in December
2005, which forced the closure of Black Mesa Mine. At their peaks, about 12 million tons of coal
was mined annually from Black Mesa and Kayenta mines (4 million from the former to power
Mohave and about 8 million tons from the latter for NGS).
Considerable time has passed since the closure of both mines, yet neither the Office of Surface
Mining, Enforcement and Reclamation (OSMRE), nor Peabody have completed the steps to
fully and appropriately reclaim both mine sites as required by the site leases and the Surface
Mining, Reclamation and Control Act (SMCRA). Reclamation at Black Mesa Mine is still
incomplete 16 years after closure. And the massive scars from the most recent mining at
Kayenta still stretch across thousands of acres, with hardly any clean-up work done since it shut
down nearly a year and half ago.
Without a serious change in the status quo of federal oversight, the injustices and harm
endured by Navajo and Hopi will continue. Without intervention that alters the current
course of enforcement, the many families that were forced to move to make way for
mining will not be able to return to their ancestral homes. The water they need for
survival will not be available. And basic amenities that were lost when mining began will
remain inaccessible. Reclamation must mean more than what has already been done;
Peabody cannot be allowed to walk away from hundreds of residents without any basic
assistance for their survival as a community.
Wth President-Elect Biden's vision and Secretary Haaland's leadership, it is time for the
Department of the Interior to rectify these injustices by living up to its tribal trust responsibilities
and legal obligations by bringing together people from across all of its agencies (Bureau of
Reclamation; Bureau of Indian Affairs; Bureau of Land Management; Office of Surface Mining,
2
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Reclamation and Enforcement; and the National Park Service), along with the Indian Health
Service within the Department of Health and Human Services, the Environmental Protection
Agency and the Department of Energy to work cooperatively with community and tribal leaders.
This effort must hold Peabody and the utility owners of NGS accountable for the restoration of
Black Mesa Mine and Kayenta Mine lands and waters, to address the exploitative legacy of coal
mining, and to create a path to a sustainable and sustaining future for the land, water and
people that have been affected by decades of coal mining.
We, community leaders from both tribes, jointly request that the Department of the
Interior lead an all-of-government approach to support robust reclamation, restoration
and revitalization of the lands and waters of Black Mesa that have been scraped, drilled,
dug up and dewatered in the name of coal that for decades powered far away western
cities and pumped the water that has allowed Arizona to thrive for the past half century.
In the past, the Department of the Interior, Department of Energy, and Environmental Protection
Agency, in a joint statement signed bv the secretaries and administrator (Exhibit A), committed
to working together to address the impacts of NGS and the mines on tribal communities. It is
time to pull together again in a renewed and cooperative all-of-government approach.
Actions Needed
Consistent with President Clinton's November 6, 2000 Executive (3rd ultation
and Coordination With Indian Tribal Governments and President Obama's November 5. 2009
Presidential Memorandum on Tribal Consultation, we ask that the Interior Department work
with Navajo and Hopi tribal governments, their members and impacted communities to
develop a comprehensive approach to mine reclamation, restoration and revitalization on
Black Mesa that includes robust input from impacted people and communities. A
coordinated, multi-agency approach to these issues is one important way to begin addressing
numerous injustices. These are the areas in which coordinated federal interagency action
should begin immediately:
Launch a significant permit revision/comprehensive reclamation plan for Kayenta Mine
and Black Mesa Mine (Lead DOI Agency: Office of Surface Mining Reclamation and
Enforcement. Other Agencies: Bureau of Reclamation, U.S. Geological Survey)
Kayenta Mine ceased mining in August 2019 in advance of the permanent closure of
NGS, the power plant for which it was the sole source of coal. Since that time, little to no
reclamation has occurred at the mine. In fact, Peabody has submitted formal requests to
delay much of the current reclamation work for another two to four years. At Black Mesa
Mine, which closed in 2005, the U.S. Bureau of Indian Affairs has determined that
reclamation remains "inconsistent and often unacceptable, with considerable acreages
remaining as raw ungraded and eroding spoil piles, largely void of vegetation."1
On June 10, 2020, former Hopi tribal chairmen Vernon Masavesva and Benjamin
Nuvamsa wrote to QSMRE Western Region Director David Berry (Exhibit C) to remind
the agency of its trust duty to move toward full reclamation and recovery of the Black
1 June 9, 2015 letter from the director of the U.S. Bureau of Indian Affairs Navajo Regional Office to
Peabody Energy's Environmental Services Director re: Indian Lands Lease Relinquishment
Requirements - Mined Land Revegetation Standards. Attached as Exhibit B.
3
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Mesa mined lands. They requested that OSMRE initiate a "significant permit revision"
under the Surface Mining, Control and Reclamation Act (SMCRA) that would provide for
a comprehensive Environmental Impact Statement (EIS) and full compliance with the
National Environmental Policy Act (NEPA). A "significant permit revision" would provide
the Hopi Tribe, Navajo Nation and other interested members of the public an opportunity
to engage OSMRE over Peabody's plans to carry out the final reclamation and closure of
the mine sites.
A comprehensive approach to mine reclamation is necessary, and it must include
protection and restoration of the groundwater aquifer from which billions of gallons of
water were drawn to support mine operations over the course of more than five decades.
The aquifer is the main source of drinking and irrigation water for Navajo and Hopi living
on Black Mesa, and mining-related depletions have had a measurable impact on water
availability.
OSMRE must ensure that Peabody is held to account for complete and thorough
reclamation and restoration of the lands and waters at both Black Mesa and Kayenta
Mines. We urge DOI, through OSMRE, to work with the Navajo and Hopi tribes and
their members to enact a significant permit revision as the agency considers
renewal of Peabody's permit at Kayenta Mine, which expired in July 2020, and to
collaboratively develop with community members a comprehensive reclamation
plan that addresses all the remaining issues at both mines.
Convene representatives from the tribes, communities and agencies to facilitate
respectful repatriation, reburial or other disposition of Hopi and Navajo ancestral remains
and artifacts and restoration of traditional cultural properties (Lead DOI Agency: National
Park Service. Other agencies: Office of Surface Mining Reclamation and Enforcement, Bureau
of Indian Affairs).
To the Hopi and Navajo, Black Mesa (known as Nayavuwaltsa to the Hopi and Dzilijiin to
the Navajo) is sacred, a defining cultural resource due to its role in our traditional stories
and ceremonial and clan traditions. It connects past with present, and under the Native
American Graves Protection and Repatriation Act (NAGPRA), the Department of the
Interior must consult with the two tribes on how they want the numerous human remains
and associated artifacts that were removed for mining activities returned and reinterred.
While a major repatriation and re-interment occurred in May 2019 for remains disturbed
between 1977 and 1983 (during a massive series of archaeological digs at Black Mesa
led by Southern Illinois University-Carbondale), further disturbance of burial and cultural
sites at Black Mesa and Kayenta continued in the years since as mining expanded. To
date, archaeological surveys have identified roughly 3,000 sites of cultural importance.2
As Hopi and Navajo people, we support reinterment in locations as close as
possible to where remains of our ancestors were found and we call on the federal
government to provide resources to help facilitate the remaining work on
repatriation. Now that Kayenta Mine is closed, we request that a comprehensive
consultation, plan and program under NAGPRA and the National Historic
Preservation Action be initiated immediately.
2 Draft Environmental Impact Statement for Navajo Generating Station-Kayenta Mine Complex Project,
4
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Use authority within DOI and other agencies (e.g., EPA sole source designation) to take
action to protect and restore vital water resources.
For 50 years, Peabody Coal pumped thousands of acre-feet a year of pristine drinking
water from the main groundwater source on Black Mesa, the Navajo, or N, Aquifer. The
N Aquifer is the sole source of potable water for the residents of Black Mesa and
surrounding communities; the people of Black Mesa rely on it for both domestic and
agricultural purposes, and the springs, seeps and washes that historically have arisen
from it are culturally and spiritually central to both Navajo and Hopi beliefs. The lives of
the people of Black Mesa and surrounding communities, as well as future generations,
depend on the water and its sustainability into the future.
Due to withdrawals from the N Aquifer, Navajo and Hopi wells near the Kayenta and
Black Mesa Mines have declined more than 100 feet and the majority of monitored
artesian spring discharges have decreased over 50 percent. The N Aquifer and related
spring and wash discharge shows continued evidence of declining integrity.3,4 yet
OSMRE to date has completely dismissed the impacts of a half century of mining on
water levels, choosing instead to blame community use for depletions (Exhibit D).5
Surface waters on Black Mesa are also vital. Currently, EPA is preparing to reissue
Peabody's National Pollution Discharge and Elimination System (NPDES) permit for
Kayenta Mine. Our organizations are deeply concerned about how surface waters
impacted by a half-century of strip-mining will be fully remediated by Peabody to a
pre-mine condition. The comment period for this permit closed on December 23, 2020.
Our organizations and the Hopi Tribe both provided critical comments while also asking
for an extension of time to further review and comment on this proposal.
Water is the foundation to the way of life for the Dine and Hopi people, spiritually,
physically and emotionally. Water is life - it is evident throughout our cultures, teachings
and ceremonies. For the Hopi, the lack of water in our springs has directly impacted the
ceremonies we perform. In addition to the depletion, Hopi also face the dangers of
having arsenic in our drinking water at Second Mesa and now First Mesa.
We ask the Interior Department to coordinate the use of its authorities within the
Interior Department and with other agencies (e.g., through the designation by EPA
of the N Aquifer as sole source aquifer and through strict enforcement of Kayenta
Mine's NPDES permit) to take action to restore and protect the Navajo Aquifer, D
Aquifer, springs, and surface waters.
Create a DOI-EPA-DOE Just Transition Working Group for Navajo Generating
Station/Kayenta-Black Mesa Mines (NGS/Coal Mines Just Transition Working Group) and
task it with working with stakeholders to develop a Just Transition Roadmap
3 Groundwater Mining of Black Mesa. Natural Resources Defense Council (NRDC). 2001.
4 As cited in "A Confluence of Anticolonial Pathways for Indigenous Sacred Site Protection." Ellis, R. and
Perry, D. (2020). Journal of Contemporary Water Research & Education, 169: 8-26.
Mbs;//oM^ J938JMXi.2Q2Q,Q3329Jx.
5 See response from OSMRE to letter from Vernon Masayesva and Ben Nuvamsa. Sept. 25, 2020.
Attached as Exhibit D.
5
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We ask the Department of the Interior EPA, and Department of Energy to establish an
NGS/Coal Mines Working Group to work with stakeholders, including the Navajo Nation,
Hopi Tribe, NGS plant owners and former plant owners, Central Arizona Project (CAP),
Gila River Indian Community and other Arizona Indian tribes who receive water from
CAP, non-Indian CAP water users, tribal members and environmental and community
groups.
We recommend the goal of this Working Group be to develop a roadmap for a Just and
Equitable Transition for affected communities to post-coal economies. The roadmap
should include action recommendations and oversee initial steps to begin implementing
key recommendations. It should be consistent with federal trust responsibilities to
federally recognized Indian tribes in the region.
Reform OSMRE's oversight of mining on tribal lands so that transparency and access to
critical filings and documentation is readily available to members of impacted
communities and the general public.
OSMRE is responsible for regulation of coal mining and cleanup activities on Indian
lands. Unlike most states, no tribe has received delegation authority to regulate coal
mining under SMCRA. OSMRE's Indian lands program provides funds to tribes to assist
it in regulating surface coal mining and reclamation but the agency is ultimately
responsible for all regulatory decisions affecting tribes, including permit application
review, determination of performance bond amounts, inspection and enforcement, bond
release, and maintaining a staff to coordinate with the individual tribes and other federal
agencies. Approximately 65% of all coal mine lands regulated by OSMRE's Indian Lands
Program nationwide are within the Kayenta Mine/Black Mesa Mine complex.6
Despite its trust responsibilities to tribes, however, OSMRE is failing in its regulatory
responsibilities. Through its oversight of state mining offices such as in Montana,
BMldjn.cLaBBlicMi-Qn_s__an^CTM£QnillCTta|_^sessiiients are available to the public online.
Such accessibility is not provided to Navajo or Hopi who are looking for information on
Black Mesa or Kayenta mines. Anyone wanting to view pending applications or other
documentation must do so at OSMRE's office in Denver or at the offices of the Navajo
Nation Minerals Department in Window Rock, Arizona, the Hopi Tribe Minerals
Department or the Forest Lake Chapter of the Navajo Nation. No public notice of
applications for minor permit revisions is provided. For example, OSMRE did not provide
public notice of Peabody's "minor" permit revision application to substantially change the
permit schedule for final reclamation by delaying 70% of backfilling and grading for two
years or more.
We respectfully request the Interior Department to mandate that OSMRE
immediately make available online all documentation as required by federal
administrative procedures so that our people and communities can more fully
participate in reclamation decisions that affect their lives, the land and water they
depend on, and future generations.
Source: Office of Surface Mining FY 2021 Budget Justification Green Book p. 57-58,
6
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Conclusion
For nearly half a century, coal extracted and electricity generated on lands of Navajo and Hopi
were the underpinning of growth and prosperity in the Southwestern United States. The federal
government authorized the creation of Navajo Generating Station and Kayenta Mine to provide
key resources of water and electricity that fueled the aggressive growth of Phoenix, Las Vegas,
Tucson and other cities. Mining and combustion of coal has been outcompeted by less
expensive alternatives. The era of coal for Navajo and Hopi has passed, but the nearly 50 years
of damage done by mining remains. There is an enormous amount of work to be done to return
tens of thousands of acres to pre-mining conditions that will allow Navajo and Hopi communities
to once again make use of their land. Many artifacts and ancestral remains still must be
repatriated. And the critically important source of groundwater that thousands of Navajo and
Hopi depend on for domestic and agricultural use has been severely depleted by industrial use.
These impacts and damages must be remedied, and we are putting our trust in the incoming
Biden Administration to use its authority to ensure that appropriate policies are enacted and
undertaken for a full reclamation, restoration and revitalization of coal-impacted land, water and
resources, and that our people are given an opportunity to fully participate in these efforts.
ABOUT THE HOPI AND NAVAJO LEADERS
Benjamin Nuvamsa and Vernon Masayesva are both former Chairmen of the Hopi Tribe, a
federally recognized American Indian tribe. The chairmen are working in support of their Tribe's
interest in ensuring proper consultation with their tribal government, as well as securing
meaningful public participation opportunities for tribal citizens related to Peabody Western Coal
Company's closure of Kayenta Mine in August 2019.
Nicole Horseherder, Executive Director, To Nizhoni AnL, which translates to "Beautiful
Water Speaks." TNA provides community education on the Black Mesa mine and mobilizes the
Black Mesa community in advocacy for sustainable economic development. TNA's mission is
consistent with the philosophy of traditional Dine and seeks a more sustainable future. Many
members of TNA reside on Black Mesa and have families that were displaced and relocated in
order to accommodate the Kayenta Mine operation.
Carol Davis, Executive Director, Dine C.A.R.E. Dine C.A.R.E. is a nonprofit Navajo
grassroots organization comprising tribal members who work with Navajo communities affected
by energy and environmental issues. Dine C.A.R.E.'s mission is to advocate for our traditional
teachings by protecting and providing a voice for all life within and beyond the Four Sacred
Mountains of the Dine (Navajo).
Percy Deal is a lifelong resident of Black Mesa on the Navajo Nation, where he raises cattle
and crops. He is a former Navajo Nation Council Delegate, former Navajo County Supervisor,
former Hard Rock Chapter President, and former director of the Navajo Hopi Land Commission.
Herb Yazzie is a resident of Black Mesa and retired Chief Justice of the Navajo Nation. He also
served the Navajo Nation as its Attorney General and as its Chief Legislative Counsel and was
an attorney for the Yavapai-Apache Nation. He is a veteran, having served a tour in Vietnam as
an Army lieutenant. He graduated from Arizona State University College of Law in 1975.
7
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Exhibit B
8
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September 22, 2021
Via Electronic Mail (PDF)/Certified Mail
Honorable Deb Haaland, U.S. Secretary of the Interior
U.S. Department of Interior
1849 C Street, N.W.
Washington, D.C. 20240
Re: Permanent Closure of Peabody Western Coal Company's Kayenta Mine and
Reclamation of Tribal Homelands
Honorable Secretary Haaland:
We very much appreciate the time Steve Feldgus, Deputy Assistant Secretary for Land and
Minerals Management within U.S. Department of Interior ("Interior") and Glenda H. Owens,
Deputy Director, Office of Surface Mining Reclamation and Enforcement ("OSMRE") took to
speak with us regarding the closure of Peabody Western Coal Company's half-century old
Kayenta Mine and ongoing efforts to reclaim our Tribal homelands.
Our Navajo and Hopi Tribal communities are deeply concerned about the current status and
future plans for reclamation of Tribal lands currently occupied by Peabody's sprawling Kayenta
and Black Mesa surface coal mines. Despite the fact that Peabody permanently ceased coal
production at Kayenta in August of 2019, Federal regulators have never provided our Tribes or
Tribal communities the opportunity to have a meaningful voice in the end of Peabody's coal
production and the planning for reclamation and timely return of mined lands and waters to our
people in their pre-mine condition.
Navajo Nation President Nez and Vice-President Lizer recently told Congress, "[wjithout proper
remediation, the land devastated by the Black Mesa and Kayenta mines may never fully recover.
On that point, we believe OSMRE has been negligent in duties to hold Peabody accountable for
the damage they have done to our land and our people. Peabody did not hold to their end of the
bargain in our lease, and they should be denied the opportunity to renew leases or obtain new
permits until a plan is put in place to begin the remediation process now. We have already
waited more than 2 years since all operations in the area ceased. We shouldn't have to wait any
longer." 1 Numerous Navajo Nation local governments have passed resolutions expressing
similar concerns.2
We believe the Biden Administration has the opportunity to correct a historic wrong, put its
environmental justice commitments into practice, and meaningfully engage our communities on
how best to restore our lands and return them to Native people after more than 50 years of strip
mining.
1 See Exhibit 1.
2 Id.
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Under your leadership, Interior asserts it is "playing a central role in how the United
States... increases environmental protections, pursues environmental justice and honors our
nation-to-nation relationship with Tribes." 3 And it also touts that "the President knows that the
intersecting health, economic, racial justice and climate crises disproportionately impact
American Indians and Alaska Natives, which is why he has directed the entire federal workforce
to take a whole-of-government approach to supporting Indian Country." 4
Similarly, the President has ordered "that the Federal Government should pursue a
comprehensive approach to advancing equity for all, including people of color and others who
have been historically underserved, marginalized, and adversely affected by persistent poverty
and inequality" and that the administration is advancing "a systematic approach to embedding
fairness in decision-making processes, executive departments and agencies (agencies) must
recognize and work to redress inequities in their policies and programs that serve as barriers to
equal opportunity."5 Further, "[i]n carrying out this order, agencies shall consult with
members of communities that have been historically underrepresented in the Federal
Government and underserved by, or subject to discrimination in. Federal policies and
programs."
We're asking Interior to ensure these are not empty promises; to finally engage Tribal
communities on Black Mesa, to listen to community concerns, openly discuss the process of
reclaiming and returning our lands and water and ensure our Tribal communities have a
meaningful voice in this process. We believe that these goals can be accomplished through
regular public meetings with the communities most directly impacted by the mines, and that
there is an existing regulatory framework under Federal surface mining laws and the "significant
permit revision" process that can provide substantive protections for our lands and waters as well
as opportunities for public engagement. Although we have received a letter from OSMRE
indicating it intends to hold a virtual public hearing on Peabody's requested bond release on
October 21, 2021, initiating a process to return millions of dollars in reclamation bonds to
Peabody before holding discussions with the affected community of Navajo and Hopi people
about the restoration and return of our lands and waters is not appropriate. That puts the cart
squarely before the horse and tells us that OSMRE values Peabody's bottom line more than it
respects the input of Navajo and Hopi communities that are directly impacted by decades of
Peabody's pollution.
Our Tribes and communities across Black Mesa have been living with the social and
environmental impacts from Peabody's coal mining operations for a half century. We deserve a
plan from Peabody that meaningfully addresses when our land and water will be returned to us,
3 https://www.doi.gov/blog/meeting-moment-interiors-bold-action-preserve-public-lands-and-waters-invest-clean-
energy.
4 https://www.doi.gov/blog/enduring-partnership-interiors-commitment-honoring-our-nation-nation-relationship-
tribes
5 See Order Executive Order On Advancing Racial Equity and Support for Underserved Communities Through the
Federal Government (January 20, 2021) https://www.whitehouse.gov/briefing-room/presidential-
actions/2021/01/20/executive-order-advancing-racial-equity-and-support-for-underserved-communities-through-
the-federal-government/
A4 p.112
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explains how Peabody will reclaim our land and water for return to our people and community to
its pre-mining condition, and adequately analyzes how much it will cost Peabody and other
entities to do the necessary reclamation work so that our communities can be confident that
Peabody's clean-up operations are adequately bonded. And we deserve a transparent and
public process that will ensure the people who live on Black Mesa and continue to be directly
affected by Peabody's mine operations can understand and meaningfully participate in efforts to
reclaim and restore our lands and water as they are returned our people.
As explained in greater detail below, we believe that means treating Peabody's permanent
cessation of active coal mining operations in August of 2019 as a "significant permit
revision" under the Surface Mining Control and Reclamation Act ("SMCRA") and that
Interior and OSMRE begin that process now.
BACKGROUND
The Kayenta Mine sits on top of Black Mesa, located above the Navajo Aquifer, and has
disproportionately impacted our families, our communities, and our lands and waters for a half-
century. Most of us have lived on Black Mesa for the majority of our lives. We all know
families, including some of our own relatives, that were relocated in the early 1970s to make way
for the coal mine, and we want to ensure that our families and communities can return to these
lands after Peabody leaves and find more than a scarred, barren, waterless landscape.
In October of 2017 when OSMRE approved yet another in a long line of 5-year permit renewals
for the Kayenta Mine dating back to 1990, the agency told our communities and the public that
permanent closure of Kayenta was "uncertain at this time" and "therefore does not necessitate
the submission of an application for revision of the mine permit at this time." 6 In assuming no
changes to Peabody's mine operation for purposes of "renewal" of Peabody's operating permit at
maximum coal production, OSMRE circumvented permitting procedures for addressing
permanent cessation of coal production and intentionally limited the scope of its environmental
assessment to "mining and reclamation operations during the [renewal] period of July 6, 2015
through July 5, 2020."7
By contrast, OSMRE's sister agencies within Interior - the Bureau of Reclamation ("BOR") and
Bureau of Indian Affairs ("BIA") - prepared an environmental assessment in 2017 that analyzed
in toto permanent retirement and remediation of the Navajo Generating Station ("NGS") to begin
6 Additionally, OSMRE told the public that "[t]he proposed Renewal application does not include any revisions to
the mining and operations plan or the addition of any new mining areas and is therefore under 30 CFR
774.15(b)(2)(4) is not subject to processing as a permit revision. For the proposed Renewal period, coal-mining
operations would be assumed to continue at the recent historical pace of approximately 8 mtpy and existing
facilities would be used for ongoing operations." See OSMRE Kayenta Mine SMCRA Permit Renewal
Environmental Assessment (August 17, 2017) at Appendix H page 5, "17 (emphasis supplied) (Exhibit 2).
7 See OSMRE Kayenta Mine SMCRA Permit Renewal Environmental Assessment (August 17, 2017) at 1-1. The
environmental assessment and underlying permit documents are no longer publicly available on OSMRE's website.
3
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in 2020 and end in 2025 ("NGS Retirement EA").8 OSMRE excused itself from this process,
and did not serve as a cooperating agency on the NGS Retirement EA. The plan governing
retirement of NGS was finalized on November 27, 2017 and, unlike Peabody's Kayenta mine,
NGS is now on a glidepath to timely completing remediation of the facility.
Since mine closure, Peabody has exacerbated public confusion around permanent closure of the
Kayenta Mine by seeking yet another 5-year permit renewal from OSMRE for continued coal
production.9 Additionally, since mine closure in August of 2019, Peabody appears to have
submitted numerous "revisions" to its operating permit addressing mine reclamation for which
OSMRE has provided no public participation opportunities or environmental analysis.10 More
recently, Peabody has now demanded $25 million in bond release while offering negligible
public participation and oversight opportunities and no environmental analysis.11
Based on our review of documents obtained from OSMRE, it is not clear to us whether Peabody
has ever meaningfully notified OSMRE that it permanently stopped mining at Kayenta.12
We do not expect reclamation will be easy, but at a minimum it must be transparent and involve
the public and impacted community. The Kayenta mine area is roughly 44,000 acres and once
housed livable Native communities; it is indeed a city-sized coal mine.13 The mine opened in
1973, and now a half-century later, Peabody has made little progress in restoring mined lands
on Black Mesa to a pre-mine condition.
As of April 20, 2017, and of the more than 17,000 acres of Tribal homelands disturbed by
mining and regulated under the OSMRE's Permanent Regulatory Program, no lands whatsoever
had been permanently reclaimed to a pre-mine condition {i.e. achieved Phase III bond release).
Further, and of the 5,400 acres of mined lands at Kayenta regulated under OSMRE's antiquated
8 Unlike OSMRE, BIA and BOR had the prescience to recognize that "[w]hen NGS operations cease on or before
December 22, 2019, it is assumed that closure and reclamation of the [Kayenta Mine] also would occur because the
NGS is the sole commercial customer of coal produced at the [Kayenta Mine]")- NGS Retirement EA at 13. The
NGS Retirement EA can be found here: https://www.usbr.gov/lc/phoenix/reports/NGS/nepa.html
9 Peabody's demand for an additional 5-year permit renewal and continued coal production which was submitted to
OSMRE on February 20, 2020 is not publicly available on OSMRE's website.
10 None of Peabody's permit revisions are available on OSMRE's website.
11 https://www.wrcc.OSMREre.gov/initiatives/kayentaBlackMesa.shtm
12 Notably, Peabody failed to notify the Bureau of Land Management ("BLM') of the cessation of coal production
until January 31, 2020 - four months after mine closure. Exhibit 3. Peabody's notification was triggered by a
December 19, 2019 letter from the BLM requesting that Peabody "submit a modification to its current coal
Resource Recovery and Protection Plan (R2P2) for the Kayenta mine, last approved in 2016." Id. Upon
information and belief, OSMRE has never sent a similar request to Peabody.
13 44,000 acres is approximately 68 square miles; for reference, the city of San Francisco, California is only about 47
square miles.
4
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initial regulatory program, only 2,400 acres, or less than half, have seen OSMRE "terminate
jurisdiction" over Peabody's operation.14
With regard to water resources, and in particular Peabody's drawdown of the Navajo Aquifer
over the last half-century which has led to dried up springs and surface land subsidence in our
communities, there simply is no timeframe or estimate of when or how (if at all) Peabody can
and will restore our critical Tribal water resources to their pre-mine condition, as required by
law.
Peabody's track record is shameful. Peabody has not been a good neighbor. Most of us can
barely remember a time without mine pollution. We cannot remember a time without the heavy
equipment or the dust and chemicals from blasting. But in our dried-up wells, in the daily
commutes to get adequate water for our livestock and homes, and in the health of our children,
we see daily reminders of what Peabody has taken from our land and what it has left behind.
COMMUNITY CONCERNS
Going forward, we have several specific concerns that we want to bring to your attention.
First, and because Peabody failed to notify OSMRE of permanent cessation of mine operations
when OSMRE authorized a 5-year Permit Renewal for the Kayenta Mine on October 3, 2017,
the environmental impacts of mine closure have never been analyzed and Peabody was not
required to complete an updated reclamation plan governing mine closure. Specifically, Peabody
was not required to provide a "detailed timetable" for the completion of each major step in
the reclamation process post-closure in August of 2019 including:
(1) Backfilling;
(2) Grading;
(3) Establishment of the surface drainage pattern and stream-channel configuration;
(4) Soil redistribution;
(5) Planting of all vegetation;
(6) Demonstration of revegetation success;
(7) Demonstration of restoration of the ecological function of all reconstructed perennial
and intermittent stream segments; and,
(8) Application for each phase of bond release.
See 30 C.F.R. § 780.18(b). As it currently stands, there is no timetable (enforceable or
otherwise) for Peabody to achieve permanent reclamation of mined land and water to a pre-mine
condition. The reclamation schedule in Peabody's operating permit was last revised in October
2012 and only runs through 2019.15 Importantly, the schedule does not provide precise
14 See Exhibits 4 and 5. The situation at Peabody's Black Mesa Mine, where active mining ceased in 2005, is no
different. Of the 5,780 acres of mined lands at Black Mesa regulated under OSMRE's initial regulatory program
and after nearly 15 years of alleged reclamation operations by Peabody, only 1,600 acres, or 27%, have seen
OSMRE "terminate jurisdiction" over Peabody's mine operation. Exhibit 6.
15 See Exhibit 7.
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specification of the timing or area for each reclamation phase in each mining area, which
OSMRE asserts "is not possible" due to ongoing coal production by Peabody.
Second, and although Peabody prepared a "final reclamation cost valuation" for the Kayenta
Mine in early 2017, that cost valuation was not provided to OSMRE during the 2017 renewal
permitting process and has never been made public.16 As it currently stands, we have no way of
assessing whether Peabody's behind-closed-doors cost estimate adequately reflects Peabody's
full reclamation costs at the Kayenta Mine - costs which we believe to be significant and
necessarily include hydrologic reclamation of our people's water resources to a pre-mine
condition.
Third, while Peabody's bond will presumably cover land disturbances, we have no indication
that Peabody's reclamation bond is sufficient to restore the quality and quantity of Black Mesa's
water resources, in particular the N-Aquifer that our communities depend on, to a pre-mine
condition. We need assurances from OSMRE, Peabody, and the owners of NGS that our lands
and water will be fully, and timely, reclaimed to their pre-mining condition.
These are serious concerns that directly affect the communities that live on Black Mesa and are
compounded by Peabody's own statements that the mine company's reclamation bond was
"underfunded." 17
OUR REQUEST TO U.S. DEPARTMENT OF THE INTERIOR
Peabodv's permanent cessation of coal production in August of 2019 must be treated by
OSMRE as a significant permit revision.18 Treating Peabody's permanent closure of the
Kayenta Mine as a significant permit revision is critical for three reasons:
16 See Chris Walker, Peabody Letter to Navajo Generating Station Owners at 1 (April 17, 2017), Exhibit 8. The
final reclamation cost valuation referenced in the letter has never been made publicly available, analyzed in any
impact statement, or incorporated into Peabody's operating permit.
17 At a May 16, 2017 meeting in Chandler, Arizona on the long-term future of NGS, Peabody representative Chris
Walker told officials from the Department of Interior, Bureau of Reclamation, and other entities that Peabody's
reclamation bond was at that time "underfunded," and that the owners of NGS were contractually responsible for
70 percent of final reclamation costs and 100 percent of employer health-care costs at the Kayenta mine. Peabody
made similar statements in an April 4, 2017 letter signed by Mr. Walker to the owners of NGS. The letter asserts
that based on a reclamation cost study prepared by Golder and Associates - which has never been made available
to the public - that the owners of NGS were responsible for $137 million of the $191 million in expected
reclamation costs. See Chris Walker, Peabody Letter to Navajo Generating Station Owners at 1 (April 17, 2017),
Exhibit 8.
18 In determining whether a permit revision is "significant," OSMRE "shall consider" the following factors:
(1) Changes in production or recoverability of the coal resource;
(2) the environmental effects;
(3) the public interest in the operation, or likely interest in the proposed revision; and,
(4) possible adverse impacts from the proposed revision on fish or wildlife, endangered species, bald or
golden eagles or cultural resources.
See 30 C.F.R. § 750.12(c)(3)(ii)(B) ("OSMRE shall determine if the application for revision is complete and if the
proposed revision is significant ") (emphasis supplied).
6
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1. Peabody must "affirmatively demonstrate" and OSMRE find "in writing" "that
reclamation as required by the Surface Mining Control and Reclamation Act and the
regulatory program can be accomplished under the reclamation plan contained in
the permit application."19
2. OSMRE is required to "[d]etermine[ ] that the proposed operation has been designed
to prevent material damage to the hydrologic balance outside the permit area."20
3. OSMRE is required "to determine if the findings which were made in issuing the
original permit are still valid."21
CONCLUSION
After more than 50 years of mining at Kayenta and Black Mesa, it is time to repair the land,
restore the Navajo Aquifer, which is vital for the continued prosperity of our Tribal communities,
and return Peabody's mined land and waters to the people of Navajo and Hopi in their pre-
mining condition. Six years ago, then-Interior Secretary Sally Jewell promised the American
people "an open and honest conversation" about the Federal coal program. The Hopi and Navajo
communities on Black Mesa deserve an open and honest conversation about how to reclaim our
lands and waters and return them to displaced communities. We deserve to have our voices
heard in that process.
Secretary Haaland, we are pleased that the Biden administration has made environmental justice
and redress of historic wrongs in Indian Country a priority, and we're eager to see that promise
of meaningful engagement, cooperation and an honoring of relationships - what we Dine call
Hozho and we Hopi call Sumi 'na 'gnwa - put into practice here. Toward that end, it would be an
honor to meet with you so you can hear our concerns in person. Beyond that, we trust that your
team at Interior will honor your commitment to pursue environmental justice and meaningfully
engage our communities in the significant permit revision process necessary for addressing
permanent closure of Peabody's Kayenta and Black Mesa mines and currently occupying our
homelands.
Thank you for your attention to these important issues. We look forward to hearing from you
after you have had a chance to review this letter.
19 30 C.F.R. § 773.15(b) (emphasis supplied).
20 30 C.F.R. § 773.15(e) (emphasis supplied).
21 30 C.F.R. § 750.12(c)(3)(ii)(C) (emphasis supplied).
7
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Respectfully,
Nicole Horseherder, Director Ben H. Nuvamasa,
To Nizhoni Ani ("Sacred Water Speaks") Former Hopi Tribal Chairman
www.tonizhoniani.org Email: ben@kivainstitute.com
Email: nhorseherder@gmail.com Phone: 928-380-6677
Phone: 928-675-1851
Exhibits:
1. Navajo Nation Letter to House Natural Resources Committee (June 29, 2021) and
Navajo Nation Chapter resolutions;
2. OSMRE, Kayenta Mine SMCRA Permit Renewal, Environmental Assessment,
Appendix H: Response to Comments (August 17, 2017);
3. BLM, Letter to OSMRE (July 24, 2020);
4. Peabody Western Coal Company, Table 2. Reclamation Status of Areas Disturbed
Under the Permanent Regulatory Program at Kayenta Surface Mine (April 20, 2017);
5. Peabody Western Coal Company, Table 1. Reclamation Status of Areas Disturbed
Under the Initial Regulatory Program at Kayenta Surface Mine (April 20, 2017);
6. Peabody Western Coal Company, Table 3. Reclamation Status of Areas Disturbed
Under the Initial Regulatory Program at Black Mesa Surface Mine (April 20, 2017);
7. Peabody, Kayenta Mine Reclamation Schedule, (October 12, 2012);
8. Peabody Letter to NGS Participants Regarding Reclamation Liabilities at Kayenta
Mine (April 3, 2017).
Copy: Johnathon Nez, President of the Navajo Nation
Timothy L. Nuvangyaoma, Hopi Chairman
Bryan Newland, Assistant Secretary of Indian Affairs
Steve Feldgus, Deputy Assistant Secretary for Land and Minerals Management, U.S.
Department of Interior
Glenda H. Owens, Deputy Director, Office of Surface Mining Reclamation and
Enforcement
David Palumbo, Deputy Commissioner, U.S. Bureau of Reclamation
U.S. Senator Mark Kelly
U.S. Senator Kyrsten Sinema
U.S. Senator Martin Heinrich
U.S. Senator Ben Ray Lujan
U.S. Congressman Tom O'Halleran
U.S. Congressman Raul Manuel Grijalva
U.S. Congresswoman Teresa Leger Fernandez
8
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Exhibit C
9
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VIA CERTIFIED MAIL
June 10, 2020
Mr. David Berry, Director
Office of the Regional Director
Office of Surface Mining and Reclamation and Enforcement
Western Region
1999 Broadway, Suite 3320
Denver, CO 80202-3050
Dear Mr. Berry,
In the spirit of environmental, social and economic justice, and on behalf of the
Hopi people, we write to ask that you treat the closure nearly nine (9) months ago of
Peabody Western Coal Company's (Peabody) Kayenta Mine as a "significant permit
revision" under Section 511 (a)(2) of the Surface Mining Control and Reclamation Act
(SMCRA). 30 U.S.C. § 1261(a)(2). The process for reviewing and acting upon this
revision must also include preparation of an Environmental Impact Statement (EIS) and
full compliance with the National Environmental Policy Act (NEPA) and its
implementing regulations.
As you know, in early 2019, Peabody announced its intent to close the Kayenta
Mine by October of that year. Now more than one year later and more than eight
months after mine production has ceased, Peabody has failed to lay out a clear,
substantive plan for the safe closure and reclamation of the Kayenta Mine and the
remaining Black Mesa Mine lands as required by SMCRA. See
https://www.eenews.net/energvwire/201Q/02/07/stories/io6oiiq8q3.
The cessation of coal production at Kayenta has had a significant adverse impact
on the economic health and well-being of the Hopi Tribe; and was not contemplated
when the Kayenta mine permit was last renewed in 2015. In fact, even though prior to
approving the Renewal Permit in October 2017, Peabody notified OSM that it would
cease coal mining at Kayenta in 2019. The permit renewal was approved anyway, with
no modifications addressing the cessation of mining and the onset of reclamation work.
The permanent halt to mining activities should have triggered a fundamental shift
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toward reclamation and closure. Yet, Peabody seems a long way from completing - or
even starting - its reclamation work, having utterly failed to meet its legal obligation to
reclaim both the Kayenta and Black Mesa mines "as contemporaneously as practicable"
with mining.
A comprehensive environmental impact assessment process would at least
ensure a thorough assessment of reclamation activities, a realistic but aggressive
timetable for carrying them out, and alternative approaches to reclamation. Just as
importantly, it would afford the Hopi Tribe and other interested members of the public
an opportunity to engage the Office of Surface Mining Reclamation and Enforcement
(OSMRE) over Peabody's plans to carry out final reclamation and closure of the mine
site.
Our concern about public participation is not hypothetical. Already, the Hopi
Tribe has been denied the opportunity to comment on and object to Peabody's revised
reclamation schedule due to OSMRE's treatment of this revision as "minor." Yet, in that
supposedly minor revision, Peabody proposes to delay reclamation for five years, and it
does not intend even to begin backfilling and grading on more than 70% of the disturbed
land until 2022 or later. This is unacceptable and a flagrant violation of SMCRA's
requirement that Peabody "insure that all reclamation efforts proceed in an
environmentally sound manner and as contemporaneously as practicable with the
surface coal mining operations...." 30 U.S.C. § 1265(b).
The Kayenta Mine has been closed for more than eight (8) months. Black Mesa
Mine (BMM) has been closed since 2005, prior to closure, BMM was operating on an
interim program permit. And yet Peabody has effectively ignored its contemporaneous
reclamation obligation on these sites. We cannot understand why OSMRE has failed to
recognize this fact and demand a reclamation schedule that is in line with SMCRA's
requirements. But it illustrates why affording the Hopi Tribe and other interested
parties' fair opportunities for civic engagement is so important.
Peabody is also currently in violation of 30 C.F.R. §78o.i8(b)(i). This provision
requires Peabody to provide "[a] detailed timetable for the completion of each major
step in the reclamation plan." Yet Peabody has offered no clear plan or detailed
timetable for: (1) backfilling and grading; (2) protection and restoration of the
hydrologic balance for surface and groundwater resources (30 CFR §780.21 & 816.41-
42): and (3) redistribution of topsoil or approved topsoil substitutes (30 CFR
§8i65.22(d)). Moreover, we have special concerns about several specific matters,
including:
2
A4 p. 121
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1. The restoration of springs, some of which are used for religious ceremonial
purposes;
2. The restoration of water which flowed through Moenkopi Wash and was the main
source of irrigation for Moenkopi fields. Moenkopi Wash is now dry due to the
construction of over 165 impoundment dams on Peabody's leasehold under the
Nation-Wide permit in violation of Section 404 of Clean Water Act, which
requires Individual Permit;
3. Ameliorating the high levels of arsenic in deep wells at First and Second Mesa
villages due to over-drafting of billions of gallons of water from the Navajo
Aquifer for mining uses over the past half century;
4. The construction of a facility to store all archaeological artifacts and remains of
our ancestors who settled on Black Mesa over 1,000 years ago that were
recovered during mining; and
5. An alternatives analysis, a review, and reconsideration of the post-mining land
use to consider options that might better address the dire economic condition
facing the Hopi Tribe as a result of the closure of the Kayenta Mine.
A comprehensive environmental impact assessment that addresses Peabody's
plans for reclaiming and closing the Kayenta Mine would provide the Hopi Tribe and the
Hopi people, and others with an opportunity to engage with OSMRE on these and other
issues that might be raised by interested parties.
Peabody's lack of transparency regarding its plans are further revealed by its
failure to release the "final reclamation cost valuation" for the Kayenta Mine that it
prepared in early 2017. As it currently stands, neither we, nor the Hopi Tribe have any
way of assessing whether Peabody's secret cost estimate adequately reflects Peabody's
full reclamation costs at the Kayenta Mine. We do know, however, that these costs will
be significant as they must include the restoration of the hydrologic balance of our
people's water resources (including the Navajo Aquifer) to their pre-mining condition.
All of this can be addressed in the environmental impact assessment that we are
requesting and requiring.
We also want to express our deep concern that Peabody's reclamation bond will
not prove sufficient to restore the quality and quantity of Black Mesa's water resources,
including the Navajo Aquifer that our villages depend upon. The adequacy of Peabody's
bonds is a critical issue for the Hopi people that must be reviewed during the impact
assessment process.
3
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Finally, OSMRE appears to be in violation of the National Historic Preservation
Act (NHPA) for its failure to consult with the Cultural Preservation Office (CPO), or the
equivalent of a Tribal Historic Preservation Office (THPO), over "historic properties"
that have been adversely affected during the reclamation process at the Black Mesa and
Kayenta mines.
As OSMRE surely knows, the mine site is host to many historic and cultural sites
protected under the NHPA; and OSMRE has a legal obligation to make reasonable and
good faith effort to identify those sites and to work with us to ensure their protection.
While the Hopi Tribe may not have a veto over OSMRE's approval of a reclamation plan,
it certainly has the right to consult with OSMRE; and if they cannot agree on an
appropriate plan to avoid or reduce adverse effects, to enlist the assistance of the
Advisory Council on Historic Preservation to help reach an appropriate agreement. See
36 C.F.R. §§ 800.4 and 800.5.
If OSMRE is serious about its legal obligation to address these critical issues and
protect the Hopi Tribe and other affected parties from the adverse impacts from
Peabody's activities at the Kayenta and Black Mesa mine sites, then it must recognize
that Peabody's permanent cessation of coal production at Kayenta, by statutory
mandate, requires a significant permit revision under SMCRA. Indeed, Kayenta's
closure in 2019 represented a stark change from Peabody's public statement that it
expected to produce coal at Kayenta and "generate significant economic benefits for
tribal communities from 2020-2044." The loss of these economic benefits and
alternative closure strategies that might help secure the Hopi Tribe's financial future are
therefore, fair subjects for review during the impact assessment process. See
https://mscusppegrsoi.blob.core.windows.net/mmfiles/files/factsheets/kayenta.pdf.
It is our view that the designation of a significant permit revision at Kayenta is
NOT discretionary. It is required in light of the halt to production at the mine. OSMRE
can demonstrate its respect for the people of Black Mesa and the Hopi Tribe, and ensure
that the Hopi Tribe and others will have a fair opportunity to participate in the key
decisions that will impact our land and water resources long after Peabody is gone, by
designating Kayenta's closure as a significant permit revision.
We believe that after 50 years of sacrifice, we are entitled to that respect. If
OSMRE chooses to deny this request, we and the Hopi Tribe will pursue other avenues
to ensure that our views are given the respect that we are due. But our strong preference
is to have OSMRE accept our request and move forward promptly with the
environmental impact assessment process.
4
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Respectfully submitted,
Benjamin H. Nuvamsa
Former Chairman, Hopi Tribe
Vernon Masayesva
Former Chairman, Hopi Tribe
Cc: Honorable Timothy L. Nuvangyaoma, Chairman, Hopi Tribe
Honorable Clark Tenakhongva, Vice Chairman, Hopi Tribe
Honorable Jonathan Nez, President, Navajo Nation
Honorable Myron Lizer, Vice President Navajo Nation
Honorable Tara Sweeney, Assistant Secretary - Indian Affairs
Hopi Tribal Council Secretary, Hopi Tribe
Hopi - Tewa Villages
5
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Exhibit D
A4 p. 125
10
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July 9, 2021
Mr. Marcelo Calle
Division Chief, Program Support Division
OSMRE, Western Region
mcallegosmre.gov
Ms. Amy McGregor
Kayenta Mine Team Leader
Indian Program Branch
OSMRE, Western Region
amcgregorgosmre.gov
Mr. Jeremy Spangler
Civil Engineer, Indian Program Branch, Program
Support Division
OSMRE, Western Region
ispanglergosmre.gov
Re: Termination of Jurisdiction and Bond Release Applications for Kayenta Mine:
J1, N6, J16, and N14-Termination of Jurisdiction (TOJ)
J16, J19 and J21 - Phase II Release
J19, J19W and N9 - Phase I Release
Via email
Dear Mr. Calle, Ms. McGregor and Mr. Spangler:
We are writing to indicate our interest in participating in the bond release processes currently underway
at Kayenta Mine, to request the opportunity for site visits, and to request more time to provide
comments.
We are concerned that too many bond release applications, covering too many areas are moving too
fast for our communities to meaningfully engage. At the same time, we are concerned that OSMRE and
Peabody have so far refused to commit to a significant permit revision that would allow our
communities to understand what is needed to fully reclaim the lands and waters of Black Mesa and to
make a plan to ensure full reclamation becomes a reality.
For nearly a half century, our communities and people have borne the direct impacts of operations at
Black Mesa Mine and Kayenta Mine. Now that the mines are closed, the federal government must finally
live up to its trust responsibilities and ensure that our sacrifices of our tribal land and water, the removal
of our ancestors and their artifacts, and the contribution made by our people to provide Arizona with
cheap water and cities across the Southwest with cheap power are recognized and addressed.
Five decades of coal mining have left indelible marks on the Navajo and Hopi, scarring not only our land,
but also our water and cultural resources. It is OSMRE's and the Department of the Interior's
responsibility to ensure that our lands and waters, which have been used for decades to provide energy
to fuel development of the West, are returned to us in as good condition as they were received when
Peabody first leased these lands. This is what is required by the company's leases with the Navajo
Nation and Hopi Tribe.
A4 p. 126
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Last month, OSMRE moved forward with multiple applications submitted by Peabody for termination of
jurisdiction and bond release at Kayenta Mine. These applications were all submitted after the mine
closed and one of them was submitted during COVID closures. Each of these applications is substantial
in terms of acres affected (6,560 in total), in terms of technical documentation that we must review (933
pages), and in terms of the impact these decisions will have on the future of our lands and waters. And
together, they create a huge burden on individuals, communities and organizations who want to
participate in assuring reclamation of the lands and waters of Black Mesa.
These proposals cover more than 10 square miles across eight distinct mining areas in the heart of the
Kayenta Mine. Though OSMRE has now posted these applications online at
https://www.wrcc.osmre.gov/initiatives/kayentaBlackMesa.shtm. no electronic notice was provided,
and no announcement is posted on OSMRE's home page. That Peabody followed the antiquated rules
for notice by posting public notices in two paper newspapers—newspapers that do not make their
public notices available in their online versions of the publications—is the equivalent of no notice at all.
The notices to the Navajo Chapters and Navajo Nation were apparently sent on June 17, 2021 — during
the pandemic when chapter and tribal offices were still largely closed and access to records and
notifications was all but impossible.
We intend to fully participate in these bond release processes. To do so, we request the following from
OSMRE:
• An opportunity to visit each of the areas proposed for bond release for a field inspection,
pursuant to CFR §800.40(b)(1).
• Copies of any and all reports that result from OSMRE's field inspection(s) scheduled to begin
on June 15, 2021. The comment period for these bond release applications should not begin
until we have copies of the results of the field inspections.
• Copies of public notices posted by Peabody in the Navajo Times and the Navajo Hopi Observer,
confirmation of the date they were posted, and the expected date for the final posting of the
notices, which will start the clock ticking on the 30-day regulatory comment period.
• A public meeting convened by OSMRE to explain the Termination of Jurisdiction and bond
release processes and these proposals and for the public to ask questions. Given that these
proposals could result in the release of almost $25 million in Peabody's bond obligations, we do
not believe Peabody will provide a fair forum for the public — the meeting must be hosted and
run by OSMRE. Again, the comment period should NOT begin until the community has had an
opportunity to hear from OSMRE (not Peabody) about the process for and the substance of the
pending bond release applications.
• More time to review and comment on the voluminous Termination of Jurisdiction and bond
release applications. COVID — and OSMRE's practice of not providing public notice of
applications by Peabody and not making those applications available on the internet in a timely
manner — has limited our awareness of and our opportunity to review these significant
proposals. We request a meaningful extension of time to comment.
• A summary of the reclamation and other actions actually taken in each bond release areas and
the planned next steps in the process. This will provide the information residents are asking
about the most, what and how is reclamation being done and evaluated.
• A copy of the revegetation plan, including how plants are selected and why. In addition, where
and why native are plants not being reseeded.
And perhaps most importantly, we are requesting a comprehensive approach to the closure and
reclamation of Kayenta Mine as part of signification permit revision associated with the now overdue
permit renewal for the mine. OSMRE's practice of moving forward piecemeal under "minor permit
revisions" and bond releases in the absence of significant permit revision that allows the public the
A4 p. 127
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opportunity to participate in planning for the future of the mine areas excludes us from shaping our
future.
Please respond as soon as possible so we can plan for our participation in these processes.
Respectfully,
Nicole Horseherder
Executive Director
To Nizhonf Ani
nhorseherder@gmail.com
Ben Nuvamsa
Former Hopi Council Chair
ben@kivainstitute.com
Carol Davis
Director
Dine C.A.R.E.
carol.davis@dine-care.org
'Ahtza D. Chavez
Executive Director
NAVA Education Project
ahtza@NAVAEducationProiect.org
Vernon Masayesva
Former Hopi Council Chair
Executive Director
Black Mesa Trust
kuuyi@aol.com
CC:
The Honorable Deb Haaland, Secretary of the Interior
The Honorable Jonathan Nez, President, Navajo Nation
The Honorable Timothy L. Nuvangyaoma, Chairman, Hopi Council
The Honorable Jimmy Yellowhair, Navajo Nation Council Delegate
The Honorable Raul Grijalva, Chairman, House Natural Resources Committee
The Honorable Tom O'Halleran, Representative, Arizona House District 1
The Honorable Alan Lowenthal, Chairman, House Subcommittee on Energy and Mineral Resources
The Honorable Kyrsten Sinema, Senator, Arizona
The Honorable Mark Kelly, Senator, Arizona
The Honorable Martin Heinrich, Senator, New Mexico
The Honorable Ben Ray Lujan, Senator, New Mexico
The Honorable Teresa Leger Fernandez, Representative, New Mexico House District 3
Steve Feldgus, Deputy Assistant Secretary, Lands and Minerals, Department of the Interior
Glenda Owens, Acting Director, OSMRE
Johnna Blackhair, Acting Director, Bureau of Indian Affairs
Peter Kozelka, EPA Region IX, NPDES Permits Section
Rowena Cheromiah, Manager, Navajo Nation Minerals Dept.
A4 p. 128
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Exhibit E
11
A4 p. 129
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October 6, 2021
Via Electronic Mail (PDF)/Certified Mail
Mr. Marcelo Calle, Manager
Program Support Division
Office of Surface Mining Control and Enforcement
Re: Peabody Western Coal Company's Applications for Bond Release and
Termination of Jurisdiction for the Kayenta and Black Mines
Dear Mr. Calle:
We appreciate the response of the Office of Surface Mining Reclamation and Enforcement
("OSMRE") to our July 9, 2021 letter regarding the applications by Peabody Western Coal Company
("PWCC") for bond release and termination of jurisdiction for the Kayenta and Black Mesa Mines.
Our communities remain deeply concerned that OSMRE is not taking our concerns seriously and is
instead moving forward with a process to return tens of millions of dollars in reclamation bonds to
Peabody while giving empty talk to meaningful engagement of affected Navajo and Hopi communities
about the restoration and return of our lands and waters.
OSMRE's September 20, 2021 response letter is an indignation, and wholly inconsistent with the
Biden Administration's stated commitment to American Indian tribes and tribal communities.
First, our July 9, 2021 letter specifically requested a public meeting so that the community has an
opportunity to hear from OSMRE about the process and substance of the pending bond release
applications. Under OSMRE's regulation governing bond release, OSMRE "shall hold a public
hearing within 30 days after receipt of the request for the hearing" and, at the option of the objector,
the public hearing "shall be held in the locality of the surface coal mining operation from which bond
release is sought..."1
We are requesting that OSMRE hold two public hearings in our communities so that we can hear
directly from OSMRE. The meetings can be held out-of-doors if you are concerned about COVID-19,
and we are willing to work with OSMRE to identify potential meeting locations and dates.
Second, and with regard to the inspection and evaluation of PWCC's reclamation work scheduled for
Tuesday, October 19, 2021, the three-hour drive-by inspection offered by OSMRE is simply not
adequate. PWCC's leasehold covers 65,858 acres and the areas covered by PWCC's bond release
application cover over 6,500 acres. OSMRE's suggestion that an inspection of the mined lands can be
completed in just three (3) hours is impracticable - especially given OSMRE's acknowledgement that
we will be traveling "over 20 miles of dirt road and two track." At a minimum, the inspection needs to
be scheduled for a full-day from 8 a.m.- 5 p.m. and should include the option for an additional half-
day follow up at the inspector's request.
Further, there is no legal basis for OSMRE's demand that we limit attendance at the inspection to the
signatories of the July 9, 2021 letter. We will provide OSMRE with the names of the attendees
1 30 C.F.R. §800.40(f) (emphasis added).
1
A4 p. 130
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seventy-two (72) hours prior to the inspection and expect OSMRE to work with and accommodate the
inspectors identified by our communities.
Additionally, and in order that we may prepare for the inspection and evaluation, please provide the
following documents no later than October 15, 2021: all OSMRE inspection reports of the bond
release areas; PWCC's approved reclamation plan; and, the Full Reclamation Cost Full Interim True-
Up valuation study (2017) prepared by Colder Associates. Failure to provide these documents in
advance of the inspection could result in delay or cancelation of the inspection.
Third, and finally, we believe that OSMRE's scheduling of a "virtual" informal conference on October
21, 2021 violates the Surface Mining Control and Reclamation Act ("SMCRA") and is premature.
SMCRA mandates that any informal conference be held in our community.2 As such, OSMRE's
decision to hold a two-hour "virtual" informal conference violates SMCRA. A virtual conference is
especially unhelpful on the Navajo Nation, where internet access is extremely limited.
Finally, and while we may be open to waiving the statutory requirement and holding an informal
conference at OSMRE's offices in Denver, Colorado, we are deferring that deci si on at this time. Once
OSMRE has held public hearings in our communities, allowed for a full-day inspection of PWCC's
mined lands to be released from bond, and received our written comments/objections will the agency
be in a position to hold an informal conference necessary to resolve any outstanding issues raised by
our tribes and tribal communities as provided in Section 513(b) of SMCRA.
Thank you for your attention to these important issues. We look forward to hearing from you after you
have had a chance to review this letter.
Sincerely,
Nicole Horsdierdcr. Director BettiffNuva
To Ni/h»>nt \ni rNucred Water Speaks")^' Pofaqer Hopi Tribal Chairman
w w u .toiti/honiain.org Email: ben@ki\ .iinNtimte.com
f-iiutil: nhor>eherder «i gmail.com Phone:
Phone. 1N5 I
Copy: Jonathon Nez, President of the Navajo Nation
Timothy L. Nuvangyaoma, Hopi Chairman
Steve Feldgus, Deputy Assistant Secretary for Land and Minerals Management, U.S.
Department of Interior
Glenda H. Owens, Deputy Director, Office of Surface Mining Reclamation and
Enforcement
2 30 U.S.C. § 1263(b) (OSMRE "shall... hold an informal conference in the locality of the proposed mining...") (emphasis
added).
A4 p. 131
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Exhibit F
12
A4 p. 132
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January 27, 2022
Via Electronic Mail (PDF)/Certified Mail
Glenda H. Owens, Deputy Director
Office of Surface Mining, Control and Enforcement
U.S. Department of the Interior
1849 C Street NW
Washington, D C. 20240
Email: gowens@osmre.gov
Re: Kayenta and Black Mesa Mine: Virtual Informal Conference, January 27, 2022
Deputy Director Owens:
By this letter and for the reasons set forward herein, the undersigned objectors hereby notify you
and the Office of Surface Mining Reclamation and Enforcement ("OSMRE") of our intent to
boycott OSMRE's two-hour "virtual informal conference to receive comments on two proposed
Surface Mining Control and Reclamation Act (SMCRA) performance bond release applications
submitted by Peabody Western Coal Company (PWCC)" scheduled for January 27, 2022.
Simply put, we will not allow our participation in OSMRE's sham virtual informal conference to
be used as proof by OSMRE that meaningful consultation with our communities is occurring.
It's not.
OSMRE's (mis)handling of permitting matters related to permanent mine closure, reclamation,
and bond release at PWCC's Kayenta and Black Mesa mines is an outrage, and does tremendous
injustice to the tribal communities who have borne the brunt of PWCC's strip mine operations
for the last half-century and who will be forced to live with OSMRE's regulatory failures long
after PWCC has been allowed by the U.S. government to abandon its duty to restore tribal lands
and waters to a pre-mine condition.
Requests for Public Meetings
Since July of 2021, our tribal communities have repeatedly requested that OSMRE hold
meetings in the local community to discuss PWCC's applications for bond release and as
expressly mandated by our nation's bedrock mining law, SMCRA.1
Our letter dated July 9, 2021 explicitly requests "apublic meeting convened by OSMRE to
explain the Termination of Jurisdiction and bond release processes and these proposals and for
the public to ask questions." We reiterated that request in our October 6, 2021 letter, specifically
requesting "apublic meeting so that the community has an opportunity to hear from OSMRE
about the process and substance of the pending bond release applications." Under SMCRA, a
public hearing must be convened within 30 days of receipt of the request. That, of course, would
1 See 30 U.S.C. §1263(b); 30 C.F.R. §800.40(f), (g), & (h).
1
A4 p. 133
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have been impossible considering that OSMRE did not respond to our initial communication
until seventy-three (73) days later, on September 20, 2021.
Now, OSMRE is outright denying the request for a public hearing and any form of in-person
engagement for the Navajo and Hopi residents of Black Mesa, the communities OSMRE's
decisions will most directly impact. In its January 25, 2022 communication, OSMRE states that
objector's "request for a public hearing at this juncture is not timely," citing as reasons that it fell
outside the 30-day window beginning July 1, 2021, and the health concerns associated with
COVID-19. OSMRE's statement is infuriating, unjustifiable and beyond belief.
Our request for a public meeting came within eight (8) days of OSMRE's notice in July 2021,
and had the agency acted in a timely manner as required under SMCRA, OSMRE could have
held a public meeting in August 2021 outdoors on Black Mesa and/or using precautions that
reduced COVID-19 transmission. Now the agency is pushing forward as if it our original
request was never made and in late January 2022 when convening safely outdoors is impossible.
All of this adds up to a serious neglect of the agency's trust responsibilities. Tellingly, durins the
last decade. OSMRE has failed to hold or conduct a single public meeting with local tribal
communities or the public and in an effort hear or address our ongoing concerns about the
fate of PWCC's Kayenta and Black Mesa Mines. And yet, during this same decade, PWCC
permanently ceased coal-strip mining operations at Kayenta in August of 2019, and thereafter
began submitting numerous permit applications to OSMRE requesting revisions to its operating
permit to address permanent reclamation of mined land and waters at Kayenta, as well as release
from its performance bond obligations.
OSMRE's decade-long failure to hold public meetings in our communities to discuss the fate of
PWCC's mine operations is in are an affront to our Indian communities and tell us that OSMRE
has placed PWCC's corporate interests above the interests of the people who will have to live in
perpetuity with the legacy of PWCC's half-century of coal strip mining.
Requests for Public Records
Our experience with requesting access to public documents is similarly frustrating. Site
inspections for PWCC's bond release applications were conducted in June 2021. However, the
associated reports were not provided to us until October 14, 2021, providing just five (5) days to
review the technical documentation and reclamation maps before our October 19, 2021 site
inspection. As of that date, PWCC's full Permit Application Package (or PAP), along with the
mine reclamation plan, was not electronically available.
Instead, we were instructed that paper copies could be accessed at three different locations on the
Navajo Nation and Hopi. However, none of those locations could certify that they had complete
copies of PWCC's PAP nor could they identify which provisions of the PAP governed
permanent reclamation of mined land and waters at Kayenta and Black Mesa. Not until January
13, 2022, were we notified that PWCC's PAPs would be made available to us electronically.
Together, these files encompass 933 pages and appear to be a half-centuries worth of assorted
documents thrown together helter-skelter by OSMRE.
A4 p. 134
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Aside from the bond release documents, we note that OSMRE's Kayenta/Black Mesa Mine
Initiative web page is woefully out of date and functionally obsolete. The last documents posted
on OSMRE's website are from 2014. In the intervening eight years, PWCC has declared
bankruptcy twice, the mine has been through two permit renewals (one of which is now overdue
by almost two years), the mine has shut down, and numerous permit revisions appear to have
been submitted and approved by OSMRE behind closed doors and without public knowledge or
input, leaving the Indian communities most impacted by OSMRE's decisions completely in the
dark.
A thorough search of OSMRE's Oversight Document Database turns up no documentation.
Searching under the Navajo Nation heading from 2020 and 2021 in all 15 categories of
documentation2 for the keyword "reclamation" returns not a single document. In every instance,
the resulting search says "No records match query." Given all that has transpired at Kayenta
Mine over the past two years, we're not sure how it is possible that there is zero documentation
available to the public.
As with the public meetings, we have repeatedly requested that documentation relevant to the
Kayenta and Black Mesa reclamation work, including minor permit revisions, be posted online
for public access and to encourage greater public involvement. These are documents critical to
our understanding of reclamation activities and timing, to our engagement in the public process,
and to ensuring that the restoration of our land and water is timely and adequately achieved. And
our requests have been ignored. We should not have to fight for access to information that is so
critical to securing the return of our land and water in a condition that will once again allow our
people to live on it.
Moving Forward
OSMRE has simply ignored pleas from our communities for meaningful engagement in
OSMRE's regulatory decisions, and instead has continued to embrace and employ the failed
policies of obfuscation, secrecy, and disenfranchisement of the Trump administration.
Over the last year, and when it comes to our tribal communities who have long suffered the
impacts of PWCC's strip mine operations at Kayenta and Black Mesa, the Biden administration
has done nothing more than pay lip-service to embedding fairness and transparency in OSMRE's
decision-making processes, and utterly failed to redress the very real racial and environmental
injustice in our Indian communities from OSMRE's clandestine regulatory and permitting
decisions.
Instead of creating a process for reconciliation with our tribal communities, OSMRE has allowed
bureaucratic intransigence to dictate its policies at Kayenta and Black Mesa and, in so doing,
denied the affected community of Navajo and Hopi people a meaningful voice in the restoration
2 The 15 categories of searchable documents are: Action Plans, Annual Performance Agreements, Annual
Evaluation Reports, Correspondence, Inspectable Units/Inspections Conducted, Meeting Summaries, Oversight
Guidance, Public Comments, Summary of Citizen Complaints, Topic Specific Oversight Reports, State Comments,
Work Plans, AML Site Visits, AML NEPA Documents, Federal Program Permitting Actions.
A4 p. 135
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of mined lands and waters on our homelands. Under these circumstances we cannot in good
conscience participate in a process that has short-changed our efforts at meaningful engagement
at every turn and thus allow OSMRE to check a box that meaningful consultation with our
communities is occurring.
Moving forward, we implore OSMRE to hold public meetings in and with our communities to
discuss PWCC's bond release applications; provide transparency and create public participation
opportunities around PWCC's numerous permit revision applications addressing mine
reclamation activities; comply with the National Environmental Policy Act (or NEPA) and
analyze the impact of OSMRE's permitting deci sions; and, more generally, abide by President
Bi den's executive orders on advancing racial equity and supporting our underserved
communities.3
Beyond that, and as we have continually prescribed, we believe PWCC's permanent cessation of
coal production in August of 2019 must be treated by OSMRE as a significant permit revision
and warrants development of a supplemental Environmental Impact Statement to address and
inform PWCC's permanent mine closure and reclamation. This action alone would go a long
way toward reconciling community concern with OSMRE's taciturn handling of PWCC's
permanent mine closure.
Thank you for your consideration of this matter. Objectors respectfully request the ability to
submit written comments on PWCC's bond release applications within thirty (30) days of the
informal conference or within ten (10) days of any public meetings held by OSMRE in our
communities.
Phone; 928-675-1851
Copy: Honorable Deb Haaland, U.S. Secretary of Interior
Steve Feldgus, Deputy Assistant Secretary for Land and Minerals Management, U.S.
Department of Interior
Marcelo Calle, Manager, Office of Surface Mining Reclamation and Enforcement
Honorable Johnathon Nez, President of the Navajo Nation
Honorable Timothy L. Nuvangyaoma, Hopi Chairman
3 See Order Executive Order On Advancing Racial Equity and Support for Underserved Communities Through the
Federal Government (January 20,2021) https://www.whitehouse.gov/briefmg-room/presidentiaI-
actioiis/2021/01/20/executive-order-advancing-racial-equitv-and-support-for-underserved-commmiities-through-
the-fede rat-government/
Sincerely,
www .ittni/honiauuoru
Email: nhorselierder a uuiail.com
I-mail; bcir
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Exhibit G
13
A4 p. 137
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United States Department of the Interior
OFFICE OF SURFACE MINING
RECLAMATION AND ENFORCEMENT
Interior Region 7
Lakewood, CO 80225
January 25, 2022
CERTIFIED RECEIPT REQUESTED
Ms. Nicole Horseherder
Director, To Nizhoni Ani
P.O. Box 483
Kykotsmovi Village, AZ 86039
Mr. Benjamin H. Nuvamsa
KIVA Institute, LLC
P.O. Box 1320
Pinetop, AZ 85935
Re: Kayenta and Black Mesa mines bond release and termination of jurisdiction applications
Dear Ms. Horseherder and Mr. Nuvamsa:
This letter is in response to your letter dated January 21, 2022. As we informed you on January 13,
2022, OSMRE will be hosting an informal conference virtually on Thursday, January 27, 2022, from 4
to 6 PM mountain standard time (MST) in accordance with the regulations defining bond release
procedures at 30 C.F.R. § 800.40.
Regarding your reference to a public hearing and appurtenant hearing information, under 30 C.F.R. §
800.40, requests for a public hearing must be submitted within 30 days from the date the last required
notice is published in a newspaper of general circulation. Here, the last newspaper notice was published
on July 1, 2021, and the 30-day period for requesting a public hearing expired on August 1, 2021.
Accordingly, your request for a public hearing at this juncture is not timely.
The informal conference will be recorded and OSMRE will provide you a written transcript of the
informal conference. OSMRE previously provided the records you are requesting in your January 21,
2022 letter to Ms. Pamela Eaton, who we understand is acting on your behalf. We will, however,
provide you any records not previously provided.
The Navajo Nation's declared state of emergency related to the pandemic and surging infections remains
in effect. OSMRE has taken several factors into account in determining that an "in-person" informal
conference is neither required nor prudent at this time and would be contrary to public health and safety
measures. An in-person meeting would also be inconsistent with the Nez-Lizer recommended
INTERIOR REGION 7 • UPPER COLORADO BASIN
COLORADO, NEW MEXICO, UTAH, WYOMING
A4 p. 138
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precautions and approved resolution reauthorizing chapters to continue conducting public teleconference
meetings due to COVID-19, issued on January 19, 2022 (CJA-01-22).
Questions on the informal conference should be addressed to Amy Ryser, OSMRE, One Denver Federal
Center, Building 41, Lakewood, CO 80225 or at (303) 236-4690 or amcgregor@osmre.gov.
Respectfully,
Digitally signed
MARCEL by MARCELO
CALLE
0 CALLE Date: 2022.01.25
12:49:56 -07'00'
Marcelo Calle, Manager
Program Support Division
Electronic Copy:
Nicole Horseherder, Executive Director, To Nizhoni Ani, nhorseherder@gmail.com
Ben Nuvamsa, Former Hopi Council Chair, ben@kivainstitute.com
A4 p. 139
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Exhibit H
14
A4 p. 140
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March 10, 2022
Via Electronic Mail (PDF)
Marcelo Calle, Regional Director
Amy Ryser, Kayenta and Black Mesa Mine Team Leader
Office of Surface Mining Reclamation and Enforcement
Western Regional Office
One Denver Federal Center, Building 41
Lakewood, CO 80225
Email: mcalle@osmre.gov
Email: amcgregor@osmre.gov
Re: OSMRE Western Regional Office's Sham Permit Revisions Process for PWCC's Kayenta
Mine
Dear Regional Director Calle and Team Leader Ryser:
We are writing to draw attention to actions by the Western Regional Office of the Office of Surface
Mining Reclamation and Enforcement's ("OSMRE) that have undermined public confidence in the
agency's leadership and ability to meaningfully regulate and permit mine activities at Peabody Western
Coal Company's ("PWCC's") Kayenta Mine.
Specifically, your office has established a sham permit revision process which acts as a subterfuge to
avoid triggering a much-needed significant permit revision process addressing permanent mine closure
and reclamation of the Kayenta Mine and which denies the public and local impacted communities the
opportunity to participate in numerous permitting decisions that are critical to informed evaluation of
reclamation at the Kayenta Mine. By this letter, we demand that the Western Regional Office provide
greater transparency and public participation opportunities in its permitting activities for the
Kayenta Mine.
On February 27, 2020, PWCC submitted a permit renewal application to OSMRE. On June 25, 2020,
OSMRE "administratively delayed" noticing the application for public review and comment, and ultimate
decision. OSMRE action on PWCC's permit renewal application has now been stalled for over two years.
In the meantime, PWCC has used OSMRE's administrative delay on the permit renewal application as an
opportunity to submit numerous piecemeal permit revision applications addressing mine reclamation
activities - activities which collectively would trigger a significant permit revision process. Instead of
treating PWCC's permanent cessation of coal production as a whole and undertaking a meaningful
significant permit revision process, OSMRE has instead allowed PWCC to submit numerous permit
revision applications addressing different aspects of mine closure that are reviewed and approved by your
office behind closed doors with no public participation opportunities whatsoever.
Specifically, since PWCC stopped producing coal at the Kayenta Mine in August of 2019, PWCC has
submitted at least nine separate permit revisions to your office addressing various aspects of mine
closure. These include,
1. 5-year Reclamation Schedule Permit Revision;
2. N-9 Pit Estimated Postmining Topography (PMT) Map Permit Revision;
3. N9-B Pond Permit Revision;
1
A4 p. 141
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4. J-19 Postmining Topograph\ (PMT) Permit Revision;
5. J19-D Temporary Sedimentation Impoundment Permit Revision;
6. J-21 Postmining Topograph\ (PMT) Permit Revision;
7. J21-G and H Temporary Sedimentation Structure Permit Revisions;
8. Sediment Control Plans Permit Revision, and;
9. Blasting Permit Revision.
Upon information and belief, at least three (and possibly more) of PWCC's permit revisions have already
been approved by your office. None of PWCC's revision applications and OSMRE's subsequent
decisions on the applications have been subject to public notice and comment procedures and National
Environmental Policy Act ("NEPA") analytical requirements - let alone appear on OSMRE's website.
It's well-past time for OSMRE's Western Regional Office to stop coddling PWCC as if they are a patron,
customer, or client and instead start treating PWCC like a regulated entity. At a minimum, PWCC's
permit revision applications need to be publicly noticed and your office needs to create meaningful public
participation opportunities. Further, those revision applications that have already been approved by your
office need to be re-noticed so that the public has an opportunity to meaningfully participate in the
agency's decisions.
That said, and as we have repeated I \ told OSMRE, we believe there is a regulatory pathway under existing
federal surface-mining laws to address PWCC's permanent cessation of coal production at the kayenta
Mine, and we again ask that the Western Regional Office treat PWCC's permanent closure of the Kayenta
Mine as a significant permit revision under the Surface Mining Control and Reclamation Act, which in
turn will create a comprehensive, transparent and inclusive process for reviewing and addressing permanent
mine closure and cleanup.
Thank you for your consideration of these comments. We look forward to your written response.
Sincerely,
Nicole 1 lorschcrder, Director
i o Ni/hotn Am f"Sacred Water Speaks"]^-^'
w u w .tom/hoiitani org
I'inail: nhorsehcrdcr a gimiil.coin
Photic: 928-0 75-li>5i
!. Nuv
Foftajer Ilopiji'ibul Chairman
EmaiI: ben@kivaiii.stituto.com
Phone: 928-380-6677
Copy: Steve Fcldgus, Deputy Assistant Secretary for Land and Minerals Management, U.S.
Department of Interior
Glenda H. Owens, Deputy Director, Office of Surface Mining Reclamation and
Enforcement
Honorable Jonathon. Nez, President of the Navajo Nation
Honorable Timothy L. Nuvangyaoma, Hopi Chairman
2
A4 p. 142
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BEYOND EXTREME ENERGY
PEOPLE TAKING ACTION TO KETIOE FOSSIIFOELS
To: White House Environmental Justice Advisory Council Chairs Richard Moore &
Peggy Shepard
CC: Administrative staff
From: Beyond Extreme Energy (BXE)
RE: Docket ID No. EPA-HQ-OA-2021-0683 Request for public hearing on the Federal
Energy Regulatory Commission, and the potential to replace it with a Federal
Renewable Energy Commission
Chairs Moore & Shepard, all the distinguished members of the WHEJAC:
Greetings and good wishes from Beyond Extreme Energy - we are an activist network
of organizations and individuals that came together in the summer of 2014 to protest at
the Federal Energy Regulatory Commission (FERC). For the last 8 years we have
worked, across 3 presidential Administrations, to change FERC from an agency that
rubber stamps fossil fuel infrastructure and related environmental injustice, into
something that can and will take action to protect our communities, climate, and
common home.
Over the years we have been pleased and privileged to work with many WHEJAC
members - including recently interviewing Mr Phillips, now confirmed as the 5th
commissioner and 3rd Democrat FERC Commissioner-with Chair Peggy Shepard and
WHEJAC members Dr Bullard, Dr. Wright, and Mr Parras. We have also worked with
many of your members on individual campaigns to oppose infrastructure that FERC
reviews and (in all but 2 instances) inevitably approves.
And thus we come to the crux of our problem with FERC, an independent regulatory
agency within the Department of Energy, and therefore, we think, within the jurisdiction
of this Advisory Council.
For the last two years we have been speaking to members of Congress about a bold
new idea: If FERC cannot be reformed, then it must be re-made. To this end we
have researched and proposed a new agency to take FERC's place - a Federal
Renewable Energy Commission (FREC).
A4 p. 143
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BEYOND EXTREME ENERGY
PEOPLE TAKING ACTION TO RETIRE FOSSIL FUELS
FREC would be given a fresh mandate rooted in the challenges of the 21st century, and
not operating within the legal and energy paradigms of 1978 or 1999.1
FREC would be focused on:
• Addressing the climate crisis;
• Transitioning to 100% renewable energy (wind, solar, moving water, and
geothermal);
• Decarbonization and the sunsetting of fossil fuel infrastructure;
• Environmental justice and decolonization; And
• Community decision-making and DER integration.
Often suggestions that institutions be "dismantled" or "abolished" are not treated
seriously. But FERC itself was created by an act of Congress in 1977, and numerous
members of Congress have been interested in talking with BXE and working with us on
policies up to and including replacing FERC with FREC.
• The Federal Power Commission (FPC) was created in 1930, to formalize energy
regulation policies from the 1920s.
• In 1977 Congress deemed the FPC was ineffective and enacted the Department
of Energy Organization Act to dismantle the FPC and create the Federal Energy
Regulatory Commission.
44 years later, FERC sits amongst the wreckage wrought by the fossil fuel industry and
failed energy and environmental justice policy. FERC has played no small part in the
fossil fuel buildout that destroys our communities, our health, and our planet.
For more details on FREC, check out the Legislative Case for A Federal Renewable
Energy Commission and our 30 Legislative Points for a Federal Renewable Energy
Commission. Since launching the FERC Into FREC Campaign in 2019, BXE has
received the support of frontline communities and presidential candidates.
We are now pleased to invite the White House Environmental Justice Advisory
Council to join us in co-hosting a Congressional hearing and inquiry into FERC,
1 https://youtu.be/HHtVpMELJuQ
A4 p. 144
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BEYOND EXTREME ENERGY
PEOPLE TAKING MIION TO RETIRE FOSSII FUELS
and legislative and regulatory pathways to re-making it as an agency dedicated to
renewable energy and environmental justice.
Please have your staff or administrators contact us if you are interested in learning
more, meeting with our Congressional allies, or otherwise exploring this exciting
opportunity
Sincerely,
Beyond Extreme Energy
A4 p. 145
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Illustrative Case
Elemental Mercury Poisoning Presenting as
Hypertension in a Young Child
Elizabeth H. Brannan, MD, * Sharon Su, MD, *f and Brian K. Alverson, MD*f
Abstract: Mercury intoxication is an uncommon cause of hypertension
in children and can mimic several other diseases, such as pheochromo-
cytoma and vasculitis. Mercury intoxication can present as a diagnostic
challenge because levels of catecholamines may be elevated, suggesting
that the etiology is a catecholamine-secreting tumor. Once acrodynia is
identified as a primary symptom, a 24-hour urine mercury level can
confirm the diagnosis. Inclusion of mercury intoxication in the differ-
ential diagnosis early on can help avoid unnecessary and invasive diag-
nostic tests and therapeutic interventions. We discuss a case of mercury
intoxication in a 3-year-old girl presenting with hypertension and acro-
dynia, without a known history of exposure. Chelation therapy suc-
cessfully treated our patient's mercury intoxication. However, it was also
necessary to concurrently treat her hypertension and the pain associated
with her acrodynia. Because there were no known risk factors for mercury
poisoning in this case, and because ritual use of mercury is common in
much of the United States, we recommend high clinical suspicion and
subsequent testing in all cases of acrodynia.
Key Words: mercury poisoning/toxicity, hypertension, acrodynia,
chelation therapy
(Pediatr Enter Care 2012;28: 812-814)
Elemental mercury intoxication is a rare cause of hyperten-
sion in children1 but has potential for serious morbidity and can
mimic several other serious conditions, including catecholamine-
secreting tumors, Kawasaki disease, stimulant ingestion, and
vasculitis. Elemental mercury intoxication affects, with varying
degrees, the central and peripheral nervous systems, the cardio-
vascular system, the kidneys, the lungs, the gastrointestinal tract,
and the skin, depending on the dose and chronicity of exposure.2'3
In the 19th and early 20th centuries in the United States,
children in particular were exposed to elemental mercury in the
form of laxatives and diaper and teething powders.2 Present-day
sources of elemental mercury exposure include thermometers,
disk batteries, fluorescent light bulbs, sphygmomanometers,
latex paint, and dental amalgams, as well as certain cultural and
religious practices and industrial processes.2 4 We present here
a case of a child with elemental mercury intoxication that raises
implications for the differential diagnosis and evaluation of hy-
pertension in children and highlights the need for further evidence-
based recommendations for treatment of mercury intoxication
and interim management of mercury-induced hypertension and
acrodynia.
From the *Department of Pediatrics, Rhode Island Hospital; and fBrown
University, Providence, RI.
Disclosure: The authors declare no conflict of interest.
Reprints: Brian K Alverson, MD, Brown University and Department
of Pediatrics, Rhode Island Hospital, 593 Eddy St, Providence, RI 02903
(e-mail: balverson@lifespan.org).
There are no sources of support/funding for this study.
Copyright © 2012 by Lippincott Williams & Wilkins
ISSN: 0749-5161
812 I www.pec-online.com
CASE
A 3-year-old girl presented with 3 weeks of intermittent
abdominal pain, diaphoresis, and tachycardia. Four days before
admission, she developed pain in her hands and feet. On presen-
tation she was hypertensive, with blood pressure of 158/100 mm
Hg while calm. The patient's initial examination revealed a thin,
diaphoretic girl with tachycardia and a hyperdynamic precordium,
a diffusely tender but soft abdomen, and a normal result in the
neurological examination aside from irritability. She had warm,
erythematous, edematous palms and soles with intermittently
appearing papules and desquamation, as well as a pruritic, ery-
thematous, maculopapular rash over her chest and back. Her
systemic symptoms were episodic throughout the day, and she
appeared anxious during the episodes. Her extremity findings
were consistent with acrodynia—an idiosyncratic hypersensi-
tivity reaction to mercury exposure.5 On further examination of
history, the patient's mother reported that there had been no fish
ingestion in the last month. They also denied any broken ther-
mometers in the house, burning of batteries or fluorescent lamps,
contact with miners, steel workers, or with people working in
cement factories or crematoria. They denied the patient had any
recent ingestion of paint or new toys and stated that the patient
did not regularly put toys in her mouth. The mother did, however,
note that the family moved into a new apartment 2 months before
presentation.
The patient had symmetrically elevated blood pressure in
4 extremities, unremarkable echocardiogram and electrocardio-
gram, and a normal result on fiindoscopic examination. Her initial
electrolytes, creatinine, and urinalysis were all normal and remained
so on serial evaluations. Urine drug screen was negative. Thyroid
function panel and levels of renin and aldosterone were normal.
An abdominal plain film was unremarkable. Plasma metanephrine
and plasma and urine catecholamine levels were elevated, sug-
gestive of pheochromocytoma (Table 1). A magnetic resonance
imaging (MRI)/angiography of the abdomen and MRI of the
chest and pelvis showed no masses or renal artery stenosis, and
an MRI of the brain and neck showed no masses or other abnor-
malities. Given the patient's persistent hypertension, tachycardia,
diaphoresis, irritability, acrodynia, and elevated catecholamine
levels without evidence of a tumor on imaging, mercury toxicity
was suspected, despite absence of any known exposure. A 24-
hour urine mercury sample was elevated at 60 |xg (reference
range, 0-20 |xg/24 h).
The patient was started on oral chelation therapy with
dimercaptosuccinic acid (DMSA) 16 mg/kg divided twice daily.
Her hypertension was controlled with labetalol and amlodipine.
One week after initiation of therapy, her urine mercury level rose
to 178 |xg, but after 2 weeks on therapy, it began to drop and
she was continued on therapy for approximately 2.5 months
(Fig. 1). Creatinine levels and results in liver function tests during
chelation therapy remained normal. She required antihyperten-
sive therapy for 2 months. At 3 months of follow-up, the patient
was normotensive off medication, her acrodynia and irritability
had resolved, and plasma metanephrine levels normalized.
Pediatric Emergency Care • Volume 28, Number 8, August 2012
A4 p. 146
Copyright © 2012 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
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Pediatric Emergency Care • Volume 28, Number 8, August 2012
Mercury Poisoning Presenting as Hypertension
TABLET. Laboratory Evaluation
Free T4 (reference range, 0.8-1.8 ng/dL)
1.8 ng/dL
TSH (reference range, 0.35-5.5 uIU/mL)
3.85 uIU/mL
Plasma renin activity (reference range,
542 ng/dL per hour
100-650 ng/dL per hour)
Aldosterone (reference range, 2-37 ng/dL)
16 ng/dL
Plasma
Total metanephrine (reference range,
424 pg/mL
<205 pg/mL)
Normetanephrine (reference range,
392 pg/mL
<148 pg/mL)
Dopamine (reference range, 0-135 pg/mL)
<20 pg/mL
Norepinephrine (reference range,
1474 pg/mL
0-600 pg/mL)
Epinephrine (reference range, 0-90 pg/mL)
149 pg/mL
24-h urine
Total metanephrine (reference range,
797 (xg/d
0-900 (xg/d)
Norepinephrine (reference range, 4-29 (xg/d)
119 (xg/d
Epinephrine (reference range, 0-6 (xg/d)
33 (xg/d
Dopamine (reference range, 40-260 (xg/d)
284 (xg/d
T4 indicates thyroxine; TSH, thyroid-stimulating hormone.
The state Department of Health was notified when the
patient's urine mercury level returned elevated and investigation
by the Department of Environmental Management revealed ele-
vated mercury levels throughout the home and levels above
30,000 ng/m3 in the master bedroom whereas a limit of 1000 ng/m3
has been set as the safe level for occupancy. Neighbors reported
that the previous tenant was a Columbian woman who practiced
rituals in the home that involved the use of mercury. Such
practices are well described in the literature, and elemental
mercury is obtainable at community botanicas.4
DISCUSSION
This case report highlights the importance of including
mercury intoxication in the differential diagnosis of children with
hypertension, even in the absence of known exposure, and par-
ticularly when symptoms suggest pheochromocytoma. Mercury
interferes with the catabolism of catecholamines by inactivat-
ing a coenzyme used by catecholamine-O-methyltransferase,
resulting in accumulation of norepinephrine, epinephrine, and
dopamine in the blood and urine.1 This is responsible for both
the pheochromocytoma-like symptoms (hypertension, diapho-
resis, tachycardia) and the laboratory findings (elevated levels
of plasma and urine catecholamines and metanephrines) asso-
ciated with mercury intoxication. Mercury intoxication should
be considered in any child in whom a catecholamine-secreting
tumor is suspected.
In this particular case, with no tumor visible on MRI and
before the result of the urine mercury level, the diagnosis of
erythromelalgia was also considered. Erythromelalgia is a rare
condition composed of episodic erythema, warmth, and burning
pain in the extremities.6 Primary erythromelalgia can begin
spontaneously at any age. and new research suggests a hereditary
component involving mutation in the Nav1.7 voltage-gated so-
dium channel.7 Secondary forms are associated with underly-
ing illness such as myeloproliferative and autoimmune diseases.
Symptoms are triggered by warm temperatures, and patients of-
ten find relief by cooling the affected extremities. Interestingly,
€> 2012 Lippincott Williams & Wilkins
our patient did find comfort in running her hands under cold
water. The pathophysiology has yet to be fully characterized but is
believed to be due to vascular shunting and reactive hyperemia.6
Management of this patient's hypertension was complicated
by the combination of increased sympathetic nervous system
activity and persistent pain resulting from this patient's acrodynia.
In addition, the choice of antihypertensive agents had an impact on
imaging modalities. Given that her symptoms were most sug-
gestive of an elevated catecholamine-like state, labetalol was
chosen because of its combined blockade of a- and (3-adrenergic
activities. Selectively blocking only a- or (3-adrenoreceptors can
result in overstimulation of the unblocked pathway, so it is re-
commended that both adrenoreceptors be inhibited. Her blood
pressures were only partially controlled on labetalol. When im-
aging failed to demonstrate a tumor and vasculitis was suspected,
calcium channel blockers (CCB)—amlodipine and isradipine—
were added to her antihypertensive regimen. It was postulated
that hypertension from vasculitis may result from endothelial
dysfunction of the vasculature, and CCBs may inhibit this pro-
cess. When no laboratory data supported a diagnosis of vascu-
litis, meta-iodobenzylguanidine (MIBG) scan was considered
to identify any catecholamine-secreting tumor. However, labe-
talol and CCBs have been shown to reduce uptake of MIBG
and lead to false-negative scans,8 so there was consideration
of switching her to other blood pressure agents, such as an
angiotensin-converting enzyme inhibitor and a vasodilator.
Fortunately, her urine mercury level came back elevated, and a
MIBG scan was no longer indicated.
Hypertension resulting from mercury toxicity often requires
more than 1 class of antihypertensive medication. Case reports
have described the simultaneous use of up to 4 different anti-
hypertensives .1 -5 Our report describes the successful management
of this patient's hypertension with the dual therapy of labetalol
4.5 mg/kg per day and amlodipine 0.4 mg/kg per day. The em-
phasis placed on adequate pain management and the use of
topical mexiletine to the hands and feet and oral gabapentin may
have contributed to the successful control of her blood pressures.
In the literature, nephrotoxic effects from mercury exposure
often present as nephrotic syndrome.9 12 Occasionally, revers-
ible renal tubular dysfunction has also been reported.13 Fortu-
nately, the patient did not develop either sign of renal toxicity.
There is no specific therapy to treat the nephrotoxic effects of
Urine Mercury Levels (mcg/24 h)
Number of Days
FIGURE 1. Urine mercury levels from diagnosis through
treatment with DMSA.
www.pec-online.com I 813
A4 p. 147
Copyright © 2012 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
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Brannan et al
Pediatric Emergency Care • Volume 28, Number 8, August 2012
mercury poisoning, but removal of the heavy metal by chelation
can reverse the nephrotic syndrome and tubular defects.14'15
The patient received chelation therapy with DMSA. As
expected, her urine mercury level initially rose on starting che-
lation therapy (Fig. 1) because the mercury was liberated from
her body tissues, but then it began to drop and eventually nor-
malized. Of note, DMSA is the most frequently used oral che-
lation therapy for mercury toxicity in children, but treatment
remains controversial, and several studies suggest no clear clin-
ical benefit of chelation with DMSA in people with elemental
mercury poisoning.16 Some suggest that natural clearance of
mercury in the urine follows a linear 1-compartment elimination
model.17 In our case, the fact that the urine levels rose after
DMSA administration implies that chelation was effective.
Clinical suspicion for mercury toxicity should remain high
in the absence of risk factors. The use of mercury in religious
practice is well described; however, the extent of this problem
is hard to understand or measure.18 Sale of elemental mercury
from botanicas for the purposes of sprinkling about the home
is not uncommon.4'19 One screening study in New York City
demonstrated that 5% of healthy pediatric volunteers had un-
expected elevated urinary mercury levels.20
CONCLUSIONS
This case illustrates that evaluation for mercury exposure
should be considered when there is presentation of hypertension
and acrodynia, even in the absence of a known exposure. Se-
lection of appropriate antihypertensive medications in the setting
of increased catecholamines is challenging given the diagnostic
possibilities. Management of mercury toxicity includes not only
chelation therapy but also supportive care, particularly providing
adequate pain control for the patient. The availability of ele-
mental mercury at community botanicas and its use in cultural
practices also represents a public health concern that warrants
further attention.
REFERENCES
1. Torres AD, Rai AN, Hardiek ML. Mercury intoxication and arterial
hypertension: report of two patients and review of the literature.
Pediatrics. 2000;105:E34.
2. Clifton JC 2nd. Mercury exposure and public health. Pediatr Clin
North Am. 2007;54:237-269, viii.
3. Clarkson TW, Magos L, Myers GJ. The toxicology of mercury—current
exposures and clinical manifestations. N Engl J Med. 2003 ;349:
1731-1737.
4. Riley DM, Newby CA, Leal-Almeraz TO, et al. Assessing elemental
mercury vapor exposure from cultural and religious practices.
Environ Health Perspect. 2001;109:779-784.
5. Michaeli-Yossef Y, Berkovitch M, Goldman M. Mercury intoxication
in a 2-year-old girl: a diagnostic challenge for the physician.
Pediatr Nephrol. 2007;22:903-906.
6. Buttaci CJ. Erythromelalgia: a case report and literature review.
Pain Med. 2006;7:534-538.
7. Fischer TZ, Waxman SG. Familial pain syndromes from mutations
of the Navl.7 sodium channel. Ann NY Acad Sci. 2010;1184:196-207.
8. Khafagi FA, Shapiro B, Fig LM, et al. Labetalol reduces iodine-131
MIBG uptake by pheochromocytoma and normal tissues. J Nucl Med.
1989;30:481^189.
9. Becker CG, Becker EL, Maher JF, et al. Nephrotic syndrome after
contact with mercury. A report of five cases, three after the use of
ammoniated mercury ointment. Arch Intern Med. 1962;110:178-186.
10. Williams NE, Bridge HG. Nephrotic syndrome after the application
of mercury ointment. Lancet. 1958:2:602.
11. Wilson VK, Thomson ML, Holzel A. Mercury nephrosis in young
children, with special reference to teething powders containing mercury.
Br Med J. 1952;1:358-360.
12. Agner E, Jans H. Mercury poisoning and nephrotic syndrome in two
young siblings. Lancet. 1978;2:951.
13. Roels H, Gennart JP, Lauwerys R, et al. Surveillance of workers
exposed to mercury vapour:validation of a previously proposed
biological threshold limit value for mercury concentration in urine.
Am JInd Med. 1985;7:45-71.
14. Kazantzis G, Schiller KF, Asscher AW, et al. Albuminuria and the
nephrotic syndrome following exposure to mercury and its compounds.
Q J Med. 1962;31:403—418.
15. Friberg L, Hammarstrom S, Nystrom A. Kidney injury after exposure to
inorganic mercury. AMA Arch Ind Hyg Occup Med. 1953;8:149-153.
16. Risher JF, Amler SN. Mercury exposure: evaluation and intervention
the inappropriate use of chelating agents in the diagnosis and treatment
of putative mercury poisoning. Neurotoxicology. 2005;26:691-699.
17. Sallsten G, Barregard L, Schutz A. Clearance half life of mercury in
urine after the cessation of long term occupational exposure: influence
of a chelating agent (DMPS) on excretion of mercury in urine.
Occup Environ Med. 1994;51:337-342.
18. Wendroff AP. Domestic mercury pollution. Nature. 1990;347:623.
19. Zayas LH, Ozuah PO. Mercury use in espiritismo: a survey of botanicas.
Am J Public Health. 1996;86:111-112.
20. Ozuah PO, Lesser MS, Woods JS, et al. Mercury exposure in an urban
pediatric population. Ambul Pediatr. 2003;3:24-26.
814 I www.pec-online.com
© 2012 Lippincott Williams & Wilkins
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Copyright © 2012 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
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Elemental Mercury Use in Religious and Ethnic
Practices in Latin American and Caribbean
Communities in New York City
Clyde Johnson
Medgar Evers College
Elemental mercury is used in folk medicine and in certain religious practices in the
Latin American and Caribbean communities. However, exposure to mercury can
cause serious health problems including neurotoxicity. There are, therefore, con-
cerns that mercury users are exposing themselves to dangerous levels of this toxi-
cant. A survey was conducted to determine the use pattern of elemental mercury in
the Latin American and Caribbean communities in New York City. Two hundred
and three adults participated in the survey. Forty-four percent of the respondents
from the Caribbean and 27% from Latin America stated that they have knowledge
of such cultural uses.
INTRODUCTION
Mercury has long been known as a human toxicant. Paracelsus re-
ported on mercury poisoning among miners several centuries ago (Gold-
water, 1972). It has also been associated in other occupational exposures
such as "Mad Hatters" disease. Elemental mercury is a heavy, silvery liquid
at room temperature and pressure. It is remarkably volatile for a heavy
metal, with a vapor pressure of 0.002 mm Hg at 20°C. Mercury can exist in
three oxidation states: Hg° (metallic), Hg22+ (mercurous) and Hg2+ (mer-
Please address correspondence to Dr. Johnson, Department of Physical Sciences and
Computer Science, Medgar Evers College, CUNY, 1150 Carroll Street, Brooklyn, NY 11225.
Population and Environment: A Journal of Interdisciplinary Studies
Volume 20, Number 5, May 1999 ^4 p. 149
© 1999 Human Sciences Press, Inc. 443
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444
POPULATION AND ENVIRONMENT
curie)2 (Cotton et al., 1972; EPA, 1996). Most of the mercury encountered
in the atmosphere is monatomic elemental mercury vapor.
Mercury has many uses including in fluorescent lamps, wiring devices
and switches (e.g., thermostats) mercuric oxide batteries, instruments that
measure temperature and pressure (thermometers, barometers, etc.), as a
component of dental amalgams used in repairing dental caries (cavities).
Some of these uses contribute to the ambient, and in some cases, the in-
door air mercury levels.
Elemental mercury is a toxic substance that causes many serious health
problems. These include neurotoxicity, learning disabilities in children,
sleeplessness, acrodynia, lung disease and respiratory failure (Fagala et al.,
1992; Karpathios et al., 1991; Schwartz et al., 1992; Klassen et al.,
1986). Very young children and fetuses are most vulnerable (Dencker et
al., 1983). Exposure to elemental mercury can occur through the air,
water, food (usually from contaminated fish) and direct contact (absorption
through the skin). Human exposure to elemental mercury occurs primarily
from breathing contaminated air. Recently, The Agency for Toxic Sub-
stances and Disease Registry (ATSDR) and the Environmental Protection
Agency (EPA) jointly issued a mercury alert to the general public (ATSDR,
1997).
It is common knowledge in the Latin American and Caribbean com-
munities that elemental mercury is used in ethnic folk medicine and for
religious practices. Elemental mercury is sold under the name "azogue,"
"azoge" or "quicksilver" in stores (sometimes called Botanicas) which spe-
cialize in religious items used in Esperitismo (a spiritual belief system na-
tive to Puerto Rico), Santeria (a Cuban and Brazilian-based religion that
venerates both African deities and Catholic saints) and voodoo. The use of
mercury in religious practices is recommended in some Latin American
and Caribbean communities by family members, spiritualists, card readers
and santeros.
In the present work, a survey was conducted to determine the use
pattern of elemental mercury among Latin American and Caribbean
communities in New York City. Two hundred and three (203) adults (128
Caribbean, 75 Latin American) age 19-56 years were asked about their
knowledge or use of mercury in religious/ethnic practices in their homes.
Forty-four percent of the respondents from the Caribbean and 27% from
Latin America stated that elemental mercury is used in their homes, cars or
carried on their person in these cultural practices.
In 1994, the Agency for Toxic Substances and Disease Registry
(ATSDR) collaborated with the Hispanic Health Coj$ci|$f Hartford and
the Connecticut Department of Health Services (CTDHS) in a project inves-
-------
445
CLYDE JOHNSON
tigating the use of metallic mercury during spiritual rituals (ATSDR, 1994).
Azogue is the term used by the Hispanic community when referring to
metallic mercury. Santeria is the product of the syncretism of the worship
of the Yoruban deity called the Oricha and the cult of the saints charac-
teristic of Spanish Catholicism. This study found some evidence of mercury
use inside homes (14%) and a limited number of persons have been identi-
fied who actually use azogue. The Connecticut study focused on the use of
mercury among Santeria believers in the Hispanic community of Hartford.
Our survey focused on mercury use in folk medicine and in religious and
ethnic practices in Latin American and Caribbean communities in New
York City.
METHOD
Fourteen (14) Environmental Science students from Hostos Commu-
nity College in the Bronx, New York, conducted personal interviews with
203 adults in ten sections of New York City. Respondents had to meet two
criteria to participate in this survey: (a) be an adult, and (b) be Latin Ameri-
can or Caribbean or of Latin American or Caribbean ancestry. Latin Amer-
ica includes all countries south of the United States of America: Central
and South America. The Caribbean is made up of all the islands in the
Caribbean Sea. Guyana, which is in South America, was grouped with the
Caribbean nations. The survey was conducted in the following areas in
New York City: Manhattan—Clinton, Harlem and Hamilton Heights;
Bronx—High Bridge, Morris Heights, Concourse Village, Mott Haven,
Longwood and East Crotona Park; Brooklyn—Wingate.
After establishing that respondents met the study criteria, they were
asked the following questions: (a) is mercury being used in your home in
religious/ethnic practices, (b) how is mercury used in the home, (c) how
often is mercury used in the home, (d) would you be willing to have your
home tested for mercury, (e) how many children are in the home, (f) what
are the ages of the children, (g) would you be willing to have your children
tested for mercury, (h) from where did you obtain the mercury, (i) what is
your or ancestors' place of origin (Latin America or Caribbean) and (j) how
do you dispose of "used" or surplus mercury.
Students were instructed on the sensitive nature of this survey and on
the importance of being nonjudgemental and professional. They were in-
structed to focus on and emphasize the Environmental Science and Public
Health concerns of our research. Informed consent was obtained after the
research objectives were explained to participants. Becausi o?\he sensitive
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446
POPULATION AND ENVIRONMENT
Latin American
Caribbean
Burned with a candle
Mixed with ammonia
and camphor
Mixed with soap
solution
Mixed with perfume
Mixed with bath
water
Carried on one's
person (amulet)
Kept in containers
in the home
Sprinkled in car
Sprinkled on floor
or carpet
10 15 20 25
Percent of mercury users
FIGURE 1. Elemental mercury use in religious and ethnic practices in
Latin American and Caribbean Communities in New York City.
nature of such a survey, the names of the respondents were not requested
and information about their specific country of origin was optional.
RESULTS
Fifty-four percent (54%) of those respondents who are users said that
they use mercury in several different religious and ethnic practices. Some
sprinkle it in their homes and cars, burn it with candles, add it to their bath
water, soap solution and perfume, or wear an amulet containing mercury.
Figure 1 lists the different uses. Thus, exposure is from multiple sources.
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447
CLYDE JOHNSON
Latin American
Caribbean
Occasionally
Monthly
Weekly
Dally
Percent of mercury users
FIGURE 2. Frequency of elemental mercury use in religious and ethnic
practices in Latin American and Caribbean Communities in New York City.
Figure 2 gives the frequency of mercury use in the Latin American and
Caribbean communities. Fifty-four percent (54%) of the Latin American
and 50% of the Caribbean practitioners use it occasionally. Twelve percent
of the Caribbean and 6% of the Latino practitioners use mercury daily. The
second largest groups of users in both communities are the weekly users. It
is important to note here that exposure to mercury may not be limited to
religious practitioners and their families, but includes all visitors to contam-
inated homes and passengers in contaminated cars. During the survey, we
asked respondents how they disposed of their mercury ard learned that
"used" or "surplus" mercury was being disposed of imp/operly. Sixty-four
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448
POPULATION AND ENVIRONMENT
FIGURE 3. Methods of disposal of elemental mercury used in religious
and ethnic practices in Latin American and Caribbean Communities in
New York City.
percent said they threw it in the garbage, 27% flushed it down the toilet
and 9% threw it outdoors (Figure 3).
Table 1 shows that 66% of the respondents who use mercury in reli-
gious practices and 64% of the respondents who are nonusers would wel-
come indoor air measurement for this metal. Sixty-one percent (61%) of
mercury users and 63% of nonusers want their children tested for mercury.
Thus, most users and nonusers alike are interested in indoor air measure-
ment and biological testing.
Eighty-two percent (82%) of the respondents said they obtained ele-
mental mercury from a Botanica, 3% brought it with them when they mi-
grated to the US, while a total of 6% got it from their job (unspecified), a
pharmacy, their landlord or their parents. The other 9% got it from un-
named sources. Twenty-six percent (26%) of the respondents gave specific
country of origin data. Figure 4 gives us a sampling of nationalities in-
volved in these practices. However, this is not truly representative since
this information was optional and it was found that Puerto Ricans and Do-
minicans were more likely to give their country of origl^lp 154
-------
449
CLYDE JOHNSON
TABLE 1
Respondents from the Latin American and Caribbean Communities
in New York City Who Were Asked Whether They Want Their
Homes and Children Tested for Mercury
Indoor Air
Biological Testing
(% of
(% of
Want Test
Respondents)
Respondents)
Done
Mercury users
66
61
Yes
34
39
No
Mercury nonusers
64
63
Yes
36
37
No
DISCUSSION
The results suggest that elemental mercury is ever present in the living
environment of frequent users who are almost certainly receiving high and
continuous doses. The highest exposure levels of mercury vapor are proba-
bly associated with burning elemental mercury with a candle. The tem-
perature of a typical candle flame normally exceeds 500C. The boiling
point of liquid mercury is 356.9 C. This means that if the mercury is in
contact with the flame for an appreciable amount of time, at least some of
it will vaporize and fill the room with harmful vapors. This practice is
theoretically the most hazardous. Adding mercury to bath water and soap
solution may result in multiple exposures from inhalation, skin absorption
and accidental swallowing of bath water. Mercury can also adhere to skin,
and will contaminate towels and clothes.
Most human exposure to elemental mercury is by inhalation. Oral and
dermal exposure, however, are also important routes of entry (Hursh et al.,
1989). Mercury vapor is readily absorbed through the lungs. Studies have
shown that 75-85% of inhaled doses of elemental mercury vapor were
absorbed by the body (Hursh et al., 1985; Hursh, 1985; Oikawa et al.,
1982). Because of its appreciable lipid solubility, the vapor readily diffuses
across the alveolar membranes having an affinity for red blood cells and
the central nervous system (Berlin, 1986).
The high temperature inside a contaminated carA||iatj ^ parked out-
doors on a sunny day will result in very high mercury levels—exposing
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450
POPULATION AND ENVIRONMENT
Surinam
Columbia
Belize
Trinidad
Puerto Rico
Jamaica
Haiti
Guyana
Dominican
Republic
Cuba
20 30
Percent of respondents
40
FIGURE 4. Country of origin of 26% of the respondents from the Latin
American and Caribbean communities in New York City who use
elemental mercury in religious and ethnic practices.
riders to potentially high doses. Some mercury-containing folk medicines
are taken orally. Oral exposure is thought to be of little toxicologic conse-
quence since metallic mercury is only slowly absorbed from the gastroin-
testinal tract (0.01 percent) (Fagala et al., 1992). Frequent mercury users
are probably receiving very high and continuous doses.
Elemental mercury and its vapor are extremely difficult to remove
from skin, clothes, furniture, carpet, floors and walls. It accumulates in
electronic equipment such as computers where it vaporizes and condenses
as the instrument is turned on and off in a continuing ^pending on
the temperature. Additionally, since some people use mercury frequently
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451
CLYDE JOHNSON
and the residence life of mercury is estimated to be much longer than one
year; when that mercury user vacates the property, the new occupants are
unwittingly exposed to mercury for many months.
Improper disposal of mercury down the toilet bowl or in the garbage,
contributes to the high mercury load found in sewage and garbage (Figure
3). It is commonly thought that the high mercury levels in sewage and
garbage in New York City come from dental clinics. Our survey suggests
that improper disposal by religious practitioners in the Latin American and
Caribbean communities may contribute to this burden. Outdoor disposal is
likely to contribute to the mercury load in the local atmosphere.
The Clean Air Act Amendments (CAA) of 1990 requires the United
States Environmental Protection Agency (EPA) to study mercury emissions
from electric utility steam generators, municipal and medical waste genera-
tors and other sources, including area sources. The U.S. EPA interpreted
the phrase ". . . and other sources . . ." to mean that a comprehensive
examination of mercury sources should be made and to the extent that
data were available, air emissions should be quantified. Religious and eth-
nic uses of metallic mercury may pose a health problem but data are not
available to assign a quantitative estimate of exposure, dose and health
effects.
Very little data exists on the dynamics of mercury cycling in indoor air.
For ambient air, studies indicate that the residence time of mercury in the
atmosphere may be in the order of a year, allowing its distribution over
long distances, both regionally and globally, before being deposited to the
earth (EPA, 1996). Even after it deposits, mercury commonly is emitted
back to the atmosphere either as a gas or in association with particulates to
be re-deposited elsewhere. Humans, plants and animals are routinely ex-
posed to mercury and accumulate the metal during this cycle, potentially
resulting in a variety of ecological and human health impacts (EPA, 1996).
Sprinkling or accidentally spilling elemental mercury on clothes, furniture,
carpet, floors, walls, in cars, the natural environment and even the human
body will result in contamination. The use of elemental mercury in homes
and apartments poses a health risk to anyone who spends time in these
locations. It has been shown that accidental exposures to elemental mer-
cury vapors in private homes have led to interstitial pneumonia, dyspnea,
lung disease and respiratory failure (Hallee, 1969; Snodgrass et al., 1981;
Taueg et al., 1992). The results of this survey suggest that moderate to
extensive contamination of dwellings and cars can occur following reli-
gious/ethnic use of mercury.
There is evidence that the EPA's Mercury Study Re^p^gyerlooked or
underestimated the contributions of elemental mercury from religious use
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452
POPULATION AND ENVIRONMENT
to indoor air contamination. The EPA has finalized mercury emission limits
for municipal waste combustors, and has proposed mercury emission limits
for medical waste incinerators. These emission limits are expected to re-
duce mercury emissions from these sources by 90% (3). No action is rec-
ommended for sources from religious and ethnic uses at this time, but there
is a potential public health problem here. The EPA took this position, in
part, because of a lack of data. The present study suggests that a compre-
hensive study of the religious and ethnic uses of elemental mercury should
be undertaken including indoor air measurements. Such a study should be
given high priority and should be done with the full support and coopera-
tion of the Latin American and Caribbean communities.
ACKNOWLEDGMENTS
The author would like to thank the students of Hostos Community
College in the Bronx, New York for collecting the data reported in this
paper; and Drs. Michael Iba and Arthur Greenberg for critical reviews of
the manuscript.
REFERENCES
Agency for Toxic Substances and Disease Registry (ATSDR). (1994). Use of azogue (metallic
mercury) in santeria practices of residents of Hartford, Connecticut. U.S. Public Health
Service, Atlanta, Georgia.
Agency for Toxic Substances and Disease Registry (ATSDR). (1997). National alert: Warning
about continuing patterns of metallic mercury exposure. Atlanta, Georgia.
Berlin, M. (1986). Mercury. In L. Friberg, G. R. Nordberg & V. B. Vouk (Eds.): Handbook on
the toxicology of metals (2nd ed.). New York: Elsevier Press.
Cotton, F. A. & Wilkinson, G. (1972). Advanced inorganic chemistry (3rd. ed.). New York:
John Wiley & Sons, Inc.
Dencker, L., Danielsson , B., & Khayat, A. (1983). Deposition of metals in the embryo and
fetus. In T. W. Clarkson, G.G . Nordberg & P. R. Sager, (Eds.). Reproductive and develop-
ment toxicity of metals, pp. 607-631. New York: Plenum Press.
Environmental Protection Agency (1996). Mercury study report to Congress. (EPA publication
No. 452-R-96-001). Washington: U.S. Government Printing Office.
Fagala, G. E., & Wigg, C. L.(1992). Psychiatric manifestations of mercury poisoning. J. Am.
Acad. Child. Adolesc. Psychiat. 31, 306-311.
Goldwater, L. J. (1972). Mercury—A history of quicksilver. Baltimore, MD: York Press, Inc.
Hallee, T. J. (1969). Diffuse lung disease caused by inhalation of mercury vapor. Am. Rev.
Respir. Dis. 99, 430-436.
Karpathios, T., Zervoudakis, A. & Thodoridis, C.(1991). Mercury vapor poisoning associated
with hyperthyroidism in a child. Acta. Paediatric. Scanddinavia. 80, 551-552.
Klaassen, C. D., Amdur, M. O. & Doull, J. (1986). Toxicology, thepfapqggience of poison
(3rd. ed.). New York: Macmillan.
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453
CLYDE JOHNSON
Hursh, J. B., Clarkson, T. W. & Miles, E. F. (1989). Percutaneous absorption of mercury vapor
by man. Archives of Environmental Health 44, 120-127.
Hursh, J. B. (1985). Partition coefficients of mercury (203Hg) vapor between air and biological
fluids. Journal of Applied Toxicology 5, 327-332.
Hursh, J. B., Clarkson, T. W., Nowak, T. V., Pabicio, R . C., Mc Kenna, B. A., Miles, E. & Gibb,
F. R. (1985). Prediction of kidney mercury content by isotope techniques. Kidney Interna-
tional. 27, 898-907.
Oikawa, K., Saito, H., Kufune, I., Ohshina, T., Fujii, M. & Takizawa, Y. (1982) Mercury ab-
sorption by inhalation through the nose and expiring through the mouth at various con-
centrations. Chemosphere 11, 943-951.
Schwartz, J. G., Snider, T. E. & Montiel, M. M.. (1992) Toxicity of a Family from vacuumed
mercury, American Journal of Emergency Medicine. 10, 258-261.
Snodgrass, W., Sullivan, J. B., Rumack, B. H., et al. (1981). Mercury poisoning from home
gold ore processing: use of penicillamine and dimercaprol J. Am. Med. Assoc. 246,
1929-1931.
Taueg, C., Sanfilippo, D. J., & Rowens, B., Szejda, J. & Hesse, J. L. (1992). Acute and chronic
poisoning from residential exposures to elemental mercury. J. Toxicol. Clin. Toxicol. 30,
63-67.
A4 p. 159
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09 2 4-97
12: 30
©
® 002<'002
CHARLES E SCHUMER
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liousc of Kcprcscntanocs
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C^MMTTtES
JJOICIARY
BANKING AND
NANClAi- SERV/'CES
WHiP AT'lARGE
Septemjswi: i.
M . P . H .
f Hea : t:
Benjamin Moj iea, I D
Acting Commission r,
New York City Dec :rtnient
125 Worth Street;
New York., NY ICO' ;
Dear Dr, Mcjica,
1 am writ ing to ycu today due-
increase in the use of unlabeled me
Through the diligent work of cr.e of my constituents, Dr. Arnold
P Wendroff, manv elected off icials, including myself .. have been
made aware of the oossibility of increased usage of unlabeled
mercury by unawara New Yorkers. The;,e anonymous vials are being
sold for medicinal and religious purposes. The seriousness or this
matter cannot be underscored enough.
:o my
'curv
concern ovej
;he suspected
As you know, exposure to mercurv
Studies have shewn links between lev#..-
defects, both neurological and physic
is an extreme health hazard,
s of mercury and birth
1, in children.
York children are
If Dr- Wendroff is correct, then many New
needlessly be: ng put at risk. Therefore, I am suggest. . .ug that you
do three things; ensure the proper labeling of mercury
creating strlc; procedures or strongly enforcing curr^n
standards, alert* "at-risk" consumers to the dangers of
poisoning, and lastly, start a program which would te.v
exposure in children.
Thank you for your time. I look forward to hear,
responses to these suggestions.
.oy either
labeling
mercury
mercury
ng your
Sincerely
Charles E. Schumer
Member of Congress
CES:BCD
A4 p. 160
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PAYSUflM HOUSS OFFICE BUIlPIW
-^¦ .WASHINGTON, DC 20515 •
V ' ;so:mvS»l! '
DISTRICT OFFICES: ' .
' ¦ ,858 ICINGS HWKWAV
• ¦ BROOKLYN, OT 1WM
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FINANCIAL!
,/a.nuary 14,- 159*
VVHIP-AT-IARSE
>,
' M . ? • H
Be.njarr.ir; Monica.. i'-'i-J-1
Acting Commissioner H tx:, ' , ¦ .
New York City Department cf. neaitfi
125 Worth Street _ ' ' ¦
New York, Ui"Y. lOul^ .
Dear Dr . X;, ; ;.< -a, ,
New York
v
tp r.hat letter, ms. aw***
re- ?..V diSnay. I found .chat nearly.
to ixliv ir. t Oep.^ent
Wendro: - » 1»J; ' ;"u;^a?r?o 4spond ".c w recent inq^-V. -
°l H-aU!:i":af !**•
children. a«Urve S^tanc vigilance, not liviMeztfa^ - - ' .
¦ i would also 1 ike r-0 ,dr^ 'r^.^le'ri^ons
December 1«S> jirtlcl* in .W^;; ¦*%£&»» -fou^'.W* n?"ly 33"
the article that •* «?5 r f ,.~ ratmules o{ ireriuiy d»ly.,
percent of them aola JooV'-.i^^^v'-w'-'r'adicta the DOS'® *fre*t*M>
» publisned dates t*Vsaf • the '---H was •. . .
firvS.bccamca* 'r.nst sel'~ rner-u:i/;-^'-\^>e"lQokina aavwi^re at ail'.
' looking ia '-he P^ces-.. *¦- ^ "^e ¦ \ ¦: ,.•./, • .- ¦ ,-
, .y«ff^od a coupIe¥'S^3^of's''fuPh';
Hi my, original n-eroury by either cr-eac ing -Bwi ict-
as ensuring the propex *. ^ ^ l abeling standards srno
croccdures or strongly •eato~c*l* £e"- of mercury poisoning. . .'•
Vp—:c "at -riyk" consumers to tne «*oge~£ / these- ¦ "¦
ir.iiqhr o£ your insufficient response - ^din:'r " - • • / ;
suggst*: i¦:-us ¦ ¦ •
:on\missior»fer of •
letter, Ms. Enid ^viSS^x
bot.araca:
:k torwz-:'
<~.n
reading your re.3po.v-i-;
i;iC5-rs;-.
,?'is i'I £¦ Schu'T.^:.
Member o'i*eongieS3
/
A4 p. 161
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CHARLES E. SCHUMER
COMMITTEES:
NEW YORK
JUDICIARY
Chairman
Subcommittee on
Crime and Criminal Justice
2412 RAYBURN HOUSE OFFICE BUILDING
WASHINGTON. DC 20515
(202} 225-6616
Congress of the United States
DISTRICT OFFICES;
1628 KINGS HIGHWAY
BROOKLYN, NY 1 1229
(718) 965-5400
House of Utprtsentatioes
^Washington, ©£ 20515
BANKING, FINANCE
AND URBAN AFFAIRS
FOREIGN AFFAIRS
73-15 YELLOWSTONE BLVD.
FOREST HILLS, NY 1 1375
(718) 268-8200
WHIP-AT-LARGE
90-16 ROCKAWAY BEACH BLVD
ROCKAWAY, NY 1 1693
|718) 945-9200
June 22, 1994
NEW YORK STATE
CONGRESSIONAL DELEGATION
Treasurer
Dr. Arnold Wendroff
544 8th St.
Brooklyn, N.Y. 11215
Dear Dr. Wendroff:
Thank you for contacting me concerning warning labels on
products with mercury metal. I appreciate you sending me the
information outlining the dangers of this substance.
Your concerns about mercury metal used in household products
are certainly valid and I agree with you that warning labels are a
simple solution. As you outline in your letter, mercury metal is a
highly toxic material that is especially dangerous for pregnant
women and young children. It simply does not make sense that we
regulate labelling of a multitude of dangerous household products
and we do not have any regulation of this potentially hazardous
material.
I want you to know that I have passed along your suggestion to
the Food and Drug Administration and the Consumer Product Safety
Commission. I depend on professionals like you, with "real world"
experience, for some of the best ideas for legislation on health and
safety of consumers.
Again, thank you for taking the time to write me about this
issue. If I can be of further assistance, please let me know.
Syicerely
Member of Congress
PRINTED ON RECYCLED PAPER
A4 p. 162
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CRAFT
CITIZENS'
RESISTANCE
FERMI TWO
Post Office Box 401356
Redford, Michigan 48240
Phone 313-286-3827
shutdownfermi@gmail. com
facebook.com/craftcitizensresistance/groups
shutdownferm i. or g
Directed to The Michigan Department of Environment, Great Lakes, and Energy,
We are writing from Waawiyomtonag, where the curved shores meet, a.k.a. Detroit and metro
areas. This is the traditional homelands of the Anishinaabe 3 Fires Confederacy which is made
up of the Ojibwe, Odawa and Bodewadmi peoples.
When it comes to the future of Michigan, we must also think of the safety and future of the Great
Lakes in every move we make. Our contributions to its maintenance, renewal and living safety
are priceless. We must craft a future full of renewable and alternative energies free from
radioactive waste.
To avoid long term pollution, contamination and health impacts related to long term
radionuclides and nuclear energy generation related chemicals into our lands, waters, airs, and
fellow beings, we need pollution free energy. We can do better than 50% resolution of
renewables by 2030 - we can do more, faster.
Support should go where it is most needed, where solutions would continue to be unaffordable
otherwise. The process must be inclusive of peoples and solutions, as well as keep in heart and
mind the wellbeing of all creatures and elements we impact. The plan must have community
voices, solutions and demands implemented as a part of any facility/energy system siting
process. Environmental Justice, poor working class and already impacted communities must
have first and last word.
Just Transition support, jobs, and job training should have community involvement and
implementation lead by affected and frontline communities. There should be no tradeoffs and no
recruiting people from frontline communities to work in factories that will bring in harmful
technologies regarding energy production and manufacturing jobs.
With this we follow with our comments and recommendations in RED
Jesse Deer In Water
Community Organizer
Citizens Resistance At Fermi Two
James Sherman
Co-Chair
Citizens Resistance At Fermi Two
A4 p. 163
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Ml Healthy Climate planflink to plan)
COMMENTS BEGIN ON NEXT PAGE IN RED
Table of contents
1. Letter from EGLE Director i
2. Introduction 1
a. Governor Whitmer's commitment to achieving 100% carbon neutrality
by 2050 and position Michigan as a global leader in addressing climate
Change.
b. Climate change is an urgent global challenge that is already impacting
Michigan in unique ways.
c. Creating good jobs for Michigan workers, increasing our state's
economic competitiveness, and improving quality of life as we pursue
carbon neutrality.
d. Putting equity front and center in Michigan's climate change
response.
3. A Michigan climate plan shaped by Michigan residents 6
4. Key focus areas 8
a. The Ml Healthy Climate Plan is focused on Michigan's most
significant sources of GHS emissions and taking action where the
biggest gains can be made.
5. Summary of Key focus areas for 2022-2030 10
a. Overarching goal
b. Energy Production
c. Transportation
d. Businesses and Homes
e. Environmental Justice
f. Leadership and Innovation
6. Discussion of key focus areas 13
a. Energy production: Accelerating Michigan's transition to a clean energy
Future
i. Michigan has been moving in the right direction on clean energy
and carbon reduction
ii. Planning and the Michigan Public Service Commission's (MPSC's)
significant role in regulatory oversight of energy in Michigan will be key
in achieving targets
iii. Renewable energy is reliable and cost effective
A4 p. 164
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b. Transportation: Putting Michigan on the road and rails to carbon neutral
mobility
i. Navigating a pivotal decade of transition in automotive history
ii. Taking a broad, all-options approach to transportation to put
Michigan on track to achieve its decarbonization goals
iii. State-level policies and programs across the country provide a
bank of options and experiences for a Michigan-specific approach
iv. Strategic transportation planning will help knit traditional and
advanced transportation options into an integrated system that
serves all Michiganders
c. Businesses and Homes: Reducing energy demand and waste in
Michigan homes, commercial buildings, and factories
i. Michigan needs to invest in upgrading existing homes and buildings
ii. Proven energy waste reduction programs can save Michiganders
millions while driving decarbonization
iii. Reducing GHG emissions in how we operate buildings - like cars,
trucks, and other vehicles - will depend on our success in
transitioning to clean energy
iv. Local unites of government are leading the way in reducing their
energy use and they need support for transformative water
infrastructure projects
d. Innovation: Areas of opportunity and need
i. Clean industrial hubs
ii. Electrification of buildings and homes
iii. Closing the digital broadband divide
iv. Natural features and food
7. State of Michigan efforts 36
a. Leading by Example
b. Incorporating climate into state programs
8. Roadmap to a carbon-neutral 2050 38
9. How to get involved in climate action 39
10.Appendice s 40
I. Summary of Key Recommendations from workgroups
II. Workgroup summaries of Key Recommendations presented to the Council on
A4 p. 165
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Table of contents
1. Letter from EGLE Director i
We like the global science-based benchmark for reducing Greenhouse Gas Emissions
(GHG) to avoid the most devastating and costly impacts of climate change.
We refuse to leave it up to your creativity and ingenuity, our futures are no longer your
playgrounds. Nuclear power advocates frequently point to such economic arguments
despite the greater number of jobs in renewable energy and the potential harm posed to
the nuclear workforce. We have tested, workable solutions that do not pose the threat
level inherent in nuclear. Also, a decommission now approach would increase workloads
at the plant through the decommissioning process
The process was off. If this is a living document, then let us put some life into it.
Yes, proven clean renewable distributed generation and storage is the path already
known to us.
2. Introduction 1
a. Governor Whitmer's commitment to achieving 100% carbon neutrality
by 2050 and position Michigan as a global leader in addressing climate
Change.
-Awesome to see the notice of lowering greenhouse gas emissions. It would only
make sense to exclude Small modular nuclear from plans. Proposed Advanced
Modular Reactors (AMRs) have never operated successfully anywhere in the
world.
- helium-cooled graphite-moderated high-temperature reactors (HTGR).
-sodium-cooled fast reactors (FBR).
-molten salt reactors.
- lead-cooled fast reactors.
All the above are contributors of Halogens and other greenhouse gas emissions
as well as anthropogenic heat sources as well, and major producers of highly
radioactive waste.
Nuclear falsely claims carbon neutrality. While the reactor's fission reaction only
releases Carbon Dioxide in the form of Carbon-14, it is dependent on a fuel stream
rife with carbon emissions, a carbon-free economy is not possible with it in play.
Whereas the impact of Carbon Dioxide is global, geographic displacement of
carbon emissions is futile, it doesn't matter where the carbon emissions are
released, it equally contributes to global impacts and must be considered as a
carbon emission embedded in the final accounting of the related generation.
A4 p. 166
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Nuclear energy is NOT clean or carbon-free. The nuclear fuel chain is responsible
for carbon emissions during mining, milling, enriching, construction,
transportation, and decommissioning. From cradle to grave, nuclear reactors
pollute the environment and threaten human health and safety. Uranium fuel is
mined in or near Indigenous communities and communities of color. After mining,
milling generates vast amounts of radioactive and toxic tailings that are deposited
on the ground or in open ponds. The nuclear fuel is then enriched in an energy-
intensive process. Approximately 25,000 pounds of mining waste (rock, mill
tailings, and depleted uranium) are generated for each pound of nuclear fuel
delivered to Michigan's reactors. Nuclear plants routinely and accidentally release
radioactive isotopes to air and water, including newly generated radioactive
carbon, C-14, which results from nuclear fission. The so-called "spent" nuclear
fuel rods, which emerge from the reactor, are approximately one million times
more radioactive than when they entered, and must be stored on-site indefinitely,
with inadequate decommissioning plans or funds to ensure that this is done
safely. The Nuclear Regulatory Commission's legal limit for radiation exposure to
the public from the routine operation of a reactor is 100 millirems per year - a
dose rate which the agency itself believes will result in one additional cancer
fatality per 286 people exposed. There is no safe level of radiation exposure.
Subsidizing nuclear power will increase the amount of deadly fuel rods that each
host communities will have to store overtime. Bailing out nuclear reactors is
corporate welfare subsidized by ratepayers:
b. Climate change is an urgent global challenge that is already impacting
Michigan in unique ways.
-Yes, man-made climate catastrophes are here and more on the way, the Fermi
Two reactor in Monroe uses 45 million gallons of water a day for its processes, it
also releases that water back into Lake Erie as waste and treated wastewater. This
ratio of water to waste is 10:1, leaving 4.5 million of those 45 million gallons being
chemicals and toxins that are contributing to the pollution that our freshwater and
freshwater beings call home. This water is also released at temperatures up to 70
degrees hotter than the western basin of Lake Erie. The international Joint
Commission has identified thermal pollution such as fermi 2's a major contributor
to the degradation of The Great Lakes. Toxic Algal blooms form right off the coast
of fermi every year and it will only get worse if we continue to pump heat and
poison into our waters while taking water out of them for major processes.
The United Nations Intergovernmental Panel on Climate Change (IPCC) predicts
that human-caused climate change will highly likely both increase and intensify
severe weather.
Nuclear reactors and radioactive waste storage sites contain enormous amounts
of hazardous radioactivity. This could be catastrophically unleashed during
accidents caused by severe weather disasters, threatening to kill or injure tens to
A4 p. 167
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hundreds of thousands of people living downwind and downstream, and
contaminate vast regions, causing hundreds of billions of dollars in property
damage.
Hurricanes, tornadoes, and floods threaten reactors and waste
• Severe weather-related events, and resulting power outages, also require
reactors to shut down for extended periods for safety reasons. Hurricane Katrina
forced reactors in Louisiana and Mississippi to power off, when electricity was
needed most. The 2003 Northeast power outage spread to 50 million people as
dozens of reactors in the U.S. and Canada were forced to shut down for safety
reasons due to electric grid instability
• Floods at the Cooper reactor on the Missouri River in Nebraska, and the Prairie
Island nuclear plant on the Mississippi River in Minnesota, in the 1990s showed
the risks of loss of emergency systems, spread of radioactive contamination, and
even loss of evacuation routes for neighboring communities.
• Flooding has spread contamination at radioactive waste dumps as well. While
the proposed national dumpsite for high-level radioactive waste at Yucca
Mountain is already geologically and hydrologically unsuitable, water flow
through and radioactivity leakage from the site will only grow worse as climate
change increases precipitation in Nevada. Droughts and heat waves strain
reactors and ecosystems
c. Creating good jobs for Michigan workers, increasing our state's
economic competitiveness, and improving quality of life as we pursue
carbon neutrality.
Nuclear power is expensive.
Many of the jobs come from the refueling and fix process which brings in workers
from out of state.
Further, the jobs argument is equally faulty. Most of the workers at these facilities
will need to be retained during closure and decommissioning, and those few who
are downsized should be retrained for jobs in the emerging green energy
economy through a planned and just transition.
d. Putting equity front and center in Michigan's climate change Response.
"For this reason, Governor Whitmer called on those developing the Ml Healthy
Climate Plan to design and recommend decarbonization strategies that will
advance equity." The Nuclear Industry is and has been historically known as anti-
equity, pro monopoly and disproportionately impacts marginalized communities
through its regular practice.
3. A Michigan climate plan shaped by Michigan residents 6
FOR THIS SECTION WE SUPPORT THE RECOMMENDATIONS OF THE MICHIGAN
ENVIRONMENTAL JUSTICE COALITION, ESPECIALLY AROUND "PROCESS".
A4 p. 168
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We also ask that environmental orgs are not required to file Freedom of Information Acts
to gain access to what the heck is being dumped yearly by fermi 2, we already know what
it is, we should know exactly how much as well.
The plan must have community voices, solutions and demands implemented as a part of
any facility/energy system siting process. Environmental justice, poor working class and
already impacted communities must have first and last words. Communities need
support with technological understanding of viable solutions to resist the predictable
onslaught of false solutions like small untested unproven modular reactors.
4. Key focus areas 8
a. The Ml Healthy Climate Plan is focused on Michigan's most
significant sources of GHS emissions and acting where the
biggest gains can be made.
Nuclear falsely claims carbon neutrality. While the reactor's fission reaction does
not release Carbon Dioxide besides Carbon-14, it is dependent on a fuel stream
rife with carbon emissions. Whereas the impact of Carbon Dioxide is global,
geographic displacement of carbon emissions is futile
5. Summary of Key focus areas for 2022-2030 10
a. Overarching goal
b. Energy Production
Everything about this would prevent nuclear power as a consideration.
Holistic statewide energy planning-Definition of clean renewable energy needs to
be part of the plan. More specificity to head off coming attacks on renewable
standards. Tested tech being those that are already in use (renewable etc.)
-clean energy resources-we can do better than 50% res by 2030,
we can do more faster with it. Michigan can expand and create renewable
manufacturing like silicon wafer production to help the flow of products.
Also define and use only truly clean energy sources that don't cause harm
to communities in Michigan and as well as communities that take the brunt
of the impacts from dirty extraction processes. Nuclear power is based on
a stream of highly toxic and radioactive material. It is not based on a
circular economy. With heavy mining, processing, transportation, heavy
industrial generating footprint, and thousands of years of waste storage,
nuclear is the exemplar of non-circular.
-state electricity use-sounds good if implemented and followed
thru. Ideal goal as state can mandate. This will prove that the rest of the
state can use rapid deployment time frames to support the general welfare
of state residents and businesses. Proving there is no reason to drag our
feet till 2050.
A4 p. 169
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-siting-must have community voices, solutions and demands
implemented as a part of any facility/energy system siting process-
environmental justice, poor working class and already affected
communities must have first and last word. Communities need support
with technological understanding of workable solutions to resist the
predictable onslaught of false solutions like SMRs.
c. Transportation
d. Businesses and Homes
e. Environmental Justice
Environmental Justice is the concept that major polluting projects should not have a
disproportionate impact on Black, Indigenous, People of Color and low-wealth communities.
Uranium mines, nuclear waste dumps, toxic incinerators, atomic reactors and other such
facilities typically are located where there is cheap land, cheap facilities, and little organized
opposition. Too often, this has been in Black, Indigenous, People of Color and low-wealth
communities that have felt powerless to oppose corporate giants.
In February 1994, President Clinton issued an Executive Order requiring federal agencies to
consider environmental justice issues when issuing permits for new polluting facilities.
Although as an independent agency the Nuclear Regulatory Commission was exempt from
that order, then-Chairman Ivan Selin committed the NRC to implement the order. One result
was a victory defeating the proposed Louisiana Energy Services uranium enrichment plant
for Homer, Louisiana, which violated environmental justice principles. It became the first
license applicant before the NRC ever to be denied a license.
Reeling from that blow—after all, one denial in 45,000 applications might show a trend—the
nuclear industry suggested to the NRC that it remove environmental justice from further
licensing consideration. The result is a new NRC policy that tries to do just that.
We continue to fight for environmental justice in all our work.
-JUSTICE 40-minority of money going to people with majority of the issues,
60% of the resources going to entities that are already well positioned to leverage
solutions now. Support should go where it is most needed, where solutions would
continue to be unaffordable otherwise. We live the injustices, who in the state is
getting educated on environmental justice? You all out here making decisions for
us.
-Just Transition Support-should have community involvement and
implementation lead by communities
-Job Training-No tradeoffs, no recruiting people from frontline
communities to work in factories that will bring in harmful technologies regarding
energy production and manufacturing jobs,
f. Leadership and Innovation
A4 p. 170
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Nuclear power advocates often point to such economic arguments despite the
greater number of jobs in renewable energy and the potential harm posed to the
nuclear workforce. We have tested, workable solutions that do not pose the threat
level inherent in nuclear. Also, a decommission now approach would increase
workloads at the plant through the decommissioning process
6. Discussion of key focus areas 13
a. Energy production: Accelerating Michigan's transition to a clean energy
Future
i. Michigan has been moving in the right direction on clean energy
and carbon reduction
With the huge payback from modest investments thus far, further
investment is solidly justified
ii. Planning and the Michigan Public Service Commission's (MPSC)
vital role in regulatory oversight of energy in Michigan will be key
in achieving targets
Too much focus on GHG and only passing mention of "reducing harmful
emissions". More attention needs to be paid to toxic pollutants, water use,
air quality, thermal pollution, and all the negative externalities of dirty,
extracted energy.
• A sound energy and economic policy must be founded upon a rapid
transition to 100% renewable energy, energy efficiency, and a modern,
smart electricity grid
. • Advances in renewable energy now make it possible to both grow an
equitable economy and phase out greenhouse gas emissions at the lowest
cost.
• Policy makers and regulators must pursue this path to the fullest extent
possible, in pursuit of decarbonization, economic development, pollution
reduction, public health and protection of the environment
iii. Renewable energy is reliable and cost effective
More attention needs to be directed at the role of IOU (investor-owned
utilities) and how protecting monopolistic control of infrastructure is
working counter to the stated goals of this plan. DTE and Consumers a
lauded for their stated goals, but there's no mention of their renewable
energy obstructionist tactics (historical and/or current).
Investing in renewables is the best choice now and in the future. Keeping
uncompetitive nuclear reactors online through subsidies would squeeze
out and delay the growth of renewables for decades. The costs of nuclear
power are high and rising, reducing spending and jobs economy-wide,
affecting families' disposable income, and increasing utility costs for
consumers. Bailing out existing nuclear reactors would forgo
approximately 80% of economic benefits of the transformation and still
A4 p. 171
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require future replacement of nuclear facilities, further increasing the cost
and risk. Further, the nuclear industry is sitting on $64 billion in
decommissioning trust funds which can be used to keep nuclear workers
employed and help communities transition to the clean energy economy.
The cumulative value of federal subsidies for nuclear power dwarfs the
value of subsidies for renewables and efficiency by 10 to 1. With a much
smaller level of subsidy, renewables have achieved dramatically declining
costs in a little over a decade, a result that has eluded the nuclear industry
for half a century. The right choice is to let nothing stand in the way of the
transition to renewables and get it done as quickly as possible.
b. Transportation: Putting Michigan on the road and rails to carbon neutral
mobility
i. Navigating a pivotal decade of transition in automotive history
ii. Taking a broad, all-options approach to transportation to put
Michigan on track to achieve its decarbonization goals
iii. State-level policies and programs across the country supply a
bank of options and experiences for a Michigan-specific approach
iv. Strategic transportation planning will help knit traditional and
advanced transportation options into an integrated system that
serves all Michiganders
c. Businesses and Homes: Reducing energy demand and waste in
Michigan homes, commercial buildings, and factories
Mass timber buildings: Timber frame buildings are beautiful and efficient when
built right, but is increasing deforestation a clever idea in a GHG reduction plan?
Any such plan must have prohibitions on clearcutting mature forests and should
focus on selective cutting and reforestation with a focus on replacing
mechanically planted and non-indigenous species with species diverse natural to
the ecosystem. With advancements in engineered wood alternatives, we should
focus on leading a shift to non-forest product building products using agricultural
fiber products.
i. Michigan needs to invest in upgrading existing homes and buildings
ii. Proven energy waste reduction programs can save Michiganders
millions while driving decarbonization
iii. Reducing GHG emissions in how we operate buildings - like cars,
trucks, and other vehicles - will depend on our success in
transitioning to clean energy
iv. Local units of government are leading the way in reducing their
energy use and they need support for transformative water
infrastructure projects
d. Innovation: Areas of opportunity and need-
We can do better than a 50% Renewable Energy Standard (RES) by 2030, we can
do more faster with it. Michigan can expand and create renewable manufacturing
like silicon wafer production to help the flow of products. Also define and use only
A4 p. 172
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truly clean energy sources that don't cause harm to communities in Michigan and
as well as communities that take the brunt of the impacts from dirty extraction
processes.
Must have community voices, solutions and demands implemented as a part of
any facility/energy system siting process-environmental justice, poor working
class and already affected communities must have first and last word.
Communities need support with technological understanding of viable solutions
to resist the predictable onslaught of false solutions like Small Modular Nuclear
Reactors (SMNRs).
i. Clean industrial hubs
Clean industrial hubs should not put local communities in harm's way, the
reuse of GHG and pollutants cannot be one that would put forth harm to
human, beings and elements by capturing, releasing or transporting
unreleased materials and byproducts by way of manufacturing combined
with energy sources.
Definition of clean renewable energy needs to be part of the plan. More
specificity to head off coming attacks on renewable standards. Evaluated
tech being those that are already in use (renewable etc.). These defined
clean renewable energy sources can't cause harm to communities here in
Michigan and also don't extend harm to communities that take the brunt of
dirty extraction and transport processes.
Pg16 line 28 "Renewable energy is dependable and cost effective. As
deployment has increased and the wind, solar, and related industries have
scaled up, the cost of renewable energy has continued to fall"
Nuclear Power is heavily centralized. SMRs are unproven, not clean, cancer
risk, vulnerable to terrorism. Nothing reasonable or prudent about nuclear
power
ii. Electrification of buildings and homes
Shifting needs like heating to electrical energy sources is a vital solution in
many applications. Natural gas infrastructure is leaking vast amounts of
extremely potent GHGs and need to be retrofitted or decommissioned. A
mere reduction of dependence on this infrastructure without addressing
leakage would increase leakage as resources for maintenance diminish.
Keeping this infrastructure while reducing GHG emissions would require
addressing leaks and inputs, such as generating more natural gas from
organic wastes and agricultural products. Heat pumps are not a one size
fits all solution. This plan is missing one of the most vital areas for savings
directly from distributed energy: passive and thermal solar heating. When
people think of solar, they typically think of PV (photovoltaics). Passive and
A4 p. 173
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thermal solar (such as evacuated tube solar thermal) operate at much
higher efficiency rates than PV. Maximizing the efficiency of renewable
energy deployments require site specific considerations. Is the site
shaded, for example? Cutting mature trees for solar will increase cooling
needs and decrease biological carbon capture. For heavily shaded or multi
story tenant structures, direct solar is a challenge, so switching heating to
electric makes sense. For structures with solar resources, passive and
thermal solar offer a better return on investment and reduce grid demand.
Geothermal is also a high return investment that can reduce grid demand
and can be deployed at single dwelling to a larger district scale.
iii. Closing the digital broadband divide
iv. Natural features and food
"Similarly, Michigan's forests currently store approximately 2,045 million
tons of total forest ecosystem carbon while also sequestering atmospheric
carbon every year. In addition to their sequestration value, planting trees in
our cities and towns can reduce the urban heat island effect, reduce tree
inequity, and improve the health and well-being of urban residents" This
will require planning to not conflict with solar installations. Trees grow,
fixed panels stay fixed. Tightly spaced urban areas will require community
solar deployments to allow for urban forestry to coexist with distributed
solar.
7. State of Michigan efforts 36
Nuclear power is based on a stream of highly toxic and radioactive material. It is not
based on a circular economy. With heavy mining, processing, transportation, heavy
industrial generating footprint, and thousands of years of waste storage, nuclear is the
exemplar of non-circular.
a. Leading by Example
More attention needs to be directed at the role of IOU (investor-owned utilities)
and how protecting monopolistic control of infrastructure is working counter to
the stated goals of this plan. DTE and Consumers a lauded for their stated goals,
but there's no mention of their renewable energy obstructionist tactics (historical
and/or current).
b. Incorporating climate into state programs
Nuclear is not clean and not renewable when considering a goal is to achieve
100% clean, renewable electricity paired with robust energy storage.
8. Roadmap to a carbon-neutral 2050 38
With the wealth of Traditional Ecological and Ancestral Knowledge of the 12 federally
recognized tribes of Michigan, whose traditional homelands we occupy, there is much
already known about how to steward the land and our primarily recommendations
include working with the tribes and using that knowledge to help sustain, regenerate and
protect the land, water, beings and elements.
A4 p. 174
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Stanford Recommendations for 100% Wind. Water. Solar Roadman
Nuclear power is a wasteful energy source, today's energy systems are wasteful, up to
70% of the heat is released in the atmosphere and only 30% being used. Making it a
major contributor to the anthropogenic heat sources that are intersecting within climate
change.
The grids of the future
-Solar and wind mainstays of energy system,
-Increased efficiency
-Storage, combined heat and power, microgrids
-Demand response
-Control consumption to minimize bills
-Electrified transportation and HVAC
-Provide services to the grid, including via V2G and local storage ownership
Support offshore wind. Michigan has enormous offshore wind potential to meet a goal of
50 percent renewable energy generation by 2030.
A Renewable Energy Standard should be dedicated to accelerating the development of
offshore wind and renewable energy, not to subsidizing nuclear power. Set aggressive
energy efficiency goals.
Energy efficiency is a key component of a low-carbon energy future. It is the most
affordable way to reduce greenhouse gas emissions and displace fossil fuel and nuclear
generators.
Please consider these resources
https://ieer.org/resource/climate-change/renewable-minnesota-technical/
https://ieer.orq/resource/economic-issues/100-renewable-electricitv-supplv-marvland/
https://web.stanford.edu/groyp/efmh/iacobson/WWSBook/WWSBook.html
9. How to get involved in climate action 39
10.Appendice s 40
I. Summary of Key Recommendations from workgroups
II. Workgroup summaries of Key Recommendations presented to the Council on
The nuclear elephant in the room
There is no direct mention of nuclear power. There are statements that would preclude
nuclear power if taken at face value. There are also statements that would appear to
leave a door open to false nuclear "solutions".
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A4 p. 176
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A4 p. 177
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f- -s
New York State Department of Environmental Conservation
Region 3 Office/Solid Waste Program
21 South Putt Corners Road, New Paltz, New York 12561-1620
Phone: (845)256-3126 $ FAX: (845) 255-3414
Website: www.dec.ny.gov E-mail: sxparisi@aw.dec.state.nv.us
Joe Martens
Commissioner
October 5, 2011
Burt McCullough
Manager of Environmental Projects
Mirant Corporation
1155 Perimeter Center West
Atlanta, GA 30338-5416
Re: Mirant-Lovett LLC, T-Stony Point, Rockland County - Consent Order No. 3-20080414-15
Site Characterization Report
Dear Mr. McCullough:
The Department has reviewed the May 15, 2010 Site Characterization Report (the Report),
prepared by HDR, and submitted on behalf of Mirant Lovett LLC, in connection with the Mirant-Lovett
site in the Town of Stony Point, Rockland County and Order on Consent # 00320080414-15 (dated July
17, 2009). The Department's findings relative to the report are outlined below.
In general, the investigation was carried out in conformance with the approved site investigation
work plan (the Work Plan) previously approved by the Department. Deviations from the Work Plan are
discussed in section 2.2 of the Report and, in most cases, concurrence from Department staff is
documented in the Report. Significant exceptions include monitoring well MW-J2 which was located
approximately 25 feet northeast of the location shown in the approved Work Plan, MW"L which is located
85 feet to the east of the location shown in the approved Work Plan, MW-H2 which is located 25 feet to
the northeast of the location shown in the approved Work Plan and MW-K2 which is located
approximately 30 feet south of the location shown in the approved Work Plan. These deficiencies
notwithstanding, the Report is considered to be adequate to serve as a basis for identifying environmental
damage caused by the facility which will require remedial action and is therefore approved. Specifically,
the following are the environmental issues identified by Department staff based on review of the report
and/or observations made at the site which require remedial action or additional investigative work to
serve as a basis for remedial design^
1. A plume of groundwater contamination including sulfate, boron, selenium, arsenic and other
coal or coal ash derived contaminants which is migrating southward from the former coal storage
pile area, the former coal ash settling lagoons and the CAMF to where it may enter the capture
zone of the dewatering system of the Tilcon mine;
2. Soil contamination including PAHs, PCBs and toxic metals associated with several AOCs!
3. A groundwater contamination plume of petroleum-related contamination migrating southward
from the former PBS area under the influence of the Tilcon mine dewatering system;
4. A residue of C&D debris, other than the waste types allowed at exempt C&D debris disposal
sites, which is observable at the surface throughout the areas where facility buildings were
demolished (see August 12, 2009 inspection report, attached);
1
A4 p. 178
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5. Pockets of waste coal which were not removed due to proximity to the active railroad tracks or
other reasons! and
6. Release of contamination from the CAMF to surface water as indicated by the increase in
sulfate between the upstream sample (17 mg/L) and downstream sample (67 mg/L).
The Report is hereby approved and, in accordance with paragraph II.D.3, is incorporated into the Order
on Consent as Appendix B. Mirant has already satisfied the requirement of paragraph II.D.5 to submit
the report is an suitable electronic format.
The investigation which has been completed was extensive in scope and represents an important
milestone in the process of addressing the various environmental impacts resulting from a long and
varied site history. The next step in the process will be the development of a proposed plan of remedial
action to mitigate the impacts which have been identified and to monitor the effectiveness of the remedial
measures.
Department staff would like to continue our cooperative working relationship as we move forward
into the remedial design phase at the Site.
Please indicate whether Mirant Lovett LLC is willing to develop a remedial action plan to address
the environmental issues outlined above. To accomplish this we will need your continued cooperation
and we request your response within thirty (30) days. A meeting can then be scheduled to discuss the
details and timeframe for development of an approvable site remediation plan and an Order on Consent
to provide the necessary legal framework. I look forward to your response and to working with you to
build on the progress which was made during the investigative phase of the project.
Sincerely,
if&A
Steven Parisio
Regional Solid Waste Geologist
Attachment
Ecc w/attachment: Kevin P. Maher, Town Engineer, T-Stony Point
Maureen Leary, Office of the Attorney General
Mauricio Roma, Office of the Attorney General
W. Janeway
M. Caruso
S. Crisafulli
J. Parker
M. Brand
D. Pollock
2
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Region 3/Solid Waste Program
Solid Waste Management Facility Site Visit Report
Facility Name/Location:
Mirant-Lovett former power plant, Town of Stony Point, Rockland County
Date of Site Visit:
August 12, 2009
DEC Staff Present:
Steven Parisio
Mauricio Roma, Office of the Attorney General
Facility Representatives:
Burt McCul lough, Mirant Corp
Michael Pantliano, HDR
Tanya Goehring, HDR
Background Information:
The power plant has been demolished and removed from the site. The
Consent Order requiring a remedial investigation of the site was executed
on July 16, 2009. Installation of groundwater monitoring wells is
underway. Several of the monitoring well locations shown in the approved
investigative work plan need to be modified due to power lines and other
physical constraints encountered in the field.
Purpose of Site Visit:
To discuss changes in monitoring well locations and oversee monitoring
well installation.
New Issues and Follow-
up Required:
Modified locations for monitoring wells MW-C2, MW-E (couplet), MW-P
and MW-0 were agreed to in the field. The consultant will need to verify
the feasibility of these locations with the driller and obtain permisson for
those wells not on Mirant property. (MW-E, MW-P, MW-O). The
modified locations for MW-E, MW-P and MW-0 are not significantly
different from what is shown in the approved work plan. The new location
for MW-C2 could be either 75 feet to the east or 150 feet to the south. If
the latter location is selected, a deeper well would be needed to reach the
target depth because of the higher ground elevation and because of
groundwater flow lines which are presumed to be plunging to the south.
HDR will provide a GIS shape file showing the modified monitoring well
locations.
After demolition of the power plant buildings, C&D debris was used as
grading material throughout the site. Inspection of the ground surface
shows minor but consistent amounts of waste types which are not
acceptable for this purpose. This presence of this material is a violation of
applicable 6 NYCRR Part 360 regulations which will need to be resolved,
along with any soil and groundwater contamination identified during the
investigation, when remedial measures are negotiated.
Report prepared by:
S. Parisio
Report Date:
August 12, 2009
1
A4 p. 180
-------
Region 3/Solid Waste Program
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the process of installing groundwater monitoring wells for the remedial site investigation.
2
A4 p. 181
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Coalition for Healthier Schools
...providing the national platform and
the forum for environmental health at school, since 2001...
Coordinated by Healthy Schools Network
February 15, 2022 -via email
President Joseph R. Biden, Jr.
The White House
1600 Pennsylvania Avenue
Washington, DC 20500
Vice President Kamala D. Harris
The White House
1600 Pennsylvania Avenue
Washington, DC 20500
Dear President Biden and Vice President Harris:
As you prepare your funding requests for Fiscal Year 2023, we strongly encourage you to provide at least
$60 million to the US Environmental Protection Agency (EPA) to help protect children from
environmental risks that have been ignored for far too long, especially in view of both the climate and
COVID disasters that have impacted so many K-12 school facilities.
Despite decades-long efforts by Congress to address polychlorinated biphenyls (PCBs), asbestos, lead in
drinking water, mercury, pesticides, and other highly hazardous substances, millions of school children in
the nation's 130,000 schools (98,000 public) enrolling 54M students (49M public) (NCES data) continue to
be exposed to toxic chemicals and poor indoor air quality (IAQ) every day. The Center for Disease
Control and Prevention (CDC) estimates that 40 percent of kids in schools have existing chronic health
conditions that can be exacerbated by unhealthy indoor environments,1 including an estimated 6 million
American children with asthma — the leading cause of absenteeism due to chronic illness. Unhealthy
school environments are not only a public health concern, but also negatively impact thinking and
learning.2
Children are especially susceptible to harm from chemical exposure and unhealthy indoor air. Yet many
U.S. schools, particularly in disadvantaged communities, lack the information, tools, and resources
necessary to prevent or identify prevent and effectively address environmental risks to children.
While the bipartisan infrastructure law provides funding to address energy retrofits in schools and low
emission school buses, federal funds for technical assistance, training, and tools to help schools address
indoor air and environmental quality problems and toxic exposures are woefully inadequate. Schools need
help, as evidenced by the inability of most schools to follow CDC's guidelines for re-opening after
COVID closures.3
We urge you to request $50 million/year to fund US EPA Indoor Environments Division's proven "IAQ
Tools for Schools" program. EPA's program helps schools both prevent and solve common
environmental problems such as mold, cleaning and disinfectant exposure, air quality and ventilation, and
other school environmental health concerns, as well as how to protect IAQ during energy retrofits. We
urge an addition $10 million in FY 2023 for EPA's Office of Children's Health Protection to advance
1 https://www.cdc.gov/healthvschools/chronicconditions.htm
2 https://forhealth.org/Harvard.Schools For Health.Foundations for Student Success.pdf
3 https://www.edweek.org/leadership/vou-cant-follow-cdc-guidelines-what-schools-reallv-look-like-during-covid-
19/2021/03. See also: https://www.ashrae.org/about/news/2021/ashrae-supports-usgbc-iaq-schools-survev-and-report
A4 p. 185
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research and educational outreach to families and providers via the CDC-EPA jointly designated network
of pediatric environmental health units.
Finally, we strongly support funding for EPA's regional offices to help schools address PCBs present in
light ballasts, ceiling tiles, and window and door caulking in thousands of facilities built or remodeled
between 1950 and 1979, as well as other legacy toxics common to school facilities.
While funding to rebuild school infrastructure is desperately needed and must remain a priority for this
administration, the FY 2023 budget request for EPA provides an opportunity to ensure that all schools,
and especially those in environmental justice communities, and in other economically disadvantaged and
rural-remote areas, are provided information, training, and tools to improve children's health and learning
through addressing unjust, inequitable, and all-to-common school environmental hazards.
Thank you for considering these views.
Sincerely,
Kenneth Mendez, MBA, President & CEO, Asthma and Allergy Foundation of America
Nsedu Obot Witherspoon, MPH, Executive Director, Children's Environmental Health Network
John E. Reeder, Vice President for Federal Affairs, Environmental Working Group
Bruce Lesley, President, First Focus on Children
Claire L. Barnett, MBA, Executive Director, Healthy Schools Network
Tracy Gregoire, Healthy Children Project Director, Learning Disabilities Association of America
Veronika Carella, Legislative Director, Maryland Children's Environmental Health Coalition
Donna Mazyck, MS, RN, Executive Director, National Association of School Nurses
cc: US EPA Office of the Administrator; EPA/OAR/IED; EPA/OCHP
White House Council on Environmental Quality
White House Office of Management and Budget
White House Council on Environmental Justice
Contact: Claire L. Barnett, cbarnett@,healthyschools. orv, 202-543-7555
A4 p. 186
-------
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A4 p. 188
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cvnm
CONSERVATION
VOTERS /
NEW MEXICO (
March 7, 2022
By electronic mail
(whejac@epa.gov)
Richard Moore, Co-Chair
Carletta Tilousi, Vice-Chair
Angelo Logan, Member
Viola Waghiyi, Member
Kim Havey, Member
I Hi Xyooj, Member
LaTricea Adams, Member
Beverly Wright, PhD, Member
Jade Begay, Member
Juan Parras, Member
Jerome Foster, Member
Michele Roberts, Member
Ruth Santiago, Member
White House Environmental Justice Advisory Council
Dear Co-Chairs Moore and Shepard, Vice-Chairs Tilousi and Coleman
Flowers, and Members of the White Flouse Environmental Justice
Advisory Council:
I write for Conservation Voters New Mexico to address one issue that
should be included in the White House Environmental Justice Advisory Council
scorecard for federal agencies' efforts to address environmental injustice. We
sought to raise this issue during your meeting on February 24th, but Douglas
Meiklejohn, who was our spokesperson, was not one of the commenters called
upon to speak.
1
Peggy Shepard, Co-Chair
Catherine Coleman Flowers, Vice-Chair
Rachel Morello-Frosch, PhD, Member
Miya Yoshitani, Member
Kyle Whyte, PhD, Member
Tom Cormons, Member
Harold Mitchell, Member
Susana Almanza, Member
Robert Bullard, PhD, Member
Maria Belen Power, Member
Maria L6pez-Ni3nez, Member
Nicky Sheats, PhD, Member
A4 p. 189
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Introduction
Conservation Voters New Mexico ("CVNM") is a statewide non-profit
non-partisan organization that values responsible stewardship of New Mexico's
water, land, and other natural resources, CVNM believes that ecological health
and social equity among New Mexico's diverse and culturally rich communities
protect our state's quality of life. C VNM is dedicated to ensuring democratic
accountability and access for all New Mexicans in decision making at all levels
of government. CVNM. supports policies that promote long-term ecological and
economic sustainability. This is CVNM's responsibility to future generations.
Based on these values, CVNM supports the concept of a scorecard for use
in evaluating the progress made by federal agencies to address environmental
injustice. In addition, it is CVNM's view that such a scorecard must include
evaluation of federal agencies' performance based on the measures used by the
agencies to involve and communicate w ith the residents of underserved and
overburdened communities (''environmental justice communities").
More specifically, the scorecard should evaluate the performance of
federal agencies based on the extent to which the agencies use measures to
announce their proposals, decisions, and other activities that are actually likely
to reach the residents of environmental justice communities. The need for
agencies to use appropriate measures, and CVNM's recommendations for such
measures, are outlined below.
Argument
I. Federal agencies' traditional measures for giving notice are not adequate
to reach residents of environmental justice communities.
In the past, many federal agencies have given notice of their proposals,
decisions, and other activities by two means: publication in the l-'ederal Register
and announcements in written English on the agencies' websites. Although
publication in the Federal Register is required in many instances, neither it nor
announcements in written English on federal agency websites are adequate to
reach residents of environmental justice communities.
A. Publication in the Federal Register does not provide adequate
notice to environmental justice community residents.
2
A4 p. 190
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The Federal Register is a publication that is read almost exclusively by
attorneys, employees of regulatory agencies, analysts for regulated industries,
and advocacy groups. It is seldom, if ever, read by members of the general
public, and it is even less likely to be read by residents of environmental justice
communities. The residents of those communities usually do not have access to
the Federal Register. Moreover, even if they do have that access, the demands
of their jobs and daily lives are such that they are not likely to have the time to
track down and read the Federal Register.
For those reasons, although publication in the Federal Register may be
required for certain federal agencies, it is not an effective means of reaching
residents of environmental justice communities.
B. Notice in written English by electronic means will fail to reach
many residents of environmental justice communities.
In addition, giving notice of federal agency activities in written English on
agency websites is inadequate to reach residents of environmental justice
communities for two reasons.
First, providing announcements on agency websites fails to account for
the limited access to the internet of residents of environmental justice
communities. For example, according to the U.S. Census estimates, during 2015
to 2019 only 74.6% of households in New Mexico had broadband access. That
means that the notice given by electronic means would not reach 25.4% of New
Mexico's residents. Although CVNM does not have statistics indicating how
many New Mexico residents without internet access live in environmental
justice communities, CVNM understands that many of those New Mexico
residents who lack internet access live in such communities. In addition, CVNM
understands that this is true in other states as well.
Second, providing notice of agency activities in written English fails to
take into account populations in which written English is not the primary means
of communication. In New Mexico, for example, there are communities - such
as immigrant communities - in which communicate primarily by means of other
written languages, such as Spanish and Vietnamese. There also are communities
- such as Navajo and Pueblo communities - in which residents communicate
primarily be means of languages that are not written. In all of these
3
A4 p. 191
-------
communities, announcements made only in written English will not reach
residents effectively.
Moreover, giving public notice by such limited means as those used by
federal agencies in the past fail to comply with the requirements which were
made applicable to federal agencies by the federal Executive Order 12898 signed
by then President Bill Clinton in 1994. It provides that:
Each Federal agency shall work to ensure that public
documents, notices, and hearings relating to human health or the
environment are concise, understandable, and readily accessible to
the public.
U.S. Executive Order 12898, paragraph 5-5(c).
Thus federal agencies must do more than announce their activities in the
Federal Register and on websites in written English.
II. Federal agencies should announce their proposals, decisions, and other
activities using methods that are actually likely to reach residents of
environmental justice communities.
The points outlined above mean that federal agencies must provide notice
of their proposals, decisions, and other activities in two ways if the agencies are
going to be effective in addressing environmental inj ustice by reaching the
residents of environmental justice communities.
First, the agencies must actually reach into environmental justice
communities using means of communication that are used by the residents of
those communities. This means using methods of communication such as
announcements on radio, television, and other media used by the residents of
environmental justice communities. It also means having agency representatives
attend and speak at meetings held in places where people gather in those
communities such as Chapter Houses on the Navajo Nation, Pueblo Council
meeting halls on Pueblo Nations, community centers, libraries, and public
schools in immigrant communities, and other similar venues in environmental
justice communities.
Second, agencies must communicate the announcements of their activities
in the languages used in the environmental justice communities that the agencies
4
A4 p. 192
-------
are trying to reach. This means using translators to provide announcements and
to respond to questions in media used in the environmental justice communities
and at meetings in those communities. Moreover, the translators must be able to
deal with the technical issues that the agencies' announcements address so that
realistic and understandable information can be provided to the community
residents.
Conclusion
Thank you for your concern about whether federal agencies are addressing
environmental injustice effectively. Thank you also for giving CVNM the
opportunity to address this issue, and for your attention to CVNM's concerns
and recommendations.
Please do not hesitate to contact me if you have questions about any of
CVNM's analysis or recommendations.
Conservation Voters New Mexico
Z^
-------
Received From ;
JADE ABSTRACT
151 SOUTH MAIN ST
NEW CITY, NY 10956
First GRANTOR
Paul Piperato, County Clerk
1 South Main St., Ste. 100
New City, NY 10956
(845) 638-5070
Rockland County Clerk Recording Cover Sheet
Return To :
JADE ABSTRACT
151 SOUTH MAIN ST
NEW CITY, NY 10956
Method Returned ; ERECORDING
TILCON INC
First GRANTEE
CHAMPLAIN HUDSON POWER EXPRESS INC
Index Type ; Land Records
Instr Number: 2018-00027760
Book : Page:
Type of instrument; Option
Type of Transaction ; Ease, R-Way, Asmt Rent-Lease
Recording Fee: $81.00
Recording Pages ;
7
The Property affected by this instrument is situated in Stony Point, in the
County of Rockland, New York
Real Estate Transfer Tax
RETT #:
Deed Amount;
RETT Amount;
Total Fees :
1048
$25,000.00
$100.00
$181.00
State of New York
County of Rockland
I hereby certify that the within and foregoing was
recorded in the Clerk's office for Rockland County,
New York
On (Recorded Date) : 09/21/2018
At (Recorded Time) : 2.11:00 PM
Paul Piperato, County Clerk
This sheet constitutes the Clerks endorsement required by Section 319 of Real Property Law of the State of New Yor^ ^
Entered By: NYROCKLANDUSER19 Printed On : 09/21/2018 At: 2:11:23PM
-------
free.
Memorandum of Option Agreement
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2018, by and between TILCON INC., tfk/a/ TILCON MINERALS, INC., a Delaware
corporation (the "Grantor"), and CHAMPLAIN HUDSON POWER EXPRESS, INC., a New
York corporation, its successors and assigns (the "Grantee").
1. The names and addresses of the parties to the Agreement are as follows:
Grantor: TILCON INC.
Attn: President
9 Entin Road
Parsippany, NJ 07054
Grantee: CHAMPLAIN HUDSON POWER EXPRESS, INC.
Attention: William S. Helmer
600 Broadway
Albany, New York 12207
2. The date of the Agreement is as set forth above.
3. The Grantor has granted the Grantee an option (the "Option"') to purchase a permanent
and temporary easement (the "Easement") over, on, under, and through the real property owned
by the Grantor which real property is located at: 1 Elm Avenue, in the Town of Stony Point,
County Rockland, State of New York, which is tax parcel number 15.02-4-59, and consisting of
approximately 203.36 acres and depicted on the attached Exhibit A the ("Real Property"). The
location of the Easement on the Real Property is depicted on the attached Exhibit B.
4. The initial term for the exercise of the Option is three (3) years from the date hereof.
5. A copy of the Agreement is on file with the Grantor and the Grantee.
[Document continues on the following pages. The remainder of this page is intentionally left blank.]
Memorandum of Option -
A4 p. 195
-------
IN WITNESS WHEREOF, the parties have executed this Memorandum of Option
Agreement this I j^ay of 2018.
GRANTOR:
TILCONINC,
f/k/a TILCON MINERALS, INC.
By:
Title
Cfo/^A-ftarAa;
tfo/szc
STATE OF
GRANTEE:
CHAMPLAIN HUDSON POWER
EXPRESS, INC.
By:
Title^y-vx^-^2- \y,Vg (Aj
COUNTY OF
3^
On the
)
)SS,
)
day of
: MeLD'BrA-Q'iO
in the year 2018, before me, the
undersigned, a Notary Public in and for said/ State, personally appeared
DdbonWllfigo personally known to me or proved to me on the basis of satisfactory evidence to
be the individual(s) whose name(s) is/are subscribed to the within instrument and acknowledged
to me that he/she executed the same in his/her capacity, and that by his/her signature on the
instrument, the individual(s), or the person upon behalf of which the individual(s) acted,
executed the instrument, and that such individual made such appearance before the undersigned.
)
) SS.:
)
Notary Public v - -
KATHLEEN M. NQURY
Public ; >
* °* Connecticut 1
My Commission Expires
January 31,2022
STATE OF NEW YORK
county of AI bony'
On the day of SltpiflJlf} iK.r~m the year 2018, before me, the
undersigned, a Notary Public in and for said State, personally appeared lULLiWU']'!
jrSLlA'XJli* personally known to me or proved to me on the basis of satisfactory evidence to
be the individual(s) whose name(s) is/are subscribed to the within instrument and acknowledged
to me that he/she executed the same in his/her capacity, and that by his/her signature on the
instrument, the individual(s), or the person upon behalf of which the individual(s) acted,
executed the instrument, and that such individual made such appearance before the undersigned.
Notary Public
TRACIE A. CHASE
Notary Public, State of New York
Qualified in Albany Co. No. 01Clil49^9574
My Commission Expires |
Memorandum of Option -
A4 p. 196
-------
EXHIBIT A
Map of Real Property
Memorandum of Option -
A4 p. 197
-------
oa OMeosfla company
Torakins Cove
Operations Support
9BNTINHD.
HARSIPPANY, NJ 07QS4
Aerial Photo
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-------
EXHIBIT B
Map of Easement Location
Memorandum of Option -
A4 p. 199
-------
A4 p.200
-------
Submitted electronically to wheiac(a>,epa.gov, ward.george(a>,epa.gov, and via regulations.gov
Docket ID No. EPA-HQ-OA-2021-0683
February 9, 2022
Dear WHEJAC members,
At the January 26, 2022 WHEJAC meeting, I heard Dr. Bullard highlight the need for guardrails in the spending of
federal infrastructure funding and the need to organize, to mobilize, to build the justice framework into that funding.
As I waited for my turn to speak (which never came), that message resonated a lot for me: to be laser-focused, so we
don't get what we are always getting: nothing; to make sure we are on this and stay on it every day, 24/7.
Inspired by the call to "stay on it", I submit the following comments to ask that you consider them as you continue to
provide advice and make recommendations to the White House on environmental injustices that is likely few have
commented on, but that are in urgent need of "guardrails" so that federal agencies, and states receiving federal
funding, like Florida where I reside, don't add more harm and marginalization in our communities. The EJ issues I
present below are within the scope of the WHEJAC charter.
Recommend Environmentally Just Policies to Build Back Better Nights!
A few days before the WHEJAC hearing, driving back from the Everglades, my son & I made a stop to take pictures
of the enormous quantity of WASTED but "energy efficient" LED lighting, at a sports field at the very edge of the
Everglades, illuminating even the clouds at night. Earlier that night, we also took photos of white fog and clouds
illuminated by the bright bluish white "energy-efficient" LEDs in a Florida Power & Light solar farm within one of
the last remaining natural dark sky areas in the Everglades, and primary habitat for the federally endangered Florida
Panther, our FL state animal.
These environmental impacts are happening in many communities, but like most forms of pollution, harmful artificial
light at night tends to affect our EJ communities disproportionallv more. And NEPA is failing in this regard, as many
federally-funded transportation projects are adding new unnecessary, inappropriate, excessive and harmful LED
lighting, to the detriment of people and wildlife, as documented by plenty of peer-reviewed research. There is NO
environmental justice, in energy efficiency and renewable energy, if the health & quality of the night is NOT taken
into account. We need to Build Back Better Nights!
To that end, I ask you to please include these in your recommendations to the Chair of the Council on Environmental
Quality (CEQ) and to the White House Interagency Council on Environmental Justice (Interagency Council):
(1) All federal agencies, particularly the US Dept of Transportation and US Dept of Energy, must improve their
guidance and regulations, to ensure they adequately evaluate and address the potential direct, indirect and cumulative
impacts of harmful light at night in our communities and our sensitive habitats. Particular attention is needed to
meaningfully address the huge increase of light pollution, including agency policies that bias our federal government
to install harmful blue-rich white LED lighting because thev tend to consider them more energy efficient than other
alternatives. This is happening in many communities, including low income communities of color where excessive
bright and low-quality glaring lighting often ends up serving as vet another form of targeted policing that in addition
cause detrimental impacts to the wellbeing of people and wildlife. Federally-funded infrastructure projects should in
fact do the opposite: they should be opportunities to remove or replace lighting that is harmful to people, wildlife and
the environment. A book by Simone Browne, titled Dark Matters: On the Surveillance of Blackness, explains the
roots of this form of artificial light environmental injustice.
(2) In the EPA EJ Screen Tool, include data layers that depict artificial light pollution at night. Data also exists to help
tackle the inequity of access to nearby nature at night. Low income families should not have to settle for overlit urban
communities, including glaring LED billboards outside bedroom windows, like many do in downtown Miami. We all
deserve the benefits of healthy lighting at night, when and where needed, and affordable nearby access, without long
drives to far away areas, to enjoy the wonder of stars, the sight of fireflies and the songs of wildlife at night.
A4 p.201
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Recommend Policies to Prevent Harm by the Rush to Commercialize & Industrialize Space
I ask you to imagine a future in our children's lifetime without Earth observation satellites to monitor the vital signs of
our planet, such weather, and without GPS satellites providing location services. Imagine our future adult children no
longer able to get early warnings for hurricanes, tornadoes, or wildfires. Imagine them not being able to know where
to bring relief after natural or climate-fueled disasters, like Hurricane Maria that affected my family in the island of
Puerto Rico. Imagine an enormous amount of dangerous debris, orbiting Earth's atmosphere at speeds many times
faster than bullets, that no longer allows people to put any satellites in orbit, to explore space, or to even defend the
only planet they will ever truly call home.
That future is NOT fiction. A few months ago (October 2021), a former NASA administrator said "//we don 't take
action now to mitigate the debris problem.... space will no longer be accessible". This nightmare is happening
because the USA government lacks comprehensive national laws and regulations to prevent commercial exploitation
at or near spaceport sites, and at our very own atmosphere and near-Earth orbital environment: all to our detriment.
For instance, the FCC is categorically excluding megaconstellations (swarms') of commercial satellites from
companies like SpaceX. That means there are no NEPA environmental impact assessments, no analysis of
alternatives, no meaningful public participation, and little to no involvement by other federal agencies, including
EPA, NOAA, USGS, DOI and others that should have a say. This is further compounded by the FAA having a
conflicting mandate that encourages the agency to promote expansions of and new commercial spaceports from which
to launch rockets with big pavloads carrying large numbers of satellites (and other objects) for private profit. This is
playing out right now in places like Boca Chica, near Brownsville at the TX border, that have long experienced
environmental injustices. I ask that you "Look Up" for our EJ communities being impacted by a billionaire space
industry with no guardrails, threatening the future of us all.
To that end, I ask that you also address this matter in your recommendations to CEQ and the Interagency Council by
including the following:
(3) To prevent yet another crisis, and one that will make it next to impossible to solve the social and environmental
injustices already in our EJ communities, the USA federal government should pause how it is regulating space
commercialization to urgently examine and improve our national policies, in a comprehensive and transparent process
and in concert with other countries and the United Nations: because we all stand to lose if we don't do this right.
I hope my plea to you leads to meaningful actions on these important matters. I don't want anyone to ever say "I'm
grateful we tried" while saying goodbye to the wonder of starry nights, to the sight of "cucubanos" enchanting Puerto
Rico nocturnal landscapes, to the songs of coquis singing at night, or to the hopes of children dreaming of becoming
astronauts while looking up.
For further reference, I'm attaching excerpts from a report prepared last year by the United Nations Office for Outer
Space Affairs (UNOOSA), and excerpts from a report to which I contributed as part of an effort funded by the
National Science Foundation to understand some of the impacts to science and society from the growing number of
satellite constellations (SATCONs).
Sincerely,
Diana Umpierre, AICP, GISP
Pembroke Pines, Florida
nightskyconservancy@gmail .com
A4 p.202
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Dear Esteemed Members of the White House Environmental Justice Advisory Council,
In response to the WHEJAC public meeting on developing a scorecard for federal agencies as they try to
address environmental justice issues, I, Dr. Sacoby Wilson, Director of the Center for Community
Engagement, Environmental Justice, and Health (CEEJH) at the University of Maryland School of
Public Health, would like to provide written recommendations. Federal agencies should be reviewed
across criteria developed from the 17 Principles of Environmental Justice and CEJA's 8 Principles of
Collaboration.12 Agencies should be evaluated for each criteria on a scale of 0-5 points using publicly
available information on the agency website, and interviews with agency representatives. The full
breakdown of scoring should include the following elements:
1. Require each agency to develop an environmental justice strategic plan.
a. This should resemble the call for federal agencies to identify and address environmental
injustices as declared in Executive Order 12898 - Federal Actions to Address
Environmental Justice in Minority Populations and Low-Income Populations - first issued
by President Clinton in 1994 and commemorated by President Obama in 2014. This
executive order addresses the impacts of climate change by undertaking actions to
enhance climate preparedness and resilience. This ties into President Biden's Executive
Order on Tackling the Climate Crisis at Home and Abroad (2021).
b. Strategic plans would benefit from having a logic model to outline and track agency
inputs, goal outputs, activities to achieve specific objectives, as well as short-term,
midterm, and long-term goals. Moreover, the Prince George's County 2025 Plan provides
useful examples on potential metric systems for assessing milestone achievement,
particularly at a local level. These include: (1) the reduction of lead in or near other sites
with vulnerable groups from 63 ppm to <25 ppm by 2025; and (2) reducing the number
of wastewater treatment plants that are not meeting the EPA water quality standards from
5% to 0% by 2025. Federal agencies should adopt similar tangible metrics pertinent to
their priority areas. Other useful indicators for a metric system can include Gnuine
Progress Indicator (GPI) and Index of Sustainable Economic Welfare (ISEW). These
indicators help form a broader perspective of human welfare, rather than simply rely on
GDP performance. The U.S Environmental Protection Agency Plan EJ 2014 report is a
great reference for national agencies.
c. Agencies should make financial tracking transparent to ensure equity in resource
distribution, particularly as it relates to environmental justice planning.
2. Agencies must set measurable outcome benchmarks to track the efficacy of their
environmental justice efforts. This should apply to goals and activities outlined in the strategic
plan, as well as other agency initiatives that will impact underserved, overburdened, and/or
disadvantaged populations. Environmental justice outcomes to track include but are not limited
to: improved water and air quality, legacy pollution and toxic exposure reduction, improved
food/nutrition security, increasing climate resilient infrastructure, environmental remediation, and
-|
The First National People of Color Environmental Leadership Summit. (1991). The Principles of Environmental Justice (EJ). EJNET. Retrieved from
https://www.ejnet.org/ej/principles.pdf
2
CEJA. (n.d.). Principles of Collaboration. California Environmental Justice Alliance. Retrieved from
https://caleja.org/wp-content/uploads/2014/03/Principles-of-Collaboration.pdf
A4 p.203
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a just transition to efficient green energy. Outcomes should remediate the impacts of systemic
environmental racism and strengthen climate action and preparedness.
3. Require environmental justice and racial equity training workshops for agency employees.
Echoing President Biden's Executive Order 14035 on Diversity, Equity, Inclusion, and
Accessibility in the Federal Workforce (2021), agencies should possess training programs that
enable Federal employees, managers, and leaders to have knowledge of systemic and institutional
racism and bias against underserved communities, be supported in building skill-sets to promote
respectful and inclusive workplaces and eliminate workplace harassment, have knowledge of
agency accessibility practices, and have increased understanding of implicit and unconscious bias.
This should entail including environmental justice metrics to be weighed in performance reviews
for both process and impact evaluation. Moreover this should take an intersectional approach to
be intentional about addressing the needs of vulnerable identities which will subsequently address
disparities and encourage equitable living for all.
4. Utilize EJSM tools to microtarget areas in greatest need of program and policy intervention.
Agency employees can be trained to use environmental justice screening and mapping tools to
evaluate cumulative impacts of multiple burdens or the paucity of health promoting infrastructure.
These data can guide equitable decision making. Developing screening methodologies can ensure
that agency actions do not create or exacerbate health, environmental, or racial inequities which
harm historically disadvantaged groups.
5. Agencies should have an EJ advisory council which prioritizes meaningful community
engagement. Agencies should maintain a solid, direct line of communication with the members
of frontline communities. Moreover, agency EJ advisory councils must include seats for
community members. Dialogue should be continuous to develop programming that is responsive
to the needs of the community. Additionally, soliciting feedback from the community is necessary
to best inform future decision making. Leaving community members out of important decision
making harms attitudes and health outcomes. Every agency should have a national EJAC and
regional EJACs to ensure EJ plans are implemented effectively and provide guidance on metrics
and indicators to inform scorecards
6. Agencies should integrate environmental justice language and/or information in their
mission or vision statements. Each agency should have detailed, extensive information available
on the work they're doing to earn positive points, and the agency's work for is effective, up to
date, and evidence-based
7. Measure demographic representation and trends related to diversity in the agency's overall
workforce composition. As emphasized in EO 14035, this should include senior workforce
composition, hiring decisions, promotions, pay and compensation, professional development
programs, and attrition rates.
I hope to see these recommendations integrated into the development of WHEJAC's EJ Scorecard so that
we can hold federal agencies accountable for their environmental actions, as well as highlight those that
have been EJ champions.
Sincerely,
Dr. Sacoby Wilson
A4 p.204
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For the WHEJAC, Comments re: SCORECARD 02/24/22
Dr. Sarah Bishop Merrill (SAVERGV)
I propose EPA perhaps in conjunction with DHHS create environmental testing
programs and promote data based free TRAINING sessions to empower local communities to
test air and water quality, for contractors who will actually remedy these situations, and
health care providers who can design mitigation. As our infrastructure grows, so does noise
pollution, including that from the SPACE-X test launches from our Boca Chica site here.
Buildings on South Padre Island already show cracks in windows, and we expect the noise
and debris of the new Starship (Super Heavy) will be 1,000 times worse. This Musk project
will be the largest rocket ever launched from Earth. Scorecards should include the number of
local workers trained in sustainable building, sustainable agriculture, and Air Quality.
Harvard Sick City study may not be the model for our underserved communities, but
we do need a yardstick for making progress. I think that a simple pre- and post-intervention
questionnaire might be workable here for the needs assessment and determining whether
environmental mitigation and adaptation are improving lives. Agencies like Projecto Azteca
have been effective in training people to build their own houses with technical assistance.
They should be involved in the scorecard creation, and the on-going data-based trainings for
lAQand noise pollution. Needs assessment must flow seamlessly into mitigation,
restoration, and clean up. We agree that CEQ needs to implement WHEJAC plans.
But measuring the climate risks from the 2 proposed LNG plants, the destruction of
habitat for more obsolete and useless Border Wall, and SpaceX activities in fragile eco-
systems near the Bahia Grande is very difficult. Counting the increasing number of 100
degree days, and the above normal summer temperatures, e.g. many days when I was
teaching at UTRGV, holding office hours in the Cafe attached to the Library, the
thermometer for the campus showed +13 degrees many days. If we measure only the
AVERAGES, the mean is dominated by the extremes of weather worsened by Climate
Change. Like the Global South, we suffer here from Climate Change worse than others due
to the failure to insulate buildings here, so that air conditioning is costly and sometimes non-
existent in many workplaces, and recent colder extremes of weather with the Texas grid
failure in February of 2021 take a higher toll on us. We could count buildings needing
insulation and energy efficiency, so that cities don't end up owing $650,000 as Harlingen
does, just to heat buildings during two extreme weeks. Even in Harlingen, TX, we have a
building with 45 types of fungi, mildew, and mold, e.g. Stachybotrys, causing illness in
teachers, students, and administrators. I was fired after I blew the whistle about this.
With regard to measuring whether appropriate agencies are taking major steps to
mitigate and adapt, we must note that in Texas, the TCEQ has little effect, mere EAs are used
for major fossil fuel projects, due to the authority of FERC in permitting, instead of full EIS
with EPA involvement. We are grateful that EPA has intervened when it became clear TCEQ
could not function effectively, even though they are trying harder now, since they are under
review by our TX Sunset Commission. There are at least 4 fossil fuel projects planned for the
Bahia Grande region, near Laguna Atascosa National Wildlife Refuge, Brownsville Ship
Channel, and the town of Boca Chica which has now been "bought", along with Cameron
County, by Elon Musk.
A4 p.205
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Like other commenters today, I am concerned that we measure or at least locate
sources of mercury contamination, especially in the Rio Grande Delta. Here, in our dumps,
managed and used by many illiterate and ignorant people, mercury sits in dumps unnoticed,
and its containers bulldozed willy nilly, no doubt leaching into ground water and soils. Surely
this also is true in the dumps at Matamoros, near the new Mexican dumps, border okra
fields where farmer are not fully informed of the risks, nor are the consumers of the Mexican
Okra, either. So teams of trained local people with instruments for testing and calibration
need to be installed to prevent far more expensive harms.
Communities here are not being protected and held to federal standards of safety.
We urgently need measurement of the true costs of the TXLNG and RioGrandeLNG, and
Jupiter projects near the Brownsville Ship Channel, Bahia Grande, and the Corrizo
Comecrudo sacred site, using full EIS, not just EAs where FERC and others at the state level
see "no significant impact," using metrics that simply block out cumulative impacts and fair
and true measures of Methane releases, ...even the risk of VCEs of a catastrophic nature.
Scorecards must have negative numbers for clear conclusions about the net negative
impacts. LNG is not a "transitional fuel." Carbon and water footprints of LNG and Fracking
for the feed gas for such projects, and oil and gas pipelines designed to serve the planned
LNG export facilities. The Emergency Firefighting and Police Services have not been trained,
nor is training for them on risks of LNG including VCEs, included in permitting processes,
although in law and writing, they are required. FERC has some new members, but still need
close advice and consent of the EPA, who should not be subordinated to these state
agencies. Texas is in urgent need of honest measurement and help for our colonias without
sewers. Qualified testers, reporters, and contractors must be trained and certified with
periodic in-service testing and training. Literacy training must include toxics identification.
Texas has a number of Water and water policy meetings which we attend, including
through TX Parks and Wildlife, and the branch of the US State Dept. which interacts with
Mexican and Canadian engineers, in the International Boundary and Water Commission,
meeting in Weslaco, TX here monthly, with a Citizen's Forum. Studies are often presented,
showing that the Rio Grande is the most polluted river in the world. It is, however, the water
source for all our towns and cities Valley wide here in South Texas. The IBWC representative
stated at the last meeting, in response to my questions about flooding, even in an era of
alternating disastrous droughts, that she did not know that concrete channels (more
impervious cover) caused flooding! We need to rate this agency on a scorecard that shows
their failure to use the latest riverine habitat data, or to collect more, before laying down
more impervious cover and using their tunnel-visioned yardstick of "speed of flow" rather
than recognizing the data on the uptake of water by trees (one large tree takes up 56,000
gallons of water in one flood event).
A4 p.206
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Report to the Washington State Governor and Legislature
A4 p.207
Environmental Justice Task Force
Recommendations for Prioritizing EJ in Washington State Government
FaDU 2020
-------
To request this document in another format, call 1 -800-525-0127. Deaf or hard of
hearing customers, please call 711 (Washington Relay) or email
Para solicitor este documento en otro formato, llame al 360-236-4110. Clientes
sordos o con problemas de audicion, favor de llamar al 711 (servicios de rele de
Washington) o envie un correo electronico a <_
Task Force Staff
¦ Elise Rasmussen, Project Manager
¦ Esmael Lopez, Community Engagement Coordinator
¦ Hannah Fernald, Administrative Coordinator
For more information / Para mas informacion:
Environmental Justice Task Force Information Page:
httmiZZhegJtheayi^^
Environmental Justice Task Force Meeting Agendas, Minutes, and Materials
Page:
Christy Curwick Hoff | Manager, Governor's Interagency Council on Health
Disparities
| (360) 236-4110
Governor's Interagency Council on Health Disparities Website:
wvw wa.gov
A4 p.208
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Contents
Acronyms 5
Acknowledgement 5
Executive Summary 6
Words Hold Power 12
Prioritizing Environmental Justice in Washington 12
The Environmental Justice Task Force 27
Environmental Justice Definition 36
Environmental Justice Principles 36
Environmental Justice Task Force Recommendations 38
I. Measureable Goals and Model Policy Recommendations 39
II. Environmental Health Disparities Map Recommendations and Guidance..53
III. Community Engagement Recommendations and Guidance 62
Areas for Further Study 69
Conclusion 69
Task Force Member Statements 70
Non-Majority Opinion Statement 73
Appendices 76
A4 p.209
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"We've got to decide that we want to live
in a world that is sane and happy and
healthy, and that everyone deserves
that."
-Majora Carter, Environmental Justice Advocate
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List of Common Terms/Titles and their Acronyms
Acronym Full Term/Title
ADA Americans with Disabilities Act (e.g. ADA accessible)
BIPOC Black, Indigenous, and People of Color
CIA Cumulative Impact Analysis (e.g. Environmental Health Disparities Map)
COVID-19 Coronavirus Disease 2019, also known as 2019 novel coronavirus
EHD Map Environmental Health Disparities Map
EJ Environmental Justice
EJTF EJ Task Force
ESHB 1109 Engrossed Substitute House Bill 1109 (2019-21 State Operating Budget)
GARE Government Alliance on Race and Equity
LEP Limited English Proficiency
SEP Supplemental Environmental Project
USEPA United States Environmental Protection Agency
WA Washington (as in Washington State)
WTN Washington Tracking Network
Acknowledgement
The Environmental Justice Task Force (EJTF) recognizes that the fight for environmental justice
is ongoing—it did not begin with the EJTF, and it will not end with the EJTF. We express our
sincerest gratitude to the communities across Washington state who have been on the
frontlines fighting for environmental justice. The EJTF has greatly benefitted from community
knowledge, wisdom, and expertise, and our hope is that communities see themselves in this
report. We acknowledge that every step closer to environmental justice for Washingtonians is
because of the power that community holds.
A4 p.211
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Executive Summary
The EJTF's Authorizing Budget Proviso & Responsibilities
The Environmental Justice Task Force (EJTF) was created through a proviso in the state's 2019-
2021 operating budget (Engrossed Substitute House E II 1109. section 221, subsection 48). In
accordance with the budget proviso quoted below, this report includes:
I. Measurable Goal Recommendations: "Measurable goals for reducing environmental
health disparities for each community in Washington state and ways in which state
agencies may focus their work towards meeting those goals."
II. Model Policy Recommendations: "Model policies that prioritize highly impacted
communities and vulnerable populations for the purpose of reducing environmental
health disparities and advancing a healthy environment for all residents."
III. Environmental Health Disparities Map Recommendations: "Guidance for using
the Washington Environmental Health Disparity Map to identify communities that are
highly impacted by EJ issues with current demographic data."
IV. Community Engagement Recommendations: "Best practices for increasing meaningful
and inclusive community engagement that takes into account barriers to participation
that may arise due to race, color, ethnicity, religion, income, or education level."1
Report Overview
The first chapter of the EJTF report provides context for what environmental justice (EJ) is, how
to build on existing EJ work in Washington, and why state government must prioritize
addressing EJ issues and environmental health disparities. The second chapter focuses on the
EJTF's process for developing recommendations, a statewide EJ definition, and EJ principles.
The final chapter of the report includes all EJTF recommendations. The report appendices
include additional resources, including guidance developed by the EJTF's Community
Engagement Subcommittee for how state
agencies can develop their own community
engagement plans (Appendix C).
Environmental Justice Definition
The EJTF developed a recommended
statewide definition for EJ that builds upon
the U.S. Environmental Protection Agency's
(USEPA) definition by adding the outcomes
we want to see in Washington state. The
EJTF recommends that the definition be
adopted by all Washington state agencies tc
1 Engrossed Substitute House II1109, section 221, subsection 48.
Recommended Statewide EJ Definition
The fair treatment and meaningful involvement
of all people regardless of race, color, national
origin or income with respect to the
development, implementation, and
enforcement of environmental laws, regulations
and policies. This includes using an intersectional
lens to address disproportionate environmental
and health impacts by prioritizing highly
impacted populations, equitably distributing
resources and benefits, and eliminating harm.
A4 p.212
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identify and address current environmental injustices and to ensure future decisions and
actions promote EJ.
Environmental Justice Principles
The EJTF also developed five EJ principles to
serve as an initial blueprint for a shared
vision for EJ in Washington state. The
following EJ principles were informed by
communities across the state and with
recognition and reflection of the Principles of
EJ Principles
1. Achieve the highest attainable
environmental quality and health
outcomes for all people.
2. Adopt a racial justice lens.
3. Engage community meaningfully.
4. Be transparent.
5. Be accountable.
Environmental Justice adopted at the 1991
First National People of Color Environmental Leadership Summit. The EJ principles section in
this report defines each of these principles in more depth, including actions state agencies can
take to work toward each principle.
Measurable Goals and Model Policy Recommendations
The first set of recommendations in this report focus on measurable goals and model policies.
These recommendations are further organized into four categories that name the intended
outcomes the EJTF would like to see enhanced in state government:
• Improving Government Accountability to Communities
• Incorporating EJ into Government Structures, Systems, and Policies
• Investing Equitably
• Improving Environmental Enforcement
Additionally, the report includes guidance for using the Government Alliance on Race and
Equity's (GARE) Racial Equity Toolkit as an implementation tool to assist agencies with tracking
and communicating progress toward EJ and embedding EJ in agency strategic plans.
Environmental Justice Measureable Goals & Model Policy Recommendations
Implement recommendations in any order.
Improving Government
Accountability to
Incorporating EJ into
Government Structures,
Investing
Equitably
Improving Environmental
Enforcement
Integrate community engagement & EHD map guidance across
implementation of all recommendations.
T
A4 p.213
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Measurable Goals & Model Policy Recommendations to Reduce Environmental Health Disparities
Improving
Government
Accountability
to
Communities
1. Measurable Goals: Track & Communicate Progress
In partnership with communities, agencies should create a standard method to develop,
track, evaluate, and publish EJ and health goals focused on pollution reduction, eliminating
environmental health disparities, and improving community engagement.
2. Model Policy: Permanent EJ Workgroup
Convene a permanent EJ interagency workgroup of relevant agency staff that includes
members representing overburdened communities.
Incorporating
EJ into
Government
Structures,
Systems, and
Policies
3. Model Policy: Embed EJ in Strategic Plans
Agencies shall make achieving EJ part of their strategic plans in order to integrate EJ into
agencies' protocols and processes.
4. Model Policy: Dedicated EJ Staff in State Agencies
Agencies will have at least one staff position dedicated to integrating EJ principles
specifically, and equity more broadly, into agency actions.
5. Model Policy: Incorporate EJ in State Environmental Laws
EJ considerations should be incorporated into a range of state environmental laws. Further,
environmental and natural resource state agencies should consider EJ in developing agency
request legislation, analyzing bills during legislative session, and conducting rule reviews.
Investing
Equitably
6. Model Policy: Required use of EJ Analysis
Agencies should adopt, and the Legislature should consider, requiring EJ analyses, including
but not limited to the use of the Environmental Health Disparity Map, that combine the
cumulative impact of environmental health indicators such as environmental exposures,
environmental effects, impact on sensitive populations, and other socioeconomic factors.
7. Model Policy: Equitably Distribute State Environmental Investments
For new and existing revenue and expenditures with an environmental nexus, the state
Legislature and agencies should equitably distribute investments ensuring that resources
are allocated to the most overburdened communities.
8. Model Policy: Contracting Prioritizes High Labor Standards & Diversity
Work funded by state environmental investments should increase inclusion in contracting
with minority, women, and veteran-owned enterprises in alignment with the Governor's
Subcabinet on Business Diversity led by the Office of Minority and Women's Business
Enterprises, and have high labor standard requirements that value workers' health and
safety, regardless of whether a public or private entity is the beneficiary of the new
spending, except where legally prohibited from doing so.
9. Model Policy: Study Opportunities for Reparations in WA
As one strategy for achieving EJ, WA state government should study reparations as a
mechanism to address health disparities and historical harms affecting overburdened
communities. The state should focus on the unpaid debts from slavery and colonization, the
legacy of redlining, treaty violations, forced exclusion, and neighborhood segregation in
Washington, as well as the impact that systemic racism has had on Black, Native,
Indigenous, Latinx, Asian communities and others.
A4 p.214
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Improving
Environmental
Enforcement
10. Model Policy: Ensure Accessible Enforcement & Reporting
Processes
The EJTF recommends ensuring that enforcement and reporting processes are accessible to
overburdened communities by elevating awareness and addressing barriers to access (such
as technology, literacy, and language).
11. Model Policy: Support for Supplemental Environmental Projects
Agencies with enforcement responsibilities should, to the extent practicable and
appropriate, support the inclusion of "Supplemental Environmental Projects" (SEPs) in
settlement agreements.
Environmental Health Disparities Map Recommendations
The second set of recommendations in this report focus on the Environmental Health
Disparities (EHD) map. The Washington Tracking Network (WTN) and the EHD Map are publicly
available tools that bring much needed attention to environmental and human health
conditions statewide, and integrate data and analyses that can support pro-equity planning in a
number of agency activities. While individual agencies will determine how best to integrate
these tools, one approach is to prioritize the integration of the EHD map into community
engagement, grants programs, rulemaking, capital investment, and other activities that have
direct impacts on communities.
Recommendations
for How to use the
EHD Map to
Identify
Overburdened
Communities
12. EHD Map: The EJTF recommends that state agencies consider four initial
ways of using the WTN mapping tools and EHD data in agency activities. These
suggestions are based on using the map as it currently exists, either in its online
form or as exported map EHD data tables for integration with agency data.
I. Build demographic and environmental context to guide and inform
place-based activities.
II. Conduct EJ review and analysis as routine practice for programs and
projects.
III. Center EJ as the priority intended outcome in resource allocation
decision processes.
IV. Evaluate and measure reductions in disparities through service equity
improvements.
13. EHD Map: Use the overall EHD map rank 9 and 10 as a starting point to
identify overburdened communities.
14. EHD Map: Develop technical guidance for practitioners.
15. EHD Map: Adopt equity tools and analyses in agency practices.
16. EHD Map: Set environmental health disparity reduction goals and track
progress towards those goals.
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Key Recommendations for Addressing Structural Barriers to Community
Engagement
The third and final set of recommendations in this report address common barriers to
meaningful community engagement (CE), based on barriers identified with input from EJTF
members and the public. Refer to the Community Engagement Plan Guidance (Appendix C)
developed by the EJTF's Community Engagement Subcommittee to assist with the
implementation of these CE recommendations.
Recommendations
for Addressing
Structural Barriers
to Community
Engagement
17. CE: Each agency develops a community engagement plan, which must
include the elements outlined in the EJTF's Community Engagement Plan
Guidance (Appendix C).
18. CE: Agencies evaluate new and existing services and programs for
community engagement using a systematic process to determine outreach
goals. These evaluations weigh the goals of the service or program, potential
for its impact on the public, its importance to the community/ies being
impacted, and the makeup of the impacted community. These evaluations
determine the agency's level of engagement for the project and the potential
for outcomes the public can see from their engagement in the process.
19. CE: When planning outreach activities, agencies use screening tools that
integrate spatial, demographic, and health disparities data to understand the
nature and needs of the people who may be impacted by agency decisions. The
Task Force's recommended use of the Environmental Health Disparities map to
build the demographic and environmental context to guide and inform place-
based activities is a key example. This initial screening is followed by further
research with local people and organizations as needed.
20. CE: When agency decisions have potential to significantly impact a specific
community (as determined by the evaluation described above in
recommendation 18), agencies should work with representatives of that
community to identify appropriate outreach and communication methods.
Significant impact includes potential changes to critical determinants of health
such as legal rights, finances, housing, and safety. It is particularly valuable to
include community members in oversight, advisory, program planning, and
other processes. Washington's Department of Health community health worker
program serves as one model.
21. CE: When agencies ask for representation from a specific geographic or
cultural community, the agencies actively support such representation in
recognition of the costs of engagement borne by community members where
allowable by state law and agency policy. Doing so would reduce barriers to
engagement presented by trading time and/or money to learn about and
engage in the agency's process, such as taking time from work, finding
childcare, and arranging for transportation.
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CONTINUED:
Recommendations
for Addressing
Structural Barriers
to Community
Engagement
22. CE: In alignment with the Office of Financial Management's Model
Diversity. Equity, and Inclusion Policy, agencies should use equity-focused hiring
practices and inclusion-focused professional development to build and support
an internal staff that represents the cultural and racial makeup of the
population they serve.
23. CE: When an agency's program or service has potential to impact Tribal
and/or Indigenous people or their resources, the agency includes those groups
in their community engagement work, using tailored approaches based on the
needs of the Tribe. Note that community engagement is distinct from and not a
substitute for formal government-to-government or cultural resource
consultation.
24. CE: Agencies conduct compliance reviews of existing laws and policies that
guide community engagement, and where gaps exist, ensure compliance for
the following laws in agency service and program budgets:
• Title VI of the Civil Rights Act, prohibiting discrimination based on race,
color, or national origin and requiring meaningful access to people with
limited English proficiency.
• Executive Order 05-03 requiring Plain Talk when communicating with the
public.
• Executive Order 13166, requiring meaningful access to agency programs
and services for people with limited English proficiency.
25. CE: Change state laws that restrict agencies from purchasing goods and
services, such as childcare and food, which support broad community
participation.
26. CE: In cooperation with the Governor's Subcabinet on Business Diversity,
led by the Office of Minority and Women's Business Enterprises, agencies
should increase contracting diversity by proactively engaging and contracting
with local organizations that are community-based, community-rooted, and
community-led to improve community health outcomes and eliminate
environmental injustices across Washington state.
Addressing EJ Means Addressing Current Crises
Now is the time to take action. The EJTF acknowledges that Washington state is in the midst of
four concurrent crises: COVID-19, police use of force and racial injustices, climate change, and
an economic recession. Each of these crises adds disproportionate burden to the already
overburdened communities at the center of the environmental justice movement. An EJ
framework is useful in addressing these crises, and if state government chooses to prioritize its
collective resources and expertise, we can make great strides toward a more equitable and
resilient Washington.
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Words Hold Power
The Environmental Justice Task Force (EJTF) is committed to an asset-based framing throughout
this report, particularly when it comes to communities experiencing environmental injustices.
Words have the power to be divisive, as well as create and perpetuate harm. Words also have
the power to uplift, affirm, and value one another and our lived experiences.2 In the
environmental justice (EJ) discipline, there are many terms that are used to describe
communities who experience disproportionate exposure to environmental burdens such as "EJ
communities", "fenceline communities", and
After careful consideration and community
input, the EJTF is using the term
"overburdened" when referring to
communities or populations with EJ
concerns.
The term "overburdened" recognizes that
society has decided, implicitly and
explicitly, to value some communities and populations more than others. Overburdened
communities are exposed to more environmental hazards. They live with the risks and
consequences of decisions outside their control and experience far fewer benefits. Conversely,
other communities and populations experience far more benefits with far fewer burdens.
"Overburdened" forces us to ask: What are the burdens faced by these communities, who is
benefiting from the burdens, and why are these particular communities burdened in the first
place? The term "overburdened" recognizes that a community may be facing the cumulative
impacts of social, environmental, and economic burdens.
The EJTF understands that this term may evolve as engagement with overburdened
communities continues in Washington state.
Prioritizing Environmental Justice in Washington
What is Environmental Justice?
Environmental justice is rooted in the belief that everyone—regardless of race, ethnicity,
language, income, or other demographic factors—has the right to live, learn, work, and play in
a clean, safe, and healthy environment. We will know that we have successfully achieved EJ
when we eradicate health inequities caused by environmental hazards.
2 Refer to Appendix A for a glossary of key terms used in this report.
highly impacted communities .
"Overburdened communities" are
communities who experience
disproportionate environmental harms
and risks due to exposures, greater
vulnerability to environmental hazards,
or cumulative impacts from multiple
stressors.
A4 p.218
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Black, Indigenous, and People of Color (BIPOC) communities have been, and continue to be, the
primary leaders of the EJ movement in the United States. Civil Rights giants such as Cesar
Chavez, Dolores Huerta, and Larry Itliong created the United Farm Workers labor union in 1962
in part to fight for greater protection from toxic chemicals for farmworkers.3 In the final
moments of his life, Dr. Martin Luther King Jr. marched with Black sanitation workers in
Memphis to protest low wages and unsafe working conditions.4
The fight for EJ caught traction in 1982 in a low-income, Black community in Warren County,
North Carolina where residents and their allies protested against bringing 6,000 truckloads of
soil laced with toxic polychlorinated biphenyls (PCBs) into their community. Six weeks of
protests, including the first ever arrests over the siting of a landfill, put more than 500 people in
jail in the name of EJ. The people of Warren County ultimately lost the battle in their backyards,
but this injustice ignited the fight for EJ across the country. EJ activists organized and educated
the nation about environmental racism throughout the 1980s and 1990s (Figure 1) leading up
to President Clinton's EJ Executive Order (EO).5 This activism led to further study of
environmental hazards, which unveiled that pollution producing facilities were
disproportionately and intentionally placed in poor communities of color.
Figure 1. Brief History of Early EJ Milestones
1987: Foundational Study
United Church of Christ's
Comission for Racial Justice's
"Toxic Wastes and Race in the
United States" found that race
was the single most important
factor in determining where
toxic waste facilitates were
sited in the US. Furthermore,
the report clearly linked this
outcome to local, state, and
federal land use policies.
1991: First National People
of Color Environmental
Leadership Summit
Hundreds of EJ leaders from
across the globe came together
to network and organize. They
produced two foundational EJ
documents: the "Principles of
Environmental Justice" and the
"Call to Action
1994: Clinton's Executive
Order 12898
This EO directs federal
agencies to identify and
address adverse health or
environmental effects of their
policies and programs in low-
income and BIPOC
communities. Additionally, it
directs agencies to prevent
racial discrimination in any
federally funded health or
environmental programs.
3 "UFW History". 2020. UFW. https://ufw.org/research/historv/ufw-historv/.
4 "Memphis Sanitation Workers' Strike". 2020. The Martin Luther King, Jr., Research and Education Institute.
https://kinginstitute.stanford.edu/encvclopedia/memphis-sanitation-workers-strike.
5 Renee Skelton and Vernice Miller. 2020. "The Environmental Justice Movement". NRDC.
https://www.nrdc.org/stories/environmental-iustice-movement.
A4 p.219
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Disproportionate Environmental Exposures
Achieving health equity requires that Washington prioritize and strategically address
environmental injustice. Racially and economically segregated neighborhoods across the United
States are the resulting legacy of redlining and other racist and discriminatory policies. These
policies have led to the continued divestment of BIPOC neighborhoods which has contributed
to the racial wealth gap6 and has made it exceptionally difficult for BIPOC and low-income
communities to access safe and healthy homes, schools, jobs, and community spaces.
Washington state studies reflect the findings of national EJ research,7,8 that people of color and
low-income people continue to be disproportionately exposed to environmental hazards in
their communities.
The 1995 Washington State Department of Ecology's Environmental Equity Study and the 2001
Washington State Board of Health's EJ report concluded that contaminated sites, entities that
produce regulated hazardous waste, incinerators, and solid waste landfills are more
concentrated in low-
income and BIPOC
communities.
Furthermore, these
reports also stated that
the disproportionate
number of facilities in
these communities likely
result in higher levels of
exposures to
environmental hazards
and potentially assume a
higher risk of adverse
health outcomes.9,10
These exposures are
compounded with factor:
6 Kriston Mcintosh, et al., "Examining the Black-White Wealth Gap," Brookings, February 27, 2020,
https://www.brookings.edu/blog/up-front/2020/02/27/examining-the-black-white-wealth-gap/.
7 Commission for Racial Justice, United Church of Christ, "Toxic Wastes and Race in the United States: A National
Report on the Racial and Socio-Economic Characteristics of Communities with Hazardous Waste Sites," (1987):
https://www.nrc.gov/docs/ML1310/ML13109A339.pdf.
8 Robert D. Bullard, et al., "Toxic Waste and Race at Twenty: Why Race Still Maters After All of These Years,"
(Spring 2008), https://www.istor.org/stable/43267204?sea=l.
9 https://p2infohouse.org/ref/14/13244.pdf Environmental Equity Study in Washington State. Department of
Ecology. Publication Number 95-413. October 1995.
10 Committee Final Report State Board of Health Priority: Environmental Justice (June 2001),
https://www.digitalarchives.wa.gov/do/F093B7854B3FFB31174507C2F873DC56.pdf.
Figure 2. Race and Ethnicity by Environmental Health Disparity Rank
o
o H
I
1
CD
m
co
CM
8
9 10 \AA
| White
| Black
| American Indian or Alaska Native
| Asian
| Native Hawaiian or Other Pacific Islander
| Two or More Races
| Other Race
| Hispanic or Latino
A4 p.220
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such as racism, stress, and poverty that, on their own, are associated with poorer health
outcomes and shorter life expectancies.
Race/Ethnicity and Environmental Health Disparities
Examining publicly available data from the Washington Tracking Network (WTN) illustrates the
disproportionate burdens faced by BIPOC communities and people living in poverty. These data
show that census tracts with greater environmental health disparities (EHDs) also have greater
percentages of BIPOC communities than census tracts with fewer EHDs when analyzing the
environmental health disparities rank for communities. Figure 211 shows that census tracts with
the lowest EHD rank are 83.2% white, 0.9% Black, and 6.2% Hispanic or Latino, while census
tracts with the highest EHD rank are 45.6% white, 10.5% Black, and 22.7% Hispanic or Latino.
Black Washingtonians were ten times respectively more likely to live in the highest ranked
census tract than the lowest ranked census tract. If race was not associated with EHDs, one
would expect the census tracts to have similar racial proportions.
Life Expectancy and Environmental Health Disparities
Living in areas with more
environmental hazards and
pollution is associated with
a shorter lifespan. Figure 3
illustrates the difference in
life expectancy compared
to the state average. These
data show a linear
association between a
census tract's EHD rank
and life expectancy.
Namely, the data indicate a
5.7 year difference in life
expectancy among census
tracts.12 In other words,
the population in census
tracts with the lowest
environmental health disparities (rank 1) on average lived 5.7 years longer than those in census
tracts with the highest environmental health disparities (rank 10).
11 See Appendix F for more information on the methods and analysis used to create the bar graphs (Figures 2-4)
from WTN data.
12 The U.S. Census Bureau defines census tracts as, "...small, relatively permanent statistical subdivisions of a
county or equivalent entity....Census tracts generally have a population size between 1,200 and 8,000 people, with
an optimum size of 4,000 people." For more information visit: https://www.census.gov/programs-
survevs/geographv/about/glossarv.html#par textimage 13.
Figure 3. Difference in Life Expectancy by EHD Rank Compared to the
State Average
Environmental Health Disparities Rank
A4 p.221
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Poverty and Figure 4. Poverty by Environmental Health
Environmental
Health Disparities
There is also a linear
association between
EHD rank and
poverty. Figure 4
shows that the
poverty rate in the
highest EHD ranked
census tract (rank
10) is more than
double that of the
lowest EHD ranked
census tract (rank 1).
While the EHD map plays an important role in raising awareness and contributing to our
understanding of environmental and health disparities, these data cannot and do not reflect
the lived experiences of communities. Nor are the findings above surprising for frontline
communities and social justice advocates across the state. Environmentally overburdened
communities have given voice to the challenges they face, and demand accountability for the
impacts to their health and environment.
Foundational to the EJ movement, and essential to our collective work towards equity, is
grounding our efforts in a community led vision and centering the voices of those most
impacted. The following EJ concerns and observations are from community members who
shared their stories during EJTF public meetings or with the EJTF's community engagement
coordinator. These accounts highlight only a couple of the issues communities across
Washington have raised. The following are intended to provide brief, illustrative examples of
concerns voiced by community members who participated in EJTF meetings and discussion.
Lower Yakima Valley: Water and Soil Contamination
Concerns were raised by the public during EJTF meetings that communities in the Yakima Valley
are overburdened by pollution and have EJ issues affecting their health and daily lives. During
the EJTF's public meeting in Yakima, a community member shared her family's experience with
contaminated well water due to high nitrate levels that she attributed to neighboring farms.
She reported that several of her family members became seriously ill as a result.
Her family replaced their well, yet continue to be concerned about unsafe drinking water after
over 1,800 cows died nearby during a severe blizzard in 2019. She described that while some
carcasses were sent to Oregon and local landfills, 950 dead cows remained on two Lower
Yakima Valley dairies after exhausting all other composting options, which created the potential
for environmental health hazards. Community advocates are now worried about pathogens and
A4 p.222
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endotoxins potentially infiltrating the water supply, as well as other hazards that might cause
adverse health outcomes in the region. They have been vocal about their concerns of
insufficient monitoring of air, water, and soil after they witnessed composting cow carcasses in
their communities. Lower Yakima Valley community members are asking for increased
monitoring of domestic wells for nitrate and bacterial contamination.
Farmworkers: Working and Living Conditions during a Pandemic
Farmworkers, who feed our state and are a critical contributor to our economy, were
designated as essential workers and have continued to work during the COVID-19 pandemic.
Agricultural workers and advocates have spotlighted the injustice of working in conditions
where laborers and their families risk exposure to pesticides, wildfire smoke, and the
coronavirus each day - often without adequate compensation or access to affordable health
care. The COVID-19 crisis has also elevated attention to the inadequacies of housing for
farmworkers. Densely populated farmworker housing may not allow for physical distancing, or
safely quarantining when individuals within a housing unit are exposed to COVID-19 or test
positive for the virus.
In Washington, farmworkers are disproportionately people of color, the majority of whom are
Latinx. There are many reasons workers may be less willing to raise concerns or organize for
their health and safety, including language barriers, overt intimidation, fear of retaliation, and
concerns about jeopardizing immigration or their H-2A visa status. However, farmworkers in
Yakima went on strike in the spring of 2020 to bring attention to their working and living
conditions and demands for COVID-19 safety measures such as improving physical distancing
while at work, a hazard pay increase, employer-provided masks, and protection from retaliation
for protesting.
Washington state has a rich environmental justice history built by leaders from community,
advocacy organizations, and government who challenged injustice and fought for change. This
critical work continues to grow and transform Washington into a place where all people thrive
in safe and healthy homes, neighborhoods, schools, and jobs. The EJTF builds upon this
foundation. The following highlights some of the key EJ efforts that has shaped this work in WA.
Community Activism in Washington State
Organizing in Washington around EJ gained momentum in the early 1990s, elevating public
awareness about the devastating legacy of US Government uranium mining on the Spokane
Indian Reservation and 40 years of federal military plutonium production at the Hanford site,
dairy farm waste and farmworkers protections in the Yakima Valley, air pollution in south
Seattle and the International District, and industrial chemical contaminants in the Duwamish
Waterway, to name a few. In 1993, the Community Coalition for Environmental Justice was
established by people of color organizing for social, economic, environmental, and health
A4 p.223
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justice in Washington. This advocacy continues to grow across the state, championed by
organizations such as C and Puget Sound Sage. In 2014, the coalition
was formed to harness the collective power of advocates united by the common goals of racial
and economic justice, climate justice, and environmental justice and stewardship. Front &
Centered currently has 63 member organizations across the state, and has a representative
who is serving as Co-Chair of the EJTF.
Legislative Study
In 1993, the Honorable Senator Rosa Franklin13 proposed that Washington conduct an
environmental equity study. The Legislature funded the Department of Ecology to assess
whether the distribution of facilities and toxic chemical releases were distributed equally.
Results of this study showed that low-income communities and communities of color were
disproportionally impacted by pollution in Washington state.14
Washington State Board of Health
The Washington State Board of Health identified EJ as a top priority in 2000-2001, promoting
the concept of "One Washington" - the goal that all residents experience the benefits of a
healthy environment. The Board focused on raising awareness of EJ issues by publishing
articles, giving presentations, and attending numerous community forums related to EJ. The
Board also encouraged state and local agencies to incorporate EJ principles into agency
practices and convened a short-term Interagency Workgroup on EJ that focused on creating a
set of guidelines to promote EJ in government decision making for agency staff.15
Governor's Interagency Council on Health Disparities
The Council was established in 2006, and is responsible for identifying priorities and creating
recommendations for the Governor and Legislature on ways to promote health equity and
eliminate health disparities in Washington. The Council has and continues to serve as one of the
only state agency forums to engage and communicate with the public on issues of health
equity. In 2012, the Council convened an Environmental Exposures and Hazards Advisory
Committee to identify actions to reduce the disproportionate health impacts from
environmental exposures and hazards. Based on the work of this Advisory Committee, the
Council's 2012 Action Plan's leading recommendation was that "Washington state should make
a clear commitment to environmental justice."16
13 Washington State Senator (D-Tacoma) from 1993 to 2010. She led state efforts addressing EJ and health equity.
14 Environmental Equity Study in Washington State. Department of Ecology. Publication Number 95-413. (1995):
h Jinfo 3c|f,
15 Committee Final Report State Board of Health Priority: Environmental Justice (2001):
16 Governor's Interagency Council on Health Disparities. "State Policy Action Plan to Eliminate Health Disparities".
(2012): htt|j]/£heaIt,hegujtY ,gdf.
A4 p.224
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Washington State Department of Ecology
After Ecology's publication of Washington's first statewide EJ study in 1995, the agency has
continued to expand its EJ commitments and capacity. An Environmental Justice & Title VI
Senior Advisor, EJ Committee, and Civil Rights Compliance Team currently support these efforts
at the agency. EJ and equity are core elements of Ecology's strategic plan, integrated into its
rulemaking and public engagement processes, and is also prioritized in several grant programs.
The agency strives to support EJ through collaboration with various external partners, and was
a core partner in the development the EHD map.
Washington State Department of Health
In 2006, the Department of Health convened the Environmental Public Health Community
Equity Workgroup to address EJ. In 2010, they committed to the "Agenda for Change",17 which
focused on providing equal opportunities for all residents to live in healthy environments no
matter what background they come from.
Creation of the Washington Environmental Health Disparity Map
In 2017, Front & Centered worked with community organizations across Washington state to
identify opportunities to listen to and understand EJ concerns in overburdened communities.
The goal of these listening sessions was 1) to identify and prioritize community driven solutions
and 2) to develop and advocate for equitable strategies. Communities of color, low-income
households, immigrants, refugees, and linguistically isolated groups participated in these
listening sessions. Community listening sessions took place across the state in 11 different
communities with 178 participants from July to November 2017. Communities expressed
concerns about the presence of air pollution, water and soil contamination, housing, and
healthy food access.18
Following the conclusion of the 2017 listening sessions, Front & Centered and the University of
Washington Department of Environmental & Occupational Health Sciences brought together
partners from the Washington State Department of Health, the Department of Ecology and the
Puget Sound Clean Air Agency. This group undertook a two-year process to develop a statewide
map reflecting Washington's environmental health disparities. The EJ Mapping Work Group's
primary goal was to develop a way to identify communities most affected by cumulative
environmental health impacts, and resulted in the Environmental Health Disparities map (EHD
map). Details and guidance for how to use the EHD map are provided later in this report.
17 Washington State Department of Health. "Agenda for Change". 2010.
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18 Washington State Department of Health. "Environmental Health Disparities Map."
!lttEs;iMtQhs.wast llMiS
A4 p.225
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The Healthy Environment for All (HEAL) Act - SB 5289 & HB 2009
Soon after the EHD Map was finalized, Senator Rebecca Saldana and Representative Kristine
Reeves sponsored The Healthy Environment for All (HEAL) Act. The bill would have created a
definition of EJ in Washington state law; required the use of EHD map in a range of agency
activities including policy development, enforcement, and investments; and would have
created a community-agency task force to develop guidance for agencies on implementing this
requirement. Furthermore, the HEAL Act would have made recommendations to the Governor,
Commissioner of Public Lands, and the Legislature on how to incorporate EJ principles and
policies into state law and government processes. While each bill passed their respective
houses, the Legislature did not ultimately pass the bill.
However, a budget proviso was included in the 2019-2021 biennial operating budget (ESHB
subsection 48) that directed the Governor's Interagency Council on Health
Disparities to convene and staff the EJTF. Details on the membership, responsibilities, and
processes are included later in this report.
Clean Energy Transformation Act (SB 5116)
In 2019 the Washington State Legislature passed the Clean Energy Transformation Act (CETA),19
accelerating a move to 100% clean electricity use in WA. The law addresses EJ in a number of
ways, including requiring equitable distribution of clean energy benefits and reduction of
burdens to highly impacted populations. CETA requires utilities to do an analysis based on the
cumulative impacts of communities overburdened by fossil fuel pollution and climate change in
WA for integrated resource planning.20 The Washington State Department of Commerce and
the Utilities and Transportation Commission are currently developing rules to implement this
requirement. The legislation also requires the Washington State Department of Health to
develop another map on the Washington Tracking Network (WTN) to designate communities
that are highly impacted by climate change and fossil fuels. The Department of Commerce is
also updating the State Energy Strategy, which includes a focus on improving the quality of life
for people of color and low-income communities and ensuring frontline communities and
communities of color equitably benefit from the transition to clean energy.21
Local Government Initiatives
City ofTacoma's EJ Leaders Workgroup
19 "Chapter 19.405 RCW: Washington Clean Energy Transformation Act". 2019. Washington State Legislature.
h . MMMm.
20 "RCW 19.280.030: Development Of A Resource Plan—Requirements Of A Resource Plan—Clean Energy Action
Plan". 2019. Washington State Legislature.
21 "2021 State Energy Strategy". 2020. Washington State Department of Commerce.
A4 p.226
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In 2016, the Tacoma City Council published the Environmental Action Plan and pledged to
provide guidance and investments to meet the plan's goals, which include transportation,
reducing emissions, air and local food, waste reduction, and buildings and energy.22
City of Seattle's Office of Sustainability and Environment's EJ Committee (EJC)
The EJC is local committee that engaged over 1000 residents to develop its "Equity and
Environment Agenda".23 This committee is made up of individuals who are directly connected
to the communities who disproportionately face EJ issues.24
King County Equity and Social Justice Initiative and Strategic Climate Action Plan
In 2016, King County published their "Equity and Social Justice Strategic Plan",25 which
developed tools to assist in equity impact assessments, community engagement, and
translation policies to guide social equity and EJ work. Additionally, King County updates its
"Strategic Climate Action Plan"26 (SCAP) every 5 years, with the most recent update in 2020.
The 2020 SCAP outlines the County's priorities, strategies, and commitments for climate action,
with the goal to make King County more resilient, sustainable, and equitable.
Washington state government has steadily addressed EJ since the early 1990s. Each major EJ-
focused effort prior to the EJTF has drawn similar conclusions to the EJTF with respect to the
state of EJ in WA, and has developed comparable recommendations for how to achieve EJ.
State government has examined how to embed EJ into laws, policies, programs, and processes
for nearly three decades. Now is the time to take action.
Building room in government decision-making for the voices of underserved and overburdened
communities is one necessary component of correcting current and historical harms that
communities of color, low-income communities, and other affected populations in Washington
have endured. The Government Alliance on Race and Equity (GARE) names the responsibility
that government has in reversing these injustices and building community trust in government
systems and institutions.
22 City Of Tacoma. "Environmental Action Plan".
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23 City Of Seattle. "Equity And Environment Agenda."
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24 City of Seattle. "Environmental Justice Committee 2020
eilVSrOIIITH ; us is ncs it
25 King County. "Equity and Social Justice Strategic Plan". (2016): httPSi//kirigcouritv.go^
sociaj;
26 King County. "King County Climate Action." (2020):
h iMiMOficaunl MM!
A4 p.227
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"From the inception of our country, government at the local, regional, state, and federal
level has played a role in creating and maintaining racial inequity. A wide range of laws
and policies were passed, including everything from who could vote, who could be a
citizen, who could own property, who was property, where one could live, whose land
was whose and more. With the Civil Rights movement, laws and policies were passed
that helped to create positive changes, including making acts of discrimination illegal.
However, despite progress in addressing explicit discrimination, racial inequities continue
to be deep, pervasive, and persistent across the country...Institutions and structures have
continued to create and perpetuate inequities, despite the lack of explicit intention.
Without intentional intervention, institutions and structures will continue to perpetuate
racial inequities."27
Washington state cannot achieve equity without achieving EJ. The EJTF understands that the
pathway to reaching an equitable Washington is only possible through ongoing anti-racism,
environmental conservation, public health, and community engagement work.
The goals of the EJ movement are clear:
• Ensure equitable protection and access.
• Undo institutional discrimination.
• Dismantle environmental racism.
• Eliminate environmental health disparities.
Addressing EJ Means Addressing Current Crises
The EJTF acknowledges that
we are in the midst of four
concurrent global crises:
COVID-19, police use of
force28 and racial injustices,
climate change, and an
economic recession. An EJ
framework is useful in
addressing these crises, and
if state government
chooses to prioritize its
collective resources and
expertise, we can make
great strides toward a more
27 Government Alliance on Race and Equity. "GARE Racial Equity Toolkit", httjjs;£/www,racialegujtyalljancejOrgZwj^
coQlfil
28 The Office of the Governor. "Governor's Task Force on Independent Investigations of Policy use of Force."
Mill s illMM.w ;£0ve r qo r
|0cleienc|<
A4 p.228
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equitable and resilient Washington.
1. COVID-19: Recent scientific publications suggest that air pollutant exposure worsens
COVID-19 symptoms and outcomes,29 and a Harvard University study concluded that,
"...a small increase in long-term exposure to PM2.5 leads to a large increase in the
COVID-19 death rate."30 Furthermore federal data show that there have been racial
disparities in coronavirus infections and deaths nationwide.31 Washington's Latinx
population is experiencing COVID case rates that are about seven times higher,
hospitalization rates that are eight times higher, and death rates that are four times
higher than white Washingtonians.32 We know our essential workers who are keeping
our economy afloat often come from BIPOC communities, and are also risking their own
health as they may experience unsafe work environments and overcrowded housing
that contribute to the spread of the virus. If we do not incorporate an EJ and equity lens
to the State's COVID-19 response and relief efforts, we can expect to see people of color
and people with low-incomes experience the most adverse health and economic
outcomes as a result of this pandemic.33
2. Police Use of Force:34 Combating
racism is at the heart of all EJ work,
and addressing police use of force,
specifically in Black communities,
continues to be a key anti-racist
priority. The historic origins of
American policing are traced to
slavery,35'36 and racial prejudice, bias, and profiling continue to be well-documented in
29 Centers for Disease Control and Prevention. "Wildfire Smoke and COVID-19: Frequently Asked Questions and
Resources for Air Resource Advisors and Other Environmental Health Professionals". 2020.
https://www.cdc.gov/coronavirus/2019-ncov/php/smoke-faq.html.
30 Wu, X., et al. "COVID-19 PM2.5: A National Study on Long-Term Exposure to Air Pollution and COVID-19
Mortality in the United States". Harvard University. 2020. https://proiects.iq.harvard.edu/covid-pm.
31 Oppel, Richard, et al. The Fullest Look Yet at the Racial Inequity of Coronavirus. The New York Times. 2020.
https://www.nvtimes.com/interactive/2020/07/Q5/us/coronavirus-latinos-african-americans-cdc-
data.html?action=click.
32 Washington State Department of Health. "COVID-19 Morbidity and Mortality by Race, Ethnicity and Language in
Washington State". 2020. https://www.doh.wa.gov/Portals/l/Documents/1600/coronavirus/data-tables/CQVID-
19MorbiditvMortalitvRaceEthnicitvLanguageWAState.pdf.
33 For more information on the intersection between EJ and COVID-19, see the EJTF Co-Chairs' letter to the
Governor in Appendix H.
34 The Office of the Governor. "Governor's Task Force on Independent Investigations of Policy use of Force."
https://www.governor.wa.gov/boards-commissions/workgroups-task-forces/governor%E2%80%99s-task-force-
independent-investigations-police.
35 Kappeler, Victor. "A Brief History of Slavery and the Origins of American Policing".
https://plsonline.eku.edu/insidelook/brief-historv-slaverv-and-origins-american-policing.
36 American Police. NPR, June 4, 2020. https://www.npr.org/2020/06/03/869Q46127/american-police.
"Until we can all breathe in every sense of
the word, we cannot achieve
environmental equity."
-Kurtis Robinson, President of the Spokane
Chapter of the NAACP
A4 p.229
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research on disparities in the criminal justice system, sentencing, incarceration, and
policing outcomes for Black, Indigenous, and other people of color.37'38'39 The persistent
role of race in modern day policing is evident, especially in the most extreme cases,
where the use of deadly force has cut too many lives short.40 A 2020 study by
researchers at Harvard found that Black Americans were over three times more likely
than white Americans to be killed by police.41 The psychological42 and physical harms to
individuals, families, and communities is multi-generational and devastating. The failure
to address these inequities has, again, led to an uprising against racism following the
killings of George Floyd and Breonna Taylor by police officers.43
3. Climate Change: Climate change is affecting Washingtonians now. The Quinault people,
whose ancestors lived and fished on their traditional land since time immemorial, are
facing environmental threats due to tsunami risk, storm surge, and riverine flooding
along the WA coastline. These reoccurring natural disasters have forced the Quinault
Nation to relocate to higher ground.44 Tragically, these circumstances are not unique to
the Quinault as many of Washington's Tribal Nations are experiencing the life-changing
effects of environmental degradation.45 Furthermore, climate change has contributed to
an even more dangerous wildfire season which is especially challenging during the
COVID-19 pandemic.46 The Washington State Department of Health (DOH) recognizes
the, "...concern about the health impacts of wildfire smoke overlapping with COVID-19
because both impact respiratory and immune systems. COVID-19 restrictions limit how
37 Katherine B. Spencer, Amanda K. Charbonneau and Jack Glaser. "Implicit Bias and Policing". Social and
Personality Psychology Compass. (2016): 50-63,10.Illl/spc3.12210.
https://oag.ca.gov/sites/all/files/agweb/pdfs/ripa/studv-glaser.pdf.
38 Jelani Jefferson Exum. "Sentencing Disparities and the Dangerous Perpetuation of Racial Bias". 26 Wash. &
Lee J. Civ. Rts. & Soc. Just. 491 (2020). h [iMSlSMffionsJaj^ i.
39 Omori, M., & Johnson, O. "Racial Inequality in Punishment." Oxford Research Encyclopedia of Criminology.
(2019): m/crimir
9780190264079-e-241.
40 "Say Their Names List 2020".
41 Schwartz GL, Jahn JL (2020) Mapping fatal police violence across U.S. metropolitan areas: Overall rates and
racial/ethnic inequities, 2013-2017. PLoS ONE 15(6): e0229686. https://doi.org/10.1371/journal.pone.0229686
42 Bowleg, L. et al. "Negative Police Encounters and Police Avoidance as Pathways to Depressive Symptoms Among
US Black Men, 2015-2016". American Journal of Public Health. 2020.
https://aiph.aphapyblications.org/doi/full/10.2105/AJPH.2019.30546Q.
43 Williamson, V., Trump, K., & Einstein, K. (2018). Black Lives Matter: Evidence that Police-Caused Deaths Predict
Protest Activity. Perspectives on Politics, 16(2), 400-415. doi:10.1017/S1537592717004273.
44 Quinault Indian Reservation. "Taholah Village Relocation Master Plan".
htt2iZZwwwigu]nauit^
45 Northwest Treaty Tribes. "Climate Change Impacts to Tribal Rights and Resources". 2016.
h ¦ jOr^cNmatech^nge^.
46 Centers for Disease Control and Prevention. "Wildfire Smoke and COVID-19: Frequently Asked Questions and
Resources for Air Resource Advisors and Other Environmental Health Professionals". 2020.
Mt|3S]//www1cdk;gg^/g^
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we can reduce our exposure to wildfire smoke."47 There are several shared goals
between the climate and environmental justice movements. The cumulative effects of
climate change and environmental injustices are most adversely affecting BIPOC and
low-income communities.48 As Washington continues to take climate change seriously,
we need to prioritize the communities that are most overburdened by pollution.
4. Economic Recession: Washington state's decision makers will need to make tough
budget decisions due to the steep, and likely long-lasting, economic downturn due to
COVID-19. The EJTF has had several conversations about prioritizing overburdened
communities through the equitable distribution of resources and investments, which is
reflected in our recommendations. The year 2020 has highlighted and exacerbated
numerous challenges and has presented several urgent, competing priorities. However,
one thing remains consistently apparent: our economy is reliant on the health of our
people and the health of our environment. We are reckoning with the fact that our
economy would collapse without our essential workers, many of whom do not earn
livable wages and are often a part of BIPOC communities who often also experience
environmental injustices. Washington state government has the power to lift up those
who have kept us afloat throughout this pandemic and economic recession by ensuring
their right to safe, clean, and healthy environments. The state budget explicitly
articulates the State's priorities, which means the State's decision makers have the
opportunity to reaffirm their commitment to social and racial justice in the actions they
take next.
The Work that Lies Ahead
Often it is the responsibility of state agencies whose work directly touches the environment and
public health to achieve EJ. However, EJ is clearly connected to many different facets of our
government, from our education system to our police force. In order to make lasting change
47 Washington State Department of Health. "COVID-19 and Wildfire Smoke". 2020.
tl , ilwJoiliMiJS ilMBilMil nment/AirQi ililiss.
48 University of Washington. An Unfair Share Exploring the Disproportionate Risks from Climate Change Facing
Washington State Communities. (2018):
£! \OMoSj5llIie vvasmngtonState_£
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happen for Washington's overburdened communities who experience the most extreme
environmental health disparities, it will take the work of all state agencies to meaningfully
partner with communities and identify how they can take an active role in addressing EJ by
promoting safe, clean, and healthy environments for all.
Meaningful engagement and government transparency are central tenets of EJ. The following
questions can help guide state government as it continues to advance EJ in Washington.
1. How is state government increasing transparency?
2. How is state government institutionalizing and demonstrating intentionality to eliminate
disparities?
3. How is state government creating standards for accountability to communities, and
adhering to those standards?
It is clear throughout the EJTF work that future study is needed to fully answer these questions,
however, the EJTF's recommendations are focused on creating the infrastructure across the
state to begin doing the necessary anti-racism, environmental conservation, public health, and
community engagement work.
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The Environmental Justice Task Force
Authorizing Budget Proviso
The EJTF was created through a proviso in the State's 2019-2021 operating budget (Engrossed
Substitute House Bill 1109). Section 221, subsection 48 directed the Governor's Interagency
Council on Health disparities to convene and staff the EJTF and outlined the EJTF's membership
and reporting requirements to the Governor and Legislature. In accordance with the budget
proviso quoted below, this final report includes:
• Measurable Goal Recommendations: "Measurable goals for reducing environmental health
disparities for each community in Washington state and ways in which state agencies may
focus their work towards meeting those goals."
• Model Policy Recommendations: "Model policies that prioritize highly impacted
communities and vulnerable populations for the purpose of reducing environmental health
disparities and advancing a healthy environment for all residents."
• Environmental Health Disparities Map Recommendations: "Guidance for using
the Washington Environmental Health Disparity Map to identify communities that are
highly impacted by EJ issues with current demographic data."
• Community Engagement
Recommendations: "Best
practices for increasing
meaningful and inclusive
community engagement that
takes into account barriers to
participation that may arise
due to race, color, ethnicity,
religion, income, or education
level."
Membership
The EJTF's authorizing budget
proviso outlines membership. The
EJTF has two designated Co-
Chairs. One Co-Chair is a
community representative serving
on the Governor's Interagency
Council on Health Disparities. The
other Co-Chair position was
designated for an organization
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representing statewide EJ issues, which was assigned to Front & Centered.
Additionally, the EJTF includes representatives from select state agencies, a business
association, an organization representing statewide agricultural interests, a labor organization,
and communities across the state. The full EJTF membership list is included in Appendix B.
Bylaws describe the operation and management of EJTF business whereas rinciples
are the values that guided the EJTF throughout our work. The operating principles were
adapted from those of the -ties, and EJTF
members thoughtfully engaged with each principle to ensure the final product is reflective of
our aspirations and commitment. The EJTF's operating principles are included below to
highlight the EJTF's commitments and priorities.
Environmental Justice Task Force Operating Principles, Adopted November 2019
EMBRACE EQUITY
We use equity to strive for fairness and justice to ensure that everyone has the opportunity to
meet their full potential. This includes the right to live and work in a healthy environment and
shape decisions that improve the health of their environments. Equity takes into account
disadvantage experienced by groups.49 Equity is not equality. Equity is achievable, but requires
prioritizing resources and support towards communities facing inequities. Our work prioritizes
communities of color, workers, and low-income communities in both urban and rural regions of
Washington. Embracing equity requires us to identify, name, and dismantle institutional racism,
economic injustice, and oppression.
FOCUS ON RACISM
We are committed to promoting equity for all historically marginalized communities. We
recognize that different forms of discrimination and oppression are related to each other, and
we will take the intersections of various identities such as, but not limited to: the LGBTQIA+
community, women, people who are limited English proficient, people with low incomes and
limited wealth, and people with disabilities into account. We also recognize that racism is
ingrained in our history and deeply embedded in our institutions today, leading to the
inequities we see across all sectors. We will seek to challenge and undo all forms of oppression,
and are committed to making anti-racism work a primary focus.
CENTER COMMUNITY
We recognize that we can only achieve equity if the communities suffering from inequities
where they live and work are at the center of our work. We acknowledge that each community
knows their assets, and needs, and as such, can speak best to the viability and impact of
proposed solutions. This is especially true when we build relationships with Tribal governments
49 Governor's Interagency Council on Health Disparities. "Equity Language Guide". 2018.
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and respect treaty rights. We strive to transparently recognize and share the power we have as
representatives of our organizations, and to structure our meetings to foster meaningful,
community-oriented engagement. Stakeholder and community engagement will be intentional.
We will create opportunities as a Task Force, individual members, and staff to listen, learn, and
seek input to guide our work. We will strive to incorporate stories of lived experience into our
reports and recommendations.
COMMIT TO BOLD ACTION
Inequities exist because of racism, economic injustice, and systemic oppression that hinder
opportunities for individuals and communities to thrive. Eliminating racism, economic injustice,
and oppression requires bold change. We commit to using our power, privilege, and collective
influence to propose changes that interrupt and dismantle historical systems of oppression. We
will use our time in Task Force meetings to engage in discussions that lead to actionable
recommendations. We will commit as individual Task Force members to be bold and serve as
champions for equity in our respective roles.
BE VIGILANT FOR UNINTENDED CONSEQUENCES
Policy, program, and budget decisions can have adverse, unintended consequences if principles
of equity are not intentionally and systematically considered. We commit to using an equity
lens in the development of recommendations as a Task Force and in our decisions as individual
members. We, as a government entity, seek to understand that our decisions have long-term
impacts. An example of that is the Seven Generation Principle50 as standing in the present while
looking back three generations to the wisdom and experience of our ancestors, thinking about
issues in the current context, and planning
forward for three generations for the protection
of our children and the generations to come.
Task Force Meetings
The EJTF held regular public meetings
throughout 2019 and 2020. The EJTF had
originally planned to meet in communities
across the state, but had to begin meeting
virtually due to the COVID-19 statewide physical
distancing mandates. In addition to the open
public meetings listed in Table 1, the EJTF
hosted two community listening sessions; one in
Table 1. 2019-2020 EJTF Public Meeting
Dates & Locations
Date
Location
September 30, 2019
Lakewood, WA
November 21, 2019
Yakima, WA
January 14, 2020
Vancouver, WA
April 2, 2020
Virtual
May 18, 2020
Virtual
June 22, 2020
Virtual
August 7, 2020
Virtual
September 11, 2020
Virtual
September 25, 2020
Virtual
50 The EJTF acknowledges the Tribal and Urban Indian Pulling Together for Wellness Leadership Advisory Council
and the American Indian Health Commission for Washington State for sharing this articulation of the Seven
Generation Principle.
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Everett at the beginning of the EJTF's work in September 2019, and another in July 2020 which
was held virtually.
Mapping and Community Engagement Subcommittees
The EJTF work was supported by two Subcommittees. One Subcommittee focused on the
development of guidance for the EHD map (Mapping Subcommittee), and the other focused on
the development of best practices related to community engagement (Community Engagement
Subcommittee). Both Subcommittees were Co-Chaired by at least one EJTF member, and
included a mix of EJTF members, state and local government staff, academics, EJ advocates, and
community members across Washington.51
The Community Engagement and Mapping Subcommittees both held monthly open public
meetings from December 2019 through July 2020. Subcommittee work informed the EJTF's
final EHD map and community engagement recommendations. The EJTF and the public
provided feedback and guidance to both Subcommittees during EJTF meetings, and after
thoughtful and thorough consideration across several Task Force and Subcommittee meetings,
the full EJTF formally approved Subcommittee draft recommendations.
Member Engagement
EJTF Co-Chairs and staff sought TF member feedback throughout the year. This included:
• Several one-on-one meetings with each member to better understand their agency or
organization's perspectives, priorities, feedback, and ideas for consideration.
• Multiple opportunities for members to provide written comment on developing
recommendations, report drafts, and general feedback.
• Invitations for members to join monthly Subcommittee meetings and to contribute to
Subcommittee work.
Member Voting and Feedback Processes
Due to the diversity of perspectives, priorities, and opinions represented on the EJTF, all
decisions were made with a simple majority vote. Members had the option to include a verbal
or written non-majority statement in instances where their vote did not align with the majority
opinion. See the Non-Majority Opinion and Member Statements sections of this report for
member-provided context for where they may not have aligned with the majority opinion, or
where they provided their perspectives about their experiences serving on the EJTF.
51 See Appendix B for the Subcommittees' respective membership lists.
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The EJTF "tentatively approved" each draft recommendation, which meant that members could
continue to provide feedback on the recommendations until the formal adoption of the final
report, when the recommendations were then considered final.
4. Follow
up after
EJTF
meeting
Community Engagement Strategy
The EJTF was supported by a Community Engagement Coordinator to bring in community
perspectives from across the state throughout the EJTF's work. This section outlines the process
the coordinator used to engage communities. With this said, the coordinator altered this
general approach based on specific community needs and asks.
1. Broad community Figure 5' Community Engagement Process for the EJTF
engagement: 6-8 weeks prior to
EJTF public meeting
Objectives: Get the word out as far
and wide as possible and garner
interest for participating in the
EJTF's process, either in listening
sessions52 or during EJTF public
meetings via: social media and
website posts, emails to the EJTF
listserv, and meeting invitations.
1. Broad
community
engagement
I
1
3. EJTF
meeting
2. Attend
community
meetings
2. Attend community, cultural, and Tribal meetings: 3-6 weeks before EJTF public meeting
Objectives: Listen to stories, lessons, and feedback from grassroots organizations and
overburdened communities. Share EJTF public meeting invitations with community
representatives so they can share their stories, lessons, and feedback with the EJTF directly.
3. EJTF Public Meeting
Objectives: Include community voice throughout EJTF public meetings by encouraging
community members to speak and participate throughout meetings. Strive for transparency by
informing communities about the EJTF process and the work to date. The EJTF did not require
prepared statements in order to give public comment, and when the EJTF met in-person, there
was dedicated time for a community dinner, community presentations, and small group
discussions between communities and EJTF members. When the EJTF held virtual meetings due
52 EJTF staff were invited to listening sessions funded by Front & Centered, a statewide convener of community
advocates working toward environmental, racial, economic, and climate justice. Front & Centered worked with
local organizations and advocates to organize and lead these listening sessions in a manner that best suited their
own communities. EJTF staff attended these listening sessions to learn about EJ issues across the state from
community leaders and community members. EJTF staff hosted two additional listening sessions.
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to COVID-19, community members were encouraged to contribute verbally and in the chat
function of the virtual meeting platform.
4. After meeting follow-up
Objectives: Synthesize community stories, lessons, feedback, and desired action items for the
report back to the EJTF during the next public meeting and for other community members who
were not able to attend the EJTF meetings via multiple mediums. Provide information to
communities about future opportunities to participate in and contribute to the EJTF's work.
¦ i, 1 , ¦ munity Engagemen 1 ardinator
The Environmental Task Force has been working to improve how state agencies improve
community engagement. This work was divided into two distinct paths, direct engagement
with communities and the Community Engagement Subcommittee. I led the direct
community engagement piece, which meant going out into communities and working directly
with members and organizations across Washington.
An important thing to note is that I led community engagement for two statewide Task
Forces, which meant I was often only able to devote 50% of my time to the EJTF. I
appreciated the beautiful, synergetic way both Task Force managers and the Co-Chairs of
each Task Force allowed me to work collaboratively and spend as much time as possible in
communities. We worked to hold as many consecutive public meetings across the two Task
Forces in the same geographic area as possible, which meant I was often able to spend
multiple weeks in a community. First building connections and getting the word out to
communities about an upcoming Task Force meeting, and then I often stayed the following
week in the same community to do engagement work for the other Task Force.
Why is this important? It takes time to build strong relationships with communities. The
most consistent feedback we heard from communities was that agencies should spend
more time and resources to build relationships and develop trust with community
members and organizations.
We held regional public and community meetings in Everett, Lakewood, Yakima and
Vancouver before the COVID-19 pandemic. We had to transition to online and phone
engagement due to COVID-19. This was difficult, but we were still able to hear from
communities all across the state. I also participated in almost every community listening
session that Front & Centered sponsored, which allowed me to meet and learn about even
more community members and organizations across the state. In each of the Task Force's
public meetings, we heard public comment from a wide variety of people with different
concerns. There was also space for community voice throughout each EJTF meeting that
enriched the Task Force process. Almost every EJTF meeting had a standing agenda item for a
community engagement update that allowed me to report what I heard from people leading
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up to the meeting during one-on-one conversations and from people who might not have
been able to attend the public meeting.
Our meetings with communities often served as workshops for community members and
organizations to develop and conceptualize what EJ is, identify community concerns, discuss
the value of the EHD map, and improve how state agencies do community engagement. The
process of distilling all the information gathered at meetings across the state gave us insight
into community-identified community engagement goals.
I made a deliberate decision against reporting quantitative data such as, "This many people
said x, and this many people said z". Quantitative methodology often may not provide
transformational information about why communities are experiencing hardships or what
solutions they have to address these hardships. I do not want to discount the importance of
quantitative information, but I know that I am uniquely qualified to bring a different
perspective.
My grandparents and parents were farmworkers; they all got sick and never made it out of
their 60s. I grew up in an agricultural community steeped in institutional racism and lived in a
tough neighborhood influenced by gang culture, but at the same time, I lived in a
neighborhood filled with cooperation, talent, love, and hope. I know when certain people
hear my story, they understand what I mean by the contradiction that is "the struggle". I
share my story to articulate why I chose to use a qualitative methodology approach to this
work.
In my experience, it is very difficult for non-BIPOC individuals to understand the nuances,
attitudes and pressures facing BIPOC communities. My work as the EJTF's community
engagement coordinator has been to listen, learn, and find ways to support existing work in
communities across Washington state. Through conversations, community meetings and
existing work groups, I worked with communities to understand the most important EJ issues
they are currently facing.
This report addresses several issues that were of high importance to communities.
Communities identified barriers to their participation such as a lack of childcare, food,
transportation, and language assistance at public meetings. The EJTF has made the
recommendation to amend state laws in order to address these common barriers. The
community shared their concerns about government oversight and its accountability to
communities. The EJTF's recommendation to incorporate environmental justice into state
environmental laws, as well as equitable investment in overburdened communities are good
starting places to address these concerns. This report also includes thorough guidance for
developing an agency-specific community engagement plan to ensure that community voice
is centered in government practices and processes.
Aside from these issues, communities have two major concerns: racism and environmental
conservation. I repeatedly heard that people want to make sure that this world is a better
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place for future generations, and they want the help of state agencies to make that happen—
this all begins with trust.
We learned that it's about building relationships. This may seem like an oversimplification,
and I imagine the initial reaction to this statement may be, "You did all this work to come up
with this obvious realization?" To this, I would respond that I could go back to these
communities and connect with people today, tomorrow, or next year. I am sure that many
people in these communities will be more responsive to state agencies after having a positive
experience with how we engaged with communities throughout the EJTF's work. We cannot
erase hundreds of years of colonialism, racism, inequities, and violence committed by the
government in a year, but we can do things differently. We can make an honest effort to
honor people's pain and be vulnerable in a way that inspires connection and healing. People
and agencies working together will lead to change, one step at a time.
--Esmael Lopez, Community Engagement Coordinator
Limitations to the EJTF Process
Tribes, Indigenous communities, and other groups who are vital to the EJ conversation were
not at the decision-making table:
Tribes and Indigenous people were among the founding activists and advocates for
environmental justice, but these perspectives are notably absent from this report. The EJTF
acknowledges these gaps in the EJTF's recommendations and the limitations of an
environmental justice report that does not include the invaluable expertise, historical
perspective, and ecological knowledge of Tribes and Indigenous people. EJTF staff reached out
to Puyallup, Upper Skagit, Swinomish, Yakama, and Tulalip Tribal members and government
officials through visits, emails, and personal contacts. Unfortunately, staff and EJTF members
were unsuccessful in filling the designated Tribal representative seat on the EJTF. The EJTF
recognizes that it did not have the appropriate political standing to engage with sovereign
Tribal nations, nor did it have established trusting relationships with Tribal and Indigenous
organizations or representatives. This is a substantive shortcoming of the EJTF report. State
government is accountable to repairing the environmental harms done to Tribes and
Indigenous communities, and the path towards healing that harm includes meaningful and
authentic relationships.
Due to limited staff time and the inability to conduct in-person meetings that are essential to
relationship building in the wake of the COVID-19 pandemic, a more comprehensive approach
to engagement ultimately was not possible. While we made every effort toward inclusion and
representation of overburdened communities, our work is inherently limited to the
perspectives of those who were able to participate most. Namely, the perspectives most
represented in this document are from people whose time was supported financially by their
jobs and whose workload allowed time to participate. In this document, there are many
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instances when the EJTF speaks for people whose needs and experiences we do not fully
understand, and we recognize that as a limitation to this work.
Timeframe:
The bulk of the EJTF work occurred in one year. A single year is not enough time to build
relationships and trust with overburdened communities across the state, or fully understand
the myriad of pressing EJ issues in Washington. Further discussion is needed to critically think
about how to thoughtfully work toward environmental justice with coordination among
communities, Tribes, state government, and other stakeholders.
COVID-19 Pandemic:
The EJTF had originally planned to hold at least six public meetings in different regions across
Washington, but was only able to hold three in-person public meetings due to the COVID-19
pandemic. This made it difficult for EJTF members to build relationships with one another and
with overburdened communities. In addition to the physical distancing mandates that made it
challenging to conduct meaningful community engagement, communities overburdened by
environmental hazards are often also highly impacted by COVID-19 and may not have had the
capacity to participate in the EJTF process as a result. With this said, the virtual meetings did
make it easier for broader community participation in public meetings, which likely would not
have been possible with in-person meetings in different corners of the state. The EJTF had very
large turnouts at all our virtual public meetings, including consistent participation across
meetings for several community members.
Many EJTF and Subcommittee members' responsibilities shifted to directly responding to the
COVID crisis. On a number of occasions, including mandatory state government furloughs for
several EJTF members and staff, the EJTF's work was delayed due to the urgent nature of the
COVID-19 response.
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Environmental Justice Definition
Many EJ definitions exist and no single definition can perfectly capture expectations and goals
that communities have been fighting for decades. The EJTF developed a recommended
statewide definition for EJ that builds upon the U.S. Environmental Protection Agency's (USEPA)
definition by adding the outcomes we want to see in Washington state. The EJTF recommends
that the definition be adopted by all Washington state agencies to identify and address current
environmental injustices and to ensure future decisions and actions promote EJ.
Environmental Justice Principles
The EJTF also developed EJ principles to serve as an initial blueprint for a shared vision of
environmental justice in Washington State. The following EJ principles were informed by
communities across the state and with recognition and reflection of the Principles of
Environmental Justice adopted at the First National People of Color Environmental Leadership
Summit in 1991.
Recommended use for EJ Principles
Washington state agencies and decision makers should consider these EJ principles when
creating and implementing agency-specific or enterprise-wide EJ goals. The principles can also
assist agencies in implementing many of the EJTF's recommendations.
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Environmental Justice Principles
I. Achieve the highest attainable environmental quality and health outcomes for all people.
¦ Prioritize health of the land, humans, animals, air, water, and marine ecosystems.
¦ Create sustainable systems for production, consumption, processing, and distribution.
¦ Recognize the ecological unity and the interdependence of all species.
¦ Ensure the ethical, balanced, and responsible uses of land and resources in the interest of a sustainable Washington.
¦ Commit to actions that ensure all children have opportunities to reach their full health and life potential.
II. Adopt a racial justice lens.
¦ Commit to identifying and disrupting racism embedded in your organization, policies, protocols, practices, and
decision-making.
¦ Dismantle all forms of racism, including environmental racism, by meaningfully partnering with communities to
eliminate environmental and health disparities for Black people, Native and Indigenous people, and people of color.
¦ Develop public policy based on mutual respect and justice for all peoples, free from any form of discrimination or bias.
¦ Recognize a special legal and natural relationship of Native Peoples to the U.S. government through treaties,
agreements, compacts, and covenants affirming sovereignty and self-determination.
III. Engage community meaningfully.
¦ Prioritize continuous engagement with communities who face environmental injustices and continue to be
underinvested and underserved.
¦ Recognize that people and communities hold intersecting identities that have been subject to systemic oppression
including but not limited to gender, ethnicity, and disability status.
¦ Focus engagement on building long-term, trust-based relationships with cultural humility.
¦ Adequately fund opportunities for meaningful community engagement by supporting and providing opportunities for
civic voice and community capacity building that builds on existing community priorities, research, and expertise. Value
different "ways of knowing"53 and share power between governments, Tribal nations,54 and Indigenous communities in
decision-making, needs assessment, planning, implementation, enforcement, and evaluation to find community-driven
solutions that are sustainable and amplify community assets.
IV. Be transparent.
¦ Ensure participation and decision-making processes are equitable and accessible.
¦ Make information easily accessible and relevant to the public and ensure communications are culturally and
linguistically grounded.
¦ Engage community in processes early and often (e.g. planning, funding, policy, evaluation).
¦ Provide clarity on how the community engagement process informs government processes.
V. Be accountable.
¦ Embed equity and the elimination of environmental and health disparities into mission, planning, goals, and measures
of progress.55
¦ Center the community in identifying the problems, solutions, and successes.
¦ "Close the loop" with communities by sharing how their involvement shaped and informed decisions, and by gathering
feedback on how the government can continue to improve service delivery and engagement.
53 The EJTF values epistemological differences.
54 The EJTF recognizes the importance of engaging meaningfully with non-federally recognized Tribes, urban
Natives, and the global Indigenous diaspora.
55 Refer to the EJTF's recommendations for creating measurable goals and embedding EJ into strategic plans for
guidance.
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Environmental Justice Task Force Recommendations
This chapter of the report includes all EJTF recommendations for how to embed EJ into state
government actions and processes. This chapter has three sections:
• Section I: Measurable Goals and Model Policy Recommendations
• Section II: Environmental Health Disparities Map Recommendations and Guidance
• Section III: Community Engagement Recommendations and Guidance
Each section in this chapter includes a brief description of the EJTF's responsibilities with
respect to that specific set of recommendations.
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I. Measurable Goals and Model Policy
Recommendations
Section Overview
The Task Force is responsible for providing:
• Measurable goals recommendations: "Measurable goals for reducing environmental
health disparities for each community in Washington state and ways in which state
agencies may focus their work towards meeting those goals."
• Model policy recommendations: "Model policies that prioritize highly impacted
communities and vulnerable populations for the purpose of reducing environmental health
disparities and advancing a healthy environment for all residents."56
This chapter of the EJTF report includes one measurable goal recommendation and ten model
policy recommendations. Figure 6 illustrates how these recommendations are further
organized into four categories that name the intended outcomes the EJTF would like to see
enhanced in state government:
• Improving Government Accountability to Communities
• Incorporating EJ into Government Structures, Systems, and Policies
• Investing Equitably
• Improving Environmental Enforcement
Figure 6. Overview of EJTF Measurable Goal and Model Policy Recommendations
Environmental Justice Measureable Goals & Model Policy Recommendations
Implement recommendations in any order.
Improving Government
Accountability to
Incorporating EJ into
Government Structures,
Investing
Equitably
Improving Environmental
Enforcement
Integrate community engagement & EHD map guidance across
implementation of all recommendations.
56 Engrossed Substitute House B 1109, section 221, subsection 48.
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Each of the following recommendations includes "Strategies and Considerations for
Implementation" that reflect the EJTF's conversations about the complexities and nuances that
accompany each recommendation. These strategies and considerations were also informed by
communities, stakeholders, and agencies not represented on the EJTF. Further study is needed
to implement any of these recommendations, as the strategies and considerations are not
meant to be comprehensive. Rather, they call attention to many of the most urgent and crucial
elements of a recommendation, provide context about the purpose and rationale of a
recommendation, and in some cases, provide resources and existing examples of related work.
Overarching Strategies and Considerations for Implementation:
The following considerations apply to all measurable goals and model policy recommendations,
and are listed here to avoid repetition:
• In many instances, agencies will need additional funding, staff support, and leadership
buy-in to adequately and effectively implement a recommendation.
• Select recommendations may require legislative action to support implementation.
Further study is needed to determine if these same recommendations can be
implemented through administrative action, legislation, or a combination of both.
• The EJTF recognizes that agency compliance with legal requirements and federal and
state guidelines take precedent during recommendation implementation.
• Recommendations can be implemented in any order, although certain
recommendations (e.g. "Permanent EJ Workgroup" and "Embedding EJ in Agency
Strategic Plans") are meant to build a strong foundation for continued EJ work and may
bolster the implementation efforts of other recommendations.
• The EJTF recognizes the need to improve coordination among state agencies to build a
strong, well-maintained, and adequately funded infrastructure that will achieve EJ in
Washington by addressing the needs of overburdened communities across the state.
These measurable goal and model policy recommendations are focused on building this
infrastructure and removing barriers so agencies can efficiently and effectively address
EJ issues across Washington. Additionally, the EJTF recommends integrating the EHD
map and community engagement guidance and recommendations across
implementation of all measurable goals and model policy recommendations. The EHD
map serves as an initial EJ analysis to assist with agency decision making, and
community voices are essential to all EJ work.
A4 p.246
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l. REVIEW/
ARTICULATE GOALS
& OBJECTIVES
(THEORY OF
CHANGE)
8. LEARN/REVISE
/ADAPT
7. COMMUNICATE
RESULTS/BE
ACCOUNTABLE ,
6. MONITOR AND
EVALUATE
PROGRESS A
2. RESEACH EJ
CONDITIONS AND
IMPACTS: REVIEW
DATA
Related to Embed EJ in
Agency Strategic Plans
T\
3 RESEARCH E.
CONDITIONS AND
IMPACTS:
COMMUNITY
ENGAGEMENT —
Related to Track and
Communicate Progress
Link to community
engagement guidance
A
K
Link to EHD mapping
guidance
Operationalizing Measurable Goals and Model Policy Recommendations: A
Primer on the GARE Toolkit
Overview and Purpose
The EJTF Figure 7. Embedding EJ: 8-Step Process (adapted from GARE racial equity
recommendations guide toolkit)
state agencies on how to
incorporate EJ into the
core of how they do
business by embedding EJ
into agency strategic
plans, developing systems
to track, evaluate, and
communicate progress in
advancing equity, and EJ
through agency
operations and programs,
Washington state
agencies can learn directly
from the work of the
Government Alliance on Racial Equity (GARE), GARE is an organization that works with
governments across the U.S. to incorporate racial equity analyses and goals into government
operations. GARE has published multiple tools and resources to support governments, including
their Racial Equity Toolkit, which can be applied at the programmatic level and can be scaled up
to meet agency-wide priorities. Appendix D provides a user overview of GARE's Racial Equity
Toolkit, with specific guidance for state agency staff seeking to apply this toolkit as a first step
towards implementing EJTF recommendations#! "Trackand Communicate Progress" and #3
"Embed EJ in Strategic Plans". Figure 7 also illustrates connections between the GARE toolkit
and EJTF recommendations pertaining to community engagement best practices and use of the
Environmental Health Disparities (EHD) map.
Figure 8. GARE Racial Equity Toolkit is adapted to help with the implementation of two
EJ Task Force recommendations.
5. CREATE A
MEASUREMENT
FRAMEWORK
4. REVISE AND
DESIGN
STRATEGIC GOALS
& OBJECTIVES TO
ADVANCE EJ^^
Track &
Communicate
Progress
-¦
GARE Toolkit
VripJomerifafron toot"
Embed EJ In
Agency Strategic
Plans
A4 p.247
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Recommendations for Improving Government Accountability to
Communities
Overview
EJTF recommendations #1 and #2 focus on improving government accountability to
communities. Increasing accountability was a consistent message we heard from communities
throughout the EJTF's community engagement process.
Track and Communicate Progress - Measurable Goals Recommendation
Recommendation 1: In partnership with communities, agencies should create a standard
method to develop, track, evaluate, and publish environmental justice and health goals
focused on pollution reduction, eliminating environmental health disparities, and improving
community engagement.
Strategies and Considerations for Implementation:
• Engage with communities throughout the goal development, tracking, and development
processes: Agencies should work with communities experiencing EJ issues, including Tribes
and Indigenous communities, to identify appropriate measures and baseline indicators for
tracking disparate impacts and progress towards reducing disparities. Refer to the
Community Engagement Key Recommendations (recommendations #17-26) and Community
Engagement Plan Guidance (Appendix C) included in this report. Consider contracting with
community-led organizations and partnering with academic institutions to support goal
development, tracking, and evaluation.
• Use existing equity toolkits for goal development: Use GARE Framework Guidance included
in Appendix D to help with creating agency-specific and program-specific, theories of
change, metrics, and indicators.
• Create enterprise-wide and agency-specific goals: While goals should be enterprise-wide to
encourage the interagency coordination necessary to address EJ and environmental health
disparities, agencies should also use statewide EJ and environmental health goals to inform
agency-specific EJ and environmental health goals.
• Create outcome and process measures: Eliminating environmental health disparities and
reducing pollution are outcome measures, whereas community engagement goals will need
a set of process metrics that hold state agencies accountable for increasing meaningful
engagement with communities.
• Strive for absolute numbers: The EHD map's relative rankings across census tracts allows
the user to visualize which areas of the state are most overburdened by specific EJ issues.
Relative rankings also add a layer of complexity for the user to track changes over time. In
order to clearly assess progress over time, state government should strive to develop EJ and
health goals that use absolute numbers.
A4 p.248
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• Leverage Permanent EJ Workgroup to track and evaluate goals: If stood up, the permanent
EJ workgroup can assist with creating, tracking, and evaluating these goals with support
from Results Washington, the Office of Financial Management, the Office of Equity, and
other entities that specialize in and maintain public data dashboards. Alternatively, a third-
party reviewer or agencies could review reports and track and evaluate progress toward EJ
goals. Examples of existing related work in state government:
o Results Washington can serve as a useful partner in tracking EJ outcome measures,
o Refer to Puget Sound Partnership's \ ;ns for possible EJ measures.
° Office of Financial Manageme iboard could be used to track agencies-
specific EJ activity (e.g. Workforce Performance Measi
o WSDOT has accountability measures in its Gray Notebook,
• Publishing progress toward goals: Agencies should regularly report their progress and
contribution toward enterprise wide EJ and environmental health goals. If stood up, the
permanent EJ workgroup can be responsible for ensuring that the public is regularly
updated on progress toward achieving EJ and environmental health goals.
• Addressing data gaps: Quantitative metrics that are standardized across regions will be
limited to what is available, what can be measured, and where it is being measured. To
address data gaps, collect additional local data and engage with communities for local
knowledge to learn more about current and past conditions and better understand
community-based solutions to EJ and environmental issues.
• Increase access to environmental data: Increase government transparency and
accountability through improving access to environmental data by providing technical
assistance and tools, such as the work supported by Environmental Data and Governance
Initiative, an organization that promotes environmental data justice.
• Community partnerships: Developing measurable goals in partnership with communities
will ensure that government is tracking the metrics communities care about.
Recommendation 2: Convene a permanent environmental justice interagency workgroup of
relevant agency staff that includes members representing overburdened communities.
Strategies and Considerations for Implementation:
• Granting authority: The Washington state Legislature should consider convening a
workgroup that can serve as a forum for collaboration and creation of accountability
structures. Possible workgroup responsibility examples include: review agency-specific
community engagement and strategic plans, track and publish progress toward
achieving EJ goals, and advise state staff on integrating the EJTF's EJ principles into state
agency actions.
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Shared leadership and resources: Communities and agencies share workgroup
leadership responsibilities and resources. Agencies defer to community leadership as
appropriate.
Build on previous and ongoing work: Build on existing EJ, equity, and community
engagement work in Washington state such as partnering with state boards and
commissions, the Office of Equity, and the Governor's Interagency Council on Health
Disparities to achieve EJ in Washington.
State EJ staff to serve: Dedicated state agency EJ staff should be designated to serve on
this workgroup, or staff deemed appropriate by agency leadership. Refer to
recommendation #4, "Dedicated EJ Staff in State Agencies", for more information.
Coordinate to address existing EJ concerns: Currently, there is no interagency
mechanism in state government to address EJ-specific community concerns. EJ issues
are often left unheard and inadequately addressed such as, but not limited to:
environmental clean-ups across Washington, farmworkers' rights (especially in light of
COVID-19), wildfire hazards, workplace hazards and exposures, addressing concerns
related to existing or possible new sources of pollution in communities, and supporting
community capacity building related to EJ issues.
Proactively advance EJ and implement existing recommendations: Currently, there is
no other interagency body working to proactively advance EJ. A permanent EJ
workgroup would lead to increased interagency coordination and alignment with
respect to EJ-focused investments. While there has been interagency EJ work in the
past, all such groups have been temporary and have not had the authority or
opportunity to implement existing EJ recommendations.
Create an EJ community of practice: A permanent workgroup would lend itself to a
community of practice for all agency EJ staff, and has the potential to bring in innovative
ideas and solutions from commissions, boards, communities, and academic institutions.
Demonstrate commitment to overburdened communities: This workgroup would
prioritize communities with cumulative environmental & health burdens, and sensitive
populations in its community engagement and service delivery approach.
Select appropriate agencies and entities to serve: State leadership to determine which
agencies or entities should serve in the permanent workgroup, for example the
Governor's Executive Cabinet, the Department of Natural Resources, the Energy Facility
Site Evaluation Council, the Interagency Council on Health Disparities, Ethnic
Commissions, and any other agency or entity deemed appropriate by the Governor.
A4 p.250
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- ,:' i ¦ , 1 ,ior ,¦ ¦ :" ¦; oratir : 1 ¦ h 1 '¦: < ,:
Struct' licies
Overview
This set of recommendations focuses on enhancing state government's infrastructure to
address EJ concerns in a meaningful, authentic, and strategic manner.
Embed EJ in Strc Plans - Model Policy mmendation
Recommendation 3: Agencies shall make achieving EJ part of their strategic plans in order to
integrate EJ into agencies' protocols and processes.
Strategies and Considerations for Implementation:
• EJ Staff to implement: Dedicated EJ staff to assist with implementing EJ and equity
components of the agency's strategic plan. Refer to recommendation #4, "Dedicated EJ
Staff in State Agencies", for more information.
• Adapted GARE Toolkit: Agencies should use the GARE Toolkit adapted specifically for
this recommendation to aid with strategic plan development and programmatic
theories of change. See Appendix D for more detailed guidance on the GARE Toolkit.
• Align with Federal EJ Executive Order (EO): should be considered the
baseline standard for how agencies can approach their EJ work.
Dedicated EJ Staff in State Agencies - Model Policy Recommendation
Recommendation 4: Agencies will have at least one staff position dedicated to integrating
environmental justice principles specifically, and equity more broadly, into agency actions.
Strategies and Considerations for Implementation:
• Suggested EJ Staff qualifications and principle responsibilities: Qualified EJ staff will
have demonstrated experience working with communities facing EJ concerns and a
deep understanding of the EJ discipline, including how to connect EJ to equity.
o Tribal Liaison position can serve as a model: This position could be structured
similarly to the Tribal Liaison positions within a state agency, for example: (1)
Assisting the state agency in developing and implementing EJ into agency actions,
processes, and protocols; (2) Serving as a contact person with overburdened
communities and maintaining communication between the state agency and
overburdened communities; and (3) Coordinating training of state agency
employees in EJ.
o A potential approach to develop qualifications: The Office of Financial
Management could develop competency language for certain job classifications,
with a focus on senior management. Guidelines about how to apply these
A4 p.251
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competencies for both new and existing staff, and timelines for implementation by
agencies, should also be developed.
• Leadership support and training: Agencies ensure EJ staff are closely connected to
agency executive leadership. Agency leadership will be best suited support EJ staff by
participating in ongoing EJ and diversity, equity, and inclusion (DEI) trainings and
professional development opportunities. Furthermore, agency staff that regularly
interface with the public (e.g. community engagement coordinators) should closely
collaborate with dedicated EJ staff, and also participate in EJ and DEI trainings.
• Expand staffing over time: Over time, the agency should support and resource lead EJ
staff with other staffing support. Support staff would ideally come from different areas
of the agency with the goal of infusing EJ and equity across the agency.
• Create an EJ-Focused Community of Practice: EJ staff could co-construct an informal57
community of practice within their agency and among other agency staff to support
agency accountability to communities, facilitate equity and EJ learning opportunities at
agencies, and apply equity and EJ lens to agency work.
• Examples of other possible EJ staff responsibilities:
o Designated staff to serve on the permanent EJ workgroup, if stood up.
o Participate in informal interagency EJ community of practice.
o Track and communicate agency progress toward EJ, perhaps in partnership with an
external entity.
o Oversee EJ-specific community engagement, including reviewing, updating, and
implementing the agency's community engagement plan (see: recommendation
#17).
o Ensure EJ and equity is included in the agency's strategic plan (see:
recommendation #3), and that the agency is actively working toward EJ and
equity.
• State leadership should determine which agencies this recommendation should apply
to, for example the Governor's Executive Cabinet, the Department of Natural Resources,
the Energy Facility Site Evaluation Council, the Interagency Council on Health Disparities,
and any other agency or entity deemed appropriate by the Governor.
Recommendation 5: Environmental justice considerations should be incorporated into a
range of state environmental laws. Further, environmental and natural resource state
agencies should consider environmental justice in developing agency request legislation,
analyzing bills during legislative session, and conducting rule reviews.
Strategies and Considerations for Implementation:
57 Non-mandatory, and not necessarily a public meeting.
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Prioritizing efforts to reduce inequities: Agencies should prioritize agency request
legislation and rule updates that will reduce inequity or have a positive impact on
overburdened communities.
EJ impact review: In analyzing bills during legislative session, the legislators, legislative
staff and agencies should consider what communities will be affected and whether the
bill will reduce, increase, or have no impact on EJ. Health Impact Reviews developed by
could serve as a model for this work.
Engage with stakeholders and communities to identify the best path forward:
Significant additional work is needed to identify how to best incorporate EJ into state
laws.
Illustrative examples on how to implement this recommendation include:
° Modernizing the Evergreen Communities Act (SB 6529/HB 2413):
¦ This update of the Evergreen Communities Act to help communities develop urban
forestry plans aligning with other high priority goals, such as salmon and orca
recovery, reducing environmental health disparities, and local air and water
quality improvements. The bill includes a focus on EJ and ensures at least 50% of
all program activities benefit overburdened communities.
o Growth Management Act (GMA):
¦ ill 1000 provides an example of incorporating EJ into Washington's
GMA. For example, EJ could be incorporated as a new mandatory goal. This goal
could require identification of overburdened communities, prioritization of
improvements and programs that address the needs of overburdened
communities—including addressing reduction of greenhouse gasses (GHG) that
put communities at risk due to climate change, and affordable housing to combat
gentrification and displacement.
o State Environmental Protection Act (SEPA):
¦ Pennsylvania Enhanced Public Participation Policy: This policy was created to
ensure that EJ communities have the opportunity to participate and be involved in
a meaningful manner throughout the permitting process when companies propose
permitted facilities in their neighborhood, or when existing facilities expand their
operations. Only those activities that may lead to significant p due to
potential impacts on human health and the environment trigger this process. Such
activities include new major sources of hazardous air pollutants, commercial
incinerators, coal preparation facilities or expansion of large concentrated animal
feeding operations.
¦ New Jersey Senate Bill : This bill requires consideration of the potential for
disproportionate cumulative health impacts on the local community when certain
types of new facilities, or expanded facilities, are proposed in an overburdened
neighborhood. The bill also includes explicit guidelines for meaningful public
participation during public hearings in overburdened communities.
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Recommendations for Investing Equitably
Overview
Applying an equity lens to the distribution of state investments is at the core of EJ work. The
following recommendations focus on strategies that promote equitable investments in
overburdened communities across Washington state.
Required use of EJ Analysis - Model Policy Recommendation
Recommendation 6: Agencies should adopt, and the Legislature should consider, requiring
environmental justice analyses, including but not limited to the use of the Environmental
Health Disparity Map, that combine the cumulative impact of environmental health
indicators such as environmental exposures, environmental effects, impact on sensitive
populations, and other socioeconomic factors.
Strategies and Considerations for Implementation:
• Reference EHD map Recommendations: Refer to the EHD map recommendations (see:
recommendations #12-16) when requiring, developing, or using EJ analyses in
implementing applicable environmental, natural resource, and public health programs
in order to ensure appropriate use of these types of analyses. Some areas in which
environmental analyses are appropriate include:
¦ Program Planning, Monitoring,
and Evaluation
• Strive for a consistent methodology through agency collaboration: To ensure
consistency of an EJ analysis application, there should be ongoing collaboration of
agencies using these types of analyses. The proposed permanent EJ workgroup would
be a valuable resource in this effort.
• Illustrative examples of how aspects of this recommendation have been implemented:
o The Clean Energy Transformation Act (SB 5116) requires utilities to do an
analysis based on a cumulative impacts analysis of the communities highly
impacted by fossil fuel pollution and climate change in Washington for
integrated resource planning.58 Rulemaking by Commerce and the Utilities and
Transportation Commission (UTC) is in process on how to implement this
requirement.
o The CalEnviroScreen mapping tool is used in California state government by
CalEPA to aid in administering EJ grants, promote compliance with
58 RCW 19.280.030(l)(k) https://app.leg.wa.gov/RCW/default.aspx?cite=19.280.030.
Community Engagement
Capital Investment
Fees and Costs of Service
Policy Development
¦ Grants and Loans
¦ Contracting
¦ Enforcement
¦ Rulemaking
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environmental laws, prioritize site-cleanup activities and identify opportunities
for sustainable development,
o EHD Map: A number of state agencies have utilized the EHD map in different
aspects of their work, including by not limited to the Departments of Ecology,
Commerce, and Transportation.
• Train staff to conduct EJ analyses: Training in both the development and use of the map
for state staff may be needed. In addition, funding would be needed to maintain and
update current analyses, like the EHD map and should also be provided to allow state
agencies to work with local jurisdictions for important granular data that either could be
incorporated into state tools or be considered in addition to what the state can access.
Refer to EHD map recommendation #14 for more information about developing
technical guidance for practitioners.
• Engage and consult with Tribes: Formal Tribal consultation should be offered in both
the development of and proposed uses of environmental justice analyses.
• Operationalize EJ analyses: The California Department of Public Health and the Public
Health Institute developed the Five Key Elements of Health in All Policies as a guide and
filter for identifying opportunities for operationalizing this work: Promote health, equity,
and sustainability; support intersectoral collaboration; benefit multiple partners; engage
stakeholders; create structural or procedural change.
• Resource: The ;y Index may be a resource to help measure impacts
resulting from greater investments in communities.
Equitably Distribute State Environmental Investments - Model Policy
R ec o m m e n d a t i o n
Recommendation 7: For new and existing revenue and expenditures with an environmental
nexus, the state Legislature and agencies should equitably distribute investments ensuring
that resources are allocated to the most overburdened communities.
Strategies and Considerations for Implementation:
• Identifying overburdened communities: Overburdened communities should be
identified through project-or program-specific EJ analyses. Refer to EHD map
recommendation #13 for more information on how to use the EHD map as a starting
point to identify overburdened communities.
• Conduct an EJ analysis: The EHD map is an example of an EJ analysis that can assist with
equitable distribution of environmental investments. Environmental investments and
programs directed toward overburdened communities should be made proportional to
the health disparities that a specific community experiences.
• Consideration of multiple factors: An EJ analysis should serve either as the primary, or
one of multiple factors, for the prioritization process.
A4 p.255
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• Possible investment opportunities: The intended result of this recommendation is that
agencies will be directed to invest resources and programs under their control in the
areas that are most disadvantaged. Additionally, funds can go toward grants, hiring, and
contracting opportunities.
• Promote transparency: Goals and assessment metrics should be in place to in order to
clearly communicate where, why, and how funds are distributed. Furthermore, efforts
should be made to balance investments across the state, not just in urban areas in the
Puget Sound region.
• Illustrative examples of how aspects of this recommendation have been implemented:
o ?1 Act (h The Department of Ecology oversees MTCA
implementation has used both the EHD map and other criteria in order to identify
areas for environmental cleanup, public participation grants, remediation, and
pollution prevention programs statewide.
° New York Clir imunity Protection Act: This law sets a target
for "disadvantaged communities" to receive 40% of the overall benefits from the
state's climate programs, and at a minimum, "disadvantaged communities" must
receive no less than 35% of those benefits.
o : California state law created a program that has been
periodically updated to ensure that 25% of the proceeds from the Greenhouse
Gas Reduction Fund benefit projects that provide a benefit to "disadvantaged
communities" as identified by the CalEnviroScreen map, which the EHD map was
modeled after.
• Possible investment priorities: Investments should focus on eliminating health burdens
and raising the standard of living.
• Illustrative examples of ways to equitably distribute funds:
o Community grants to monitor pollution that would be focused on building capacity
and training for community scientists. Note that adequate staff capacity would be
needed to support and provide technical assistance to communities that may be
new to receiving agency grant funding.
o Education and work-readiness youth programs focused on infrastructure or utility
related internships, careers, and eventually leadership.
irds and Diversity - Model Policy
R ec o m m e n d a t i o n
Recommendation 8: Work funded by state environmental investments should increase
inclusion in contracting with minority, women, and veteran-owned enterprises in alignment
with the Governor's Subcabinef on Business Diversity led by OMWBE. and have high labor
standard requirements that value workers' health and safety, regardless of whether a public
or private entity is the beneficiary of the new spending, except where legally prohibited from
doing so.
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Strategies and Considerations for Implementation:
• Examples of high labor standards include, but are not limited to: pay equity, local hire
and project labor agreements, livable wages, safe work environments, paid family and
sick leave, protecting the rights of workers to organize, flexible work schedules and
telework options, retirement benefits, and comprehensive health insurance.
• Refer to WA State Disparity Study Findings: Agencies should include the strategies and
recommendations put forward by OMWBE from the 2019 WA State Disparity Study in
their inclusion plans.
• Exceptions: Possible exceptions to this recommendation include any statutory and
constitutional limitations, such as the Department of Natural Resources'Trust Mandate-
Recommendation 9: As one strategy for achieving environmental justice, Washington state
government should study reparations as a mechanism to address health disparities and
historical harms affecting overburdened communities. The state should focus on the unpaid
debts from slavery and colonization, the legacy of redlining, treaty violations, forced
exclusion, and neighborhood segregation in Washington, as well as the impact that systemic
racism has had on Black, Native, Indigenous, Latinx, Asian communities and others.
Strategies and Considerations for Implementation:
• Identify where to house this work: As an option, the Office of Equity could develop a
plan for studying reparations with the continued input and guidance from the public and
the state's Ethnic Commissions. One additional strategy could be the creation of a
community task force to guide this work.
• Further explanation on reparations: Reparations can take many forms, such as: direct
payments to communities and individuals, environmental cleanups, increased
investments in overburdened communities in the form of grants, programs, and projects
(see: recommendation #7 "Equitably Distribute State Environmental Investments"). The
process, budget, and outcomes must be community-led and co-created with
government agencies.
• Other possible areas for study: Slavery, colonization, internment, employment
discrimination, labor and land theft, and financial services discrimination.
• California Reparations Task Force: California state government passed legislation (
) in September 2020 to study and develop proposals for potential reparations to
those affected by slavery and the direct descendants of enslaved people.
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" ,:' i ¦ , 1 , ions , ¦ . :,, ¦, 1 ¦ : , ironn ¦ , , al : ,; ¦ . " ,: < ,: f
Overview
The following set of recommendations focus on how to improve existing mechanisms for
environmental enforcement to promote access to and benefits for overburdened communities.
Ensure Accessible Enforcement and Reporting Processes - Model Policy
R ec o m m e n d a t i o n
Recommendation 10: The EJTF recommends ensuring that enforcement and reporting
processes are accessible to overburdened communities by elevating awareness and
addressing barriers to access (such as technology, literacy, and language).
Strategies and Considerations for Implementation:
• Increase awareness of reporting systems: Increase public education and awareness of
environmental reporting tools such as the Environmental Reporting and Tracking System
(ERTS), the Environmental Crime Report Form, Clean Air Agencies' complaint forms, and
other environmental reporting mechanisms.
• Ensure accessibility: Ensure reporting options are accessible to a diverse audience,
including: multilingual formats, phone reporting, and systems navigators who can
provide online, in-person, and phone support.
• Ensure compliance with existing laws and policies: Assessment of existing
environmental reporting systems to evaluate access to services and compliance with
Title VI, ADA, and non-discrimination obligations.
S il Environmental Projects (SEPs) - Model Policy
Recommendation
Recommendation 11: Agencies with enforcement responsibilities should, to the extent
practicable and appropriate, support the inclusion of "Supplemental Environmental Projects"
(SEPs) in settlement agreements.
Strategies and Considerations for Implementation:
• Further explanation of SEPs: As part of a voluntary settlement, the responsible party
may propose to undertake a project to provide tangible environmental or public health
benefits to the affected community or environment. The responsible party can
voluntarily choose to fund a SEP to offset part of the penalty they would otherwise be
required to pay for the violation.
• Engage affected communities: When possible, SEPs should be developed through a
partnership between the responsible party and the affected community and provide
tangible environmental or public health benefits.
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II. Environmental Health Disparities Map
Recommendations and Guidance
Section Overview
The Task Force is responsible for providing:
"Guidance for using the Washington Environmental Health Disparities Map to identify
communities that are highly impacted by environmental justice issues with current
demographic data."59
The (EHD map) is a cumulative impact map that
compares census tracts across Washington for environmental health disparities. It is part of the
Washington Tracking Network (WTN). WTN and the EHD map are useful for exploring
geographic areas in Washington to better understand communities' health as well as the social,
economic, and environmental impacts influencing them. Developed jointly through community,
academic, and government agency collaboration, the EHD map and data can be used by state
agencies to improve accountability, engagement, and transparency towards EJ goals. The EHD
map may also be used by the public, community leaders, and community organizations to
improve awareness of and work towards EJ solutions. The following mapping recommendations
and guidance from the EJ Task Force focus on:
• How to use the EHD map to better understand who is potentially affected by agency
activities
• How to guide agency resources and decisions towards eliminating environmental and
health disparities, and
• How to set goals and measure progress for the distributional equity of benefits and
burdens across communities.
Refer to Appendix E for more information about the Washington Tracking Network that houses
the EHD map. Appendix E also discusses how the EHD map was developed and important
considerations for using the EHD map.
Considerations for EHD Map Use
The WTN and the EHD map are valuable for state agency planning and programming activities.
The EHD map is a model and no model fully captures reality. The EHD map is built using the
best available data to Washington state using a specific scientific model where risk is comprised
of threat and vulnerability to arrive at environmental health disparity rankings.
The EHD map was developed in a robust partnership of government agencies, academia, and
community-based organizations. Front & Centered, a statewide coalition that organizes and
advocates for EJ, held listening sessions and community conversations to seek input into the
map's development, but those sessions did not cover all communities in Washington. The EHD
59 Engrossed Substitute House Bill 1109. section 221, subsection 48.
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map is a dynamic, informative tool, but does not replace the need for thoughtful state agency
engagement with impacted communities and the incorporation of additional historic disparities
information into decision-making.
As a cumulative impact analysis map, there are a number of considerations that will influence
how the EHD map can and should be used. The Task Force has identified the following
information for agencies to be aware of when using the EHD map to inform their decisions.
Interactive
The EHD map is a robust, interactive mapping display that quickly provides a synopsis of
cumulative impacts, considering environmental exposures and effects, sensitive populations,
and socioeconomic factors. The resulting disparity rank is easy to understand and creates a
powerful visual of where environmental health disparities exist in Washington and which
measures contribute to each area's rank.
Ranking-based
The use of rankings allows disparate data sets to be displayed together, which would otherwise
be difficult to display in a meaningful way. Rankings also protect sensitive health information in
situations where a very limited number of individuals in an area are impacted.
The rank for each census tract indicates the order from smallest to largest value, but does not
indicate how great the difference in values are for any two ranked items. This means that a user
cannot draw conclusions about how large or small the disparity is between any two ranks (such
as between 1 and 10, or 9 and 10). In other words, even if there is an overall reduction in
environmental health disparities, relative rankings mean there will always be census tracts
ranked 1 through 10. It is possible to view the data distribution (Figure 9) among the deciles in
the EHD map. In this way a user can gain additional insights into the magnitude of the
differences between census tracts.
Figure 9. EHD Map Rank Data Distribution Examples
JS.
Rank Data Distribution for Ozone Concentration (x) Rank Data Distribution for Population Living in Poverty (x)
Rank
^L.
< = 185% of Federal Poverty Level (%)
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Current, accessible, statewide
The EHD map includes the most current statewide data, is publicly accessible, and the data are
available for download from the WTN Query Portal if additional analysis or access to absolute
values are needed.
The map relies on a number of national data sources. These data may not reflect localized
environmental health disparities and conditions. It also does not map the sum total of impacts.
It is cumulative, but not all encompassing. State agencies should ground-truth findings from the
EHD map with qualitative data and lived experiences from engaging with communities to create
a fuller picture of current conditions and needs.
Relying on available data means that there are gaps in the data and in what information the
EHD map reflects. It is not representative of all threats and vulnerabilities. For example, data
limitations related to Tribes and Indigenous populations, statewide water quality information,
rural or urban indicators, and other important considerations are not fully captured by the EHD
map. In addition, Tribes were not formally consulted and business interests were not
represented during the development of the EHD map.
Flexible
Overlays allow more site specific or project relevant information to be displayed, such as Tribal
lands boundaries, city limits, school locations, and 100-year flood zones. Since the EHD map is
built on the IBL platform, Department of Health can add new data and overlay maps.
Geographic scale
Census tracts are used because they tend to
provide a stable geographic unit for
presenting data. A user cannot view and
analyze environmental health disparities at
geographic scales that are smaller than a
census tract (such as a neighborhood block)
or larger areas (such as multiple tracks or
zip codes). The EHD map provides rankings
relative to the entire state, and does not
allow for comparative rankings within other
geographic boundaries (such as a county).
Certain agency activities or organizations
whose jurisdictions are not statewide may
benefit from other maps that operate at
finer or more flexible geographic scales.
Tracking changes over time
Since the EHD map is based on relative rankings, a census tract that increases or decreases in its
ranking reflects how that census tract currently compares to others. It does not mean that
disparities increased or decreased in terms of the absolute value. This distinction also means
The Port of Seattle developed an
consisting of 25
indicators using the same categories
and ranking scale as the EHD map. The
is the first
project to use this Index to award $10
million between 2019 and 2023 to
address noise mitigation,
environmental health and sustainability
in near-airport communities.
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that the EHD map is useful for point-in-time comparisons, but not for tracking changes over
time.
To examine changes over time, one method could be to export and analyze the underlying
data. Selecting the graph icon next to the measure within the IBL will search WTN data to see
the range of data used to create the rankings.
Additional measures identified during the development of the EHD map include asthma, noise
pollution, proximity to state-specific cleanup sites, and surface water quality. At the time the
map was developed, these measures were not available statewide, but they are currently under
development. The EHD map will be updated as statewide data for these measures become
available.
Communities have expressed interest in resilience and asset-based approaches to describing
their communities. Currently, the EHD map focuses on disparities. However, future map
enhancements could include resilience or asset-based indicators of environmental health such
as measures of civic participation or local non-profit funding. Community voice was critical
throughout the development of the EHD map and should continue to play a role. Both
enhancements to the usability of the EHD map and the incorporation of new data should be
informed by public engagement and collaboration with overburdened communities. Resources
and capacity will be needed to fully engage community in this process.
Finally, WTN was established, and continues to be mostly funded, by a Centers of Disease
Control and Prevention (CDC) grant. Funding from the CDC has declined over time, and there is
no dedicated funding to expand the IBL functionality or add new data to the EHD map.
Department of Health staff time is critical to updating and enhancing the EHD map, such as
recent WTN data updates to the American Community Survey (ACS) data (October 2019), low
birth weight data (December 2019), and cardiovascular disease data (January 2020). It is
anticipated that maintenance and enhancement of the EHD map will need dedicated support
and funding.
" , : ' ) ¦ , 1 . ions ,' . . , : " ; I : ,! ' / ¦ . , 1
The EHD map is publicly available bringing much needed attention to environmental and
human health conditions statewide and reveals disparities across Washington's communities.
Identifying areas where people may face the most risk and exposure to environmental pollution
is a critical step towards EJ and provides a way for state agencies to transparently and
consistently integrate cumulative impact considerations into activities and decisions.
The Washington Tracking Network and the Environmental Health Disparities map have data and
analyses that can support pro-equity planning in a number of agency activities. While individual
agencies will determine how best to integrate WTN and the EHD map, one approach is to
A4 p.262
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prioritize the integration of the EHD map into activities that have direct impacts on
communities.
In line with this, the following activities could serve as important starting points for agencies:
• Community Engagement
• Grants Programs
• Capital Investment
• Policy Development
• Rulemaking
Recommendation 12 (EHD Map): The EJTF recommends that state agencies consider four initial
ways of using the WTN mapping tools and EHD data in agency activities. These suggestions are
based on using the map as it currently exists, either in its online form or as exported map EHD
data tables for integration with agency data.
I. Build demographic and environmental context to guide and inform place-based
activities.
Purpose: Use the WTN, including the EHD map, to learn about the intended audience
and community potentially affected by an agency activity or service.
When to implement: As policies, program changes, practice improvements, and facility
management decisions are being considered.
Example: In the initial planning stages of community engagement, review the EHD map
and its individual measures to learn about a population's education background,
availability of affordable housing, and proximity to sources of pollution. These data can
help ensure outreach is accessible and reflects community concerns.
Example: A review of WTN data will also support more comprehensive and inclusive
community engagement planning. Specifically, WTN data on preferred languages for
non-English speaking populations will help ensure critical information reaches diverse
audiences, and that federal compliance obligations for language access are met.
II. Conduct environmental justice review and analysis as routine practice for programs
and projects.
Purpose: Use the EHD rankings to identify highly impacted communities to assess how
these areas may be positively and negatively affected by a proposed policy, program,
project, or activity. If highly impacted communities will be negatively affected by a
decision or activity, the agency should strive to mitigate or minimize impacts, enhance
public engagement, or seek alternatives to avoid potential impacts.
When to implement: As activities, policies, program changes, practice improvements,
and facility management decisions are being considered.
Example: When evaluating the potential impacts of a project on communities, the
agency finds that highly impacted communities will be negatively affected by a decision
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or activity. Agency staff elevate efforts to consider alternatives to avoid potential
impacts.
III. Center environmental justice as the priority intended outcome in resource allocation
decision processes.
Purpose: Direct beneficial environmental activities and investments towards areas with
environmental health disparities and where the environmental health improvements
will be greatest.
When to implement: When allocating resources and funding across an agency's service
area.
Example: An agency includes "benefits to overburdened communities" as one element
in evaluating grant proposals. Grant proposals that benefit areas with EJ or cumulative
impacts considerations (such as tracts ranked 9 and 10 in the EHD map) are allocated
additional points in application scoring.
Example: An agency implements a "targeted universalism" approach to allocating
resources. Using a determination method that factors heavily for environmental health
disparities, operational and capital dollars are prioritize to facilities or service area
geographies that will most benefit (as identified by areas with high EHD rankings).
IV. Evaluate and measure reductions in disparities through service equity improvements.
Purpose: Evaluate the distributional equity characteristics of historic, current, and
projected agency activities across the agencies service area.
When to implement: Program and activity strategic planning.
Example: An agency evaluates where past and current grants have been allocated across
the state relative to EHD map ranking and geographic representation (e.g., urban/rural).
The service equity analysis identifies a pattern of higher investments in urban areas with
low EHD rankings. The agency addresses potential barriers to grant access, by expanding
notification about the grant, adjusting the application and scoring process to support
first time applicants and those with limited resources, and adjusting funding-match
requirements.
Recommendation 13 (EHD Map): Use the overall EHD Map rank 9 and 10 as a starting point to
identify highly impacted communities.
The EHD map is designed to identify communities who are potentially hardest hit by
environmental injustices and cumulative impacts. Drawing from both federal and state
experience with similar maps, the EJ Task Force recommends initially identifying highly
impacted populations as census tracts ranked 9 and 10 in the overall EHD map ranking. By using
rank 9 and 10 as a starting point, agencies will have a transparent and consistent approach to
identifying areas with environmental health disparities. As we advance this work and refine our
use of the EHD map, agencies and departments will likely tailor how they identify and prioritize
highly impacted communities depending on program and project needs. This recommendation
should not be construed as a definitive characterization of a place or community, or as a way to
label an area as an "EJ community."
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Recommendation 14 fEHD Map): Develop technical guidance for practitioners.
The EJTF acknowledges that in order to increase the use of a cumulative impact analysis to
inform agency decision-making and potentially influence environmental health disparities,
agency staff will need training and guidance on how to best use the EHD map and the
supporting data. The Task Force recognizes that funding to maintain the EHD map and support
training may be needed meet this recommendation.
DOH has developed a tutorial for beginner EHD map users interested in exploring the EHD map.
The EJTF recommends additional training for practitioners that could include:
• In-depth training materials for practitioners
• Opportunities for consultation with WTN staff
• Detailed descriptions of how to utilize EHD map features and access the source data
• Guidance on EHD map limitations
Recommendation 15 (EHD Map): Adopt equity tools and analyses in agency practices.
The EJTF recommends using the EHD map in conjunction with other equity-focused tools and
analyses. The development and application of equity tools and analyses are rapidly expanding
both in Washington and nationally. These tools, when supported with open spatial data, help
inform, guide and account for progress toward environmental health disparity reduction and
elimination. These equity tools and practices take many forms, such as checklists, toolkits,
impact assessments, and participatory project planning. Like the EHD map, these tools have a
range benefits and limitations, and their application will depend on factors such as the type of
activity, potential to affect communities, and data availability. Examples of equity tools and
analyses that have been adopted by other government agencies include, the GARE Racial Equity
Toolkit, City of Seattle Racial Equity Toolkit, California Governor's Office Resiliency Guidebook
Equity Checklist, and City of San Antonio Budget Equity Tool.
Recommendation 16 (EHD Map): Set environmental health disparity reduction goals and
track progress towards those goals.
Achieving EJ and eliminating disparities must be part of an overall state effort to systematically
promote and track progress towards these goals. The EJ Task Force recommends that state
government entities work collaboratively to set goals, integrate accountability into current
tracking systems, and regularly report on progress. Possible approaches to this work include:
• Include EHD map environmental and health disparities indicators in state performance
management goals and tracking.
• Partner with the Governor's Office, Commissioner of Public Lands, Office of Equity,
Office of Financial Management, and others to strengthen and expand EHD map use and
capacity.
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King County Uses Mapping to Track Progress toward Equity
King County tracks and measures progress toward equity as agencies implement
the King County Equity and Social Justice Strategic Plan. Mgpping hgs been g key
component in this work, including on interactive operations doshboord (Figure 10)
thgt Igyers program inforrnotion onto community conditions over spoce gnd time.
Using mgps to visuolize historic gnd current service delivery hgs improved program
gnd resource planning by revegling the degree of potentiol effect of the county's
efforts toword heglth dispgrity reduction. As o result of this work, King County is better
suited to moke pro-equity decisions by bringing equity octions gnd desired equity
outcomes together in o shgred megsurement construct to inform leorning gnd the
gbility to odgptiveiy mgngge.
Figure 10. Example of King County's interactive operations dashboard
ENVIRONMENT & CLIMATE / Tree Coverage
Condition
Where the needs are greatest
Trees and tree canopy provide an
array of quality of life, physical
health, mental well-being, crime
deterrence, and property value
benefits. In King County and most
areas, access and proximity to this
community resource is notable
disparate. Affluent neighborhoods
have significantly more tree
coverage when measured
countywide, within each sub-
region, and within each municipal
boundary, and within Zip codes.
Here tree and canopy data is from
Lidar scans from airplanes that
give us details to the I meter pixel
resolution which are presented as
values for each census tract.
Equity Ratio
D1 rpbtivpfn O1^
Trees Planted by
Quintile
.1
I Tree Cove rage by I
Quintile |
Tree Coverage by Tract
The value of Q1
114.5%) is ?8% of the I
"rnportional History
Trees Planted
18,302
\ 100% of the total
' 118,302)
Lessons Learned for the State to Consider
King County's experience offers o several insights for other governments. Key
ingredients include: oction megsurement stgndgrds, functioning dotg governonce
processes, gnd defined glignment between the ggency gctions ond outcomes.
Goining legdership support is chollenging becguse these tools expond transpgrency
gnd gccountobility which mgy cgn be thregtening. Chgmpions ore those willing to
co-convene, co-design, gnd co-develop the work so thot there is g high degree of
trust gnd understgnding. Setting dgtg stgndgrds gnd estgblishing governonce gre
key to sustoingbility gnd help guide the process of motching gctivities to intended
outcomes over time ond place. Building from pilot opprooches gnd tgking gn
iterative or scalable approach can help ensure efforts are effective. In addition,
requiring equity analysis in budget requests and creating accountability forums can
improve sustainability.
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Opportunities for Community Use of the EHD Map
The Washington Tracking Network and the Environmental Health Disparities map are free
publicly available resources. While state agencies are the focus for this report's
recommendations, the WTN and the EHD map are valuable resources for communities and
organizations across Washington state. Below are examples of how the public might use the
EHD map, many of which were identified during community meetings as part of the EJTF
process.
Community Information and Assessment
The public can use the EHD map to learn more
about the current environmental and social
conditions in their communities and workplaces.
Washington is making progress toward EJ when
communities and workers have access to
information about the possible environmental
risks they face, especially considering many dire EJ
issues are not easily detectable.
Community Projects and Activism
Community organizations and the public can use
the EHD map, and its underlying data to inform
and leverage their advocacy work. For example:
The EHD map could help build community
visioning projects to inform local planning
processes; EHD disparity ranks and data can
enhance communication with decision makers
about community EJ concerns and support
requests for increased enforcement, monitoring,
and environmental cleanup; and community
based organizations can use the EHD map to
identify areas of need.
Education
Educators can use the EHD map to inform their EJ, environmental, anti-racism, health, or any
community-based curricula. The EHD map is appropriate for students of all ages to foster their
own curiosity about the environment around them, and to inform their education and research
in a school setting.
"As a non-profit, the Communities
of Color Coalition (C3) used the
EJ mapping tool to assist in the
distribution of monetary funds
provided by a COVID-19 Rapid
Development Grant. The EJ
mapping tool assisted
in identifying critical
community needs in Yakima,
Bellingham, and Seattle. Most
non-profits do not have an in-
house research department
dedicated to collecting and
interpreting environmental,
health, social, and economic
disparities data. Your map
provided us with a vital tool and
opportunity to improve our
engagement efforts and review
data visually to help support
communities in need."
-David Ortiz, C3 Chair (May 2020)
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III. Community Engagement Recommendations
and Guidance
Section Overview
The EJTF is responsible for providing:
"Best practices for increasing meaningful and
inclusive community engagement that takes into
account barriers to participation that may arise
due to race, color, ethnicity, religion, income, or
education level."60
This section of the report has ten recommendations for
increasing meaningful and inclusive community
engagement, and includes supporting guidance for how
to implement these recommendations.
Community Engagement and Environmental Justice
All agencies can embed EJ into their policies, practices, and processes by prioritizing and
investing in meaningful community engagement, especially in areas of critical concern across
Washington.61 One of the seminal documents of the EJ movement is the 17 Principles of
Environmental Justice, which were drafted and adopted by the delegates to the First National
People of Color Environmental Leadership Summit in 1991. Principle #7 explicitly states the
need for community engagement to achieve environmental justice.
EJ Principle #7; "Environmental justice demands the right to participate as equal partners at
every level of decision-making, including needs assessment, planning, implementation,
enforcement and evaluation."62
The foundation of meaningful community engagement must be an evaluation of who is
negatively impacted and who is benefitted by any agency decisions meant to benefit the public
as a whole. This foundation would help surpass the common practice of starting with
requirements outlined in law or policy. This guidance outlines and helps agencies identify
common agency activities that do not typically involve, but can significantly impact, the public.
"One of the key components
in environmental justice is
getting people to the table
to speak for
themselves...they need to be
in the room where policy is
being made."
-Dr. Robert Bullard, Father of
Environmental Justice
60 Engrossed Substitute House B 1109, section 221, subsection 48.
61 As an initial step, agencies can consider prioritizing investing in community engagement in census tracts ranked
nine and ten on the Environmental Health Disparities Map.
62 'The Principles of Environmental Justice". 1991. https://www.nrdc.org/sites/default/files/ej-principles.pdf.
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Why Community Engagement is Crucial
The governing structures of the United States were designed to elevate the rights and access to
its resources of some people at the expense of the rights and access of others. These weighted
structures led to the systemic inequity that the EJ movement responds to. They have been
reaffirmed across history, often in response to efforts to move toward more equitable laws and
practices, and are widely maintained today.
The Community Engagement Plan Guidance developed by the Task Force's Community
Engagement Subcommittee in Appendix C is grounded in the position that these systems
cannot change without the direct involvement of the communities who have borne the weight
of systemic disparities, and that such involvement is rarely supported by Washington state's
government. The EJTF and the Community Engagement Subcommittee recognize the critical
value of repairing relationships and building trust with communities.
Repairing relationships and building trust between government and those members of the
public harmed by environmental injustice is central to this guidance. A focus on trust-building in
this context sends skills like cultural humility and emotionally intelligent communication to the
forefront, and we see more ties to community organizing than to conventional
communications-oriented information sharing.
Truly meaningful community engagement builds more sustainable agency programs and
decisions, and it increases community understanding of agency decisions and transparency and
trust in government actions. State agencies have a responsibility to create community
engagement opportunities that allow all of Washington's diverse communities, "equal access to
the decision-making process to have a healthy environment in which people live, learn, and
work."63 Without it, as history demonstrates,64 entire populations are systematically left out,
curbing their ability to effectively advocate for their own health and safety. Furthermore, many
agencies are directed by policy and federal, state, and local laws to implement meaningful
community engagement and participation.
63 U.S. Environmental Protection Agency. "Environmental Justice", https://www.ep nmentaliustice.
64 Maantay, Juliana, Jayajit Chakraborty, and Jean Brender. "Proximity to Environmental Hazards: Environmental
Justice and Adverse Health Outcomes". (2010): h
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Key Recommendations for Addressing Structural Barriers to
Community Engagement
The third and final set of
recommendations in this report address
common barriers to meaningful
community engagement (CE), based on
barriers identified with input from EJTF
members and the public (Figure ll).65
Refer to the Community Engagement
Plan Guidance (Appendix C) developed
by the EJTF's Community Engagement
Subcommittee to assist with the implementation of these CE recommendations.
Recommendation 17 (CE): Each agency develops a community engagement plan, which must
include the elements outlined in our Community Engagement Plan Guidance (Appendix C).
Recommendation 18 (CE): Agencies evaluate new and existing services and programs for
community engagement using a systematic process to determine outreach goals. These
evaluations weigh the goals of the service or program, potential for its impact on the public, its
importance to the community/ies being impacted, and the makeup of the impacted
community. These evaluations determine:
• The agency's level of engagement for the project.
• The potential for outcomes the public can see from their engagement in the process.
Agencies then communicate both determinations in their outreach process. Example
evaluation tools are attached in Attachments A and B of the Community Engagement
Plan Guidance (Appendix C).
4- Further guidance: Section 2.01 in Community Engagement Plan Guidance (Appendix C).
Recommendation 19 (CE): When planning outreach activities, agencies use screening tools that
integrate spatial, demographic, and health disparities data to understand the nature and needs
of the people who may be impacted by agency decisions. The Task Force's recommended use of
the Environmental Health Disparities map to build the demographic and environmental context
to guide and inform place-based activities is a key example. This initial screening is followed by
further research with local people and organizations as needed.
4- Further guidance: Sections 2.01, 2.08, and 2.09 in Community Engagement Plan Guidance
(Appendix C).
65 See Attachment C in the Community Engagement Plan Guidance (Appendix C) for further explanations and
examples on each of the Barriers to Community Engagement.
Figure 11. Barriers to Community Engagement
Access
Process
Apathy/Burden
Resources
Communication
Sovereignty
Potential for Influence
Trust
Representation
Types of knowledge
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Recommendation 20 (CE): When agency decisions have potential to significantly impact a
specific community (as determined by the evaluation described above in recommendation #18),
agencies should work with representatives of that community to identify appropriate outreach
and communication methods. Significant impact includes potential changes to critical
determinants of health such as legal rights, finances, housing, and safety. It is particularly
valuable to include community members in oversight, advisory, program planning, and other
processes. Washington's Department of Health community health worker program serves as
one model.
Further guidance: Sections 2.02, 2.03, 2.04, and 2.07 in Community Engagement Plan
Guidance (Appendix C).
Recommendation 21 (CE): When agencies ask for representation from a specific geographic or
cultural community, the agencies actively support such representation in recognition of the
costs of engagement borne by community members where allowable by state law and agency
policy. Doing so would reduce barriers to engagement presented by trading time and/or money
to learn about and engage in the agency's process, such as taking time from work, finding
childcare, and arranging for transportation.
*4 Further guidance: Sections 2.02 gnd 2.04 in Community Engggement Plgn Guidgnce
(Appendix C).
Recommendation 22 (CE): In alignment with the Office of Financial Management's Model
iclusio »*, agencies should use equity-focused hiring practices and
inclusion-focused professional development to build and support an internal staff that
represents the cultural and racial makeup of the population they serve.
*4 Further guidgnce: Sections 1.06, 2.04, and 2.06 in Community Engggement Plgn Guidgnce
(Appendix C).
Recommendation 23 (CE): When an agency's program or service has potential to impact Tribal
and/or Indigenous people or their resources, the agency includes those groups in their
community engagement work, using tailored approaches based on the needs of the Tribe. Note
that community engagement is distinct from and not a substitute for formal government-to-
government or cultural resource consultation.
4- Further guidgnce: Sections 2.01 and 2.03 in Community Engggement Plgn Guidgnce
(Appendix C).
Recommendation 24 (CE): Agencies conduct compliance reviews of existing laws and policies
that guide community engagement, and where gaps exist, ensure compliance for the following
laws in agency service and program budgets:
• Title VI of the Civil Rights Act, prohibiting discrimination based on race, color, or national
origin and requiring meaningful access to people with limited English proficiency.
• Executive Order 05-03 requiring Plain Talk when communicating with the public.
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• Executive Order 13166, requiring meaningful access to agency programs and services for
people with limited English proficiency.
Further guidance: Sections 1.05 and 2.13 in Community Engagement Plan Guidance
(Appendix C).
Recommendation 25 (CE): Change state laws that restrict agencies from purchasing goods and
services, such as childcare and food, which support broad community participation.
Further guidance:
• Attachment C and Sections 1.07, 2.02, and 2.06 in Community Engggement Plgn
Guidgnce (Appendix C).
• Common barriers to meaningful community engagement include lack of: compensation
for community time and expertise, food during community meetings, transportation to
meeting spaces, childcare, language access services, and internet access for virtual
meetings. Additionally, the Legislature should consider providing assistance to increase
access to virtual meetings, especially for rural communities that have limited broadband
services. There should be as much cross-agency coordination as possible to create
common "best practices" for how and when to offer these services. Forums for this
coordination could be the proposed permanent EJ workgroup (see: recommendation
#2) or the Office of Equity. Changes considered and developed should be done in
compliance with state guidelines on ethical community engagement by the Department
and the state
• Significant additional work is needed to comprehensively identify the legal restrictions
and develop best practices to remove these barriers. Some initial RCWs to consider
amending for more effective community engagement include:
¦ RCW 43,03,050: Subsistence, compensation, lodging and refreshment, and per diem
allowance for officials, employees, and members of boards, commissions, councils or
committees.
> Suggested gmendments: Compensation or reimbursement for participation on
boards, commissions, councils, and committees should be allowed for those
with low incomes. Providing food and services, such as daycare, to attendees of
public meetings should also be allowed when adequate funds are available and
deemed appropriate based on the type of engagement required.
¦ RCW 39,26,040: Prohibition on payments to board, commission, council, or committee
members.
> Suggested gmendment: Using agency discretion, allow payment for service on
boards, commissions, councils, and committees for those with low incomes.
Reducing barriers for community participation will allow a broader cross-section
of people to share their expertise and lived experiences in shaping policies and
other government processes to better reflect the needs and desires of
communities that may not otherwise get a seat at the decision-making table.
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Recommendation 26 (CE): In cooperation with the Govern n Business Diversity
led by the Office of Minority and Women's Business Enterprises (OMWBE), agencies should
increase contracting diversity by proactively engaging and contracting with local organizations
that are community-based, community-rooted, and community-led to improve community
health outcomes and eliminate environmental injustices across Washington state.
4- Further guidance:
• Sections 1.07, 1.08, 2.02, 2.04, and 2.06 in Community Engagement Plan Guidance
(Appendix C).
• Agencies have tended to contract with highly paid consultants who, in turn, reach out to
community organizations who are asked to provide their time and expertise without
compensation. This proposal is intended to offer a more direct path for agencies to hear
directly from the relevant stakeholders.
• The EJTF recognizes that, "Those closest to the problem are closest to the solutions but
furthest from resources and power."66 Implement this recommendation in specific
instances in which community expertise and understanding of community experiences is
needed, such as: development of strategic plans, policy development, community
engagement, or any other process that would benefit from the expertise held by local
organizations and the communities they work with.
• Agencies should consider contracting with non-profit organizations, small for-profit
businesses, OMWBE-certified businesses, Tribal governments or entities in WA.
• Agencies and the Legislature should work with the OMWBE and the Department of
Enterprise Services to remove barriers to the contracting and procurement processes
for community organizations, especially smaller or understaffed organizations, with the
goal of including more trusted community organizations listed on the State's Qualified
Master Contract List. Furthermore, contracting processes should be re-evaluated to
ensure that small entities and organizations are seriously considered.
• Agencies should work to eliminate their contracting disparities outlined in this 2019
Washington :udy and in their annt by
implementing the recommended policies, procedures, training, and implementation
plans for individual agencies outlined by the an Business
l Furthermore, agencies can prioritize the action steps outlined in their
individual Inclusion Plans for increased supplier diversity.
• Recommendations from the 2019 WA State Disparity Study are forthcoming,67 and
include policy recommendations such as: increasing access to state contracting
information, lengthening solicitation times, raising the direct buy limits, and reviewing
contract sizes and scopes.
• In determining the appropriate organization to contract with, considerations must be
made in understanding both how the organization being considered for a contract is
66 Martin, Glenn E. "Those Closest to the Problem Are Closest to the Solution". The Appeal, 2017.
MteSIitftheaiJBeaLanj/thase^^
67 Expected publication date of November 2020.
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representative or able to engage in outreach to a specific aspect of a diverse
community, and also their ability to engage a full range of community stakeholders.
• Consider the need for a variety of knowledge and expertise types. Input is needed not
just from those with government, business, or academic expertise but all community
expertise and expertise from lived and intersectional experiences.
• The restrictions imposed by lnitiative-200 (1-200), now in place as RCW 49.60.400, may
serve as a barrier to meeting the goals of this recommendation. As such, repeal of these
restrictions should be considered by the Legislature in order to update our state's
policies and ensuring diversity, equity, and inclusion in government contracts,
employment, and schools. In narrow circumstances, an agency may be able to tailor
preferences based on race or sex.68
68 "Washington State Office of the Attorney General. "Use of Race- Or Sex-Conscious Measures or Preferences To
Remedy Discrimination in State Contracting". 2017. )pinions/use-race-or-sex-
coQscious:::measur^
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Areas for Further Study
Section Overview:
The EJTF discussed several ideas for how to work towards environmental justice in Washington,
many of which came directly from conversations with communities across the state. The ideas
that had the most promise for implementation were refined and included as formal
recommendations in this report. The following two ideas need more time for thorough research
and consideration. As the fight for EJ in Washington continues, further study is needed to
determine if and how these two ideas will support overburdened communities.
I. Study: Concept of "Concurrent Jurisdiction" for state agencies, which would allow state
agencies to seek compliance or enforcement actions that are currently the sole
responsibility of City, County & Regional agencies.
Considerations
• Constitutional and current state law restrictions create exclusive authority for local
jurisdictions.
• May create confusion on how best to report violations.
II. Study: The expansion of "Private Rights of Action" (PRA) to allow for resident lawsuits to
be filed against alleged violators of environmental laws.
Considerations
• PRAs should not encourage lawsuits based on private interests. Rather, PRAs should
focus on ameliorating environmental law regulations that negatively affect the public's
health.
Conclusion
The EJTF's recommendations are focused on creating the infrastructure across the state to
meaningfully and systematically work toward environmental justice. The EJTF recognizes that
the fight for environmental justice is ongoing, and that the partnerships and trust between
community and government are essential to achieve EJ in Washington.
Washington state government has steadily addressed EJ since the early 1990s. State
government has worked with communities to examine how to embed EJ into laws, policies,
programs, and processes for nearly three decades. Each major EJ-focused effort prior to the
EJTF has drawn similar conclusions to the EJTF with respect to the state of EJ in Washington,
and has developed comparable recommendations for how to achieve EJ. Environmental justice
will not be achieved as a result of our intentions, but it can be achieved through the actions we
choose to take next. Now is the time for Washington state government to take action and
honor its commitment to environmental justice.
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Task Force Member Statements
Section Overview
All members were given the opportunity to write a member statement, about anything they felt
was relevant or important to highlight, for the final report. The following statements provide
insight into how the following members approached their work as EJTF members, their
critiques of the EJTF process, what their hopes are for the future of EJ work in Washington, and
context for why they may have made specific decisions as EJTF members.
Member: Community to Community Development, Bellinghcim
"We're the ones on the front line and bearing the brunt of climate change and all the injustices
that happen to farmworkers. We've been trying to ring the alarm for many years."-Edgar
Franks, FUJ
"It's not about the apples. It's about our people. It's about the farmworkers, it's not about the
berries. It really isn't about the pears or berries. We're talking about human beings...that are
interested and are fighting for a better food system...It's about the survival of farmworkers in
the agricultural industry...We're not against anybody. We are for farmworkers living through
this pandemic." -Rosalinda Guillen
The absence of key stakeholders in the proceedings of the Environmental Justice Taskforce is
reflected in the limits of the general body recommendations put forward by the Taskforce.
Being that it was an agency heavy body, most of the recommendations have to do with the
minutiae of specific agencies in Washington state when it comes to considering Environmental
Justice.
Though I cannot fill the silence left by all communities that were not at the decision making
table, the one resounding policy recommendation that has been voiced by Black, Indigenous
and Farmworker front line communities alike has been the unfulfilled need to access land in
Washington State. Whether that means the abolition of treaties and the corresponding
agencies to facilitate the transfer of all public lands to the areas original stewards now
compartmentalized on reservations a fraction of their original territory; to allowing for
reparations to black front line communities in the form of access to land, such as the current
proceedings in Seattle's Central District; to providing access to farmland to farmworkers such as
the current Tierra y Libertad sixty-five acre farm in Whatcom County are all the necessary first
step toward moving Washington agriculture from a mere commodity export industry, towards a
more sustainable and thriving localized food system.
Providing access to land to front line communities would be the first step toward moving the
dial on many of these Environmental Justice policy goals.
Though I cannot speak for a large and diverse population of farmworkers in Washington State, I
can provide examples of the policy recommendations for the Governor's review that have been
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presented over the last seven years at the Annual Farmworker Tribunals held in Olympia that
would be a step toward Environmental Justice.
Recommendations from Washington's Farm Worker Tribunals:
This body recommends that the state of Washington agencies be required to collect data on
surveillance of pesticide illness and exposure, premature deaths, and workplace injuries by
RCW or Rule to systematically make annual reports available to the public. (2020)
This body recommends for Community to Community Development and Familias Unidas por la
Justicia to draft a Farmworker Bill of Rights for Washington, which should incorporate a
comprehensive vision which includes agricultural worker protection, opportunities, and
community aspirations advancing equity across generations of farmworkers and farmworker
families. This bill of rights should include the systemic issues of access to fair, equitable, and
environmentally sustainable, labor conditions, health, justice, education, economic
development, and community infrastructure. (2020)
This body recommends that we must affirm the farmworker unions, cooperatives and collective
actions for bringing real solutions into existence. We must contrast the collective good of these
efforts to the industry equivalents to demonstrate that another agriculture is possible. (2019)
Member: Puget Sound Partnership
We are deeply grateful to have been a part of this important Task Force effort to advance
environmental justice as an integral component of good governance and critical aim for
Washington State. As the state agency leading the collective effort to restore and protect Puget
Sound, we at the Puget Sound Partnership firmly believe that environmental progress cannot
be achieved without first confronting environmental injustices. We are energized by the
excellent start made with these Task Force recommendations and look forward to
advancement of environmental justice aims across our shared work.
-- Larry Epstein, Leah Kintner, Alexandra Doty, and Beihua Page
Member: Washington State Department of Natural Resources
The Washington State Department of Natural Resources (DNR) is thankful to have participated
on the statewide Environmental Justice Task Force over the last year. Our agency has learned a
lot from participating and we are very encouraged by the content of the final report. As our
time on the task force comes to an end, we wanted to take this opportunity to share a bit about
our agency, our mission, and how we are prioritizing environmental justice.
In 1957, the Legislature created the DNR to manage state trust lands for the beneficiaries of
those trusts. Under the elected leadership of the Commissioner of Public Lands and the Board
of Natural Resources, DNR manages these trusts to generate revenue while stewarding the
lands, waters, and habitats entrusted to its care. DNR manages over 3.2 million acres of forest,
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range, agricultural, and commercial lands for more than $160 million in annual financial benefit
for public schools, state institutions, and county services.
The State's Enabling Act, Constitution, and Statutes created these trusts and because of this
DNR has specific management obligations. A trust is a relationship in which the trustee holds
title to property that must be kept or used for the benefit of another. The relationship between
the trustee and the beneficiary for these lands is a fiduciary relationship. A trust includes a
grantor (the entity establishing the trust), a trustee (the entity holding the title), one or more
beneficiaries (entities receiving the benefits from the assets), and trust assets (the property
kept or used for the benefit of the beneficiaries). For these state trust lands, the trustee is the
legislature and the beneficiaries are named public institutions of state and local governments.
The common law obligations of a trustee include to operate as a prudent person, have
undivided loyalty, generate revenue, not foreclose future options and protect the corpus of the
trust on behalf of the beneficiaries is commonly known as the "trust mandate". The legal
construction of Washington's trust lands also creates considerable differences in how these
lands are managed when compared to other public lands. For example, because the
beneficiaries are public institutions, the trust obligation continues in perpetuity—that is,
forever.
Despite our trust mandate, DNR is still leading the way in utilizing tools such as the
Environmental Health Disparities (EHD) mapping tool to guide our decision-making. For
example, we have partnered with the Department of Health and the Department of Commerce
to overlay EHD mapping data over DNR-managed state lands and broadband access need data.
This GIS-based map shows specific areas around the state that have the greatest need and can
help drive the conversation forward about where to target investments, for example, in
communication site towers. We've also been utilizing the EHD mapping tool to look at where
investments in our salmon strategy work in the Snohomish Watershed will yield multiple
benefits. We are working on finalizing this GIS-based tool in the coming months so that
investors, legislators, and other public entities who are interested in salmon recovery efforts
can also ensure that their dollars promote job creation, environmental health, and community
resilience.
Additionally, the DNR Urban Forestry Program reformed its community forestry assistance
grant program to include a focus on equity, including a requirement that applicants use EHD
mapping tool to develop their projects in highly impacted communities. As a result, the Urban
Forestry Program has awarded funding to three equity-focused urban forestry projects: one in
Tacoma in 2018 and two in Spokane in 2019. In this same timeframe the program has procured
roughly $800,000 in additional grant funding from the Forest Service for three urban forestry
projects in the Seattle metro region where key project components include emphasis on
diversity, equity, and accessibility.
And, as part of the agency's Wildfire Strategy, we used the EHD map to identify many of
Washington's most vulnerable populations who live in areas with high wildland fire risk. Older
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adults, young children, and those with limited English proficiency can be vulnerable during
wildland fires due to potential health impacts (to the old and the young) and language barriers
(those with limited English proficiency). Recent research indicates that vulnerability to wildland
fire is unequal; census tracts that are majority Black, Hispanic, or Native American have a 50
percent greater vulnerability to wildland fire than other census tracts. Our use of the EHD
mapping tool helped us to develop a plan to better protect non-English speaking communities
during wildfire response.
Lastly, we utilized environmental justice analysis as part of the NEPA/SEPA final Environmental
Impact Statement for the marbled murrelet conservation strategy. This environmental justice
analysis was used to more fully understand the impacts the decision would have on various
communities around the state.
We will continue to lean in on equity and environmental justice, and look forward to finding
new ways to do so based on recommendations and ideas within this document and our ongoing
partnerships with community organizations.
Non-Majority Opinion Statement
Section Overview
One of the strengths of the EJTF process was that EJTF members brought a diversity of
perspectives, opinions, and priorities. The range of viewpoints represented on the EJTF also
meant that consensus was not always possible. As such, all EJTF members were given the
opportunity to include a non-majority opinion statement in instances where the member's
agency, community, or organization did not align with an official EJTF decision.
Member: Association of Washington Business
The Association of Washington Business was pleased to represent our state's businesses on the
Environmental Justice Task. Overall, AWB supports many of the recommendations outlined in
this report. However, there are a few recommendations which we have some reservations
around and believe they needed more discussion and refinement.
As a task force member, we were frustrated that new recommendations continued to be added
to the report at the last three meetings. These last-minute recommendations took time away
from discussing and refining the existing recommendations and made it difficult to fully explore
the new additions. In addition, there are a few recommendations which we believe require a
larger stakeholder discussion than was available in the task force and we are uncomfortable
advancing those without having that larger discussion.
In that spirit, we have identified the following areas where we depart from the majority opinion
regarding the final recommendations of this task force. These departures are not a rejection of
the goal of reducing environmental justice in the state or a signal that the conversation around
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this topic is completed. We believe this report represents the beginning of larger conversations
about the need for reform.
However, the format of the task force was such that we were unable to fully vet the entire
report before being asked to approve language or express our concerns. We would like to use
this space to clarify our position.
Our first departure from the task force report is in relation to Recommendation Five
(incorporate environmental justice concerns into state environmental laws). This report
highlights two major state environmental laws where environmental justice should be
integrated, the Growth Management Act and the State Environmental Protection Act. These are
major state laws which impact multiple state agencies, counties, cities, individual Tribes, and
number businesses and community organizations. Each of these stakeholders has a particular
view of what changes they might like to see made in each law and we are uncomfortable
recommending those changes without having a broader discussion within the stakeholder
community.
In regards to Recommendation 6 (agencies should adopt and the Legislature should consider
requiring EJ analysis, including the health disparity map...), we continue to have ongoing
concerns related to the construction of the Cumulative Impact Mapping tool. As this tool is at
the heart of several ongoing rulemakings and many of the recommendations of this report, we
believe that there needs to be a higher level of confidence that the mapping tool is properly
expressing health disparities on the ground.
We appreciate the emphasis on the use of this tool as one of several to identify environmental
heath disparities and that it is not meant to be used for decision making but there are some
methodological questions related to the generation of the scores that we think need to be
better examined. While aspects of the tool have been published and received some peer
review, we think a full analysis of the mapping equation by an independent group is an
important step before it is used more widely at the state level and inform state policy decisions.
Finally, for Recommendation 7 (new and existing revenue expenditures with an environmental
nexus....), we are concerned at the requirement for resources to be allocated according to one
singular criteria. We think adding an equity consideration is a valid suggestion but it should not
be the only decision that influences where and how state environmental revenues are spent.
The effort and work going into this report shows the importance of addressing the issue of
environmental justice and disparate health outcomes in Washington State. The Association of
Washington Business and our members share the goals of creating a more equitable
environment that are expressed in this report. However, we want to ensure any of the
substantive changes suggested in this report are carefully thought out and vetted within the
broader stakeholder community.
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"In the end, all the strugg
objective: the defense of life. That is the
most important, no matter where we are or
what the specific goal of each fight is."
-Ana Sandoval, Guatemalan Environmental Justice Activist
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Appendices
• iietieii Glossary of EJ Related Terms
• uetieibc I, Task Force, Mapping Subcommittee, and
Community Engagement Subcommittee Membership
• Dendi Community Engagement Subcommittee
Guidance document
o „ Public Participation Tool
o Public Participation Spectrum
o Barriers to Meaningful Engagement
• 3endi Operationalizing EJ Task Force Measurable Goals
and Model Policy Recommendations: A Primer on the GARE
Toolkit
• dendix E. Further Guidance on the Environmental Health
Disparities Map
• Dendi Methodology and Analysis - Washington Tracking
Network Bar Graphs on Environmental Health Disparities
• Appendi Memo: EJ and Reparations from Systemic Racism
• iiendi EJ and COVID-19 Memo from EJTF Co-Chairs
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Appendix A. Glossary of EJ Related Terms
The following definitions are pulled from multiple sources that are specific to Washington state
and/or environmental justice. 69<70<71<72<73<74
Access Creating and advancing barrier-free design, standards, systems,
processes, and environments to provide all individuals, regardless of
ability, background, identity or situation, an effective opportunity to
take part in, use and enjoy the benefits of: employment, programs,
services, activities, communication, facilities, electronic/information
technology, and business opportunities.
Burden
Community of
Practice
The magnitude of poor health that exists within a community that is
attributable to the risk factors that are present.
A group of people who share a concern or a passion for something
they do and learn how to do it better as they interact regularly.
Community
Resilience
Cultural
Competence
The ability of communities to withstand, recover, and learn from past
disasters and to learn from past disasters to strengthen future
response and recovery efforts.
An ability to interact effectively with people of all cultures and
understand many cultural frameworks, values, and norms. Cultural
competence comprises four components:
• Awareness of one's own cultural worldview,
• Attitude towards cultural differences,
• Knowledge of different cultural practices and worldviews, and
• Cross-cultural skills.
A key component of cultural competence is respectfully engaging
others with cultural dimensions and perceptions different from our
own and recognizing that none is superior to another. Cultural
69 University of Washington Department of Environmental & Occupational Health Sciences. Washington
Environmental Health Disparities Map: technical report. Seattle; 2019.
70 Washington State Office of Financial Management Diversity, Equity and Inclusion Council. Diversity, Equity and
Inclusion: Glossary of Equity Related Terms. 2019.
71 Asian Pacific Environmental Network. Mapping Resilience: A Blueprint for Thriving in the Face of Climate
Disasters. Oakland; 2019.
72 Ajmera, C., Dubytz, K., Lih, E., Rahman, S., & Six, J. University of Washington Daniel J. Evans School of Public
Policy and Governance. Embedding Environmental Justice into the Washington State Department of Ecology:
Promising Practices for Advancing Equity and Environmental Justice: Report. Seattle; 2020.
73 "RFA-ES-14-010: Centers of Excellence on Environmental Health Disparities Research (P50)." National Institutes
of Health. U.S. Department of Health and Human Services. https://grants.;
010. html
74 Powell, John, Stephen Menendian and Wendy Ake, "Targeted universalism: Policy & Practice." Haas Institute for
a Fair and Inclusive Society, University of California, Berkeley, 2019.
httesiiibe i.
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competence is a developmental process that evolves over an
extended period.
Cultural Humility
Cumulative
Impact
Approach to respectfully engaging others with cultural identities
different from your own and recognizing that no cultural perspective
is superior to another. The practice of cultural humility for white
people is to: acknowledge systems of oppression and involves critical
self-reflection, lifelong learning and growth, a commitment to
recognizing and sharing power, and a desire to work toward
institutional accountability. The practice of cultural humility for
people of color is to accept that the dominant culture does exist, that
institutional racism is in place, to recognize one's own response to the
oppression within it, to work toward dismantling it through the
balanced process of calling it out and taking care of one's self.
The combined impact of multiple environmental health indicators on
a population.
Disproportionate
Impacts
Distributive
Justice
Diversity
Environmental
Effect
In the context of EJ, this refers to when one group or population bears
an environmental or health impact that is substantially higher than
the average distribution. This impact is usually compounded by
existing inequities due to historic discrimination against certain
groups.
The equitable distribution of resources. In the context of EJ, this
means reducing environmental harm in communities with
disproportionately high environmental pollution, as well as increasing
access to environmental benefits.
Describes the presence of differences within a given setting,
collective, or group. An individual is not diverse - a person is unique.
Diversity is about a collective or a group and exists in relationship to
others. A team, an organization, a family, a neighborhood, and a
community can be diverse. A person can bring diversity of thought,
experience, and trait, (seen and unseen) to a team — and the person
is still an individual.
Adverse environmental quality generally, even when population
contact with an environmental hazard is unknown or uncertain.
Environmental equity will be achieved when no single group or
community faces disadvantages in dealing with the effects of the
climate crisis, pollution, environmental hazards, or environmental
disasters.
Environmental
Equity
Refers to how a person comes into contact with an environmental
hazard. Examples of exposure include breathing air, eating food,
drinking water or living near to where environmental hazards are
released or are concentrated.
Environmental
Exposure
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Environmental
Hazard or Risk
Factor
Refers to a specific source or concentration of pollution in the
environment. Polluted air, water and soil are examples of
environmental hazards.
Inequities in illnesses that are mediated by disproportionate
exposures associated with the physical, chemical, biological, social,
natural and built environments.
Environmental
Health
Disparities
Environmental
Health Indicator
Refers to either a specific environmental risk factor or a specific
measure of population susceptibility or vulnerability.
Environmental
Justice
Environmental
Justice Analysis
The fair treatment and meaningful involvement of all people
regardless of race, color, national origin or income with respect to
development, implementation, and enforcement of environmental
laws, regulations and policies. This includes using an intersectional
lens to address disproportionate environmental and health impacts
by prioritizing highly impacted populations, equitably distributing
resources and benefits, and eliminating harm.
A study that considers how current conditions or proposed actions
may affect surrounding communities and populations, to include
consideration of possible impacts on BIPOC communities and low-
income communities who may be disproportionately exposed to
environmental burdens. The USEPA provides several resources to
support this type of analysis, such as this jr
Assessing E
kei
Analysis.
Environmental
Racism
Equality
Any policy, practice, or directive that differentially affects or
disadvantages individuals, groups, or communities based on race or
ethnicity (whether intended or unintended).
Treating everyone the same, regardless of their circumstances.
Equity
Ethnicity
Framework
The act of developing, strengthening, and supporting procedural and
outcome fairness in systems, procedures, and resource distribution
mechanisms to create equitable (not equal) opportunity for all
people. Equity is distinct from equality which refers to everyone
having the same treatment without accounting for differing needs or
circumstances. Equity has a focus on eliminating barriers that have
prevented the full participation of historically and currently oppressed
groups.
A social construct that divides people into smaller social groups based
on characteristics such as values, behavioral patterns, language,
political and economic interests, history, and ancestral geographical
base.
An overarching strategy or organizational structure.
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Health
Disparities
Refers to a higher burden of illness, injury, disability, or death
experienced by one group or population relative to another.
Refers to everyone having the opportunity to attain their highest level
of health.
Health Equity
Indicator
A proxy variable that aims to capture a specific trend.
Refers to federally recognized Tribes, state recognized Tribes, and
Tribes and Bands who have not been formally recognized by the
federal or state governments. This includes Indigenous persons living
in Tribal and U.S. territories.
Indigenous
Populations
Intersectionality
Low-Income
Overburdened
Communities
Race
Racism
Risk
Sensitive
Populations
Intersectionality is a framework for understanding the interaction of
cultures and identities held by an individual. Intersectionality explains
how an individual with multiple identities that may have been
marginalized can experience compounded oppression (such as racism,
sexism, ageism, ableism, and classism) or how an individual can
experience privilege in some areas and disadvantage in other areas. It
takes into account people's overlapping identities to understand the
complexity of their life outcomes and experiences.
Individuals and families who make less than 80 percent of the median
family income for the area.
Communities who experience disproportionate environmental harms
and risks due to exposures, greater vulnerability to environmental
hazards, or cumulative impacts from multiple stressors.
A social construct that divides people into smaller social groups based
on characteristics most typically skin color. Racial categories were
socially constructed, and artificially created whiteness as one of the
elements of the dominant culture. Race was created to concentrate
power and advantage people who are defined as white and justify
dominance over non-white people. The idea of race has become
embedded in our identities, institutions, and culture, and influences
life opportunities, outcomes, and experiences. Racial categories
change based on the political convenience of the dominant society at
a given period of time.
A way of representing or describing race that creates or reproduces
structures of domination based on racial categories. In other words,
racism is racial prejudice plus power. In the United States, it is
grounded in the creation of a white dominant culture that reinforces
the use of power to create privilege for white people while
marginalizing people of color, whether intentional or not.
How likely exposure to environmental hazards will result in poor
health for a population.
Those who are at greater risk due to biological/intrinsic vulnerability.
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Social Justice
Targeted
Universalism
Toolkit
Vulnerability
Workforce
Diversity
A practice within a society based on principles of equality and
solidarity that understands and values human rights and recognizes
the dignity of every human being. Such a practice would strive to
provide basic human needs and comforts to all members of the
society regardless of class, race, religion or any other characteristic.
The practice of setting universal goals and using targeted processes to
achieve those goals. Within a targeted universalism framework, an
organization or system sets universal goals for all groups concerned.
The strategies the organization/system develops to achieve those
goals are targeted to different groups—based on how different
groups are situated within structures, culture, and across
geographies—to obtain the universal goal.
A specific, prescriptive, action-oriented set of steps to integrate
equity or EJ into the policy process.
A person's (or population's) non-biological situation that affects their
ability to cope with risk factors. Examples of vulnerability include low
income, language barriers or poor access to health care.
A collection of individual attributes that together help agencies
pursue organizational objectives efficiently and effectively. These
include, but are not limited to, characteristics such as national origin,
language, race, color, disability, ethnicity, gender, age, religion, sexual
orientation, gender identity, socioeconomic status, veteran status,
political beliefs, communication styles], and family structures. The
concept also encompasses differences among people about where
they are from, where they have lived and their differences of thought
and life experiences.
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Appendix B. Task Force, Mapping Subcommittee,
and Community Engagement Subcommittee
Membership
Environmental Justice Task Force Member Roster
Representing
Member
Alternate Member
Interagency Council on Health Disparities
(HDC)
Victor Rodriguez (Co-Chair)
Statewide EJ Issues; Front & Centered
David Mendoza (Co-chair)
Public Lands (Dept. of Natural Resources)
Cassie Bordelon
Stephanie Celt
Department of Commerce
Michael Furze
Sarah Vorpahl
Department of Ecology
Millie Piazza
Puget Sound Partnership
Larry Epstein
Leah Kintner
Department of Transportation
Allison Camden
Megan White
Department of Health
Laura Johnson
Energy Facility Site Evaluation Council
(Utilities & Transportation Commission)
Sonia Bumpus
Department of Agriculture
Ignacio Marquez
Community-Based Organization:
Community to Community Development
Tomas Madrigal
Community-Based Organization: Tacoma
Urban League of Young Professionals
Emily Pinckney
Community-Based Organization: Asian
Pacific Islander Coalition
Rowena Pineda
Union/Organized Labor Association: UAW
Local 4121
Judy Twedt
Business Interests
Gary Chandler
Peter Godlewski
Statewide Agricultural Interests: Farm
Bureau
John Stuhlmiller
Tribal Leader
Unconfirmed
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Mapping Subcommittee Roster
Subcommittee Co-Chair: Laura Johnson (EJTF
Member)
Washington State Department of Health
Subcommittee Co-Chair: Millie Piazza (EJTF
Member)
Washington State Department of Ecology
Alison Beason
Port of Seattle
Beihua Page
Puget Sound Partnership
Caroline Smith
Labor & Industries
David Mendoza (EJTF Co-Chair)
Front & Centered
Deric Gruen
Front & Centered
Edmund Seto
University of Washington
Elizabeth Lanzer
Washington State Department of Transportation
ErikSaganic
Puget Sound Clean Air Agency
Esther Min
University of Washington
Lauren Freelander
Washington State Department of Health
PaulTabayoyon
Asian Pacific Islander Coalition of WA
Peter Godlewski (EJTF Member)
Association of Washington Business
Richard Gelb
Public Health Seattle & King County
Sarah Vorpahl (EJTF Member)
Washington State of Department of Commerce
Tomas Madrigal (EJTF Member)
Community to Community Development
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Community Engagement Subcommittee Roster
Subcommittee Co-Chair: Megan MacClellan
Washington State Department of Ecology
Subcommittee Co-Chair: Emily Pinckney (EJTF
Member)
Tacoma Urban League of Young Professionals
Alexandra Doty
Puget Sound Partnership
Bill Bennion
Washington State Department of
Transportation
Brett Houghton
PRR Seattle
Bridgette Valdez-Kogle
Washington State Department of Ecology
David Mendoza (EJTF Co-Chair)
Front & Centered
David Ortiz
Communities of Color Coalition
Farah Mohamed
Public Health Seattle King County
Ignacio Marquez (EJTF Member)
Washington State Department of Agriculture
Julia Havens
Washington State Department of Commerce
Micaela Araguz Razo
Latino Community Fund
Mike Chang
Makah Tribe, Cascadia Consulting Group
Myra Hernandez
Washington State Commission on Hispanic
Affairs
Rowena Pineda (EJTF Member)
Asian Pacific Islander Coalition, Spokane
Chapter
Shirlee Tan
Public Health - Seattle & King County
Sinang Lee
Public Health - Seattle & King County
Stephanie Celt (EJTF Member)
Department of Natural Resources
Tomas Madrigal (EJTF Member)
Community to Community Development
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Appendix C. Community Engagement Plan Guidance
with Corresponding Attachments
COMMUNITY
ENGAGEMENT PLAN
GUIDANCE
ABSTRACT
The Community Engagement
Subcommittee recommends that
each agency develop a Community
Engagement Plan to fit agency-
specific work. We have outlined
elements of a plan in this
document to support meaningful
engagement. Our approach guides
an agency to develop its own best
practices, informed by successful
examples, and comprising
elements designed to overcome
barriers to engagement that are
typical of agency work.
Community
Engagement
Subcommittee
Washington Environmental justice
Task Force
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1. Introduction 87
1.01 Why Community Engagement is Crucial 87
1.02 Community Engagement and Environmental Justice 88
1.03 Acknowledging Current and Historical Harms 88
1.04 Scoping Considerations 89
1.05 Authority 89
1.06 Who Washington State Agencies Serve 90
1.07 Equitable Approaches to Community Engagement 91
1.08 Community Engagement Planning Process and Considerations 92
2. Elements of Your Agency-Specific Community Engagement Plan 94
2.01 Determining Obligation 94
2.02 Funding 95
2.03 Engagement and Consultation with Tribal and Indigenous Peoples 96
2.04 Choosing Services and Service Providers 98
2.05 Identifying a Responsible Coordinator and Alliance with Agency Leadership 99
2.06 Representation and Access 99
2.07 Effective Communication 100
2.08 Ethical Data Collection 100
2.09 Language Access 101
2.10 Online Engagement and Internet access 102
2.11 Training 103
2.12 Policy and Legislative Development 103
2.13 Agency Accountability and Responsibility 104
Community Engagement Plan Guidance Attachment A, Public Participation Evaluation Tool . 106
Site Information 106
Best Practices and Assumptions 106
Scoring System - Adapted from IAP2 Evaluating Public Participation 106
Community Engagement Plan Guidance Attachment B, Public Participation Spectrum 108
Community Engagement Plan Guidance Attachment C, Barriers to Meaningful Engagement. 109
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The governing structures of the United States were designed to elevate the rights and access to
its resources of some people at the expense of the rights and access of others. These weighted
structures led to the systemic inequity that the EJ movement responds to. They have been
reaffirmed across history, often in response to efforts to move toward more equitable laws and
practices, and are widely maintained today.
The guidance that follows is grounded in the position that these systems cannot change
without the direct involvement of the communities who have borne the weight of systemic
disparities, and that such involvement is rarely supported by Washington state's government.
We recognize the critical value of repairing relationships and building trust with communities
who have.
Repairing relationships and building trust between government and those members of the
public harmed by environmental injustice is central to this guidance. A focus on trust-building in
this context sends skills like cultural humility and emotionally intelligent communication to the
forefront, and we see more ties to community organizing than to conventional
communications-oriented information sharing.
Truly meaningful community engagement builds more sustainable agency programs and
decisions, and it increases community understanding of agency decisions and transparency and
trust in government actions. State agencies have a responsibility to create community
engagement opportunities that allow all of Washington's diverse communities "equal access to
the decision-making process to have a healthy environment in which people live, learn, and
work."75 Without it, as history demonstrates,76 entire populations are systematically left out,
curbing their ability to effectively advocate for their own health and safety. Furthermore, many
agencies are directed by policy and federal, state, and local laws to implement meaningful
community engagement and participation.
The Community Engagement Subcommittee recommends that each agency develop a
Community Engagement Plan to fit agency-specific work. We have outlined elements of a plan
in this document to support meaningful engagement. Our approach guides an agency to
develop its own best practices, informed by successful examples, and comprising elements
designed to overcome that are typical of agency work.
Here, we describe pathways to a type of community engagement that empowers members of
the public to collaborate with state agencies in making decisions that will have direct impacts
75 U.S. Environmental Protection Agency. "Environmental Justice." https://ww nmentaliustice.
76 Maantay, Juliana, Jayajit Chakraborty, and Jean Brender. "Proximity to Environmental Hazards: Environmental
Justice and Adverse Health Outcomes". (2010): h
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on them. However, while agencies remain responsible for communicating what decisions are
made on behalf of the public, we recognize that engaging the public as partners in 100% of
agency decision-making is not ideal for even the most motivated community. As a foundation of
this guidance, we recommend an evaluation pn to determine when that level of
engagement, on one end of a spectrum, is valuable and when engagement that requires fewer
resources is appropriate.
1.02 Community Engagement and Environ mental Justice
All agencies can embed EJ into their missions by prioritizing and investing in meaningful
community engagement, especially in ross Washington.77 One of the
defining documents of the EJ movement is the 17 Principles of Environmental Justice, which
were drafted and adopted by the delegates to the First National People of Color Environmental
Leadership Summit in 1991. Principle #7 explicitly states the need for community engagement
to achieve environmental justice.
EJ Principle #7: "Environmental justice demands the right to participate as equal partners at
every level of decision-making, including needs assessment, planning, implementation,
enforcement and evaluation,"/H
The foundation of meaningful community engagement must be an evaluation of who is
negatively impacted and who is benefitted by any agency decisions meant to benefit the public
as a whole. This foundation stands in contrast to the common practice of starting with
requirements outlined in law or policy. This guidance outlines and helps agencies identify
common agency activities that do not typically involve, but can significantly impact, the public.
1.03 Acknowledging Current and Historical Harms
Building room in government decision-making for the voices of underserved and overburdened
communities is one necessary component of correcting current and historical harms that
communities of color, low-income communities, and other affected populations in Washington
have endured. The Government Alliance on Race and Equity (GARE) names the responsibility
that government has in reversing these injustices to eliminate environmental health disparities
initiated and perpetuated by governmental actions, and to build community trust in
government systems and institutions.
"From the inception of our country, government at the local, regional, state, and federal
level has played a role in creating and maintaining racial inequity. A wide range of laws
and policies were passed, including everything from who could vote, who could be a
citizen, who could own property, who was property, where one could live, whose land
was whose and more. With the Civil Rights movement, laws and policies were passed
11 As an initial step, agencies can consider prioritizing investing in community engagement in Census tracts ranked
nine and ten on the Environmental Health Disparities Map.
78 'The Principles of Environmental Justice". 1991. https://ww toles.pdf.
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that helped to create positive changes, including making acts of discrimination illegal.
However, despite progress in addressing explicit discrimination, racial inequities continue
to be deep, pervasive, and persistent across the country...Institutions and structures have
continued to create and perpetuate inequities, despite the lack of explicit intention.
Without intentional intervention, institutions and structures will continue to perpetuate
racial inequities."79
The Community Engagement Subcommittee built this guidance without the benefit of the tools
and resources recommended in it. While we made every effort toward inclusion and
representation, our work is inherently limited to the perspectives of those who were able to
participate most. Namely, the perspectives most represented in this document are from people
whose time was supported financially by their jobs and whose workload allowed time to
participate. In this document, there are many instances when the Community Engagement
Subcommittee speaks for people whose needs and experiences we do not fully understand, and
we recognize that as a limitation to this work.
Washington state agencies are bound by several federal and state regulations that influence or
rely on community engagement. Central here are:
• Title VI of the Civil Rights Act, which prohibits discrimination based on race, color, and
national origin.
• Executive Order 13175, which recognizes Tribal sovereignty and requires consultation
and coordination with Indian Tribal Governments.
• Title II of the Americans with Disabilities Act, which requires agencies to conduct
business in a way that provides access to people with disabilities.
• Section 508 of the Rehabilitation Act, which prohibits discrimination on the basis of
disability by agencies receiving federal funding.
• Executive Order 13166, requiring recipients of federal funding to accommodate people
with limited English proficiency in their services and programs.
These regulations have broadly influenced state- and agency-specific policies as well. Phrases
such as "meaningful engagement" proliferate. We imagine that state-level compliance with
these laws and policies would amount to an equitable governmental landscape, free of the
objectively disproportionate impacts of state decision-making that have led to the EJ Task
Force. Agencies that may have grown accustomed to nominal compliance with laws such as
79 Government Alliance on Race and Equity. "Racial Equity Toolkit: An Opportunity to Operationalize Equity".
h iMiIIcilleguif^^ itgdf
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these are encouraged to re-evaluate their practices through the lens presented in this
document.
Relevant Tools & Resources
• Title VI of the Civil Rights Act
• Executive Order 1.31.66
• Results Washington's outcome measures:
° Efficiem :ft/e, cinei Accountable Government
o Healthy u,,u> ...life Communities
The central function of a public agency is to serve the public. We know that demographic data is
inherently limited as it does not represent major swaths of the population, such as people who are
undocumented, Indigenous peoples, and the LGBTQ community. We also know that agency leadership
and staff are often not representative of the population they serve, which means decision-makers often
do not have the same life experiences as the people affected by their decisions. Community
engagement is, therefore, a crucial process that allows agencies to better serve the public through a
greater understanding of the diversity of lived experiences and perspectives across Washington's
communities.
We recommend that agency staff prepare to create a community engagement plan by asking:
Who might be affected by the agency work? We recommend agencies name who and which
communities might benefit from or be negatively impacted by agency processes, projects, or
programs.
We recommend agencies create a "Who We Serve" section within the introduction of the
agency community engagement plan to clearly name the communities that may be impacted in
some way by internal or external agency work. In developing that section, demographic data
will be a useful starting place, but direct communication with people in the impacted
populations themselves will remain key to a meaningful understanding of the audience.
Agencies can ask themselves the following questions as part of developing the "Who We
Serve" section of their plan:
• Who or which communities benefit or are impacted by the outcomes of an agency
process, project, or program?
• Who or which communities might be impacted in some way at stages throughout an
agency process?
• Are there communities or groups of people that are especially vulnerable to impacts,
disproportionately affected, and underserved in some way by the process, project, or
program?
• Which communities might engage and which might not in an agency process, project, or
program? And why?
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• Which environmental justice-related existing assets, resources, and knowledge exist
within communities?
Relevant Tools & Resources
• Community Engagement Self-Assessments:
o Office of Financial Management Diversity. Equity. Inclusion Council Resources
o City of Seattle Inclusive Outreach and Public Engagement Guide
• The DOH Community Engagement Guide
• To Identify Stakeholders: Community Engagement: Guidelines for Excellence (pp. 126-
128)
1.07 Equitable Approaches to Community Engagement
Community engagement covers a range of approaches, from outreach and consultations, to
long-term collaborations, shared leadership, and supporting resident-led efforts. However,
meaningful community engagement goes beyond a set of activities - it is a way of fostering
trust, strengthening relationships, and honoring community knowledge. This leads to more
effective and equitable solutions.
While the specific methods of engagement will differ depending on the context and the
community, state agencies can find ways to center the voices of the highly impacted
communities in planning and decision making.
As you work to advance EJ and equity across the state, embrace community engagement as an
agency-wide plan that goes beyond the short-term needs of projects or programs. This plan
should recognize communities' expertise and power to help shape solutions, as well as create
planning and decision-making structures that are inclusive, accessible, flexible, and culturally
appropriate.
To foster trust building, center community voices, and create equitable outcomes, use an
equity lens to identify your community engagement approaches:
• Examine the power dynamics and structures within your agency that maintain
inequities. These dynamics determine who you choose to engage and how, who is
included and not included in decision-making, and how community members' power is
valued and accounted for in your agency's work. Taking this first important step to
understand and address these dynamics is critical to meaningful community
engagement.
• Ensure communications and engagement efforts are carried out in a way that honors
community assets and strengthens efforts to rebuild trust. Partner with community
liaisons, hire staff that represent the communities you serve, and train staff on cultural
competency skills.
• Align engagement efforts with clear opportunities for community to influence agency
decisions - in a process that prioritize the knowledge, concerns, and ideas of the most
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impacted communities. Ensure these opportunities are supported by the community's
capacity to engage meaningfully. If needed, invest in building their capacity.
Relevant Tools & Resources
• Racial Equit' >'sis
• Policy Lii ¦ lable Communities
1.08 Community Engagement Planning Process and Considerations
Equitable community engagement begins before the project starts. Staff need time to plan for
determining how community engagement fits into efforts as a whole using the considerations
below. These considerations allow time for staff to identify and engage the appropriate
stakeholders and community members in meaningful ways. Engagement planning steps, timing,
and considerations are often concurrent, and multiple engagement activities may be required
within a project. To ensure communities are engaged in a way that produces optimal outcomes
for all parties involved, we recommend that state agencies require that all project plans include
community engagement and outreach scope, goals, and estimated funding needs.
Key timeline and planning considerations for developing a community engagement plan:
1. Build relationships: Key contacts or community champions provide critical access to
hard-to-reach populations. Plan to take the time to solicit local and regional viewpoints,
regardless of knowledge or existing connection in the community. Recognize that
positive encounters with community contacts are valuable, especially outside of project-
focused transactions.
2. Project scope: Within the project scope, a community engagement plan should identify
what regulatory, systemic, and environmental impacts and outcomes the program,
project or policy will have—intended and unintended—on underserved, under-
supported, historically marginalized, and overlooked communities or populations.
3. Community impacts: Identify how communities and populations may be
disproportionately impacted and what guidance is needed and what input could be
gathered?
4. Types of community engagement: Use a comprehensive approach to implement the
types of engagement that are meaningful to the specific audience(s).
5. Equitable engagement: Outline an approach to determine who should be engaged and
how. Use the Environmental Health Disparities Map and/or tool to
identify additional areas of need. Include considerations for community groups and
jurisdictions that are already active on this topic.
6. Budget for engagement activity: Consider partnering with other agencies or entities to
maximize time and funding. This may take time, so provide for this in the timeline.
7. Media and promotion: Plan time to research what media platforms are most used and
most available to best reach your audiences. Consider a variety.
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8. Include timeline for application or request for funding (RFA/RFQ): There are
established timelines within procurement guidelines as outlined in RCW 39,26. You can
make access to funds more equitable with flexibility for expanded timelines or by
providing technical assistance to support communities with less capacity to be
competitive.
9. Evaluate existing programs and projects: Evaluate existing engagement to assess where
community engagement is inadequate or is missing altogether and begin to plan and
incorporate it into ongoing efforts. For example, programs like the Department of
odel Toxics Control Act are currently going through rule revision and
evaluating places where public engagement should be incorporated since it is an
opportune time to incorporate community engagement into regular requirements of
program action.
Relevant Tools & Resources
• Strategic Prevention Framework
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2. Elements of Your Agency-Specific Community
Engagement Plan
2.01 Determining Obligation
In the early stages of developing or revising any agency service or program, we recommend
that each agency determines the level of community engagement needed, based on the
program's impact on the public. This accommodates both the reality that it is not appropriate
for all agency work to be moderated by a public voice, and the fact that the voice of those
significantly impacted by agency decisions is a critical component of equitable, effective, and
sustainable programs.
Because the intent of this guidance is to integrate systemically underrepresented voices more
wholly into government decision-making, this process applies to all agency activities. The steps
outlined below are as relevant to an agency's grant-making program as to a proposal to make
changes to a neighborhood's infrastructure. They guide agencies to a more rigorous level of
community engagement when the impact of their decision is greater and a more streamlined
approach for low-impact decisions.
Using demographic data is a key element of the screening process when determining who lives
in an area that could be affected by agency decisions. We support the EJ Task Force's
recommendation of conducting area assessments using Washington's Environmental Health
Disparities Map as an initial screening process to find information about population, race,
language, and income. This screening can inform follow up outreach with local organizations,
schools, public health agents, and community leaders to learn information that demographic
data cannot provide, such as preferred communication pathways, presence of languages of
lesser diffusion, or the presence of underrepresented communities not defined in census data.
These evaluations can be conducted with a structured tool (see the Racial Equity Toolkit, linked
below, and examples provided in Attachment A and B), and can be simple screenings or
complex processes, depending on the nature of the program being evaluated.
Core Elements of Determining Obligation
These include a series of steps to understand the relevance of the program to the public:
• Understanding the intentional and unintentional burdens and benefits of the program
• Identifying who and how many people are burdened/benefit (see Demographics below)
• Identifying social relevance of the program
• Outlining the potential for the program to impact someone's legal, financial, physical, or
social health
• Confirming legal notification and outreach requirements.
These steps are followed using a systematic tool such as the International Association for Public
Participation P2 Spectrum to align the level of public relevance with the suitable level of
community engagement.
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Relevant Tools & Resources
• Community Engagement Evaluation Tool (Attachment A)
• International Association for Public Participation P2 Spectrum (Attachment B)
• Racial Equit' it, Government Alliance on Race and Equity
• If agencies receive EPA funding, consider the following resources that describe EJ and
community engagement expectations associated with that funding (note that other
federal funding agencies may have similar guidance):
° EJ Interagency Working Group Framework for Collaboration
° 'ocedui
Providing adequate funds and resources for community engagement is the backbone to
implementing best practices for meaningfully reaching diverse communities across Washington.
We argue that poorly funded community engagement delivers poor results, which feeds into
the perception that community engagement is not a valuable process. the
country illustrate cost-savings over time when investments are made in the decision-making
process. Well-resourced community engagement lowers the risk of an agency being out of
compliance with federal and state requirements and leads to greater agency efficiency.
Investing in community engagement is necessary to provide effective customer service for
Washington's residents. Therefore, think critically about how to prioritize funds and resources
for community engagement, which includes incorporating a funding element to an agency-
specific community engagement plan.
Key elements of your agency's community engagement plan identify available funds and
resources to systematically and intentionally:
• Hire or contract expert80 community engagement coordinators, possibly through
community organizations, to provide agency leadership on engagement planning and
staff training.
• Communicate with communities in a culturally and linguistically relevant way, including
following your agency's federally-mandated language access plan, translating
documents, and providing interpretation for all interactions and verbal presentations.
• Compensate community members and organizations for their time and expertise and
streamline the reimbursement process for community engagement-related expenses.
• Provide funding for multiple community engagement formats (e.g. public meetings,
focus groups, surveys, community festivals, community beautification projects or
artwork, etc.).
• Make transportation, culturally appropriate food, and childcare available for all events
that include members of the public.
• Support staff travel to different parts of the state to engage with diverse communities.
80 See section 2.09 for a discussion of expertise.
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While we stand by the recommendation that community members be compensated when they
invest significant time and labor into an agency's decision-making process, we recognize
significant barriers exist in Washington state law that make such financial compensation
challenging or impossible. Grant-making programs such as the Department of Ecology's Public
s are one option for investing in community feedback.
Relevant Tools & Resources
• The Valt Skit can help agencies identify and articulate the costs and
benefits of engagement, and assist with making the business case for community
engagement.
• The Independent Sector values volunteer time at $25.43 per hour, on average, across
the U.S.
• Government example: The National Park Service & U.S. Forest Service valued its
volunteers' time at nil lion in 2018.
• The International Association for Public Participation's , showcasing
exceptional community engagement work.
2.03 Engagement and Consultation with Tribal and Indigenous Peoples
Tribal and Indigenous peoples have existed and prospered in what is now Washington state
since time immemorial. Tribal and Indigenous peoples in Washington state are not
homogenous - there are 29 federally-recognized Tribes, many non-recognized Tribes, Tribal
and Indigenous peoples that come from other parts of what is now the U.S., Alaskan Natives,
Native Hawaiians, and Indigenous peoples from all across the world. Therefore, using a tailored
approach to engage with Tribal and Indigenous communities is not only necessary, but also
acknowledges the diversity of Tribal and Indigenous peoples in Washington. Tribal and
Indigenous engagement is a part of any project or policy that might affect these communities
(which is almost all the time) and applies to governmental and non-governmental entities.
Tribal and Indigenous engagement is not a substitute forTribal consultation, which is a specific
process of early, often, and meaningful communication and coordination between Tribal
governments and state or federal governments. Many agencies have developed plans for
formal Tribal consultation to facilitate compliance with Chapter 43.376 RCW and the
Washington State Centennial Accord of 1989, such as Washington's Department of Health.
Key considerations when engaging with Tribal and Indigenous peoples:
• European colonization has disrupted virtually all aspects of Tribal and Indigenous
cultures. This has led to a variety of disparate and disproportionate environmental,
social, and economic outcomes for Indigenous peoples in Washington state.
• Acknowledge and cede space to local Tribal and Indigenous leaders and sovereignty.
Tribal sovereignty should always be centered, and space should be ceded to the Tribal
leaders and elders. Each Tribe and Indigenous community have their own leaders,
cultural norms, and values. Tribal leadership, both in communities and in government,
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can take forms that are less common in white culture. These leadership structures, like
the role elders can play, are important to recognize. Consistency between an agency's
engagement intentions and agency policies are an integral part of honoring and
respecting sovereignty.
• Building trust and relationships is integral to have positive outcomes. Many Tribal and
Indigenous communities and peoples are protective of who is allowed to hold influence
and community platforms - even with external engagement events. It is necessary to
build trust and relationships with these communities, which means showing up and
listening without pre-intended outcomes of what you want from them. This might mean
giving something without expectation of reciprocity. One-off engagement events often
do not build the trust and relationships needed for successful outcomes and is likely to
lead to more long-lasting harm.
• Pay for time and space. If you want to do real engagement, you need to support the
local community. That could mean renting local venues, hiring Native caterers and
families, and compensating people for their time. In many communities, it is customary
to bring gifts for key individuals to express gratitude for their presence and
contributions.
• Respect local norms and protocols. There are often many formal and informal cultural
and local norms and protocols. Oftentimes, relationships must be built before these
norms and protocols become evident. Some general norms include, but are not limited
to, respecting when elders and leaders speak, scheduling meetings around fishing and
hunting seasons, and scheduling meetings around key community events (e.g., high
school football games, Tribal holidays, etc.).
• Engagement outcomes are dependent on the investments into engagement with
Tribal and Indigenous communities. People within and between Tribal communities are
part of a wide and communal network. Conducting poor engagement within a
community is likely to result in poor communication and dissemination of information
within the social networks of a community. Additionally, conducting poor or no
engagement is likely to create a bad reputation across the Tribal and Indigenous
networks in the state, which may lead to additional barriers in the future when trying to
engage those communities.
• Tribal and Indigenous engagement does NOT substitute for Tribal consultation. Each
Tribe is likely to have their own consultation procedures, which supersede agency
policies. Consultation needs to happen early, often, and meaningfully.
RCW and the ? provide background on
formal government to government consultation.
Relevant Tools & Resources
• In an effort to more fully recognize Tribal sovereignty, the
ConsoItation po 1 icy requires the Washington State Attorney General's Office to obtain
free, prior and informed consent before initiating a program or project that directly and
tangibly affects Tribes, Tribal rights, Tribal lands and sacred sites. This policy makes
significant steps toward meeting the intent of the
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Rights of Indigenoi and it is the first of its kind in Washington State. It will be
proposed for legislation during the 2020 session.
Trust is critical to effective community engagement and a currency that many agencies lack in
public perception. In our analysis of barriers to community engagement, some of the key
factors impacting trust included:
• Geographic, racial, and cultural representation in agency staff.
• Linguistic or cultural relevance of communication materials.
• History and established relationships with community.
• Two-way information sharing when community information is incorporated into agency
priorities.
When engaging the community, the ability to listen and understand issues through their
perspective is important. A community engagement practitioner is responsible for providing a
safe space and conducive environment, where community members can freely express their
experiences, stories, and frustrations with government entities without fear of negative
consequences. While professional training can be very beneficial, traits like emotional
intelligence, humility, curiosity, adaptability, planning skills, and leadership outrank formal
academic formal academic credentials or certifications when assessing the aptitude of
community engagement practitioners.
While there is obvious overlap in skill sets, the skills and knowledge of successful
communications staff and successful community engagement staff can differ in important ways
The primary goal of community outreach is to build trust with varying groups and elicit honest,
engaged feedback to inform agency decisions and promote a two-way flow of information
during decision-making. This differs from communications, which typically prioritizes providing
a one-way flow of information through traditional media channels.
Key issues on this topic to include in an agency-specific community engagement plan:
• Develop community engagement services that are not static but rather determined in
response to several factors, which are further developed in Determining Obligation,
above:
o Relevance of the issue to the impacted population(s).
o Specific linguistic and cultural needs of the impacted population(s).
• Design services to impact the primary outcomes of the program or efforts.
• Establish standards of skills, experience, and knowledge for community engagement
practitioners that value anti-racism and equity training, community outreach or
organizing experience, cultural humility, and understanding of the specific cultures and
communities at hand. Note that none of these skills are strictly tied to formal academic
accomplishments or certifications.
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• Develop engagement approaches that integrate community leaders and community
members as partners in engagement.
• Consider whether your agency supports community engagement staff who represent
the ethnic and cultural makeup of the population you serve. If not, work with your
agency's recruitment and retention specialists on a plan to include such staff.
2.05 Identifying a Responsible Coordinator and Alliance with Agency Leadership
Identify an agency-wide contact person or coordinator in your agency-specific community
engagement plan. To be effective, this coordinator will have the authority, or a clear path to it,
to make agency-wide decisions about community engagement standards and strategies. They
will be able to strategize the agency's diverse engagement needs, introduce and disseminate
best practices across the agency, and ensure that the standards identified by the agency are
being met.
More specifically, responsible coordinators are especially important during EJ emergencies. To
be most effective, coordinators will be on the frontlines with highly impacted communities and
sensitive populations to plan for and respond to emergencies such as hazardous substance
releases and oil spills in order to assess the impact, monitor the situation, provide technical
assistance, and evaluate the effectiveness of the response efforts.
Relevant Tools & Resources
• EPA's On-Scene Coordinators
One of the most critical components of conducting meaningful community engagement is
valuing the representation from community members who are most impacted by agency
decisions. This takes hard work, and often means "swimming upstream" to question agency
norms or the status quo of how an agency conducts community engagement.
At the core of representation and access is:
• A deep understanding of an agency's audience, which cannot be achieved without
valuing cultural humility, and building relationships and community trust.
• Culturally and linguistically appropriate communication, such as plain talk, translation
and interpretation, informational animations and graphics, and various formats and
opportunities for communities to engage with an agency.
• Acknowledging and addressing internal biases and hiring and other staffing practices
that may unintentionally "screen out" individuals from highly impacted communities.
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Much of the information agencies need to engage community members about is highly
technical and contextual. Agency-specific community engagement plans address the common
barriers each agency encounters when they deliver highly technical, discipline-specific
information to the public and how to share information and ask questions in ways that facilitate
understanding among the public, especially individuals with little or no technical background.
Key issues on this topic to include in an agency-specific community engagement plan:
• Plain talk, including defining what it means for the agency and when and how to use it.
This will include writing for people with varying levels of literacy, writing for translation,
and speaking for interpretation.
• The use of visuals to support written copy.
• The value of education when an agency is going to engage communities with little
technical or policy understanding, including educational tools. This will include ideas for
partnering with community-based organizations who already educate community
members on similar topics.
• Culturally appropriate communication, including how and when to assess for cultural
appropriateness and what to do when you misstep.
• Opportunities to partner with agency communications departments.
Given our increasingly diverse population, it is crucial that agencies think critically about the
way data are gathered and why certain populations routinely are not counted or accurately
represented. To get a more holistic understanding of the communities an agency serves, the
agency must collect both quantitative and qualitative data. An agency's community
engagement plan guides how the agency intends to address data gaps and prioritize ethical
data collection policies and practices. We recommend that agencies especially prioritize data
collection to evaluate the effectiveness of community engagement work to determine whether
the community is actually being served by the agency's efforts.
Quantitative Data
A common way to gather quantitative data is through surveys, like the Census. Disaggregating
demographic data allows state agencies to begin to identify how various segments of the
population may be impacted by different policies, programs, or projects. We must also
acknowledge that the way we currently collect demographic information has limitations and
cannot capture the full identify of an individual.
When collecting quantitative data, ask:
• What will these data be used for?
• Who is left out? How are they left out?
• How can we frame our approaches and questions in a culturally relevant manner?
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• When surveying people who speak languages other than English, does the survey reflect
the logic and nuance of each language?
• How will we protect the privacy and security of community members? And how will we
convey this protection to community members? How will we honestly communicate
risks?
• How will we share data with the broader community in a culturally humble manner that
leverages community assets to address existing community concerns (e.g. the process to
provide feedback on data interpretations, how data are represented in a
recommendation or final report, etc.)?
Qualitative Data
Community engagement is one important way to gather qualitative data. Agencies need to
understand the nuances of a community's lived experiences to contextualize quantitative data
and make hoiisticaIly informed decisions. Building relationships and conversing with community
members and trusted community leaders provides insight beyond demographic data. When
engaging communities, it is important to recognize and value the community as a partner in the
process, including sharing findings with communities for their feedback before finalizing a
decision that may affect their lives.
Questions to consider when collecting qualitative data include:
• How do we get informed consent? What does this mean for online spaces?
• How do we maintain anonymity if that is requested/desired? How does this happen
when state agencies given the required protocols for certain public meetings?
• How do we collect and share data from marginalized or sensitive populations without
further creating trauma or jeopardizing their safety?
All state agencies that receive federal funding are bound by a 2004 executive order and
pursuant guidance from federal agencies to ensure their services and programs are equally
accessible to people with limited English proficiency. Extensive guidance has been developed to
support those legal requirements, see Relevant Tools and Resources below for details.
In addition to agency-wide systems that help staff decide when and how provide multi-lingual
communication, cultural appropriateness of the communication and delivery method are
critical considerations.
Translation and interpretation needs are often determined using a threshold described in
federal language access plan guidance: if 5% or 1,000 individuals in a population prefer a
specific non-English language, translation or interpretation is likely appropriate. However, when
agency decisions can have meaningful, direct impacts on the public, it is important to pay
attention to smaller linguistic groups even if a language does not meet that threshold. Special
attention must be paid to providing accurate services in languages that are often overlooked.
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For example, Indigenous Mexican languages, languages that have no or short histories of being
written, and dramatically distinct "dialects."
Lastly, American Sign Language, while a key element of each agency's ADA accommodations, is
a language and belongs in language access planning.
Relevant Tools and Resources
• National standards for culturally and linguistically appropriate services
• Federal guidance for developing language access plans and providing language services
• Guidance from the U.S. Environmental Protection Agency on developing and fulfilling
language access plans
COVID Case Study
In early 2020, as Washington state was in the early stages of responding to the COVID-19 pandemic,
the State established a Community Engagement Task Force's (CETF) through its Department of Health.
This task force focused on making vital public health information related to COVID-19 accessible to
communities with limited English proficiency, in accordance with Governor Inslee's anguage Access
Plan During COVID-19 Memo. This type of language access, a task that has challenged agencies across
the state, was organized and delivered in a surprisingly short time, modeling how state resources and
power can be leveraged quickly to implement meaningful, pro-equity work alongside communities.
The task force includes health educators, policy experts, and language access specialists who have
dedicated their careers to health equity. The group's key guidance is a .anguage Access Plan. The CETF
also contracted directly with over 20 "community-rooted, community-led, and community-based"
organizations across Washington to provide critical health and safety information to communities
disproportionately impacted by COVID-19, especially among culturally and linguistically diverse groups.
2.10 Online Engagement and Internet Access
When Washington state joined the rest of the country in responding to the novel coronavirus,
formerly in-person group activities like schooling and public meetings suddenly moved online.
That transition made the impact of long-standing gaps in internet access across the state
bracingly clear. Census data from 2018 show that over 1,235,000 people in Washington lack
internet connections aside from cellphone data, with about 735,000 of those people lacking a
data connection completely. Most of this gap is due to lacking financial resources, but many
Washingtonians live in areas where broadband simply is not part of the infrastructure.
We can look to community organizers and outreach practitioners who have historically worked
with populations who have limited internet access for tools to bridge these gaps. Three
potential approaches are:
• Prioritizing community-directed outreach. Building relationships with representatives of
the relevant community and following their guidance on best outreach methods.
• Text message campaigns that introduce the issue and connect people with next steps.
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• Replacing or supplementing public meetings with websites and online tools designed for
interactive learning and engagement.
• Recording and sharing videos of online public meetings that are accessible in off-peak
hours.
• Providing opportunity to comment or take part in discussion about a decision outside of
online public meetings.
Developing an agency-wide community engagement plan sets policy for your agency and
communicates to staff and customers about engagement expectations and opportunities. A
training program can assist with implementation by promoting awareness of the plan and
teaching staff strategies and best practices for engagement. In addition to training agency staff
about how to communicate the key functions of an agency with community, Diversity, Equity,
and Inclusion (DEI), environmental justice, and cultural humility trainings are important core
competencies for community engagement.
When deciding who will provide the training, it is appropriate to look for opportunities to hire
individuals or smaller firms local to the communities the agency works with. These groups know
the needs and nuances of their communities, and working with such groups can be a tool for
relationship building.
The training topics listed above require skill, experience, and sensitivity to present effectively.
Particularly for topics with structural oppression at their roots, poorly run trainings can cause
deep and lasting organizational and personal harm. To avoid this, look for training providers
with demonstrated track records.
Relevant Tools & Resources
Reach out to peer agencies. They are often happy to share their plans, practices, experiences,
and training practices. They may even have a program you can use as-is. Do online research into
community engagement plans and training programs.
This section focuses on building internal policy and working with the legislature in a manner
that considers the experience of and integrates input from members of the public who may be
impacted by these decisions.
All agency policies impact communities and populations differently, and can have unintended
consequences unless impacted communities have an opportunity to contribute to policy
development. It is important to apply the elements of your agency's community engagement
plan when developing new or amending existing agency policies. This can lead to better policies
as well as more positive public receptivity to proposals. In particular, developing agency request
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legislation and navigating input and amendments during legislative session can require specific
planning to support community engagement.
Key issues on this topic that should be in an agency-specific community engagement plan:
• Clarification of objectives regarding environmental justice. To support work that
prioritizes equitable outcomes and recognizes the need for community engagement, the
agency should review primary objectives for proposed policies, and referring to and
applying the agency's EJ strategy if one is in place. These objectives should be clearly
articulated.
• A clear consultation and communication process in advance of legislative session:
o Roles and responsibilities. Clarify who are the primary contacts and how to
communicate with them,
o Content. Agency staff should have clear guidelines about what aspects of a draft
policy should be shared and with whom,
o Timeline. Ensure a clear timeline is provided that allows sufficient time for
policies to be communicated about, understood, and for feedback to be
provided (especially for smaller organizations with more limited resources and
capacity).
o Review and responsiveness. Agencies should have systems in place to record
input, clarifying that main points have been understood. Suggestions should be
thoroughly reviewed and considered. Agencies should plan to implement
suggested changes where possible (this may at times require new ways of
thinking or flexibility on the part of the agency) or propose alternatives when
needed. Either way, follow up with stakeholders and articulate how the agency
will respond to their input.
• Consider offering compensation for the time community partners put into policy
review.
• A clear plan for engagement during legislative session
o Key policy details. It should be clear what parts of a proposed policy would need
further engagement and review if amendments are proposed,
o Agreed points of contact during session. Agencies should agree with community
partners who is willing and able to review proposed amendments and respond in
a timeline manner during legislative session,
o Refer to objectives for quick turnaround decisions. If agencies need to make
immediate decisions during legislative session, they can refer back to the
articulated objectives to ensure final policy details further these goals.
It is the responsibility of agencies to meet the needs of the public they serve, not to selectively
choose whose needs are recognized. Secondarily, agencies are responsible for complying with,
evaluating, and holding themselves accountable to these community engagement
recommendations. Presently, there are three statewide external resources that may help hold
agencies accountable to community engagement, Results Washington, the Office of Financial
Management's interactive data dashboard, and the Office of Equity. The agency may also be
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accountable to ensure community engagement in achieving federal expectations, through
funding or other relationships between state and federal entities. To build trust and ensure
accountability with communities, agencies will maintain transparency and communication. For
this part of the community engagement plan, we recommend the agency identifies mechanisms
for evaluating community engagement work and reporting back to communities. Measurable
Goal 1, described in the Environmental Justice Task Force's final report, goes into further detail
on tools for building internal accountability, such as existing equity toolkits, internal audits,
community partnerships, and communication and evaluation strategies.
To center accountability as agencies write a community engagement plan, we recommend
agencies evaluate its community engagement work and consider the following:
• How are highly subjective words like "meaningful" and "effective" used in the context of
community engagement? Will it provide clarity for the agency to define these words
within the community engagement plan?
• How will the agency know when the agency achieved "meaningful" or "effective"
community engagement?
• Where are there pre-existing opportunities within an agency's purview to expand
community engagement to support the agency's current work and obligations?
• Where is agency funding is coming from, and are there specific requirements for
community engagement associated with that funding?
• How are agencies demonstrating the process by which they are incorporating and
engaging communities in their decision-making processes?
Relevant Tools & Resources
• £ ; il_(pp- 9-io)
• Eximihk toolkits and example evaluation iment eornrnui work
(P- 4)
• merit Accountability
• lement Contini >ach. Mobilization, Organizing and
Accountability to A ist Women ider
Communities
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Community Engagement Plan Guidance Attachment
A, Public Participation Evaluation Tool
Best Practices and Assumptions
• We assess at a higher level of public participation in the absence of technical
information and experience in the community.
• If it goes "bad," what will we wish we had done at first?
• We will reassess at key decision points.
• This evaluation tool includes the defined cleanup site and the affected community
(perceived or actual).
• We are assuming that all of our sites are difficult to communicate and may be
complicated to cleanup.
Scoring System - Adapted from IAP2 Evaluating Public Participation
1-2 Very Low to Low - recommendation: at least inform.
2-3 Low to Moderate - recommendation: at least consult (public comment periods are consult).
3-4 Moderate to High - recommendation: probably involve.
4-5 High to Very High - recommendation: minimum Involve, consider opportunities for
Collaborate or Empower if feasible
Site Information
Date:
Cleanup Process Stage:
Site Name:
Site Manager:
Public Involvement Lead:
Stakeholders:
Note:
This is a slightly modified example of a community
engagement evaluation tool that is in use. This example
is specific to one discipline (environmental cleanup) but
could be developed into something more broad or
tailored to fit agency-specific projects.
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Assessment Question
Very
Low
Low
Med
High
Very
High
1. How much do major stakeholders (i.e. Tribes, local government,
local organizations, general public) care about the cleanup and
the decision to be made?
2. Proximity to other big or controversial projects.
3. What degree of participation does the public appear to want?
4. Impact of cleanup or investigation to people's daily life?
5. What is the value of the site or the associated resources for the
community? (aesthetics, economic, etc.)
6. What degree is the risk or perceived risk of exposure off site?
7. What is the level of EJ concerns? (linguistically isolated
communities, EJ Index, demographics, workers?)
8. What is the potential for public outrage?
9. What is the legally optimal (MTCA, RCRA, Dangerous Waste
Regulations) level of public participation?
10. Level of complexity that requires agency-wide policy or
regulatory analysis (i.e. vapor intrusion, water quality standards,
other regulations).
11. To what extent do internal staff believe that the public could help
improve the outcome?
12. What is the potential for the public to influence the decision-
making process?
13. What level of media interest do you anticipate?
14. What is the anticipated potential for political controversy?
15. What is the capacity and level of resources that the community or
organizations currently have to address this site?
Count number of checks in each column.
Multiply number of checks by the weight.
XI
X2
X3
X4
X5
Enter column score.
Add total of all five column scores.
Divide total score by the number of questions.
Average score
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Community Engagement Plan Guidance Attachment B, Public
Participation Spectrum
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Community Engagement Plan Guidance Attachment
C, Barriers to Meaningful Engagement
Community Engagement Subcommittee, EJ Task Force (2019/2020)
This list was developed with input from members of the Community Engagement
Subcommittee, members of the EJ Task Force during its 1/14/2020 meeting, and members of
the public attending the same Task Force meeting. These points are largely unedited
transcriptions from contributors. This list is not intended to be static or definitive. Categories
help organize a large list, and we recognize that many/most items in the list are connected and
related to each other in complex ways.
Systems of oppression
Agency culture and structures inherently reference, rely on, and reflect systems of oppression
such as:
• White supremacy
• Settler colonialism
• Capitalist hegemony
• Patriarchy
• Christian hegemony
Access to information
When printed materials are the central mode of communication, many people are excluded.
• Print materials that are unreadable
• Print materials unreadable for people who are older or sight-impaired
• The lack of large print, braille, interpreters
• Text-heavy documents/materials (not in plain English)
• Use visuals as much as possible to convey the message (instead of relying on heavy text,
even if the text gets translated into other languages).
• Translated print materials (while important) does not guarantee information access
because some folks may not be literate in their native tongue or the translation vendor
does literal translation (that does not accurately express the true meaning) or uses
formal or complicated terms (versus colloquial word choices).
• Best practice in terms of translating text materials into other languages is to use
"transcreation" instead of direct translation services. Transcreation is the process of
adapting a message from one language to another, while maintaining its intent, style,
tone, and context.
• Printed information sometimes becomes obsolete or outdated - hard to get up to date
information.
Focus on English excludes people who speak other languages.
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• Limited proficiencies (with English for example)
• Low quality translation/interpretation and English-only speaking staff who can't assist
• When preparing translations or hiring interpreters, agencies can overlook Indigenous
languages like Purepecha or Mixtec languages, assuming Latinx people all speak Spanish.
This extends into language variants, Indigenous languages, and other linguistic nuances
worldwide.
• Some populations (e.g., Farm Workers injured on the job) need both
translation/interpretation and ADA access to information.
Access to meetings
Arrangements to get to the meeting can cost more than the meeting is worth.
• Traveling to meetings that are geographically distant from the people impacted by the
topic of the meeting
• Cost of travel
• Meetings not accessible for those living in rural areas
• Meetings not accessible for those without reliable cell service or internet connection
• Temporally and spatially accessible meeting spaces
• [Lack of] Childcare
• Inaccessible meetings: no food, no childcare, lacking transportation, lacking language
interpretation
• Business/industry members and expertise in the room can be intimidating
• Legal status and fear of retaliation from a person in power (e.g., an employer). Meeting
attendees/public comment respondents may not be safe speaking up.
The environment at the meeting can be unwelcoming or exclusive.
• People aren't sure if they are invited or welcome to the meeting
• Shame for not knowing what is going on
• For ethnically diverse communities, a conventional mainstream public meeting format
may not be culturally sensitive or appropriate.
• English-speaking presenters at meetings with LEP communities may not have the
training or knowledge on how to present while accounting for interpretation (they
speak too fast, with jargon, etc.).
• There may not be upfront work to help build knowledge capacity of the community
around a specific technical topic before bringing them into a meeting (particularly an
advisory committee type meeting where they will provide recommendations/inputs).
Thus, community members may not feel comfortable sharing ideas if they do not have
the foundational background info first.
• The physical room arrangement can have some participants in more powerful seats than
others. For example, "galleries" in meetings might discourage participation.
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Apathy/burden
Note that apathy can be claimed as a reason not to provide meaningful public engagement,
when often the appearance of apathy is a result of systemic issues like distrust, choosing to use
limited resources in systems that are more effective based on previous experience with
community engagement processes, etc.
• People don't feel responsible for what's happening in their neighborhoods.
• Participation burnout - community members have already commented on an issue
multiple times and do not see any improvements/response/actions
• [People] Feel like their voices don't matter or that the government doesn't care about
them
• Difficulties prioritizing what to care about and invest time in
• People have more pressing issues in their lives
• Multiple agencies are trying to work in the same communities but are not coordinating
among themselves to provide a more integrated engagement approach (Where it makes
sense) that reduces redundancy.
• Energy needed to engage is overwhelming compared to other needs in individual's lives
- need to make it easier to understand the issues and participate
Communication
Effectively communicating the issue and supporting information in a way that's understandable
to a broad variety of people isn't prioritized.
• Difficulties prioritizing what to care about and invest time in: How can people find out
what is meaningful for them?
• Effectively communicating why this work matters and how it affects Washington
residents' daily lives, while keeping in mind that everyone is busy and has competing
priorities
• The bureaucratization of communicating the message
• Technical language and jargon isn't understandable to the layperson
• Defined limitations of what is possible for the government to do are not clear so it is
difficult to know how to make recommendations that are possible (e.g., what is the role
of the government, what can they do within their legal limits?)
The engagement process and opportunities aren't effectively communicated.
• Can't figure out how or where to give comment(s)
• Be transparent early and throughout the program planning process the boundaries for
the program that is set
• Meeting content requires better introduction for community member(s) to feel
informed enough to participate (better educational materials in multiple languages and
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relevant to community perspective are needed as is an allotment of time needed for
community engagement)
Potential for influence
While agency process may include community engagement, it does not support external
influence on the decision-making process.
• Inflexibility, unwillingness to change
• Government fear of losing power or control can shut down the public process
• State government norms - keeping up with the status quo
• Lack of follow up from the government
• Communities questioning whether or not they actually have power and if engaging with
the government is a good use of their time as a result
• Waiting to work with communities until decisions have been made - informing
communities about decisions, rather than involving communities early and often.
• Legislature provides predetermined decisions but expects community engagement to
inform outcomes
• Norm that the technical experts know best, and community comments aren't "informed
by science"
• Devaluing Indigenous knowledge and traditional ecological knowledge (TEK) that may
come in the form of public comment compared to western science to inform processes
and decisions; not creating space and time for incorporating TEK and Indigenous
knowledge early in the process
• For Tribes - the misconstrued notion that participating in a government's public
engagement process can serve as a replacement for government-to-government
consultation and Tribal engagement.
• Pressure/power of conflicting interests from business/industry can be intimidating and
seem aligned with government.
• Funds and time not set aside by government for community engagement on an issue
puts the burden on communities to know the issue and when/how to engage and puts
out message that it is community's problem and input is not desired.
Representation
• Government agencies working with a small group of communities, so their work is not
actually representative of the community
• Agency staff don't represent community members, limiting trust and
cultural/communication skills
• Nonprofit staff may not truly represent the communities they serve (are they actually
from the community?) or community leaders may not represent all diverse voices within
a community.
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• Same folks who have easy access to participating in government's community
engagement activities may show up multiple times in different events - so the same
voice is continually being heard. Such folks have a voice to hear, but the government is
not doing extensive outreach to engage a more diverse set of community members.
• Who can represent certain groups?
o For example, some Tribal Nations may have specific procedures on who is able to
represent them publicly (e.g. elected Tribal leader, departmental staff, etc.).
Having a Tribal member present may not sufficiently meet the definition of
engagement or representation for some or many Tribes.
• We [agencies] hear from a small group of very vocal people who may not be
representative.
Process
• The fundamental goal is often to comply with the law or regulation, not to effectively
engage communities.
• Evaluation of effectiveness isn't often prioritized. Agencies can perceive success as long
as they aren't being sued or issued a formal complaint.
• The goal of the engagement isn't defined clearly to establish appropriate expectations
for the community.
• The goal of the engagement isn't defined clearly to establish appropriate goals and tasks
for agency staff.
• The decision-making process - how do we decolonize the decision-making process?
How do we support power-sharing and community self-empowerment?
• Government staff with less authority not having the power to listen and make significant
changes even if they would like to.
• Lack of working early and often with folks impacted the most
• [Lack of] Investing in black and brown communities
• Government not recognizing intersectionality [intersectionality of agency programs,
how different agencies influence each other]
• Jurisdictional and sector/department silos
• Process of mutual learning and dialogue that builds relationship versus one-time
listening session - Create or participate in opportunities for mutual learning between
community and agency staff
• Determining funding and staff time needed for community engagement is not part of
decision-making process
• The solution to the problem isn't the solution for everyone and may put some people at
risk. For example, high nitrates in the drinking water well in a home for people who may
risk getting evicted if they report it back.
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Novel processes/results of engagement aren't accommodated in agency plans
• Lack of creativity or thinking outside of the box in terms of community engagement
• Identify creative avenues to help address key community recommendations that may
fall out of your agency's program scope or authority.
• "Do meetings the black way" [Agencies expect all cultures to adapt to their culture,
rather than meeting people where they are]
• How do we do more of something we're not used to?
Agency timelines do not accommodate change or the amount of time meaningful engagement
and relationship building takes.
• Artificial deadlines - lack of understanding within government processes that deadlines
are often more adjustable than they seem.
• Lack of empowerment of government employees to ask "what is actually driving this
deadline? Where and how can we create more space to be responsive to/engaging of
communities?"
• The government rushing the decision-making process, perception that the timeline is
immovable.
• Sometimes the timeline is immovable - for legislative deadlines, budgeting, etc.
• Conducting an engagement as an afterthought or later in the process vs building it into
the process from the very beginning and have it evolve throughout the process.
• Ensure that there is a continuous loopback mechanism in sharing back with the
communities how their input informed decisions, plans and tools.
• Agencies don't value the expertise of skilled community engagement staff (e.g., include
them in scoping, budgeting, defining process needs).
Resources
Accurate amounts of time and money for meaningful engagement are not allocated when
budgeting projects.
• Lack of budget or resources for community engagement efforts. For example, if people
are being asked to travel or contribute significantly, there is often no compensation for
their time, cost burden, or expertise.
• Government resources not allocated properly.
• Hire staff that reflect diverse lived experiences from communities that the
agency/organization wants to serve
• Provide technical assistance to community grantees (especially small CBOs) to build
their capacity in managing your agency's grant funding and reporting (but also identify
areas of improvement in the contracting process within your agency to ensure that it is
not overburdening the CBOs).
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• Staff time not allocated for community engagement.
• The legislature doesn't respond well to asks for increased engagement funding.
• Resources means not just hiring a community engagement coordinator but investing in
community leadership and civic engagement (e.g., community leadership boards)
• Barriers in state law can prevent funded/compensated participation in decision-making
processes that cost money.
• The process and budget for projects that require/use community engagement is rarely
developed with someone who has expertise in community engagement.
Sovereignty
• Sovereign Tribes may see government processes at a different level than what their
sovereign status warrants. For example, most state-Tribal relations happen at a formal
government-to-government process or through formal consultation processes. If these
processes are not elevated to the status of a Tribe's sovereignty, many Tribes will
choose not to engage for fear of engaging being used against them.
Trust
• Community context - the historical relationship of the public with government agencies
and how that leads to the current level of trust
• Lack of listening skills among agency representatives
• Be present in the community and support their community-led work, not just come into
the community when you need something
• As a government staff not from the community, learn about and be sensitive the
historical and current trauma that communities of color have faced
• Agencies are only responsible for bringing offenders to compliance rather than
preventing injury.
• The public participation process often doesn't result in a different outcome.
• Agency staff from outside of a particular community can become pedantic in that
community, describing "what it's really like" when they don't have direct experience
and don't appear to listen to those who do, especially when agency staff come from a
bigger city to regulate a smaller town.
• Agency decision-makers often don't have direct experience with the system they're
working in (e.g., bus systems and public transportation). "Rules without relation lead to
rebellion."
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Types of knowledge
• Many agencies don't believe the public can provide meaningful input, and have the
colonial mindset that only academically-oriented individuals can be the experts.
• A balance needs to be established to provide the relevant technical information so that
relevant input can be received - defining the goals, limitations, etc. is important
• Don't value community engagement to invest resources to do it the right way or do it at
all
• Real or perceived sense of what you need to be "competent" enough to participate
• Prioritizing quantitative or science-based data over qualitative data
• Evaluate the weight of public comments
• Which comments hold more weight?
• Are public comments actually valued?
• Perception that "we have the right people at the table" already and the lack of ability to
see the gaps in participation/involvement
• Recognize and honor the expertise that each person brings to the table - either from
the government or community - and that we are here to learn from each other.
• Indigenous knowledge systems are often multi-generational and are constructed and
validated by different norms than Western Science.
o Also, considerations over the ethics of sharing culturally sensitive Indigenous
knowledge, how it is being recorded publicly, and how it is being used.
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Appendix D: Operationalizing EJ Task Force
Measurable Goals and Model Policy
Recommendations; A Primer on the GARE Toolkit
Overview and Purpose
The EJTF recommendations guide state agencies on how to incorporate EJ into the core of how
they do business by embedding EJ into agency strategic plans, developing systems to track,
evaluate, and communicate progress in advancing equity, and EJ through agency operations
and programs.
Washington state agencies can learn directly from the work of the Government Alliance on
Racial Equity (GARE). GARE is an organization that works with governments across the U.S. to
incorporate racial equity analyses and goals into government operations. GARE has published
multiple tools and resources to support governments, including their Racial Equity Toolkit,
which can be applied at the programmatic level and can be scaled up to meet agency-wide
priorities. This primer provides a user overview of GARE's Racial Equity Toolkit, with specific
guidance for state agency staff seeking to apply this toolkit as a first step towards implementing
Task Force recommendations #1 "Track and Communicate Progress" and #3 "Embed EJ in
Strategic Plans" (Figure 1). Figure 2 also illustrates connections between the GARE toolkit and
EJTF recommendations pertaining to community engagement best practices and use of the
Environmental Health Disparities (EHD) map.
Figure 1. GARE Racial Equity Toolkit is adapted to help with the implementation of
two EJ Task Force recommendations.
Track &
Communicate
Progress
GARE Toolkit
Vnpdemenfafion tool'
Embed EJ in
Agency Strategic
Plans
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Figure 2. Embedding EJ and Equity: 8-Step Process (adapted from GARE racial equity toolkit)
l. REVIEW/
ARTICULATE GOALS |
& OBJECTIVES
(THEORY OF
CHANGE)
8. LEARN/REVISE
/ADAPT
7. COMMUNICATE
RESULTS/BE
ACCOUNTABLE
2. RESEACH EJ
CONDITIONS AND
IMPACTS: REVIEW
DATA
3. RESEARCH EJ
CONDITIONS AND
IMPACTS:
COMMUNITY
ENGAGEMENT
Link to community
engagement guidance
W ~
Link to EHD mapping
guidance
6. MONITOR AND
EVALUATE
PROGRESS
~
5. CREATE
MEASUREMENT
FRAMEWORK
7)
ENT
~u
4. REVISE AND
DESIGN
STRATEGIC GOALS
& OBJECTIVES TO
ADVANCE EJ,
STEPS 1-4: Embed EJ into your agency's strategic plan
i. REVIEW/ARTIOJLATE
GOALS AND OBJECTIVES
(THEORY OF CHANGE)
2. RESEARCH EJ
CONDITIONS AND
IMPACTS: REVIEW DATA
3. RESEARCH EJ
CONDITIONS AND
IMPACTS: COMMUNITY
ENGAGEMENT
4. REVISE AND DESIGN
STRATEGIC GOALS &
OBJECTIVES TO ADVANCE
~
The following steps, adapted from the GARE
Racial Equity Toolkit, can be used by agency
leadership and staff to begin the process of
reviewing an agency-wide or program-level
strategic plan, defining the EJ and equity
context within which the agency or program
operates (problem identification), and
ultimately identifying opportunities to adjust
or reform agency priorities and
programmatic design to align agency goals
with EJ and equity outcomes. These steps can
be applied to an existing agency-wide
strategic plan, an existing program-level plan,
or in cases where no strategic plan currently
exists, be used to develop an EJ and equity
plan.
Terms and Definitions
Results - end conditions we are aiming to impact (at the
community level)
Outcomes - desired effects at the jurisdiction, agency,
department, or program level
Outputs - numerical counts of a program's actions or
products that were created or delivered, the number of
people served, and the activities or services provided.
Output and outcome measures - the means by which to
monitor successful implementation and effects of actions
that have a reasonable chance of influenced desired
results. They measure:
• Quantity-how much did we do?
• Quality-how well did we do it?
• Effects - Is anyone better off?
A4 p.324
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In order to identify strategic opportunities for advancing EJ
through planned agency work, a logical place to start is to
articulate why your agency or program does what it does, in
what social, economic, or environmental realms does it makes
a difference, and how (i.e. your theory of change). Clarifying
your realm of influence and your assumptions and beliefs about how your agency or program is
effecting change within that realm, is an essential step in discovering the ways in which your
agency's approach, investments, and activities may be missing an opportunity to, or in some
cases unintentionally exacerbating, environmental inequities.
A complete theory of change is comprised of the ultimate results (end conditions) you are
seeking to effect in the world, the key activities your agency or program performs to deliver
those results, and the near and long-term outcomes of those activities that are assumed to
influence those ultimate results. A very simple theory-of-change template is as follows:
l. REVIEW/ARTICULATE
GOALS AND OBJECTIVES
(THEORY OF CHANGE)
Agency
Near-term
Intermediate-
End conditions
activities
~
outcomes
term outcomes
W
(Results)
Guiding questions for crafting your theory of change:
1. Results: What change does your agency or program strive to bring about? What results
(changes in community conditions) are you seeking to deliver?
2. Agency activities: What are the key areas of work, groups of activities, or investments what
your agency or program delivers?
3. Near and intermediate-term outcomes: What are the immediate outcomes generated by
your agency or program activities? How do these outcomes lead to changes in the
community?
4. Realms of influence: In addition to the primary intended results of your agency/program,
what additional social, economic, or environmental realms does your agency/program have
the potential to influence?
Step 2 involves reviewing available data (both community-level
data on socioeconomic or environmental conditions, and/or
program-level performance data) and considering how your
agency operations or program, as designed, might contribute to
eliminating or exacerbating inequities.
* Consider using the EHD Map to support this step.
2. RESEARCH EJ
CONDITIONS AND
IMPACTS: REVIEW DATA
A4 p.325
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Guiding questions for assessing environmental injustice conditions and impacts:
Build demographic and environment context to guide and inform place-based activities:
Identify potential impacts in geographic areas & communities.
Learn about the racial, ethnic, economic demographics.
What are the existing racial, ethnic, and economic inequities in your program or
agency's service area?
Conduct EJ review and analysis as routine practice from programs and projects:
Use performance level data to learn about:
Where program activities have primarily occurred.
Who program activities have primarily served to date & how that compares with area
characteristics.
The next step is to consider information collected through
C. > _ community engagement efforts. If your agency has not yet
IMF : directly engaged communities disproportionately impacted
by environmental health inequities or has not yet done so
adequately, consider immediate opportunities to begin or
expand engagement. Look at information collected through community engagement efforts to
consider how your program, as designed, might contribute to eliminating or exacerbating
inequity.
efer to community engagement guidance during this step.
Guiding questions to answer through community engagement:
1. Who are the most affected community members who are concerned with or have
experience related to this program? How have you involved these community members in
the development of this program?
2. What has your engagement process told you about the burdens or benefits for different
groups?
3. What has your engagement process told you about the factors that produce or perpetuate
racial inequity related to this program?
Based on information collected in Steps 2 and 3, revise your
theory of change to include equity-explicit results, and
determine adjustments to your agency activities (e.g. adjust
existing activities, create new activities, eliminate harmful
activities) to achieve those results.
A4 p.326
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Guiding questions to support the revision process:
1. Based on your review of data and community engagement results, how does your program
alleviate or exacerbate inequity?
2. Who benefits from or is burdened by your program or agency operations, as currently
designed and executed?
3. What are the potential unintended consequences of not adjusting your agency or program
approach?
4. How do you presume your proposed adjustments to result in pro-equity outcomes and
results?
5, CREATE A
MEASUREMENT
FRAMEWORK
6.
EV
PR.
ND 7. COMMUNICATE
RESULTS/BE
ACCOUNTABLE
8, LEARN /REVISE
ADAPT
The following steps expand on the GARE Toolkit and provide guidance to agencies seeking to
implement the EJTF's recommendation to: track and communicate progress of measurable
goals. Establishing a system to monitor and evaluate progress, through use of performance
measures and community indicators, can only be completed once a revised, pro-equity theory
of change (near-term and intermediate-term outcomes and end results) is articulated. A
measurement framework is also the basis for accountability and transparency in
communicating progress in advancing equity and EJ goals. Finally, the results of a measurement
framework should be fed directly into the process of revisiting your theory-of-change and
program or agency effectiveness, on a periodic basis.
Create a draft measurement framework, including performance
5- C.Rt > r , , . .
measurement measures (that directly measure implementation of actions) and
FRAMEWCR< community indicators (that measure changes in community
conditions that your actions aim to influence). It is an important to
include both, as performance measures are directly responsive to your agency's work and
provide timely feedback about whether you are on track to generate meaningful change in
community conditions. Community indicators are slower to respond but provide essential
feedback about whether your agency or program is making a positive impact in advancing
equity and environmental justice.
onsider using the ap as a potential source of ideas for outcome measures,
efer to community engagement guidance during this step. A measurement framework
should be developed with direct input from the communities you are seeking to benefit.
A4 p.327
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Guidance on establishing output and outcome measures to track implementation of pro-equity
activities:
• Consider existing output measures (e.g. number of workshops per quarter, number of
people served, number of contracts, miles of utility lines installed) and outcome
measures (e.g. graduation rate, increase in jobs, change in air and water quality, change
in recidivism rate) at your agency. Can existing agency-wide or program-level measures
be disaggregated by race, income, geography, etc., to tell a story about the distribution
of your agency activities and associated benefits/effects?
• Consider new performance measures that generate feedback about whether your
new/revised activities are achieving near-term outcomes in your theory-of-change.
What new program or activity level data can be collected to determine that those
new/revised activities are being implemented as intended? What existing community-
level datasets can be leveraged to track changes in community conditions (and
distribution of positive changes across communities) over time?
• Determine the directionality or desired target for your output and outcomes measures,
to use as a guidepost during your monitoring and evaluation efforts.
Monitor output and outcomes measures and establish a regular
frequency for conducting periodic evaluations of progress.
Monitoring allows for ongoing tracking and course correction
and provides agency leaders and staff a 'signal' when
something is not making the progress you expect. Evaluation
allows for more in-depth analysis of measure data to understand how and why progress is or
isn't being made. Communities should be continuously engaged throughout the monitoring and
evaluation process, to ground truth the measures data and provide insight into why and how
changes are or are not occurring, and what should be done about it.
Guiding evaluation questions:
• How much did we do?
• How well did we do it?
• Is anyone better off?
Use a communications tool, such as the Center for Social
Inclusion's Talking About Race Right Toolkit to develop messages
and a communications strategy and share out the results of your
efforts to monitor and evaluate your progress in advancing equity
and environmental justice.
* Refer to community engagement guidance during this step. Determine approach outreach
and communication strategies to reach communities in a meaningful way and stay
accountable.
6. MONITOR AND
EVALUATE
PROGRESS
7. COMMUNICATE
RESULTS/BE
ACCOUNTABLE
A4 p.328
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Guiding questions:
1. How will impacts be documented and evaluated? Are you achieving the anticipated
outcomes? Are you having impact in the community?
2. What are your messages and communication strategies that are will help advance racial
equity?
3. How will you continue to partner and deepen relationships with communities to make sure
your work to advance equity is working and sustainable for the long haul?
directly engaged to ground truth insights and lessons you have derived from monitoring and
evaluation efforts.
Finally, agencies should adaptively manage agency or program-
level strategic plans, by learning from results of monitoring and
evaluation processes and establishing a culture of evidence-based
decision-making. Evidence should include not only findings
generated from monitoring and evaluation efforts, but from
ongoing community engagement.
ifer to community engagement guidance during this step. Communities should be
A4 p.329
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Appendix E. Further Guidance on the Environmental
Health Disparities Map
Washington Tracking Network
The Washington Tracking Network (WTN) is a suite of tools maintained by the Washington
State Department of Health focused on making up-to-date public health data more accessible.
There are over 300 measures on WTN, and data are available for download and exploration.
The following tools are relevant for the proposed mapping uses and recommendations in this
report;
• Query Portal allows users to select data according to their interest by time period and
geography (county, census tract, state). Data are available as tables, charts, or maps,
and available for download. The query portal allows you to select and view multiple
measures at the same time.
• Information by Location (IBL) is an interactive map that compares census tracts in
Washington across a variety of public health and environmental measures. IBL ranks
census tracts between 1 (least impacted) and 10 (most impacted). The EHD map is
included in IBL.
Environmental Health Disparities Map Measures and Rankings
The Environmental Health Disparities (EHD) map compares census tracts across our state for
environmental health disparities. Like all IBL maps, the EHD map uses rankings to create a
common scale to compare different issues at the census tract level. Rankings allow the map to
display health information while protecting confidentiality in census tracts with small
populations. The rankings help to compare health and social factors that may contribute to
disparities in a community. The rankings should not be interpreted as absolute values or be
used to diagnose a community health issue or to label a community.
The rankings show that there is a difference between tracts, but not how great the difference is
between tracts. The rankings were created using deciles (1 decile = 10%). Each decile
represents about 10% of the values in the data set. Because the final composite scores are
ranked by deciles, the resulting rankings shown on the map range from 1 (least impacted) to 10
(most impacted). For example, if a census tract has an EHD rank of 8, it means there are about
Figure 1. Visual of IBL ranking system.
Least impacted
Most impacted
1 | 2
3
4
5
6
7
8
9 10
10% of 10% of
communities communities
10% of
communities
10% of
communities
10% of
communities
10% of
communities
10% of
communities
10% of
communities
10% of 10% of
communities communities
70% of communities
are less impacted
are
similarly
impacted
20% of communities
are more impacted
A4 p.330
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10% of other census tracts with a similar level of disparities, 20% have a higher level, and 70%
have a lower level (Figure 1).
It is possible to explore the data that inform the overall ranking as well. Each IBL map is made
up of themes and measures. The EHD map includes 19 measures organized into four themes
(Table 1):
Table 1. Themes and Measures included in the Environmental Health Disparities Map
Themes
Measures
Environmental Exposures
NOx-diesel Emissions
Levels of pollutants that populations come
into contact with.
Ozone Concentration
PM2.5 Concentration
Populations near Heavy Traffic Roadways
Toxic Release from Facilities
Environmental Effects
Lead Risk from Housing
Measures that account for adverse
environmental quality generally, even when
population contact with an environmental
hazard is unknown or uncertain.
Proximity to Hazardous Waste Treatment,
Storage, and Disposal Facilities
Proximity to National Priorities List Sites
(Superfund Sites)
Proximity to Risk Management Plan Facilities
Wastewater Discharge
Socioeconomic Factors
Limited English
Measure population characteristics that
modify the pollution burden itself.
No High School Diploma
Poverty
Race - People of Color
Transportation Expense
Unaffordable Housing
Unemployed
Sensitive Populations
Death from Cardiovascular Disease
Those who are at greater risk due to intrinsic
biological vulnerability to environmental
stressors.
Low Birth Weight
Each census tract has an overall EHD rank, but also a rank for each of the four themes and
individual measures. For example, a census tract may have an overall EHD rank of 7, an
Environmental Exposures (theme) rank of 9, and a NOx-Diesel Emissions (measure) rank of 6. In
A4 p.331
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this scenario, a user would then understand that while this area has some of the highest
impacts for environmental exposures, NOx is probably only part of the exposures in this tract.
By exploring the individual measures in the EHD ranking for a census tract, a user can gain
insights into how the measures influence the overall ranking. A tract can be highly impacted in
some themes or measures and less impacted in others. In the highlighted tract below, the
Environmental Exposures theme has a rank of 9, while the Sensitive Populations theme has a
rank of 2 (Figure 2). A user would then understand that for this census tract the environmental
exposures theme is an area of greater concern for this census tract compared to the sensitive
populations theme.
Each tract is uniquely impacted by the measures. Exploring the themes and measures will give a
more robust picture of how a given census tract is impacted by specific environmental health
disparity measures.
Figure 2. Example of how specific measures can change a tract's rank.
— t ^—
:= S 9 i ?
Go Back to Topic Selection
Environmental
Mil Rank
Health Disparities
7
V1.1
^ Environmental
IM B
— Exposures
w tt Environmental
liM 6
A Effects
:= S 9 i ?
Q Go Back to Topic Selection
Expwuin
k tt Environmental
^ Effects
LdsL 6
a Socioeconomic
Factors
LillL 7
.a. Sensitive
Populations
IM H
EHD Model Development
The EHD map model was adapted from CalEnviroScreen—a cumulative environmental impacts
assessment map developed by CalEPA and used in California to inform implementation of
various state policies. It estimates a cumulative environmental health impact score for each
census tract reflecting pollutant exposures and factors that affect people's vulnerability to
environmental pollution. The model is based on a conceptual formula of Risk = ThreatX
Vulnerability, where threat and vulnerability are based on several indicators (Figure 3).
Figure 3. Visualization of how the disparities rank is calculated.
Environmental Exposures
& Effects
©
hJ
Sensitive Populations &
Socioeconomic Factors
•Icons shown do not represent all 19 indicators on the map.
A4 p.332
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The Environmental Effects and Environmental Exposures themes comprise the threat portion of
the conceptual formula and account for the pollution burden. Since there are uncertainties in
the extent to which proximity to hazardous sites and pollutant sources reflects exposures to
individuals in the community Environmental Exposures have a lower contribution (.5) to the
overall EHD rank following a similar methodology used by CalEnviroScreen.
The Sensitive Populations and Socioeconomic Factors themes comprise the vulnerability
portion of the conceptual formula. These measures are proxy metrics for population
characteristics. In the model, threat is multiplied by vulnerability in order to reflect the scientific
literature that indicates population characteristics often modify and amplify the impact of
pollution exposures on certain vulnerable populations.
The EHD map and CalEnviroScreen modelling differs from the US Environmental Protection
Agency's EJSCREEN. Both CalEnviroScreen and the EHD map are cumulative environmental risk
assessment maps. EJSCREEN is not a cumulative impacts model, but rather shows each
environmental and demographic indicator, one at a time, and 11 EJ Indexes that combine a
single environmental factor with demographic factors (low-income and minority residents).
Sensitivity Analysis
Two different sensitivity analyses, Spearman's correlation coefficients and principal component
analysis, were conducted to assess and reduce bias due to data availability. The only highly
correlated measure was linguistic isolation with race/ethnicity. Although highly correlated,
these indicators are not duplicative because they describe different vulnerabilities. Both
linguistic isolation and race/ethnicity add important new information. The Principal Component
Analysis (PCA) was used to understand how the indicators within a theme influenced the topic,
or overall, ranking. The PCA revealed that five principal components account for 66.26% of the
variance. The components corresponded approximately to (1) pollution related to urbanized
areas, (2) socioeconomic factors, (3) traffic-related pollution, (4) hazardous waste, and (5)
peri-urban related pollution. PCA results indicate that there may be more focused priorities for
different regions. For example, diesel emissions may be the most relevant for urbanized areas,
while low socioeconomic status may be most relevant for rural areas.81
81 Min, E., et al., (2019) "The Washington State Environmental Health Disparities Map: Development of a
Community-Responsive Cumulative Impacts Assessment Tool". Int. J. Environ. Res. Public Health, 16(22), 4470.
doi: 10.3390/ijerph 16224470.
A4 p.333
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Appendix F. Methodology and Analysis: Washington
Tracking Network Bar Graphs on Environmental
Health Disparities
Created By: Rad Cunningham, Senior Epidemiologist for the Washington State Department of
Health, rad.cunningham@doh.wa.gov
Figure 1. Race and Ethnicity by Environmental Health Disparity Rank
Race and Ethnicity by Environmental Health Disparity Rank
White
American Indian or Alaska Native
Native Hawaiian or Other Pacific Islander
Other Race
Black
Asian
Two or More Races
Hispanic or Latino
A4 p.334
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Table 1. Race and Ethnicity by Environmental Health Disparities (EHD) Rank
EHD Rank
White
Black
American
Indian or
Alaska
Native
Asian
Native
Hawaiian or
Other Pacific
Islander
Tw
M
Ra
Other
Race
Hispanic
or Latino
1
2
83.2
81.5
0.9
1.3
4.6
0.2
3.5
0.1
6.2
1.1
0.7
5.7
0.2
3.7
0.1
7.0
3
4
78.2
75.3
1.6
0.7
7.3
0.4
4.1
0.1
7.5
1.8
1.3
8.0
0.3
4.7
0.2
8.5
5
72.5
2.0
1.0
8.3
0.4
4.7
0.1
11.0
6
69.0
2.8
1.2
9.1
0.4
4.6
0.2
12.7
7
8
66.8
63.7
3.0
1.1
8.4
0.6
4.9
0.2
15.0
4.6
0.8
8.7
1.0
5.0
0.2
16.0
9
10
57.4
45.6
7.0
1.6
10.1
1.2
5.4
0.2
17.1
10.5
1.4
11.7
1.8
6.2
0.3
22.7
WA Avg.
69.1
3.6
1.1
8.3
0.6
4.7
0.2
12.5
Methods
This graph and table of race and ethnicity by Environmental Health Disparities (EHD) rank was
created using environmental health disparities ranking, whose methods are described in Min et
al. 201982, and race and ethnicity data from table DP05 from the U.S. Census's 2018 American
Community Survey83. The data were matched by census tract to create a dataset that could be
used to assess race and ethnicity differences by EHD rank. The data combines race and ethnicity
using methods developed for the Environmental Protection Agencies (EPA) EJSCREEN tool.84
The analysis follows methods developed by Min 202085.
Results
We find a linear association between increasing EHD rank and the percentage of the population
that was non-white or persons of color. In other words, minority, non-white Washington
residents were more likely to live in census tracts identified as high risk by the EHD map. White
people made up 81.5% of the population of the lowest risk census tract and 45.6% of the
highest risk census tracts. Black Washingtonians were ten times more likely to live in a census
tract ranked a ten (highest risk) than a census tract ranked a one (lowest risk). Native Hawaiian
82 Min, Esther, et al. "The Washington state environmental health disparities map: development of a community-
responsive cumulative impacts assessment tool." International journal of environmental research and public
health 16.22 (2019): 4470.
83 Data are available on the Census website: https://www.census.gov/acs/www/data/data-tables-and-
tools/american-factfinder/
84 2019 Environmental Protection Agency, Office of Policy. EJSCREEN Environmental Justice Mapping and Screening
Tool: EJSCREEN Technical Documentation. Accessed at: https://www.epa.gov/sites/production/files/2017-
09/documents/2017 eiscreen technical document.pdf
85 Min 2020, A tale of Two Community Engaged Research Studies; Addressing Environmental Health Disparities in
Washington State. [Doctoral Dissertation, University of Washington] ResearchWorks Archive.
A4 p.335
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or other Pacific Islanders were nine times more likely to live in a tract ranked ten vs one. More
Hispanic and Latino residents live in census tracts ranked a nine or a ten than live in census
tracts ranked one through five combined. There is a similar trend for Asian residents. The trend
is visible but less pronounced for Washington residents identifying as either Other Race or Two
or More Races.
Limitations
The environmental health disparities map is comprised of four themes made up of nineteen
measures. One of the measures is People of Color (POC), a measure of the percent of a census
tracts population that is non-white. Each of the four themes has a 25% weight in the final
ranking. People of Color is under the socioeconomic factors theme along with six other
measures. Therefore, its rank in the final map is (l/7)*0.25= 0.036 or 3.6% of the weight of the
ranking. A preferred method would have been to remove the POC measure and recalculate the
EHD rankings before running the analysis above. Due to staff activations to the COVID-19
response we were not able to use this method for this report but plan to for future reports and
to update the results of this report at that time using the preferred method. However, given the
clear trends seen in the data and the relatively small weight of the POC measure in the overall
ranking we do not expect meaningful changes in the outcome of the analysis. This limitation
applies equally to the poverty chart and table below.
Figure 2. Difference in Live Expectancy Compared to the State Average
Difference in Life Expectancy Compared to the State Average
123456789 10
Environmental Health Disparities Rank
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Table 2: Life Expectancy by Environmental Health Disparity Rank
EHD
Rank
Life Expectancy
at Birth
WA Average
Life
Expectancy
Difference
from State
Average
1
82.4
1.9
2
81.7
1.1
3
81.6
1.0
4
81.3
0.8
5
80.9
80.5
0.4
6
80.5
-0.1
7
80.2
-0.4
8
79.4
-1.1
9
78.2
-2.4
10
76.7
-3.8
Methods
The Center for Health Stastics at the Washington State Department of Health estimates life
expectancy using data from death certificates following methodologies developed by the World
Health Organization86. The life expectancy data was combined with the environmental health
disparities ranks to produce the chart and table above.
Results
We find that in addition to the linear trend between people of color and EHD rank there is also
a linear association between EHD rank and life expectancy. There is a 5.7 year difference in life
expectancy between the lowest and highest EHD rank.
Limitations
Our methodology was to average life expectancy across census tracts by EHD rank. One
limitation of this method is that census tracts have different popultaions. A census tract with a
smaller population would have the same weight as a census tract with a larger population.
Census tracts are standardized by the U.S. Census to have an average population of 4,000
people with a minimum of 1,200 and a maximum of 8,00087. This standardization limits the
extent of this limitation. In an unadjusted regression, life expectancy increased by 0.28 years
per additional 1,000 population. The r-squared statistic in the regression suggested that
population explains 2.8% of the variation in life expectancy.
86 Chiang CL. Life table and mortality analysis. Geneva: World Health Organization, 1977.
87 U.S. Census, Geographic Products Branch: https://www2.census.gov/geo/pdfs/education/CensusTracts.pdf
A4 p.337
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Figure 3
Poverty by Environmental Health Disparity Ranking
Poverty by Environmental Health Disparity Ranking
1 23456789 10 WA
Environmental Health Disparity Ranking
Table 3: Poverty by Environmental Health Disparity Rank
EHD Rank
Total
Population
Population Under
185% of FPL
Percent under
185% of FPL
1
583304
104927
18.0
2
701525
123562
17.6
3
714922
139970
19.6
4
720213
152462
21.2
5
703700
166292
23.6
6
725651
175160
24.1
7
735128
195393
26.6
8
746588
210981
28.3
9
704190
244429
34.7
10
702192
299041
42.6
WA
7037413
1812217
25.8
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Methods
We created the dataset used to populate the table and graph depicting the relationship
between EHD rank and poverty, defined as 185% of the federal poverty level,88 by combining
poverty data from the U.S. Census Bureau's 5-Year American Community Survey table S1701
with EHD ranks on a census tract level.
Results
We find that, as with race and ethnicity and life expectancy, that there is a linear association
between EHD rank and poverty. The poverty rate in the highest EHD rank is more than double
that of the lowest EHD rank.
Limitations
The limitations for this section are described above on page 130.
88 Data are available on the Census website:
tools/ame
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Appendix G, Memo: EJ and Reparations from
Systemic Racism
Environmental Justice and Reparations from Systemic Racism
A memo for the Washington State Environmental Justice Task Force
Written by task force members representing community organizations:
Emily Pinckney, Tacoma League of Young Professionals
Rowena Pineda, Asian Pacific Islander Coalition
Judy Twedt, UAW Local 4121
September 2020
It is a historic fact that racial disparities in health are rooted in legacies of slavery and
colonialism. Washington State's Environmental Health Disparities map outlines the current
land-based relationships between human health, income, race, and pollution. This tool,
developed through community-based participatory research, documents present inequities and
shows the links between social vulnerabilities and exposure to pollution.
But today's geographic and racial health disparities did not arise by complacency or individual
acts. Racial discrimination in New Deal housing and transportation policy, indigenous land theft,
broken treaties, and other forms of institutional (and often unconstitutional) harms shaped
these current multigenerational inequalities.
In support of the Washington State Environmental Justice Task Force, this memo does two
things:
1. Draws links between historical discrimination and contemporary health and
environmental disparities specific to Washington State.
2. Provides an (incomplete) list of resources, writings and reports to support the
development of reparations proposals to redress historic and current harms.
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I. Multigenerational Environmental Health Disparities
To heal was to be familiar with what was destroyed
-Ray Young Bear, Meskwaki poet89
Racial segregation across the country was shaped in the Jim Crow era by the exclusionary
zoning of The Federal Housing Administration's redlining maps which banks used to determine
who received federal mortgage loans for homeownership. Redlining maps of Seattle, Tacoma.
and Spokane are available through the University of Richmond's Mapping Inequality project.
The 1936 of commercial map of the greater Seattle area outlined 6 security areas, graded 'A'
through 'E'. This was supervised by deputy state appraiser, E.G. Wendland and the chief
valuator of the Federal Housing Administration. Here are few of the descriptions of
neighborhoods and their resulting grades:
• "A" rating: a waterfront area in the Seward Park neighborhood, described as "a new
area sparsely settled but protected by building and racial restrictions."
• "B" rating: the Ballard neighborhood, "the locality is populated by working men, skilled
mechanics, and white-collar workers. This is the 'Scandinavian" section of Seattle."
• "B" rating: The Capitol Hill Neighborhood surrounding Volunteer Park, because
"Notwithstanding the age of the district, the locality has no racial problems, nor has it a
problem of the influx of people of a lower earning standard."
• "C" rating: a neighborhood described by its proximity to "a gas plant which is causing a
smoke and odor nuisance
• "D" rating: A neighborhood in the Central District, described in one short sentence:
"This is the Negro area of Seattle."
In addition to redlining, racist property deeds and covenants barred the sale to or occupancy by
African Americans across the country and in Seattle. Richard Rothstein90 describes how,
between 1935 and 1944 W.E. Boeing, founder of Boeing Company, developed suburbs north of
Seattle. During this period and after WWII, more suburbs were constructed with other
developers which all wrote racially restrictive language and covenants into their property
deeds. The result was a city whose African American population was encircled by all-white
suburbs and restricted to purchasing houses in urban areas closest to polluting industries.
Boeing property deeds stated, for example, "No property in said addition shall at any time be
sold, conveyed, rented, or leased in whole or in part to any person or persons not of the white
or Caucasian race."
89 As quoted in An American Sunrise by Muskogee Creek poet Joy Harjo
90 'The Color of Law: A Forgotten History of How our Government segregated America" 2017, Liveright Publishers
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Similar racial covenants and housing policy also segregated cities in eastern Washington,
including Spokane.
The federal interstate highway system also segregated neighborhoods in many cities. In
Spokane, residents describe how 1-90 cut through the east central neighborhoods and affected
communities, just as in other major US cities including Los Angeles and Atlanta. This led to
intergenerational inequality in health and wealth.
Together, the policies of redlining, racial covenants, and infrastructure placement created
intergenerational wealth gaps that persist and contribute to environmental health disparities to
this day: Research on extreme heat suggests that these policies created heat burdens as low-
income neighborhoods that have less tree canopy. This causes a greater heat exposure on
residents, and is rising with global warming.
Research published in the Proceedings of the National Academy of Sciences shows that
racialized wealth gaps and segregation have a two-pronged effect on health outcomes: on
average white Americans create more pollution through their consumption than Black and
Hispanic Americans, but don't breathe the full costs of this consumption:
"In the United States, PM2.5 exposure is disproportionately caused by consumption of
goods and services mainly by the non-Hispanic white majority, but disproportionately
inhaled by Black and Hispanic minorities. On average, non-Hispanic whites experience a
"pollution advantage": They experience ~17% less air pollution exposure than is caused
by their consumption. Blacks and Hispanics on average bear a "pollution burden" of 56%
and 63% excess exposure, respectively, relative to the exposure caused by their
consumption
These findings are not new. Fifteen years previously, the Congressional Black Caucus
Foundation released their report African Americans and Climate Change: Unequal Burden,
noting that "policies intended to mitigate climate change can generate large health and
economic benefits or costs for African Americans, depending on how they are structured."
I. Further Resources
Reparations
1. Movement 4 Black Lives: Reparations Platform, accessed September 3, 2020
2. Resource Generation: Land Reparations and Indigenous Solidarity Toolkit Accessed
September 4, 2020
3. Catherine Millas Kaiman: Environmental Justice and Community Based Reparations
Seattle University Law Review
4. William "Sandy" Darity and Kristen Mullen: Black Reparations and the Racial Wealth
Gap June 15, 2020 Brookings Institution Report
5. Ta-Nehisi Coates: The Case for Reparations June 2014, The Atlantic
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6. Yearby, Lewis, Gilbert, and Banks: Racism is a Public Health Crisis Data for Progress,
September 2020
7. Maanvi Singh: Native American 'Land Taxes': A step on the roadmap for reparations The
Guardian, December 31, 2019
8. Daniel R. Wildcat: Why Native Americans Don't Want Reparations Washington Post,
June 10, 2014
9. Ereshnee Naidu-Silverman: What South Africa can Teach the US About Reparations
Washington Post, June 25, 2019
10. Irvine Molotsky: Senate Votes to Compensate Japanese American internees New York
Times, April 21, 1988
11. John Tateishi: Redress: The inside Story of the successful Campaign for Japanese
American Reparations Heyday Books, 2020
12. Maki, Kitano, and Berthold: Achieving the Impossible Dream: How Japanese Americans
Obtained Redress. University of Illinois Press 1999
Racism and environmental health inequities
13. Beverly Wright and Robert Bullard: The Wrong Complexion for Protection: how the
Government Response to Disaster Endangers African American Communities. NYU Press
2012
14. Meg Anderson: Racist Housing Practices from the 1930's Linked to Hotter
Neighborhoods Today Spokane Public Radio, January 14, 2020
15. US Cities Spending millions on trees to fight heat — but are their plans equitable? The
Guardian, August 26, 2020
16. Matthew Fleischer: Want to tear down insidious monuments to racism? Bulldoze LA
Freeways LA Times, June 24, 2020
17. Hannah Weinberger: UW Research shows racism and redlining hurt local wildlife too
August 20,2020 Crosscut
a. Supporting research: Schell et al.: The ecological and evolutionary consequences
of systemic racism in urban environments Science August 13, 2020
18. Brad Plummer and Nadja Popovich: Decades of Racism Housing Policy Left
Neighborhoods Sweltering New York Times, August 24, 2020
19. Supporting research: Hoffman, Shandas, and Pendleton: The effects of historic housing
policies on residents exposure to intra-urban heat Climate, January 13, 2020
20. Tessum et al.: Inequities in consumption of goods and services adds to racial-ethnic
disparities in air pollution exposure Proceedings in the National Academy of Sciences,
March 11, 2019
21. Maldonado, Shearer, Bronen, Peterson, Lazarus: impact of Climate Change on Tribal
Communities in the U.S.: Displacement. Relocation, and Human Rights Climate Change,
April 9, 2013
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22. Bailey, Kreiger, Agenor, Graves, Linos, and Basset: Structural racism and health
inequities in the USA: evidence and interventions The Lancet, April 8, 2017
Red Lining and Segregation
23. Shawn Vestal: Whites-Only covenants still exist in many mid-century Spokane
neighborhoods. Spokesman Review. December 24, 2016
24. Seattle Civil Rights and Labor History Project: Segregated Seattle
25. Richard Rothstein: The Color of Law: A Forgotten History of How Our Government
Segregated America Liveright Publishing, 2017
26. Seattle's history of redlining November 20, 2018 KCTS9
27. Mapping Inequality: Tacoma Redlining Map
28. Mapping Inequality: Seattle Redlining Map and descriptior attle's classification key
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Appendix H. EJ and COVID-19 Memo from EJTF Co-
Chairs
MEMORANDUM
to: Governor Inslee, Commissioner Franz, Speaker Jinkins, Majority Leader Bilug, Secretary
WIESMAN, AND MEMBERS OF SAFE START ADVISORY GROUPS
from: Victor Rodriguez and David Mendoza- Co-Chairs, WA State Environmental Justice
Taskforce
subject: Use the Environmental Health Disparity Map to inform COVID-19 Relief and Recovery
date: August 21, 2020
Summary & Recommendation
The COVID-19 pandemic has both illuminated and exacerbated the long-standing inequities in
our country, and in our state. As such, COVID-19 relief and recovery funds and strategies must
be equitably distributed to ensure that the state reaches communities that are experiencing the
most dire health and economic repercussions. If equity is not front and centered by considering
the underlying vulnerabilities and disparities among communities, ongoing response and
recovery efforts could exacerbate the current inequities and increase disparities for Black,
Indigenous, and People of Color. During an extreme statewide budget shortfall, our investments
must be strategic and focused on yielding the greatest returns on our investments, which
ultimately means investing in communities facing the most severe inequities to improve health
and resiliency for future emergencies in Washington.
The Environmental Justice Task Force Co-Chairs recommend that the Governor, the
Commissioner of Public Lands, the Legislature, and the Safe Start advisory groups use the
Environmental Health Disparity Map to inform the state's COVID-19 relief and recovery work.
A national study showed a disproportionate impact of COVID-19 on communities with high levels
of pollution while federal data show that there have been racial disparities in coronavirus
infections and deaths nationwide. Referencing an environmental health analysis will help to
ensure that the state prioritizes investments in communities in areas with high levels of
disparities and prevent a disproportionate impact related to potential forthcoming budget cuts.
This is especially important during the current wildfire season, which could increase the number
of people who contract COVID-19 and make the symptoms more severe in those who do get
sick, according to public health officials.
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Using Environmental Health Disparity Mapping in COVID-19 Relief and Recovery
The Environmenta ih Disparities Map is an interactive mapping tool that compares
communities across our state. The map incorporates environmental exposures and effects,
socioeconomic factors, and information on sensitive populations to rank environmental health
disparities by census tract. The map can be used to aid decision-makers on where to invest
resources, which communities to prioritize for funding, where to focus employment
opportunities, and where to focus recovery efforts. In addition, since the response to COVID-19
is likely to be long with periods of illness resurgence, the Environmental Health Disparities map
may help identify areas with likely resurgence or areas needing greater resources—testing,
cultural and linguistically appropriate materials, guidance on safe workplaces, etc.
We recommend the following ways in which to integrate the use of mapping:
• Area Assessment - Learn about the intended audience or potentially impacted
community.
• Equity Impact Analysis - Analyze whether Highly Impacted Communities will be affected
by a proposed policy, program, or activity
• Project Prioritization - Direct activities and investments towards the most burdened
communities.
• Service Equity Evaluation - Evaluate the equitable distribution of agency activities
across the state (or service area).
Disparate Impacts of Pollution and COVID-19 on Communities of Color
Our health is interconnected with the environment. Polluted water, food, air, and land makes
us sick and more susceptible to diseases like COVID-19. Recent scientific publications suggest
that air pollutant exposure worsens COVID-19 symptoms and outcomes. A Harvard study
concluded that "a small increase in long-term exposure to PM2.5 leads to a large increase in
COVID-19 death rate." Considering environmental health factors in COVID-19 relief and
recovery efforts may help save lives.
It has been well documented that Black, Indigenous, and People of Color are more likely to live
in areas with more pollution. The Environmental Health Disparity Map details the cumulative
impacts of environmental hazards and exposures overlaid with numerous social factors that
provides a comprehensive understanding of the range of impacts facing communities across
Washington State. Adding this information into planning and distribution of COVID-19 relief and
recovery efforts could greatly improve our ability to identify the areas in our state who need
the most help and attention.
Black, Indigenous, and People of Color are being disproportionately impacted by COVID-19.
According the WA State Department of Health:
• Case rates over the pandemic for Hispanic people and Native Hawaiian or Other Pacific
Islander people are nine times higher than those of White people.
• Confirmed cases statewide show 44% of all cases attributed to Latinos who only
represent 13% of the total population. The percentage of COVID-19 patients who are
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Black is also above that population's overall percentage. At this point in data collection,
White COVID-19 cases make up 35% of those sickened by the virus, while the White
population makes up 68% of the state population.
• Hospitalization rates are seven times higher for Hispanics and ten times higher for
Native Hawaiians or Other Pacific Islanders than those of White people. Case and
hospitalization rates for Black people and American Indian or Alaska Native people are
three times higher than those of White people.
• Compared to White people, death rates are over three times higher among Hispanic
people and Native Hawaiian or Other Pacific Islander people, twice as high among
American Indian or Alaska Native people, and over 50 percent higher among Black and
Asian people.
If recovery planning does not considerthe distributive injustices orgeographic inequities detailed
in the J , these injustices are bound to exacerbate the
disparities related to COVID-19. For too long, Black, Indigenous, and People of Color and poor
communities have borne disproportionate harm from pollution, a result of discriminatory
systems that perpetuate inequities within WA State.The impact of COVID-19 isjustthe latestand
most dramatic evidence of this inequity. Embracing our recommended approach in planning for
recover/relief programs can be a first step in beginning to address these longstanding inequities.
Thank you for your consideration of this recommendation. The Co-Chairs and staff of the EJ
Taskforce are ready and willing to assist any of you or your staff with addressing any questions
or concerns you may have about implementing this recommendation.
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(jl'OiUjljm: V ll\ll I.nun
SthoiJ «' Nm k>n:> & I lo >hh Studies
Adjunct Associate Professor
Department of Professional Nursing Practice
School of Nursing and Health Studies
St. Mary's Hall
2700 Reservoir Rd. NW
Washington. DC 20057
elk65@georgetown.edu
White House Environmental Justice Advisory Council
Environmental Protection Agency [Mail Code 2201A]
1200 Pennsylvania Avenue, NW
Washington DC 20460
Memorandum
TO: White House Environmental Justice Advisory Council (WHEJAC)
FROM: Emma Kurnat-Thoma, PhD, MS, RN, FAAN; EPA-HQ-AO-2022-0050-75
DATE: February 24, 2022
SUBJECT: WHEJAC Scorecard and Performance Measurement Precision in Environmental Justice (EJ)
Outcome Evaluation
SUMMARY
This memorandum provides strategic recommendations for the development of a complex construct for
whole-of-government implementation, Environmental Justice (EJ).
This summary highlights the following:
• Need 1: Accurate Definition of EJ
o There is a need for a singular, clear, succinct, and holistic definition of the EJ construct
for use in the whole-of-government approach.
• Need 2: Holistic Conceptual Model or Framework of EJ
o There is a need for a conceptual model or framework that unites the Administration's EJ
activities for a whole of government response that can be easily communicated to local
communities.
• Need 3: Clearly Defined Performance Measures and Contexts that Include Population Health
o There is a need for EJ construct operationalization that includes use of valid, reliable
performance scorecard metrics which include population health outcomes. The presence
of military, economic realities and priorities in the EJ conceptual framework should not
exclude or minimize the presence of population health constructs and measurement
outcome truths indicating the presence of grave harms.
• Need 4: Recognizing the Unseen Cultural Values and Time Periods
o There needs to be a conceptual EJ element and scorecard measure that is
temporal/historical, culturally-based, and emphasizes correction of severe inter-
generational environmental injustices for communities and locations that were/are
gravely impacted by having cultural values that are separate from standardized
financial/economic/income, racial, health, employment metrics (i.e. native languages and
cultural displacements, traditional food supply, historical legacies of ancestors, religious
resources).
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BACKGROUND
Environmental Justice
EJ is complex construct and has multiple definitions, meaning, and applications. In reviewing Justice40
and EJ Scorecard documentation, it was challenging to appreciate the unifying construct that the whole of
US Government approach would use to achieve and deliver EJ.
For example, EJ as defined in various regulatory contexts which may or may not include addressing harm
eliminations, reparations and the direct involvement of impacted marginalized groups that fully accounts
for their cultural priorities. Specific examples include:
• "The fair treatment and meaningful involvement of all people regardless of race, color,
culture, national origin, or income, with respect to the development, implementation, and
enforcement of environmental laws, regulations, and policies to ensure that each person
enjoys— the same degree of protection from environmental and health hazards; and equal
access to any Federal agency action on environmental justice issues in order to have a
healthy environment in which to live, learn, work, and recreate", (116th Congress, 2020;
Environmental Protection Agency, 2022).
• "A tool to ensuring that the needs of underserved communities are met. Underserved
communities are those which have not participated in. or have not received, limited
benefits from USDA programs which may improve their quality of life and/or
environment". (USDA, 2022).
• "Environmental justice is the fair treatment and meaningful involvement of all people,
regardless of race, color, national origin, or income, with respect to the development,
implementation, and enforcement of environmental laws, regulations, and policies. Fair
treatment means that no population bears a disproportionate share of negative
environmental consequences resulting from industrial, municipal, and commercial
operations or from the execution of federal, state, and local laws; regulations; and
policies. Meaningful involvement requires effective access to decision makers for all, and
the ability in all communities to make informed decisions and take positive actions to
produce environmental justice for themselves", (Department of Energy, 2022).
• "The fair treatment and meaningful involvement of all people regardless of race, color,
national origin, or income in the development, implementation, and enforcement of
environmental laws, regulations, and policies", (Department of Health and Human
Services, 2022).
• "The fair treatment and meaningful involvement of all people regardless of race, color,
national origin or income with respect to the development, implementation, and
enforcement of environmental laws, regulations and policies. Environmental justice
includes addressing disproportionate environmental and health impacts in all laws, rules,
and policies with environmental impacts by prioritizing vulnerable populations and
overburdened communities, the equitable distribution of resources and benefits, and
eliminating harm." (Washington State, 2020).
These definitions emphasize state and federal agency regulatory and policy applications and they also
represent key progress and laudable advancement of EJ interests. However, it is noted there are a wide
variety of socio-political and academic definitions, paradigms, theories of EJ (i.e. temporal aspects,
human-species relations aspects, varying justice term constructions) which provide richer context and can
inform broader dimensions of fundamental human rights for actualization.
We must be mindful of the level of systematic institutionalization and potential analytical weaknesses for
which current EJ definitions were developed and implemented up to this point. While we may not be able
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to fully answer or resolve them, we must acknowledge the following questions in order to perform due
diligence in seeking improved moral, social, and political EI:
• "Is our definition of EI a result of a sufficiently holistic analysis of the situation"?;
• "Is this the best definition of EI that will meet the broad needs of those impacted at such different
scales and by such different stakeholders, actors and interests across time and generations (i.e.
tribal agreements since 1800's; Trinity site; to present day corporate and military harms)"?
• "Is there anything we can add to the definition (EI) from a social, moral and political perspective
that will continue to evolve and improve this contested concept to truly benefit those most in
need?".
It is appreciated that understanding the cause-effect of environmental harms and empowering those that
have been harmed involves painful realities of political conflict and controversy (Mohai et al, 2009). In
the interests of mitigating and leaning into that very controversy, Banzhaf et al's (2019) review states that
the selection and use of an EI definition is a critical step to characterizing the nature of iniustice(s)
involved and is a necessary prerequisite to seneratins effective policy solutions.
Examples include:
• Justice and environmental ethics each have multiple forms, definitions and contributing
theoretical sub-components and concepts that can be 'mapped", (Stanford Encyclopedia
of Philosophy, 2021a; 2021b).
• "The inequitable exposure of communities of color, and communities in poverty, to
environmental risks due primarily to their lack of recognition and political power",
(Agyeman, Schlosberg, Craven & Matthews, 2016).
o Global environmental racism, deforestation, immigrant rights, military testing,
free trade agreements, human trafficking, etc.
• "A field of study and a social movement that seeks to address the unequal distribution of
environmental benefits and harms and asks whether procedures and impacts of
environmental decision-making are fair to the people they affect", (Bryant and
Callewaert, 2003; Ecological Society of America, 2022).
• EJ as both human-human relationships compared to human-natural world relationships in
our common home (the full spectrum of interrelated and interconnected ecological
diversity) because it is recognized that injuries done to the non-human world have a close
relationship to the injustices in the human world. For example "an interaction and
relationship of human beings with each other as a social concept"... .versus "our
relationship as species—human beings—to the rest of the natural world" (p. 6, Ashgar,
2001).
o Cautioning against EJ views of distributive justice only: if EJ is solely defined as
a maldistribution of and access to resources (i.e. wealth and power) then EJ
becomes defined by the conflicts required to achieve this aim and thus becomes
resigned to a consumptive path of unacceptable levels of power politics in the
absence of shared community empow erment (i.e., a path of continual reporting,
complaints, lawsuits), (p. 8, Ashgar, 2001).
o Keystone natural resources as a form of capital that is not interchangeable with
other forms of capital and that are distinctive and defining features of a place and
culture (p. 10, Ashgar, 2001).
o Balancing the need for accurate standardized measurement of scarce keystone
resources so as not to inadvertently further limit and exploit these resources over
further generations by issuing a poorly conceived reductionist-value term ("this is
it's only defined prescribed value"), (p. 11-12, Ashgar).
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Poverty as a self-perpetuating consumptive short-term bargaining cycle in
restrictive social milieus such that any successful EJ must seek to uplift those in
poverty (p. 13, Ashgar, 2001).
EJ as a failure to properly regulate the activities of major corporations "who
target minority communities for high technology, incinerators and waste", while
many middle-class Americans show little concern (p. 14, Ashgar, 2001).
While it is an important component, emphasis on only race is overly restrictive,
for example: "women, children, and the poor", (p. 15, Ashgar, 2001).
Bullard (1994) stipulated 5 principles that define the construct of EJ (p. 15,
Ashgar, 2001):
¦ Guaranteeing the right to environmental protection;
¦ Preventing the harm before it occurs;
¦ Shifting the burden of proof of contamination to polluters and not the
residents;
¦ Obviating proof of intent to discriminate; and
¦ Redressing existing iniquities.
Unintended contributions of additional poisons in the form of improperly
stewarded EJ policies that were intended to correct them (p. 16, Ashgar, 2001).
Principles of justice as a whole (separate of EJ) are linked with intra- and
intergenerational realities and mechanisms and cannot be separated from
international relationships (p. 19, Ashgar, 2001).
Justice as a desirable social virtue and cannot be realized without "the
establishment of appropriate political institutions and giving consideration to a
shared public ethics that results in a social order that is acceptable and enjoyed by
the majority if not all" (p. 19, Ashgar, 2001).
Justice is linked to central features of the political philosophies and traditions,
including liberalism, conservativism, socialism, etc., (p. 19, Ashgar, 2001).
An entitlement and the monopolistic acquisition creep over time that worsens the
positions of others by preventing them from acquiring the same to the point
where it shows no concern for vital and basic human needs of others, is
fundamentally unjust and unethical (p. 25, Ashgar, 2001).
There will always be incentives for abuse of EJ rights unless there are clearly
defined mechanisms that protect against exploitation in matters of economical
polarization (p. 26, Ashgar, 2001).
Leverage in EJ negotiations depend on the exact definition and nature of 'justice'
used which is based on how that justice is perceived (p. 27, Ashgar, 2001).
The construct of EJ needs to acknow ledge the impacts of displacement when
attempting to create conditions conducive to appropriating accountability and
responsibility for stakeholder actions. For example, avoiding the mechanisms
that can make progress to solving EJ harms such that threats are not solved, just
merely shifted and displaced elsewhere:
¦ Svacial displacement: shifting of toxic materials from one site to another;
¦ Medium displacement: dumping toxics in the sea instead of the land (or
from one state to another);
¦ Temporal displacement, problem is delayed and displaced "into the
future", such as the long-term effects of nuclear testing, (p. 37, Ashgar,
2001).
How should our definition of EJ better account for the vulnerable, weak and
impoverished that are most impacted and incapable of serving as their own
agents. These individuals are suffering from 'unequal exchanges' in their
interconnected relationships with those wielding power over them. As such, they
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lack the true knowledge of the fundamental scale of the resource iniquity
determining their 'freedoms' to equally have their say and consensually exercise
their rights (p. 39, Ashgar, 2001).
Concevtual Manning, Mans and Concevtual Frameworks Are Needed
The nature, intensity, and duration of protracted financial, land, economic, social-political conflicts and
disputes associated with EJ are severe and costly for all involved—the rich and the poor. There is a need
for a conceptual model or framework to define, clarify, and map the desired aims and achievements for
which EJ will be operationalized, measured, and actualized. For example, philosophical roots of EJ have
both 1) justice philosophy and 2) environmental ethics components. These sub-components can contribute
to a more holistic analysis and operationalization of EJ for which to align the Administration's EJ
definition, framework model, and appropriate selection of scorecard metrics that will be successful in
working with local communities.
• Justice: one of the cardinal 'virtues' and occupies centre stage in ethics, legal, and
political philosophy in terms of 'what we owe each other' in living out our relationships
with one another, and how these relate to economic efficiency and environmental value
(Stanford Encyclopedia of Philosophy, 2021a). It involves stipulating terms of
'enforcement obligations', impartiality, corrective vs distributive aims, human vs non-
human relationships, and extent to which egalitarianism, equality is present in either
relationship (i.e. an employee) or outcomes (i.e. health exposure, poverty-housing
measure, etc.).
• Environmental Ethics: "discipline in philosophy that studies the moral relationship of
human beings to, and also the value and moral status of, the environment and its non-
human contents", (Stanford Encyclopedia of Philosophy, 2021b). It involves the
challenge presented by the delicate balancing of our environmental surroundings with
our human self-centeredness, social priorities including poverty and politically
disadvantaged groups of persons such as women (i.e. in advocating for local
communities versus military or a federal agency), the role of the relationship of
wilderness protection and poverty versus built environments for economic gain, and the
ethics of sustainability and climate change.
Example of the Catholic Church and the Laudato Si Movement
Related to environmental justice is the "integral ecology" philosophy as outlined by Pope Francis in the
2015 papal encyclical Laudato Si (LS), for which drives the operationalization, action platform, and
evaluation metrics of the Catholic Church in responding to the climate crisis (Pope Francis, 2015). LS
defines integral ecology as an interconnected relationship between human beings and our common home,
such that combined environmental and social justice philosophy can be integrated to overcome rigid
socio-economic systems by strategically focusing climate crises policy response(s) on the weakest and
most vulnerable members of our human family (Sorondo & Ramanathan, 2016; Sorondo, Frumkin, &
Ramanathan, 2018). LS action platform components emphasize holistic, cultural, community-based
resilience and empowerment mechanisms including but not limited to: ecological sustainability and
biodiversity protection, worker dignity, just agricultural practices, access to education, just finance
structures, sustainable lifestyles, and defense of all forms and stages of human life with special attention
given to the most vulnerable groups throughout social, administrative systems and social service
programs (LS Platform Goals, 2022). Although still an important aspect, notice how this is not merely
reduced to just a regulatory legal-technical definition of 'regulatory or policy code' because it uses a
theological and philosophical foundation that is rooted in the Gospel. It thus offers a valuable teaching
lesson for varying scales of application and alignment (individual, local, regional, national, international
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moral priorities). Thus LS offers an example of creating a holistic and humane 'vision' of technical, legal,
regulatory definition components and implementation aspects.
Standardized Performance Metrics for EJ Scorecard
Use of strategic plans and conceptual model frameworks are standard components to operationalizing
formal performance metrics for transparent accountability via benchmarking and scoring in public health
applications (Smith et al, 2008; Stoto, 2015). EJ has a strong public health component, thus we must be
cautious in conceiving, applying, and implementing EJ (financial, -economic, carbon science, military
and homeland security, etc.) without sufficient inclusion, recognition of, or inter-agency collaboration for
public/population health considerations.
Many of the core aspects of EJ impact or feature severely health-related outcomes for marginalized and
vulnerable populations. The challenge of prioritization, selection and use of EJ performance measurement
outcomes is ensuring validity, reliability, and utility for which to evaluate and identify equity gaps for
populations that traditionally are not empowered participants for which redress inequities. If not properly
selected and used, they may contribute to additional harms and oppression intra-generationally and inter-
generationally.
In terms of selection of reliable and valid performance measures, use of well-established metrics at the
national and international levels while also developing feedback mechanisms that account for, and
meaningfully respond to, the needs of local applications will be key. For example, the WHO defines a
climate resilient health system as one that is able to "anticipate, respond to, cope with, recover from and
adapt to climate-related shocks and stress, so as to bring sustained improvements (and system future
capacity) in population health". Final selected EJ measures related to public and population health should
be able to accurately examine and reasonably indicate performance such that sustained progress and true
achievements can be accomplished. If not wisely selected, progress will not be accurately measured and
true improvement (justice) will not occur.
Previous experience in the health insurance industry policy arena (i.e.: health sector accreditation) offers
valuable collaboration lessons in capturing meaningful metrics that business interests will tolerate,
support, collaborate with and contribute to when monitoring population health system processes and
outcomes (Smith et al, 2008; Stoto, 2015). For example: those involving the most amount of automated
precision, granularity, insights, but the least amount of technical burden for data capture for which to be
aligned across as many organizations, levels, stakeholders when generating useful insights. It's not each
stakeholder stipulating their own preferred metrics—it's a collaborative integrated approach that aligns
multiple stakeholder interests for a strategic aim. Resources for health system performance measurement
stakeholders for which to optimize use and selection of population health standardized metrics, portfolios
to monitor EJ-related health impacts include, but are not limited to:
• Centers for Medicare and Medicaid Services (CMS)
• Agency for Healthcare Research and Quality (AHRQ)
• National Quality Forum (NQF) Quality Positioning System
• Institute for Health Metrics and Evaluation (IHME) at the University of Washington
• The Joint Commission
• The National Committee for Quality Assurance
A4 p.353
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RECOMMENDATIONS
The following recommendations are made to facilitate clarification of the Administration's definition,
framework, and measurement of EJ for scorecard goals and implementation aims:
• Need 1: Accurate Definition of EJ
o There is a need for a singular, clear, succinct, holistic definition of the EJ construct for
use in the whole-of-government approach so as to facilitate coordinated integration that is
effective throughout all U.S. federal agencies in achieving EJ.
• Need 2: Holistic Conceptual Model or Framework of EJ
o There is a need for a conceptual model or framework that unites the Administration's EJ
activities for a whole of government response. This framework should be a visual figure
that can easily communicate EJ's meaning and strategic roadmap for the U.S.' whole-of-
government approach to achieving and delivering EJ. It should include the required
content areas stipulated in EO 12898 (i.e. Justice 40 and any additional Administration
and Task Force priorities) that are to be evaluated and monitored with Scorecard Metrics.
Related similarities in terms of designating a visual map and aligned performance
indicators include the United Nations Sustainable Development Goals program. This
figure can be easily communicated to local communities to facilitate improved
communication about EJ.
• Need 3: Clearly Defined Performance Measures and Contexts that Adequately Includes
Population Health
o There is a need for construct operationalization and designating performance scorecard
metrics which include population health interests to be rooted in the context of the overall
EJ conceptual model or framework. EJ performance metrics should be valid, reliable and
aligned across agencies with pre-emptive resolution of conflicting accountabilities as
much as possible to encourage broad multi-sectorial participation. The presence of
military-security, economic realities and priorities in the EJ conceptual framework should
not exclude or minimize the presence of population health constructs and measurement
outcome truths indicating the presence of grave harms.
• Need 4: Recognizing the Unseen Cultural Values and Time Periods
o Despite the whole-of-government approach and the inclusion of military branches of U.S.
government in EJ leadership, there needs to be a conceptual EJ element that is
temporal/historical, culturally-based and emphasizes correction of severe inter-
generational historical environmental injustices (i.e. military atrocities from decades ago
leading up to current contexts of continued harm). This must provide for and honor EJ in
non-traditional ways that are culturally meaningful to the communities and locales most
severely affected because it harmed that which was most valuable and is not easily
defined by standardized financial/economic/income, racial, health, employment metrics
(i.e. native languages, cultural displacements, traditional food supply, historical legacies
of ancestors, religious resources).
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CLOSING
I am grateful for the opportunity to submit these written comments. Thank you for the thoughtful
consideration of these issues. I applaud the WHEJAC and the Biden/Harris Administration's commitment
to these important matters in the service of all humanity.
Respectfully Yours in the Service of the Common Good,
Emma Kurnat-Thoma, PhD, MS, RN, FAAN
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References
Agyeman, J., Schlosberg, D., Craven, L., & Matthews, C. (2016). Trends and directions in EJ: From
inequity to everyday life, community, and just sustainabilities. The Annual Review of
Environment and Resources, 41, 321-40.
Asghar, A. (2001). A conceptual framework for EJ based on shared but differentiated responsibilities. No.
01-02, University of East Anglia, The Centre for Social and Economic Research on the Global
Environment (CSERGE), Norwich. Accessed 2/24/2022: A Conceptual Framework for
Environmental Justice based on Shared but Differentiated Responsibilities (cconstor.cu)
Banzhaf, H., Ma, L., & Timmins, C. (2019). Environmental justice: Establishing causal relationships.
Annual Review of Resource Economics, 11, 377-98.
Bryant, B. & Callewaert, J. (2003). Why is understanding urban ecosystems important to people
concerned about environmental justice'.' pp. 46-57. In A.R. Berkowitz, C.H. Nilon and K.S.
Hollweg (eds.) Understanding urban ecosystems: A new frontier for science and education.
Springer-Verlag, New York, NY.
116th Congress. (2020). H.R. 5986 Environmental Justice for All Act. Accessed 2/18/2022: Text -
H.R.5986 - 116th Congress (2019-2020V Environmental Justice For All Act | Congress.gov |
Library of Congress
Department of Energy. (2022). What is Environmental Justice? Accessed 2/18/2022: What Is
Environmental Justice? | Department of Energy
Department of Health and Human Services. (2022). Environmental Justice. Accessed 2/18/2022:
Environmental Justice | HHS.gov
Ecological Society of America. (2022). About EJ. Accessed 2/18/2022: About EJ - Environmental Justice
Section (esa.org)
Environmental Justice Task Force. (2020). Report to the Washington State Governor and Legislature:
Recommendations for prioritizing EJ in Washington state government. Accessed 2/11/2022: Page
not found | Health Equity (wa.gov)
Environmental Protection Agency. (2022). Environmental Justice. Accessed 2/18/2022: Environmental
Justice | US EPA
Institute for Health Metrics and Evaluation (IHME). (2022). Accessed 2/24/2022: Institute for Health
Metrics and Evaluation I (healthdata.org)
Laudato Si Platform Goals. (2022). Accessed 2/18/2022: Laudato Si' Goals - Laudato Si' Action Platform
(laudatosiactionplatform .org)
Mohai, P., Pellow, D., & Timmons Roberts, J. (2009). Environmental Justice. Annual Review of
Environment and Resources, 34, 405-30.
National Quality Forum. (2022). National Qualify Forum (NQF) Quality Positioning System. Accessed
2/24/2022: NQF: Quality Positioning System ™ (qualitvforum.org)
Pope Francis. (2015). Laudato Si. Encyclical letter of the Holy Father Francis on care for our common
home. Accessed 1/23/2022: Laudato si' (24 May 2015) I Francis (vatican.va)
Smith, P., Mossialos, E., & Papanicolas, I. (2008). Performance measurement for health system
improvement: Experiences, challenges and prospects. Accessed 2/24/2022: 2 (who.int)
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Sorondo, M. S., Frumkin, H., & Ramanathan, V. (2018). Health, faith, and science on a warming planet.
JAMA, 379(16), El-2.
Sorondo, M., S. & Ramanathan, V. (2016). Pursuit of integral ecology. Science, 352(6287), 747.
Stanford Encyclopedia of Philosophy. (2021a). Justice. Accessed 2/24/2022: Justice (Stanford
Encyclopedia of Philosophy)
Stanford Encyclopedia of Philosophy. (2021b). Environmental ethics. Accessed: 2/24/2022:
Environmental Ethics (Stanford Encyclopedia of Philosophy)
Stoto, M. (2015). Population health measurement: Applying performance measurement concepts in
population health settings. Generating Evidence & Methods to improve patient outcomes, 2(4),
Article 6, 1-29. Accessed 2/24/2022: Population Health Measurement: Applying Performance
Measurement Concepts in Population Health Settings (nih.gov)
The White House. (2021). Executive Order on Tackling the Climate Crisis at Home and Abroad.
Accessed 2/18/2022: Executive Order on Tackling the Climate Crisis at Home and Abroad | The
White House
A4 p.357
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ENCYCLICAL LETTER
LAUDATO SF
OF THE HOLY FATHER
FRANCIS
ON CARE FOR OUR COMMON HOME
A4 p.358
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A4 p.359
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1. "Laudato si', mi' Signore" — "Praise be to
you, my Lord". In the words of this beautiful
canticle. Saint Francis of Assist reminds us that
our common home is like a sister with whom we
share our life and a beautiful mother who opens
her arms to embrace us. "Praise be to you, my
Lord, through our Sister, Mother Earth, who
sustains and governs us, and who produces vari-
ous fruit with coloured flowers and herbs".1
2. This sister now cries out to us because of
the harm we have inflicted on her by our irre-
sponsible use and abuse of the goods with which
God has endowed her. We have come to see
ourselves as her lords and masters, entitled to
plunder her at will. The violence present in our
hearts, wounded by sin, is also reflected in the
symptoms of sickness evident in the soil, in the
water, in the air and in all forms of life. This is
why the earth herself, burdened and laid waste,
is among the most abandoned and maltreated of
our poor; she "groans in travail" (Rom 8:22). We
have forgotten that we ourselves are dust of the
earth (cf. Gen 2:7); our very bodies are made up
1 Canticle of the Creatures, in Francis of Assist: liarlj Docu-
ments, vol. 1, New York-London-Manila, 1999,113-114.
3
A4 p.360
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of her elements, we breathe her air and we re-
ceive life and refreshment from her waters.
Nothing in this world is indifferent to us
3. More than fifty years ago, with the world tee-
tering 011 the brink of nuclear crisis, Pope Saint
John XXIII wrote an Encyclical which not only
rejected war but offered a proposal for peace. He
addressed his message Pacem in Term to the en-
tire "Catholic world" and indeed "to all men and
women of good will". Now, faced as we are with
global environmental deterioration, I wish to ad-
dress every person living on this planet. I11 my
Apostolic Exhortation Evangelii Gaudium, I wrote
to all the members of the Church with the aim
of encouraging ongoing missionary renewal. In
this Encyclical, I would like to enter into dialogue
with all people about our common home.
4. I111971, eight years after Pacem in Terris, Bless-
ed Pope Paul VI referred to the ecological concern
as "a tragic consequence" of unchecked human
activity: "Due to an ill-considered exploitation of
nature, humanity runs the risk of destroying it and
becoming in turn a victim of this degradation".2
He spoke in similar terms to the Food and Agri-
culture Organization of die United Nations about
the potential for an "ecological catastrophe under
the effective explosion of industrial civilization",
and stressed "the urgent need for a radical change
2 Apostolic Letter Oclogesima Adveniens (14 May 1971), 21:
AAS 63 (1971), 416-417.
4
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in the conduct of humanity", inasmuch as "the
most extraordinary scientific advances, the most
amazing technical abilities, the most astonishing
economic growth, unless they are accompanied
by authentic social and moral progress, will defin-
itively turn against man":'
5. Saint John Paul II became increasingly con-
cerned about this issue. In his first Encyclical he
warned that human beings frequently seem "to
see no other meaning in their natural environ-
ment than what serves for immediate use and
consumption".4 Subsequently, he would call for a
global ecological conversion.5 At the same time, he
noted that little effort had been made to "safe-
guard the moral conditions for an authentic human
ecology".6 The destruction of the human environ-
ment is extremely serious, not only because God
has entrusted the world to us men and women,
but because human life is itself a gift which must
be defended from various forms of debasement.
Every effort to protect and improve our world
entails profound changes in "lifestyles, models
of production and consumption, and the estab-
lished structures of power which today govern
3 Address to FAO on the 25th Anniversary of its Institution
(16 November 1970), 4: AAS 62 (1970), 833.'
Encyclical Letter Redemptor Hominis (4 March 1979), 15:
AAS 71 (1979), 287.
3 Cf. Catechesis (17 January 2001), 4: Insegnamenti 41/1
(2001), 179.
6 Encyclical Letter Ceniesimus Annus (1 May 1991), 38:
AAS 83 (1991), 841.
5
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societies".' Authentic human development has a
moral character. It presumes full respect for the
human person, but it must also be concerned for
the world around us and "take into account the
nature of each being and of its mutual connec-
tion in an ordered system".8 Accordingly, our hu-
man ability to transform reality must proceed in
line with God's original gift of all diat is.9
6. My predecessor Benedict XVI likewise pro-
posed "eliminating the structural causes of the
dysfunctions of die world economy and correct-
ing models of growth which have proved incapa-
ble of ensuring respect for the environment".10
He observed that the world cannot be analyzed
by isolating only one of its aspects, since "the
book of nature is one and indivisible", and in-
cludes the environment, life, sexuality, the family,
social relations, and so forth. It follows that "the
deterioration of nature is closely connected to
the culture which shapes human coexistence".11
Pope Benedict asked us to recognize that the
natural environment has been gravely damaged
by our irresponsible behaviour. The social envi-
ronment has also suffered damage. Both are ulti-
7 Ibid., 58: AAS 83 (1991), p. 863.
3 John Paul II, Encyclical Letter Sollicitudo Ra Socialis (30
December 1987), 34: AAS 80 (1988), 559.
* C£ Id., Encyclical Letter Centesimus Annus (1 May 1991),
37: AAS 83 (1991),' 840.
:o Address to the Diplomatic Corps Accredited to the Holy See (8
January 2007): AAS 99 (2007), 73.
11 Encyclical Letter Carilas in Yeritate (29 June 2009), 51:
AAS 101 (2009), 687.
6
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mately due to the same evil: the notion that there
are no indisputable truths to guide our lives, and
hence human freedom is limitless. We have for-
gotten that "man is not only a freedom which he
creates for himself. Man does not create himself.
He is spirit and will, but also nature".12 With pa-
ternal concern, Benedict urged us to realize that
creation is harmed "where we ourselves have the
final word, where everything is simply our prop-
erty and we use it for ourselves alone. The misuse
of creation begins when we no longer recognize
any higher instance than ourselves, when we see
nothing else but ourselves".lj
United by the same concern
7. These statements of the Popes echo the
reflections of numerous scientists, philoso-
phers, theologians and civic groups, all of which
have enriched the Church's thinking on these
questions. Outside the Catholic Church, other
Churches and Christian communities — and oth-
er religions as well — have expressed deep con-
cern and offered valuable reflections on issues
which all of us find disturbing. To give just one
striking example, I would mention the statements
made by the beloved Ecumenical Patriarch Bar-
tholomew, with whom we share the hope of full
ecclesial communion.
12 Address to the Bundestag, Berlin (22 September 2011):
AAS 103 (2011), 664.
13 Address to the Clergy of the Diocese of Bolzano-Bressanone
(6 August 2008): AAS 100 (2008), 634.
7
A4 p.364
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8. Patriarch Bartholomew has spoken in par-
ticular of the need for each of us to repent of the
ways we have harmed the planet, for "inasmuch
as we all generate small ecological damage", we
are called to acknowledge "our contribution,
smaller or greater, to the disfigurement and de-
struction of creation".14 He has repeatedly stat-
ed this firmly and persuasively, challenging us to
acknowledge our sins against creation: "For hu-
man beings... to destroy the biological diversity
of God's creation; for human beings to degrade
the integrity'- of the earth by causing changes in
its climate, by stripping the earth of its natural
forests or destroying its wetlands; for human be-
ings to contaminate the earth's waters, its land, its
air, and its life — these are sins".15 For "to commit
a crime against the natural world is a sm against
ourselves and a sin against God".16
9. At the same time, Bartholomew- has drawn
attention to the ethical and spiritual roots of
environmental problems, which require that we
look for solutions not only in technology but in
a change of humanity; otherwise we would be
dealing merely with symptoms. Fie asks us to
replace consumption with sacrifice, greed with
generosity-, wastefulness with a spirit of sharing,
14 Message for the Day of Prayer for the Protection of Creation (1
September 2012).
15 Address in Santa Barbara, California (8 November 1997);
c£ John Chryssavgis, On Earth as in Heaven: Ecological Vision and
Initiatives of Ecumenical Patriarch Bartholomew, Bronx, New York,
2012.
Ibid.
8
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an asceticism which "entails learning to give, and
not simply to give up. It is a way of loving, of
moving gradually away from what I want to what
God's world needs. It is liberation from fear,
greed and compulsion".17 As Christians, we are
also called "to accept the world as a sacrament of
communion, as a way of sharing with God and
our neighbours on a global scale. It is our humble
conviction that the divine and the human meet
in the slightest detail in the seamless garment of
God's creation, in die last speck of dust of our
planet".18
Saint Francis of Assisi
10. I do not want to write this Encyclical with-
out turning to that attractive and compelling
figure, whose name I took as my guide and in-
spiration when I was elected Bishop of Rome.
T believe that Saint Francis is the example par
excellence of care for the vulnerable and of an
integral ecology lived out joyfully and authenti-
cally. He is the patron saint of all who study and
work in the area of ecology, and he is also much
loved by non-Christians. He was particularly
concerned for God's creation and for the poor
and outcast. He loved, and was deeply loved for
his jov, his generous self-giving, his openhearted-
ness. Tie was a mystic and a pilgrim who lived in
17 Lecture at the Monastery of Utstein, Norway (23 June
2003).
18 "Global Responsibility and Ecological Sustainability",
Closing Remarks, Haiti Summit I, Istanbul (20 June 2012).
9
A4 p.366
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simplicity and in wonderful harmony with God,
with others, with nature and with himself. He
shows us just how inseparable the bond is be-
tween concern for nature, justice for the poor,
commitment to society, and interior peace.
11. Francis helps us to see that an integral ecol-
ogy calls for openness to categories which tran-
scend the language of mathematics and biology,
and take us to the heart of what it is to be hu-
man. just as happens when we fall 111 love with
someone, whenever he would gaze at the sun, the
moon or the smallest of animals, he burst into
song, drawing all other creatures into his praise.
He communed with all creation, even preaching
to the flowrers, inviting them "to praise the Lord,
just as if they were endowed with reason".19 His
response to the world around him was so much
more than intellectual appreciation or econom-
ic calculus, for to him each and every creature
was a sister united to him by bonds of affection.
That is why he felt called to care for all that ex-
ists. His disciple Saint Bonaventure tells us that,
"from a reflection on the primary source of all
things, filled with even more abundant piety, he
would call creatures, no matter how small, by the
name of 'brother' or 'sister'".20 Such a conviction
15 Thomas of Cblano, The Life of Saint 'Francis, I, 29,
81: in Francis of Assist Early Documents, vol. 1, New York-Lon-
don-Manila, 1999, 251.
*¦' The Major Legend of Saint Francis, VIII, 6, in Francis of
Assist liarly Documents, vol. 2, New York-London-Manila, 2000,
590.
10
A4 p.367
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cannot be written off as naive romanticism, for it
affects the choices which determine our behav-
iour. If we approach nature and the environment
without this openness to awe and wonder, if we
no longer speak the language of fraternity and
beauty in our relationship with the world, our at-
titude will be that of masters, consumers, ruth-
less exploiters, unable to set limits 011 their im-
mediate needs. By contrast, if we feel intimately
united with all that exists, then sobriety and care
will well up spontaneously The poverty and aus-
terity of Saint Francis were 110 mere veneer of
asceticism, but something much more radical: a
refusal to turn reality- into an object simply to be
used and controlled.
12. What is more. Saint Francis, faithful to
Scripture, invites us to see nature as a magnifi-
cent book in which God speaks to us and grants
us a glimpse of his infinite beauty and goodness.
"Through the greatness and the beauty of crea-
tures one comes to know by analogy their mak-
er" (Wis 13:5); indeed, "his eternal power and di-
vinity have been made known through his works
since the creation of the world" (Rom 1:20). For
this reason, Francis asked that part of the friary
garden always be left untouched, so that wild
flowers and herbs could grow there, and those
who saw them could raise their minds to God,
the Creator of such beauty21 Rather than a prob-
-1 C£ Thomas of Celano, The Remembrance of the Desire of
a Sold, II, 124, 165, in Francis of Assist liarly 'Documents, vol. 2,
New Yoik-London-Manila, 2000, 354.
11
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1cm to be solved, the world is a joyful mystery to
be contemplated with gladness and praise.
My appeal
13. The urgent challenge to protect our com-
mon home includes a concern to bring the whole
human family together to seek a sustainable and
integral development, for we know that things
can change. The Creator does not abandon us;
he never forsakes his loving plan or repents of
having created us. Humanity still has the ability
to work together in building our common home.
Here I want to recognize, encourage and thank all
those striving in countless ways to guarantee the
protection of the home which we share. Particu-
lar appreciation is owed to those who tirelessly
seek to resolve the tragic effects of environmen-
tal degradation on the lives of the world's poor-
est. Young people demand change. They wonder
how anyone can claim to be building a better fu-
ture without thinking of the environmental crisis
and the sufferings of the excluded.
14. I urgently appeal, then, for a new dialogue
about how7 we are shaping the future of our plan-
et. We need a conversation which includes every-
one, since the environmental challenge we are
undergoing, and its human roots, concern and
affect us all. The worldwide ecological move-
ment has already made considerable progress
and led to the establishment of numerous or-
ganizations committed to raising awareness of
these challenges. Regrettably, many efforts to
12
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seek concrete solutions to the environmental cri-
sis have proved ineffective, not only because of
powerful opposition but also because of a more
general lack of interest. Obstructionist attitudes,
even on the part of believers, can range from de-
nial of the problem to indifference, nonchalant
resignation or blind confidence in technical solu-
tions. We require a new and universal solidarity
As the bishops of Southern Africa have stated:
"Everyone's talents and involvement are needed
to redress the damage caused by human abuse of
God's creation".22 All of us can cooperate as in-
struments of God for the care of creation, each
according to his 01* her own culture, experience,
involvements and talents.
15. It is my hope that this Encyclical Letter,
which is now added to die body of die Church's
social teaching, can help us to acknowledge the
appeal, immensity and urgency of the challenge
we face. I will begin by briefly reviewing several
aspects of the present ecological crisis, with the
aim of drawing on the results of the best scientif-
ic research available today, letting them touch us
deeply and provide a concrete foundation for the
ethical and spiritual itinerary that follows. I will
then consider some principles drawn from the
Judaeo-Christian tradition which can render our
commitment to the environment more coherent.
I will then attempt to get to the roots of the pres-
22 Southern African Catholic Bishops' Conference,
Pastoral Statement on the iinvironmental Crisis (5 September 1999).
13
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ent situation, so as to consider not only its symp-
toms but also its deepest causes. This will help to
provide an approach to ecology which respects
our unique place as human beings in this world
and our relationship to our surroundings. In light
of this reflection, I will advance some broader
proposals for dialogue and action which would
involve each of us as individuals, and also affect
international policy. Finally, convinced as I am
that change is impossible without motivation and
a process of education, I will offer some inspired
guidelines for human development to be found
in the treasure of Christian spiritual experience.
16. Although each chapter will have its own
subject and specific approach, it will also take up
and re-examine important questions previous-
ly dealt with. This is particularly the case with
a number of themes which will reappear as the
Encyclical unfolds. As examples, I will point to
the intimate relationship between the poor and
the fragility of the planet, the conviction that
everything in the wTorld is connected, the critique
of new paradigms and forms of power derived
from technology, the call to seek other ways of
understanding the economy and progress, the
value proper to each creature, the human mean-
ing of ecology, the need for forthright and honest
debate, the serious responsibility of international
and local policy, the throwaway culture and the
proposal of a new lifestyle. These questions will
not be dealt with once and for all, but retrained
and enriched again and again.
14
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CHAPTER ONE
WHAT IS HAPPENING
TO OUR COMMON HOME
17. Theological and philosophical reflections
on the situation of humanity and the world can
sound tiresome and abstract, unless they ate
grounded in a fresh analysis of our present situa-
tion, which is in many ways unprecedented in the
history of humanity So, before considering how
faith brings new incentives and requirements
with regard to the world of which we are a part,
I will briefly turn to what is happening to our
common home.
18. The continued acceleration of changes af-
fecting humanity and the planet is coupled to-
day with a more intensified pace of life and work
which might be called "rapidification". Although
change is part of the working of complex sys-
tems, the speed with which human activity has
developed contrasts with the naturally slow pace
of biological evolution. Moreover, the goals of
this rapid and constant change are not neces-
sarily geared to the common good or to integral
and sustainable human development. Change is
something desirable, yet it becomes a source of
anxiety when it causes harm to the world and to
the quality of life of much of humanity.
15
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19. Following a period of irrational confidence
in progress and human abilities, some sectors
of society are now adopting a more critical ap-
proach. We see increasing sensitivity to the en-
vironment and the need to protect nature, along
with a growing concern, both genuine and dis-
tressing, for what is happening to our planet.
Let us review, however cursorily, those questions
which are troubling us today and which we can
no longer sweep under the carpet. Our goal is
not to amass information or to satisfy curiosi-
ty, but rather to become painfully aware, to dare
to turn what is happening to the world into out-
own personal suffering and thus to discover what
each of us can do about it.
I. Pollution and climate change
Pollution, waste and the thronmvay culture
20. Some forms of pollution are part of peo-
ple's daily experience. Exposure to atmospheric
pollutants produces a broad spectrum of health
hazards, especially for the poor, and causes mil-
lions of premature deaths. People take sick, for
example, from breathing high levels of smoke
from fuels used in cooking or heating. There is
also pollution that affects everyone, caused by
transport, industrial fumes, substances which
contribute to the acidification of soil and water,
fertilizers, insecticides, fungicides, herbicides and
agrotoxins in general. Technology, which, linked
to business interests, is presented as the only way
16
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of solving these problems, in fact proves inca-
pable of seeing the mysterious network of re-
lations between things and so sometimes solves
one problem only to create others.
21. Account must also be taken of the pollution
produced by residue, including dangerous waste
present in different areas. Each year hundreds of
millions of tons of waste are generated, much of
it non-biodegradable, highly toxic and radioactive,
from homes and businesses, from construction
and demolition sites, from clinical, electronic and
industrial sources. The earth, our home, is begin-
ning to look more and more like an immense pile
of filth. In many parts of the planet, the elder-
ly lament that once beautiful landscapes are now
covered with rubbish. Industrial waste and chemi-
cal products utilized in cities and agricultural areas
can lead to bioaccumulation in die organisms of
the local population, even when levels of toxins in
those places are low. Frequently no measures are
taken until after people's health has been irrevers-
ibly affected.
22. These problems are closely linked to a
throwaway culture which affects the excluded
just as it quickly reduces tilings to rubbish. To
cite one example, most of the paper we produce
is thrown away and not recycled. It is hard for us
to accept that the way natural ecosystems work
is exemplary: plants synthesize nutrients which
feed herbivores; these in turn become food for
carnivores, which produce significant quantities
17
A4 p.374
-------
of organic waste which give rise to new genera-
tions of plants. But our industrial system, at the
end of its cycle of production and consumption,
has not developed the capacity to absorb and
reuse waste and by-products. We have not yet
managed to adopt a circular model of produc-
tion capable of preserving resources for present
and future generations, while limiting as much
as possible the use of non-renewable resources,
moderating their consumption, maximizing their
efficient use, reusing and recycling them. A seri-
ous consideration of this issue would be one way
of counteracting the throwaway culture which
affects the entire planet, but it must be said that
only limited progress has been made in this re-
gard.
Climate as a common good
23. The climate is a common good, belonging
to all and meant for all. At the global level, it is a
complex system linked to many of the essential
conditions for human life. A very solid scientific
consensus indicates that we are presently witness-
ing a disturbing warming of the climatic system.
In recent decades this warming has been accom-
panied by a constant rise in the sea level and, it
would appear, by an increase of extreme weather
events, even if a scientifically determinable cause
cannot be assigned to each particular phenom-
enon. Humanity is called to recognize the need
for changes of lifestyle, production and con-
sumption, in order to combat this warming or at
18
A4 p.375
-------
least the human causes which produce or aggra-
vate it. It is true that there are other factors (such
as volcanic activity, variations in the earth's orbit
and axis, the solar cycle), yet a number of scien-
tific studies indicate that most global warming in
recent decades is due to the great concentration
of greenhouse gases (carbon dioxide, methane,
nitrogen oxides and others) released mainly as a
result of human activity As these gases build up
in die atmosphere, they hamper the escape of
heat produced by sunlight at the earth's surface.
The problem is aggravated by a model of devel-
opment based 011 the intensive use of fossil fuels,
which is at the heart of the worldwide energy
system. Another determining factor has been an
increase in changed uses of the soil, principally
deforestation for agricultural purposes.
24. Warming has effects on the carbon cycle.
It creates a vicious circle which aggravates the
situation even more, affecting the availability of
essential resources like drinking water, energy
and agricultural production in warmer regions,
and leading to die extinction of part of the plan-
et's biodiversity The melting in the polar ice caps
and in high altitude plains can lead to the dan-
gerous release of methane gas, while die decom-
position of frozen organic material can further
increase the emission of carbon dioxide. Things
are made worse by die loss of tropical forests
which would otherwise help to mitigate climate
19
A4 p.376
-------
change. Carbon dioxide pollution increases the
acidification of the oceans and compromises the
marine food chain. If present trends continue,
this century may well witness extraordinary cli-
mate change and an unprecedented destruction
of ecosystems, with serious consequences for all
of us. A rise in die sea level, for example, can cre-
ate extremely serious situations, if we consider
that a quarter of the world's population lives on
the coast or nearby, and that the majority- of our
megacities are situated in coastal areas.
25. Climate change is a global problem with
grave implications: environmental, social, eco-
nomic, political and for the distribution of
goods. It represents one of the principal chal-
lenges facing humanity in our day Its worst im-
pact will probably be felt by developing coun-
tries in coming decades. Many of the poor live in
areas particularly affected by phenomena related
to warming, and their means of subsistence are
largely dependent 011 natural reserves and eco-
systemic services such as agriculture, fishing and
forestry They have 110 other financial activities
or resources which can enable them to adapt to
climate change or to face natural disasters, and
their access to social services and protection is
very limited. For example, changes in climate,
to which animals and plants cannot adapt, lead
them to migrate; this in turn affects the liveli-
hood of the poor, who are then forced to leave
their homes, with great uncertainty for their fu-
20
A4 p.377
-------
turc and that of their children. There has been a
tragic rise in the number of migrants seeking to
flee from the growing poverty caused by envi-
ronmental degradation. They are not recognized
by international conventions as refugees; they
bear the loss of the lives they have left behind,
without enjoying any legal protection whatso-
ever. Sadly, there is widespread indifference to
such suffering, which is even now taking place
throughout our world. Our lack of response to
these tragedies involving our brothers and sisters
points to the loss of that sense of responsibility
for our fellow men and women upon which all
civil society is founded.
26. Many of those who possess more resources
and economic or political power seem mostly to
be concerned with masking the problems or con-
cealing their symptoms, simply making efforts to
reduce some of the negative impacts of climate
change. However, many of these symptoms indi-
cate that such effects will continue to worsen if
we continue with current models of production
and consumption. There is an urgent need to de-
velop policies so that, in the next few years, the
emission of carbon dioxide and other highly pol-
luting gases can be drastically reduced, for exam-
ple, substituting for fossil fuels and developing
sources of renewable energy Worldwide there
is minimal access to clean and rene wable- energy
There is still a need to develop adequate storage
technologies. Some countries have made consid-
21
A4 p.378
-------
erable progress, although it is far from constitut-
ing a significant proportion. Investments have
also been made in means of production and
transportation which consume less energy and
require fewer raw materials, as well as in methods
of construction and renovating buildings which
improve their energy efficiency. But these good
practices are still far from widespread.
II. The issue of water
27. Other indicators of the present situation
have to do with the depletion of natural resourc-
es. We all know that it is not possible to sustain
the present level of consumption in developed
countries and wealthier sectors of society, where
the habit of wasting and discarding has reached
unprecedented levels. The exploitation of the
planet has already exceeded acceptable limits and
we still have not solved the problem of poverty.
28. Fresh drinking water is an issue of primary
importance, since it is indispensable for human
life and for supporting terrestrial and aquatic
ecosystems. Sources of fresh water are necessary
for health care, agriculture and industry. Water
supplies used to be relatively constant, but now
in many places demand exceeds the sustainable
supply, with dramatic consequences in the short
and long term. Large cities dependent on signifi-
cant supplies of water have experienced periods
of shortage, and at critical moments these have
not always been administered with sufficient
22
A4 p.379
-------
oversight and impartiality. Water poverty espe-
cially affects Africa where large sectors of the
population have no access to safe drinking water
or experience droughts which impede agricultur-
al production. Some countries have areas rich in
water while others endure drastic scarcity
29. One particularly serious problem is the
quality of water available to die poor. Every
day, unsafe water results in many deaths and the
spread of water related diseases, including those
caused by microorganisms and chemical sub-
stances. Dysentery and cholera, linked to inad-
equate hygiene and water supplies, are a signif-
icant cause of suffering and of infant mortality
Underground water sources in many places are
threatened by the pollution produced in certain
mining, farming and industrial activities, espe-
cially in countries lacking adequate regulation or
controls. It is not only a question of industrial
waste. Detergents and chemical products, com-
monly used in many places of the world, contin-
ue to pour into our rivers, lakes and seas.
30. Even as the quality of available water is
constantly diminishing, in some places there is a
growing tendency, despite its scarcity to privatize
this resource, turning it into a commodity subject
to the laws of the market. Yet access to safe drink-
able water is a basic and universal human right, since it
is essential to human survival and, as such, is a condition
for the exercise of other hum.an rights. Our world has
a grave social debt towards the poor who lack
23
A4 p.380
-------
access to drinking water, because they are denied
the right to a life consistent with their inalienable dig-
nity. This debt can be paid partly by an increase
in funding to provide clean water and sanitary
services among the poor. But water continues
to be wasted, not only in the developed world
but also in developing countries which possess
it in abundance. This shows that the problem of
water is partly an educational and cultural issue,
since there is little awareness of die seriousness
of such behaviour within a context of great in-
equality.
31. Greater scarcity of water will lead to an in-
crease in the cost of food and the various prod-
ucts which depend on its use. Some studies warn
that an acute water shortage may occur within a
fewT decades unless urgent action is taken. The
environmental repercussions could affect bil-
lions of people; it is also conceivable that the
control of water by large multinational business-
es may become a major source of conflict in this
century.23
III. Loss OF BIODIVERSITY
32. The earth's resources are also being plun-
dered because of short-sighted approaches to
the economy, commerce and production. The
loss of forests and woodlands entails the loss of
23 Cf. Greeting to the Staff of FAO (20 November 2014):
AAS 106 (2014), 985.
24
A4 p.381
-------
species which may constitute extremely impor-
tant resources in the future, not only for food
but also for curing disease and other uses. Differ-
ent species contain genes which could be key re-
sources in years ahead for meeting human needs
and regulating environmental problems.
33. It is not enough, however, to think of dif-
ferent species merely as potential "resources"
to be exploited, while overlooking the fact that
they have value in themselves. Each year sees the
disappearance of thousands of plant and animal
species which we will never know, which our
children will never see, because they have been
lost for ever. The great majority become extinct
for reasons related to human activity. Because of
us, thousands of species will no longer give glory
to God by their very existence, nor convey their
message to us. We have no such right.
34. It may well disturb us to learn of the extinc-
tion of mammals or birds, since they are more
visible. But the good functioning of ecosystems
also requires fungi, algae, worms, insects, reptiles
and an innumerable variety- of microorganisms.
Some less numerous species, although generally
unseen, nonetheless play a critical role in main-
taining die equilibrium of a particular place. Hu-
man beings must intervene when a geosvstem
reaches a critical state. But nowadays, such inter-
vention m nature has become more and more fre-
quent As a consequence, serious problems arise,
leading to further interventions; human activity
25
A4 p.382
-------
becomes ubiquitous, with all the risks which this
entails. Often a vicious circle results, as human
intervention to resolve a problem further aggra-
vates the situation. For example, many birds and
insects which disappear due to synthetic agro-
toxins are helpful for agriculture: dieir disappear-
ance will have to be compensated for by yet oth-
er techniques which may well prove harmful. We
must be grateful for the praiseworthy efforts be-
ing made by scientists and engineers dedicated to
finding solutions to man-made problems. But a
sober look at our world shows that the degree of
human intervention, often in the service of busi-
ness interests and consumerism, is actually mak-
ing our earth less rich and beautiful, ever more
limited and grey, even as technological advances
and consumer goods continue to abound limit
lessly We seem to think that we can substitute an
irreplaceable and irretrievable beauty with some-
thing which we have created ourselves.
35. In assessing the environmental impact of
any project, concern is usually shown for its ef-
fects 011 soil, water and air, yet few7 careful studies
are made of its impact on biodiversity, as if the
loss of species or animals and plant groups were
of little importance. Highways, new plantations,
the fencing-off of certain areas, the damming
of water sources, and similar developments,
crowxl out natural habitats and, at times, break
them up in such a way that animal populations
can no longer migrate or roam freely. As a re
26
A4 p.383
-------
suit, some species face extinction. Alternatives
exist which at least lessen the impact of these
projects, like the creation of biological corridors,
but few countries demonstrate such concern and
foresight. Frequently, when certain species are
exploited commercially, little attention is paid to
studying their reproductive patterns in order to
prevent their depletion and the consequent im-
balance of the ecosystem.
36. Caring for ecosystems demands far-sight-
edness, since no one looking for quick and easy
profit is truly interested in their preservation. But
the cost of the damage caused by such selfish
lack of concern is much greater than the eco-
nomic benefits to be obtained. Where certain
species are destroyed or seriously harmed, the
values involved are incalculable. We can be silent
witnesses to terrible injustices if we think that we
can obtain significant benefits by making the rest
of humanity, present and future, pay die extremely
high costs of environmental deterioration.
37. Some countries have made significant pro-
gress in establishing sanctuaries 011 land and in
the oceans where any human intervention is
prohibited which might modify their features or
alter their original structures. In the protection
of biodiversity, specialists insist on the need for
particular attention to be shown to areas richer
both in the number of species and in endemic,
rare or less protected species. Certain places need
27
A4 p.384
-------
greater protection because of their immense im-
portance for the global ecosystem, or because
they represent important water reserves and thus
safeguard other forms of life.
38. Let us mention, for example, those richly
biodiverse lungs of our planet which are the Am-
azon and the Congo basins, or the great aquifers
and glaciers. We know how important these are
for the entire earth and for the future of human-
ity. The ecosystems of tropical forests possess
an enormously complex biodiversity which is
almost impossible to appreciate fully, yet when
these forests are burned down or levelled for
purposes of cultivation, within the space of a
few years countless species are lost and the ar-
eas frequently become arid wastelands. A deli-
cate balance has to be maintained when speak-
ing about these places, for we cannot overlook
the huge global economic interests which, under
the guise of protecting them, can undermine the
sovereignty of individual nations. In fact, there
are "proposals to internationalize the Amazon,
which only serve the economic interests of
transnational corporations".24 We cannot fail to
praise the commitment of international agencies
and civil society organizations which draw public
attention to these issues and offer critical coop-
eration, employing legitimate means of pressure,
24 Fifth General Conference of the Latin .American
and Caribbean Bishops, Aparedda Document (29 June 2007), 86.
28
A4 p.385
-------
to ensure that each government carries out its
proper and inalienable responsibility to preserve
its country's environment and natural resources,
without capitulating to spurious local or interna-
tional interests.
39. The replacement of virgin forest with plan-
tations of trees, usually monocultures, is rarely
adequately analyzed. Yet this can seriously com-
promise a biodiversity which the new species be-
ing introduced does not accommodate. Similarly,
wetlands converted into cultivated land lose the
enormous biodiversity which they formerly host-
ed. In some coastal areas the disappearance of
ecosystems sustained by mangrove swamps is a
source of serious concern.
40. Oceans not only contain the bulk of our
planet's water supply, but also most of the im-
mense variety of living creatures, many of diem
still unknown to us and threatened for various
reasons. What is more, marine life in rivers, lakes,
seas and oceans, which feeds a great part of the
world's population, is affected by uncontrolled
fishing, leading to a drastic depletion of certain
species. Selective forms of fishing which discard
much of what they collect continue unabated.
Particularly threatened are marine organisms
which we tend to overlook, like some forms of
plankton; they represent a significant element in
the ocean food chain, and species used for our
food ultimately depend on them.
29
A4 p.386
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41. In tropical and subtropical seas, we find
coral reefs comparable to the great forests on dry
land, for they shelter approximately a million spe-
cies, including fish, crabs, molluscs, sponges and
algae. Many of the world's coral reefs are already
barren or in a state of constant decline. "Who
turned the wonderwork! of the seas into under-
water cemeteries bereft of colour and life?"25
This phenomenon is due largely to pollution
which reaches the sea as the result of deforesta-
tion, agricultural monocultures, industrial wTaste
and destructive fishing methods, especially those
using cyanide and dynamite. It is aggravated by
the rise in temperature of the oceans. All of this
helps us to see that every intervention in nature
can have consequences which are not immedi-
ately evident, and that certain ways of exploiting
resources prove costly in terms of degradation
which ultimately reaches the ocean bed itself.
42. Greater investment needs to be made in
research aimed at understanding more fully the
functioning of ecosystems and adequately ana-
lyzing the different variables associated with any
significant modification of the environment. Be-
cause all creatures are connected, each must be
cherished with love and respect, for all of us as
living creatures are dependent on one another.
Each area is responsible for the care of this fam-
25 Catholic Bishops' Conference of the Philippines,
Pastoral Letter What is Happening to our Beautiful Land? (29 Jan-
uary 1988).
30
A4 p.387
-------
ily. This will require undertaking a careful inven-
tory of the species which it hosts, with a view
to developing programmes and strategies of
protection with particular care for safeguarding
species heading towards extinction.
IV. Decline in the quality of human life
AND THE BREAKDOWN OF SOCIETY
43. Human beings too are creatures of this
world, enjoying a right to life and happiness, and
endowed with unique dignity. So we cannot fail
to consider the effects on people's lives of envi-
ronmental deterioration, current models of de-
velopment and the throwaway culture.
44. Nowadays, for example, we are conscious
of the disproportionate and unruly growth of
many cities, which have become unhealthy to
live in, not only because of pollution caused
by toxic emissions but also as a result of urban
chaos, poor transportation, and visual pollution
and noise. Many cities are huge, inefficient struc-
tures, excessively wasteful of energy and water.
Neighbourhoods, even those recently built, are
congested, chaotic and lacking in sufficient green
space. We wTere not meant to be inundated by ce-
ment, asphalt, glass and metal, and deprived of
physical contact with nature.
45. In some places, rural and urban alike, the
privatization of certain spaces has restricted
people's access to places of particular beauty. In
31
A4 p.388
-------
others, "ecological" neighbourhoods have been
created which are closed to outsiders in order
to ensure an artificial tranquillity. Frequendy,
we find beautiful and carefully manicured green
spaces in so-called "safer" areas of cities, but not
in the more hidden areas where the disposable of
society live.
46. The social dimensions of global change
include the effects of technological innovations
on employment, social exclusion, an inequitable
distribution and consumption of energy and
other services, social breakdown, increased vio-
lence and a rise in new forms of social aggres-
sion, drug trafficking, growing drug use by young
people, and the loss of identity. These are signs
that the growth of the past two centuries has not
always led to an integral development and an im-
provement in the quality of life. Some of these
signs are also symptomatic of real social decline,
the silent rupture of the bonds of integration
and social cohesion.
47. Furthermore, when media and the digital
world become omnipresent, their influence can
stop people from learning how to live wisely, to
think deeply and to love generously In this con-
text, the great sages of the past run the risk of
going unheard amid the noise and distractions
of an information overload. Efforts need to be
made to help these media become sources of
new cultural progress for humanity' and not a
32
A4 p.389
-------
threat to our deepest riches. True wisdom, as the
fruit of self-examination, dialogue and gener-
ous encounter between persons, is not acquired
by a mere accumulation of data which eventu-
ally leads to overload and confusion, a sort of
mental pollution. Real relationships with others,
with all the challenges they entail, now tend to
be replaced by a type of internet communication
which enables us to choose or eliminate relation-
ships at whim, thus giving rise to a new type of
contrived emotion which has more to do with
devices and displays than with other people and
with nature. Today's media do enable us to com-
municate and to share our knowledge and affec-
tions. Yet at times they also shield us from di-
rect contact with die pain, the fears and the joys
of others and the complexity of their personal
experiences. For this reason, we should be con-
cerned that, alongside the exciting possibilities
offered by these media, a deep and melancholic
dissatisfaction with interpersonal relations, or a
harmful sense of isolation, can also arise.
V. Global inequality
48. The human environment and the natural
environment deteriorate together; we cannot ad-
equately combat environmental degradation un-
less we attend to causes related to human and
social degradation. In fact, the deterioration of
the environment and of society affects the most
vulnerable people on the planet: "Both everyday
33
A4 p.390
-------
experience and scientific research show that the
gravest effects of all attacks on the environment
are suffered by the poorest".26 For example, the
depletion of fishing reserves especially hurts
small fishing communities without the means to
replace those resources; water pollution particu-
larly affects the poor who cannot buy bottled wa-
ter; and rises in die sea level mainly affect impov-
erished coastal populations who have nowhere
else to go. The impact of present imbalances is
also seen in the premature death of many of the
poor, in conflicts sparked by the shortage of re-
sources, and in any number of other problems
which are insufficiently represented on global
agendas.2''
49. It needs to be said that, generally speaking,
there is little in the way of clear awareness of
problems which especially affect die excluded.
Yet they are the majority of the planet's popu-
lation, billions of people. These days, they are
mentioned in international political and econom-
ic discussions, but one often has the impression
that their problems are brought up as an after-
thought, a question which gets added almost
out of duty or in a tangential way, if not treat-
26 Bolivian Bishops' Conference, Pastoral Letter 011 the
Environment and Human Development in Bolivia El universo,
don de Diospara la vida (23 March 2012), '17.
27 Cf. German Bishops' Conference, Commission for
Social Issues, Der Klimawandel: Brennpunki"globakr, inlergeneralioml-
ler und okologscher Gerechtigkeit (September 2006), 28-30.
34
A4 p.391
-------
ed merely as collateral damage. Indeed, when all
is said and done, they frequently remain at the
bottom of the pile. This is due partly to die fact
that many professionals, opinion makers, com-
munications media and centres of power, being
located in affluent urban areas, are far removed
from the poor, with little direct contact with their
problems. They live and reason from the com-
fortable position of a high level of development
and a quality- of life well beyond the reach of
the majority'" of the world's population. This lack
of physical contact and encounter, encouraged at
times by the disintegration of our cities, can lead
to a numbing of conscience and to tendentious
analyses which neglect parts of reality. At times
this attitude exists side by side with a "green"
rhetoric. Today, however, we have to realize that
a true ecological approach always becomes a so-
cial approach; it must integrate questions of jus-
tice 111 debates 011 the environment, so as to hear
both the cry of the earth and the cry of the poor.
50. Instead of resolving the problems of the
poor and thinking of how the world can be dif-
ferent, some can only propose a reduction in the
birth rate. At times, developing countries face
forms of international pressure which make eco-
nomic assistance contingent on certain policies
of "reproductive health". Yet "while it is true
that an unequal distribution of the population
and of available resources creates obstacles to
development and a sustainable use of the envi-
35
A4 p.392
-------
roiimeiit, it must nonetheless be recognized that
demographic growth is fully compatible with an
integral and shared development".28 To blame
population growth instead of extreme and se-
lective consumerism on the part of some, is one
way of refusing to face the issues. It is an attempt
to legitimize the present model of distribution,
where a minority believes that it has the right
to consume in a way which can never be uni-
versalized, since the planet could not even con-
tain the waste products of such consumption.
Besides, we know that approximately a third of
all food produced is discarded, and "whenever
food is thrown out it is as if it were stolen from
the table of the poor".29 Still, attention needs to
be paid to imbalances in population density, on
both national and global levels, since a rise in
consumption would lead to complex regional
situations, as a result of the interplay between
problems linked to environmental pollution,
transport, waste treatment, loss of resources
and quality of life.
51. Inequity affects not only individuals but
entire countries; it compels us to consider an
ethics of international relations. A true "ecolog-
ical debt" exists, particularly between the global
north and south, connected to commercial im-
23 Pontifical Council for Justice and Peace, Compendi-
um of the Social Doctrine of the Church, 483.
Catechesis (5 June 2013): Insegnamenli 1/1 (2013), 280.
36
A4 p.393
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balances with effects on the environment, and
the disproportionate use of natural resources by
certain countries over long periods of time. The
export of raw materials to satisfy markets in the
industrialized north has caused harm locally, as
for example in mercury pollution in gold mining
or sulphur dioxide pollution in copper mining.
There is a pressing need to calculate the use of
environmental space throughout the world for
depositing gas residues which have been accu-
mulating for two centuries and have created a
situation which currently affects all the countries
of the world. The warming caused by huge con-
sumption on the part of some rich countries has
repercussions on the poorest areas of the world,
especially Africa, where a rise in temperature, to-
gether with drought, has proved devastating for
farming. There is also the damage caused by the
export of solid waste and toxic liquids to devel-
oping countries, and by the pollution produced
by companies which operate in less developed
countries in ways they could never do at home,
in the countries in which they raise their capital:
"We note that often the businesses which op-
erate this way are multinationals. They do here
what they would never do in developed coun-
tries or the so-called first world. Generally, after
ceasing their activity and withdrawing, they leave
behind great human and environmental liabili-
ties such as unemployment, abandoned towns,
the depletion of natural reserves, deforestation,
the impoverishment of agriculture and local
37
A4 p.394
-------
stock breeding, open pits, riven hills, polluted
rivers and a handful of social works which are no
longer sustainable".30
52. The foreign debt of poor countries has be-
come a way of controlling them, yet this is not
the case where ecological debt is concerned. In
different ways, developing countries, where the
most important reserves of the biosphere are
found, continue to fuel the development of rich-
er countries at the cost of their own present and
future. The land of the southern poor is rich
and mostly unpolluted, yet access to ownership
of goods and resources for meeting vital needs
is inhibited by a system of commercial relations
and ownership which is structurally perverse.
The developed countries ought to help pay this
debt by significantly limiting their consumption
of non-renewable energy and by assisting poor-
er countries to support policies and programmes
of sustainable development. The poorest areas
and countries are less capable of adopting new
models for reducing environmental impact be-
cause they lack the wherewithal to develop the
necessary processes and to cover their costs. We
must continue to be aware that, regarding cli-
mate change, there are differentiated responsibilities.
As the United States bishops have said, greater
attention must be given to "the needs of the
30 Bishops of thf, P/vt/vgonia-Comahuf, Region (Argen-
tina), Christmas Message (December 2009), 2.
38
A4 p.395
-------
poor, the weak and the vulnerable, in a debate
often dominated by more powerful interests".31
We need to strengthen the conviction that we are
one single human family. There are 110 frontiers
or barriers, political or social, behind which we
can hide, still less is there room for the globaliza-
tion of indifference.
VI. Weak responses
53. These situations have caused sister earth,
along with all the abandoned of our world, to cry
out, pleading that we take another course. Nev-
er have we so hurt and mistreated our common
home as we have in the last two hundred years.
Yet we are called to be instruments of God our
Father, so that our planet might be what he de-
sired when he created it and correspond with his
plan for peace, beauty and fullness. The problem
is that we still lack the culture needed to confront
this crisis. We lack leadership capable of striking
out on new paths and meeting the needs of the
present with concern for all and without preju-
dice towards coming generations. The establish-
ment of a legal framework which can set clear
boundaries and ensure the protection of ecosys-
tems has become indispensable, otherwise the
new power structures based on the techno-eco-
nomic paradigm may overwhelm not only our
politics but also freedom and justice.
31 United States Conference of Catholic Bishops,
Global Climale Change: A Plea for Dialogue, Prudence and the Common
Good (15 June 2001).
39
A4 p.396
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54. It is remarkable how weak internation-
al political responses have been. The failure of
global summits on the environment make it plain
that our politics are subject to technology and
finance. There are too many special interests,
and economic interests easily end up trumping
the common good and manipulating informa-
tion so that their own plans will not be affected.
The Aparecida Document urges that "the interests
of economic groups which irrationally demol-
ish sources of life should not prevail in dealing
with natural resources".32 The alliance between
the economy and technology ends up sidelining
anything unrelated to its immediate interests.
Consequently the most one can expect is super-
ficial rhetoric, sporadic acts of philanthropy and
perfunctory expressions of concern for the envi-
ronment, whereas any genuine attempt by groups
within society to introduce change is viewed as a
nuisance based on romantic illusions or an obsta-
cle to be circumvented.
55. Some countries are gradually making sig-
nificant progress, developing more effective con-
trols and working to combat corruption. People
may well have a growing ecological sensitivity but
it has not succeeded in changing their harmful
habits of consumption which, rather than de-
creasing, appear to be growing all the more. A
simple example is the increasing use and power
32 Fifth General Conference of the Latin .American
and Caribbean Bishops, Aparecida Document (29 June 2007), 471.
40
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-------
of air-conditioning. The markets, which imme-
diately benefit from sales, stimulate ever greater
demand. An outsider looking at our world would
be amazed at such behaviour, which at times ap-
pears self-destructive.
56. In the meantime, economic powers con-
tinue to justify the current global system where
priority tends to be given to speculation and
the pursuit of financial gain, which fail to take
the context into account, let alone the effects
on human dignity and the natural environment.
Here we see how environmental deterioration
and human and ethical degradation are closely
linked. Many people will deny doing anything
wrong because distractions constantly dull our
consciousness of just how limited and finite our
world really is. As a result, "whatever is fragile,
like the environment, is defenceless before the
interests of a deified market, which become the
only rule".33
57. It is foreseeable that, once certain resources
have been depleted, the scene will be set for new
wars, albeit under the guise of noble claims. War
always does grave liar in to the environment and
to the cultural riches of peoples, risks which are
magnified when one considers nuclear arms and
biological weapons. "Despite the international
agreements which prohibit chemical, bacterio-
33 Apostolic Exhortation livangeEi Gaudium (24 Novem-
ber 2013), 56: AAS 105 (2013), 1043.
41
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-------
logical and biological warfare, the fact is that lab-
oratory research continues to develop new offen-
sive weapons capable of altering the balance of
nature".34 Politics must pay greater attention to
foreseeing new conflicts and addressing the caus-
es which can lead to them. But powerful finan-
cial interests prove most resistant to this effort,
and political planning tends to lack breadth of
vision. What would induce anyone, at this stage,
to hold on to power only to be remembered for
their inability to take action when it was urgent
and necessary to do so?
58. In some countries, there are positive exam-
ples of environmental improvement: rivers, pol-
luted for decades, have been cleaned up; native
woodlands have been restored; landscapes have
been beautified thanks to environmental renewal
projects; beautiful buildings have been erected;
advances have been made in the production of
non-polluting energy and in the improvement
of public transportation. These achievements do
not solve global problems, but they do show diat
men and women are still capable of interven-
ing positively. For all our limitations, gestures of
generosity, solidarity and care cannot but well up
within us, since we were made for love.
59. At die same time we can note the rise of a
false or superficial ecology which bolsters com-
34 John P/vut, II, Message for the 1990 World Day of Peace, 12:
AAS 82 (1990), 154.
42
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placency and a cheerful recklessness. As often
occurs in periods of deep crisis which require
bold decisions, we are tempted to think that what
is happening is not entirely clear. Superficially,
apart from a few obvious signs of pollution and
deterioration, things do not look that serious,
and the planet could continue as it is for some
time. Such evasiveness serves as a licence to car-
rying 011 with our present lifestyles and models
of production and consumption. This is the way
human beings contrive to feed their self-destruc-
tive vices: trying not to see them, trying not to
acknowledge them, delaying the important deci-
sions and pretending that nothing will happen.
VII. A VARIETY OF OPINIONS
60. Finally, we need to acknowledge that dif-
ferent approaches and lines of thought have
emerged regarding this situation and its possible
solutions. At one extreme, we find those who
doggedly uphold the myth of progress and tell
us that ecological problems will solve themselves
simply with the application of new technology
and without any need for ethical considerations
or deep change. At the other extreme are those
who view men and women and all their inter-
ventions as no more than a threat, jeopardizing
the global ecosystem, and consequently the pres-
ence of human beings on the planet should be
reduced and all forms of intervention prohibit-
ed. Viable future scenarios will have to be gen-
erated between these extremes, since there is no
43
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one path to a solution. This makes a variety of
proposals possible, all capable of entering into
dialogue with a view to developing comprehen-
sive solutions.
61. On many concrete questions, the Church
has no reason to offer a definitive opinion; she
knows that honest debate must be encouraged
among experts, while respecting divergent views.
But we need only take a frank look at the facts
to see that our common home is falling into seri-
ous disrepair. Hope would have us recognize that
there is always a way out, that we can always redi-
rect our steps, that we can always do something
to solve our problems. Still, we can see signs that
things are now reaching a breaking point, due to
the rapid pace of change and degradation; these
are evident in large-scale natural disasters as well
as social and even financial crises, for the world's
problems cannot be analyzed or explained in iso-
lation. There are regions now at high risk and,
aside from all doomsday predictions, the present
world system is certainly unsustainable from a
number of points of view, for we have stopped
thinking about the goals of human activity "If
we scan the regions of our planet, we immedi-
ately see that humanity has disappointed God's
expectations".35
35 Id., Caiechesis (17 January 2001), 3: Insegnamenti 24/1
(2001), 178.
44
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CHAPTER TWO
THE GOSPEL OF CREATION
62. Why should this document, addressed to
all people of good will, include a chapter dealing
with the convictions of believers? I am well aware
that in the areas of politics and philosophy there
are those who firmly reject the idea of a Creator,
or consider it irrelevant, and consequently dis-
miss as irrational the rich contribution which re-
ligions can make towards an integral ecology and
the full development of humanity. Others view
religions simply as a subculture to be tolerated.
Nonetheless, science and religion, with their dis-
tinctive approaches to understanding reality, can
enter into an intense dialogue fruitful for both.
I. The light offered by faith
63. Given the complexity of the ecological
crisis and its multiple causes, we need to real-
ize that the solutions will not emerge from just
one way of interpreting and transforming real-
ity. Respect must also be shown for the various
cultural riches of different peoples, their art and
poetry, their interior life and spirituality. If we
are truly concerned to develop an ecology capa-
ble of remedying the damage we have done, no
branch of the sciences and no form of wisdom
45
A4 p.402
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can be left out, and that includes religion and the
language particular to it. The Catholic Church is
open to dialogue with philosophical thought; this
has enabled her to produce various syntheses be-
tween faith and reason. The development of die
Church's social teaching represents such a syn-
thesis with regard to social issues; this teaching is
called to be enriched by talcing up new challenges.
64. Furthermore, although this Encyclical wel-
comes dialogue with everyone so that together
we can seek paths of liberation, I would like
from the outset to show how faith convictions
can offer Christians, and some other believers as
wrell, ample motivation to care for nature and for
the most vulnerable of their brothers and sisters.
If the simple fact of being human moves people
to care for the environment of which they are a
part, Christians in their turn "realize that their
responsibility within creation, and their duty to-
wards nature and the Creator, are an essential
part of their faith".36 It is good for humanity and
the world at large when we believers better rec-
ognize die ecological commitments which stem
from our convictions.
II. The wisdom of the biblical accounts
65. Without repeating the entire theology of
creation, we can ask what the great biblical nar-
36 John P/vut, II, Message for the 1990 World Day of Peace, 15:
AAS 82 (1990), 156.
46
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ratives say about tlie relationship of human beings
with the world. In the first creation account in the
Book of Genesis, God's plan includes creating
humanity. After the creation of man and woman,
"God saw everything that he had made, and be-
hold it was very good" (Gen 1:31). The Bible teaches
that every man and woman is created out of love
and made in God's image and likeness (cf. Gen
1:26). This shows us the immense dignity of each
person, "who is not just something, but someone.
He is capable of self-knowledge, of self-posses-
sion and of freely giving himself and entering into
communion with other persons".37 Saint John
Paul II stated that the special love of the Creator
for each human being "confers upon him or her
an infinite dignity".38 Those who are committed to
defending human dignity can find in the Christian
faith the deepest reasons for this commitment.
How wonderful is the certainty that each human
life is not adrift in the midst of hopeless chaos, in
a world ruled by pure chance or endlessly recur-
ring cycles! The Creator can say to each one of us:
"Before I formed you in the womb, I knew you"
(Jer 1:5). We were conceived in the heart of God,
and for this reason "each of us is the result of a
thought of God. Each of us is willed, each of us
is loved, each of us is necessary".39
37 Catechism of the Catholic Church, 357.
33 Angelns'm. Osnabriick (Germany) with the disabled, 16
November 1980: Insegnamenti 3/2 (1980), 1232.
33 Benedict XVI, Homily for the Solemn Inauguration of the
Petrine 'Ministry (24 April 2005)! AAS 97 (2005), 711.
47
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66. The creation accounts in the book of Gen-
esis contain, in their own symbolic and narrative
language, profound teachings about human ex-
istence and its historical reality. They suggest that
human life is grounded in three fundamental and
closely intertwined relationships: with God, with
our neighbour and with the earth itself. Accord-
ing to the Bible, these three vital relationships
have been broken, both outwardly and within us.
This rupture is sin. The harmony between the
Creator, humanity and creation as a whole was
disrupted by our presuming to take the place of
G od and refusing to acknowledge our creaturely
limitations. This in turn distorted our mandate
to "have dominion" over the earth (cf. Gen 1:28),
to "till it and keep it" (Gen 2:15). As a result, the
originally harmonious relationship between hu-
man beings and nature became conflictual (cf.
Gen 3:17-19). It is significant that the harmony
which Saint Francis of Assisi experienced with
all creatures was seen as a healing of that rupture.
Saint Bonaventure held that, through universal
reconciliation with every creature, Saint Fran-
cis in some way returned to the state of original
innocence.40 This is a far cry from our situation
today, where sin is manifest in all its destructive
power in wars, the various forms of violence and
abuse, the abandonment of the most vulnerable,
and attacks on nature.
*• Cf. Bonaventure, The Major Legend of Saint Fran-
cis, VIII, 1, in Francis of Assisi: liarly Documents, vol. 2, New
Yoik-London-Manila, 2000, 586.
48
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67. We are not God. The earth was here before
us and it has been given to us. This allows us
to respond to the charge that Judaeo-Christian
thinking, on the basis of the Genesis account
which grants man "dominion" over the earth (cf.
Gen 1:28), has encouraged the unbridled exploita-
tion of nature by painting him as domineering
and destructive by nature. This is not a correct
interpretation of the Bible as understood by the
Church. Although it is true that we Christians
have at times incorrectly interpreted the Scrip-
tures, nowadays we must forcefully reject the no-
tion that our being created in God's image and
given dominion over the earth justifies absolute
domination over other creatures. The biblical
texts are to be read m their context, with an ap-
propriate hernieneutic, recognizing that they tell
us to "till and keep" the garden of the world (cf.
Gen 2:15). "Tilling" refers to cultivating, plough-
ing or working, while "keeping" means caring,
protecting, overseeing and preserving. This im-
plies a relationship of mutual responsibility
between human beings and nature. Each com-
munity can take from the bounty of the earth
whatever it needs for subsistence, but it also has
the duty to protect the earth and to ensure its
fruitfulness for coming generations. "The earth
is die Lord's" (Ps 24:1); to him belongs "the earth
with all that is within it" (Dt 10:14). Thus God
rejects every claim to absolute ownership: "The
land shall not be sold in perpetuity, for the land
is mine; for you are strangers and sojourners with
me" (Lev 25:23).
49
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68. This responsibility for God's earth means
that human beings, endowed with intelligence,
must respect the laws of nature and the delicate
equilibria existing between the creatures of this
world, for "he commanded and they were creat-
ed; and he established them for ever and ever; he
fixed their bounds and he set a law which cannot
pass away" (Ps 148:5b-6). The laws found in the
Bible dwell on relationships, not only among in-
dividuals but also with other living beings. "You
shall not see your brother's donkey or his ox fall-
en down by the way and withhold your help...
If you chance to come upon a bird's nest in any
tree or on the ground, with young ones or eggs
and the mother sitting upon the young or upon
the eggs; you shall not take the mother with the
young" (Dl 22:4, 6). Along these same lines, res t
on the seventh day is meant not only for human
beings, but also so "that your ox and your don-
key may have rest" (Ex 23:12). Clearly, the Bible
has no place for a tyrannical anthropocentrism
unconcerned for other creatures.
69. Together with our obligation to use the
earth's goods responsibly, we are called to recog-
nize that other living beings have a value of their
own in God's eyes: "by their mere existence they
bless him and give him glory",41 and indeed, "the
Lord rejoices in all his works" (Ps 104:31). By vir-
tue of our unique dignity and our gift of intelli-
4i Catechism of the Catholic Church, 2416.
50
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gence, we are called to respect creation and its
inherent laws, for "the Lord by wisdom founded
the earth" (Prov 3:19). In our time, the Church
does not simply state that other creatures are
completely subordinated to the good of human
beings, as if they have no worth in themselves
and can be treated as we wish. The German bish-
ops have taught that, where other creatures are
concerned, "we can speak of the priority'" of being
over that of being useful'.A1 The Catechism clearly
and forcefully criticizes a distorted anthropocen-
tnsm: "Each creature possesses its own particu-
lar goodness and perfection... Each of the vari-
ous creatures, willed in its own being, reflects in
its own way a ray of God's infinite wisdom and
goodness. Man must therefore respect the par-
ticular goodness of every creature, to avoid any
disordered use of things".43
70. In the story of Cain and Abel, we see how
envy led Cain to commit the ultimate injustice
against his brother, which in tarn ruptured the
relationship between Cain and God, and between
Cam and the earth from which he was banished.
This is seen clearly in the dramatic exchange be-
tween God and Cain. God asks: "Where is Abel
your brother?" Cam answers that he does not
know, and God persists: "What have you done?
42 German Bishops' Conference, Zukjmft der Schopfung —
Xnkmtft der Menschheit. Einklarung der Deutschen Bischofskonferen£
%u Fragett der Umivell mid der linergieversorgung, (1980), II, 2.
43 Catechism of the Catholic Church, 339.
51
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The voice of your brother's blood is crying to me
from the ground. And now you are cursed from
the ground" (Gen 4:9-11). Disregard for the duty
to cultivate and maintain a proper relationship
with my neighbour, for whose care and custo-
dy I am responsible, ruins my relationship with
my own self, with others, with God and with the
earth. When all these relationships are neglected,
when justice no longer dwells in the land, the Bi-
ble tells us that life itself is endangered. We see
this in the story of Noah, where God threatens
to do away with humanity because of its constant
failure to fulfil the requirements of justice and
peace: "1 have determined to make an end of all
flesh; for the earth is filled with violence through
them" (Gen 6:13). These ancient stories, full of
symbolism, bear witness to a conviction which
we today share, that everything is interconnected,
and that genuine care for our own lives and our
relationships with nature is inseparable from fra-
ternity, justice and faidifulness to odiers.
71. Although "the wickedness of man was great
in the earth" (Gen 6:5) and the Lord "was sorry
that he had made man oil the earth" (Gen 6:6),
nonetheless, through Noah, who remained inno-
cent and just, God decided to open a path of sal-
vation. In this way he gave humanity the chance
of a new beginning. All it takes is one good per-
son to restore hope! The biblical tradition clear-
ly shows that this renewal entails recovering and
respecting the rhythms inscribed m nature by the
52
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hand of the Creator. We see this, for example, in
the law of the Sabbath. On the seventh day, God
rested from all his work. He commanded Israel
to set aside each seventh day as a day of rest,
a Sabbath, (cf. Gen 2:2-3; Ex 16:23; 20:10). Simi-
larly, every seven years, a sabbatical year was set
aside for Israel, a complete rest for the land (cf.
Lev 25:1-4), when sowing was forbidden and one
reaped only what was necessary to live on and
to feed one's household (cf. Lev 25:4-6). Finally,
after seven weeks of years, which is to say for-
ty-nine years, the Jubilee was celebrated as a year
of general forgiveness and "liberty throughout die
land for all its inhabitants" (cf. Lev 25:10). This law
came about as an attempt to ensure balance and
fairness in their relationships with others and with
the land on which they lived and worked. At die
same time, it was an acknowledgment that the gift
of the earth with its fruits belongs to everyone.
Those who tilled and kept the land were obliged
to share its fruits, especially with the poor, widi
widows, orphans and foreigners in their midst:
"When you reap the harvest of your land, you
shall not reap your field to its very border, neither
shall you gather the gleanings after the harvest.
And you shall not strip your vineyard bare, neither
shall you gather the fallen grapes of your vineyard;
you shall leave them for the poor and for the so-
journer" (Lev 19:9-10).
72. The Psalms frequently exhort us to praise
God the Creator, "who spread out the earth on
53
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the waters, for his steadfast love endures for ever"
(Ps 136:6). They also mvite other creatures to join
us in tins praise: "Praise him, sun and moon, praise
him, all you shining stars! Praise him, you highest
heavens, and you waters above the heavens! Let
them praise the name of the Lord, for he com-
manded and they were created" (Ps 148:3-5). We do
not only exist by God's mighty* power; we also live
with him and beside him. This is why we adore him.
73. The writings of the prophets invite us to
find renewed strength in times of trial by con-
templating the all-powerful God who created
the universe. Yet God's infinite power does not
lead us to flee his fatherly tenderness, because in
him affection and strength are joined. Indeed, all
sound spirituality entails both welcoming divine
love and adoration, confident in the Lord be-
cause of his infinite power. In the Bible, the God
who liberates and saves is the same God who cre-
ated the universe, and these two divine ways of
acting are intimately and inseparably connected:
"Ah Lord God! It is you who made the heavens
and the earth by your great power and by your
outstretched arm! Nothing is too hard for you...
You brought your people Israel out of the land
of Egypt with signs and wonders" (Jer 32:17,21).
"The Lord is the everlasting God, the Creator
of the ends of the earth. He does not faint or
grow weary; his understanding is unsearchable.
He gives power to the faint, and strengthens the
powerless" (Is 40:28b-29).
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74. The experience of the Babylonian captivi-
ty provoked a spiritual crisis which led to deeper
faith m God. Now his creative omnipotence was
given pride of place in order to exhort the people
to regain their hope in the midst of their wretched
predicament. Centuries later, in another age of tri-
al and persecution, when the Roman Empire was
seeking to impose absolute dominion, the faithful
would once again find consolation and hope in a
growing trust in the all-powerful God: "Great and
wonderful are your deeds, O Lord God the Al-
mighty! Just and true are your ways!" (Rev 15:3).
The God who created the universe out of noth-
ing can also intervene in this world and overcome
every form of evil. Injustice is not invincible.
75. A spirituality which forgets God as
all-powerful and Creator is not acceptable. That
is how we end up worshipping earthly powers,
or ourselves usurping the place of God, even
to the point of claiming an unlimited right to
trample his creation underfoot. The best way to
restore men and women to their rightful place,
putting an end to their claim to absolute domin-
ion over the earth, is to speak once more of the
figure of a Father who creates and who alone
owns the world. Otherwise, human beings will
always try to impose their own laws and inter-
ests on reality.
ill. The mystery of the universe
76. In the Judaeo-Chnstian tradition, the word
"creation" has a broader meaning than "nature",
55
A4 p.412
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for it has to do with God's loving plan in which
every creature has its own value and significance.
Nature is usually seen as a system which can be
studied, understood and controlled, whereas cre-
ation can only be understood as a gift from the
outstretched hand of the Father of all, and as a
reality illuminated by the love which calls us to-
gether into universal communion.
77. "By the word of the Lord the heavens were
made" (Ps 33:6). This tells us that the world came
about as the result of a decision, not from chaos
or chance, and this exalts it all the more. The cre-
ating word expresses a free choice. The universe
did not emerge as the result of arbitrary omnip-
otence, a show of force or a desire for self-asser-
tion. Creation is of the order of love. God's love
is the fundamental moving force in all created
things: "For you love all things that exist, and de-
test none of the things that you have made; for
you would not have made anything if you had
hated it" (Wis 11:24). Every creature is thus the
object of the Father's tenderness, who gives it its
place in the world. Even the fleeting life of the
least of beings is the object of his love, and in
its few seconds of existence, God enfolds it with
his affection. Saint Basil the Great described the
Creator as "goodness without measure",44 while
Dante Alighieri spoke of "the love which moves
44 Horn, in Hexaemeron, I, 2, 10: PG 29, 9.
56
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the sun and the stars".Consequently, we can
ascend from created things "to the greatness of
God and to his loving mercy".46
78. At the same time, Judaeo-Christian thought
demythologized nature. While continuing to ad-
mire its grandeur and immensity, it no longer saw
nature as divine. In doing so, it emphasizes all the
more our human responsibility for nature. This
rediscovery of nature can never be at the cost of
the freedom and responsibility of human beings
who, as part of the world, have the duty to culti-
vate their abilities in order to protect it and devel-
op its potential. If we acknowledge the value and
the fragility of nature and, at die same time, our
God-given abilities, we can finally leave behind
the modern myth of unlimited material progress.
A fragile world, entrusted by God to human care,
challenges us to devise intelligent ways of direct-
ing, developing and limiting our power.
79. In this universe, shaped by open and inter-
communicating systems, we can discern count-
less forms of relationship and participation. This
leads us to think of the whole as open to God's
transcendence, within which it develops. Faith
allows us to interpret the meaning and the mys-
terious beauty of what is unfolding. We are free
45 The Dime Comedy, Paradiso, Canto XXXIII, 145.
Benedict XVI, Calechesis (9 November 2005), 3: luseg-
namenli 1 (2005), 768.
57
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to apply our intelligence towards things evolving
positively, or towards adding new ills, new causes
of suffering and real setbacks. This is what makes
for the excitement and drama of human history,
in which freedom, growth, salvation and love can
blossom, or lead towards decadence and mutual
destruction. The work of the Church seeks not
only to remind everyone of the duty to care for
nature, but at the same time "she must above all
protect mankind from self-destruction".47
80. Yet God, who wishes to work with us and
who counts on our cooperation, can also bring
good out of the evil we have done. "The Holy
Spirit can be said to possess an infinite creativi-
ty, proper to the divine mind, which knows how
to loosen the knots of human affairs, including
the most complex and inscrutable".48 Creating
a world in need of development, God 111 some
way sought to limit himself ill such a way that
many of the things we think of as evils, dan-
gers or sources of suffering, are in reality part
of the pains of childbirth which he uses to draw
us into the act of cooperation with the Creator.49
47 Id., Encyclical Letter Caritas in Veritate (29 June 2009),
51: AAS 101 (2009), 687.
43 |oiin Paul II, Catechesis (24 April 1991), 6: Insegnamenti
14 (1991), 856.
49 The Catechism explains that God wished to create a
world which is "journeying towards its ultimate perfection",
and that this implies the presence of imperfection and physical
evil; cf. Catechism of the Catholic Church, 310.
58
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God is intimately present to each being, with-
out impinging on the autonomy of his creature,
and this gives rise to the rightful autonomy of
earthly affairs.50 His divine presence, which en-
sures the subsistence and growth of each being,
"continues the work of creation".31 The Spirit
of God has filled the universe with possibilities
and therefore, from the very heart of things,
something new can always emerge: "Nature is
nothing other than a certain kind of art, name-
ly God's art, impressed upon things, whereby
those things are moved to a determinate end. It
is as if a shipbuilder were able to give timbers
the wherewithal to move themselves to take the
form of a ship".52
81. Human beings, even if we postulate a pro-
cess of evolution, also possess a uniqueness
which cannot be fully explained by the evolution
of odier open systems. Each of us has his or her
own personal identity and is capable of entering
into dialogue with others and with God himself.
Our capacity to reason, to develop arguments, to
be inventive, to interpret reality and to create art,
along with other not yet discovered capacities,
are signs of a uniqueness which transcends the
3U C£ Second Vatican Ecumenical Council, Pastoral
Constitution on the Church in the Modern World Gaudium et
Spes, 36.
b! Thomas Aquinas, Summa Theologiae, I, q. 104, art 1 ad 4.
32 Id., In oclo libros Physicorum Arislolelis exposilio, lib. II,
lectio 14.
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spheres of physics and biology. The sheer novel-
ty involved in the emergence of a personal being
withm a material universe presupposes a direct
action of (i < >d and a particular call to life and to
relationship 011 the part of a "Thou" who ad-
dresses himself to another "thou". The biblical
accounts of creation invite us to see each human
being as a subject who can never be reduced to
the status of an object.
82. Yet it would also be mistaken to view other
living beings as mere objects subjected to arbitrary
human domination. When nature is viewed sole-
ly as a source of profit and gain, this has serious
consequences for society This vision of "might is
right" has engendered immense inequality, injus-
tice and acts of violence against the majority of
humanity, since resources end up in the hands of
the first comer or the most powerful: the winner
takes all. Completely at odds with this model are
the ideals of harmony, justice, fraternity and peace
as proposed by Jesus. As he said of the powers
of his own age: "You know that the rulers of the
Gentiles lord it over them, and their great men
exercise authority over them. It shall not be so
among you; but whoever would be great among
you must be your servant" (Alt 20:25-26).
83. The ultimate destiny of the universe is in
the fullness of God, which has already been at-
tained by the risen Christ, the measure of the
60
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maturity of all things.53 Here we can add yet an-
other argument for rejecting every tyrannical and
irresponsible domination of human beings over
other creatures. The ultimate purpose of other
creatures is not to be found 111 us. Rather, all crea-
tures are moving forward with us and through
us towards a common point of arrival, which is
God, in that transcendent fullness where the ris-
en Christ embraces and illumines all things. Hu-
man beings, endowed with intelligence and love,
and drawn by the fullness of Christ, are called to
lead all creatures back to their Creator.
IV. The message of each creature
IN THE HARMONY OF CREATION
84. Our insistence that each human being is
an image of God should not make us overlook
the fact that each creature has its own purpose.
None is superfluous. The entire material uni-
verse speaks of God's love, his boundless affec-
tion for us. Soil, water, mountains: everything is,
as it were, a caress of God. The history of our
friendship with God is always linked to particular
places which take on an intensely personal mean-
ing; we all remember places, and revisiting those
b3 Against this horizon we can set the contribution of
Fr Teilhard de Chardin; c£ Paul VI, Address in a Chemical and
.Pharmaceutical Plant (24 February 1966): Insegnamenti 4 (1966),
992-993; John Paul II, Letter to the Reverend George Coyne (1 June
1988): Insegnamenti 11/2 (1988), 1715; Benedict XVI, Homily for
the Celebration of Vespers in Aosta (24 July 2009): Insegnamenti 5/2
(2009), 60.
61
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memories does us much good. Anyone who has
grown up in the hills or used to sit by die spring to
drmk, or played outdoors in the neighbourhood
square; going back to these places is a chance to
recover something of their true selves.
85. God has written a precious book, "whose
letters are the multitude of created things present
in the universe".54 The Canadian bishops rightly
pointed out that no creature is excluded from
this manifestation of God: "From panoramic
vistas to the tiniest living form, nature is a con-
stant source of wonder and awe. It is also a con-
tinuing revelation of the divine".55 The bishops
of japan, for their part, made a thought-provok-
ing observation: "To sense each creature sing-
ing the hymn of its existence is to live joyfully
in God's love and hope".56 This contemplation
of creation allows us to discover in each thing
a teaching which God wishes to hand on to us,
since "for the believer, to contemplate creation
is to hear a message, to listen to a paradoxical
and silent voice".57 We can say that "alongside
revelation properly so-called, contained in sa-
b4 John Paul II, Catechesis (30 January 2002),6: Jnsegnamenti
25/1 (2002), 140.
55 Canadian Conference of Catholic Bishops, Social
Affairs Commission, Pastoral Letter You hove All that Exists...
All Things are Yours, God, hover of Life" (4 October 2003), 1.
56 Catholic Bishops' Conference of Japan, Reverence for
Life. A Message for the Twenty-First Century (1 January 2000), 89.
5/ John Paul IT, Catechesis (26 January 2000), 5: Insegnamen-
ti 23/1 (2000), 123.
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cred Scripture, there is a divine manifestation
m the blaze of the sun and the fall of night".38
Paying attention to this manifestation, we learn
to see ourselves in relation to all other creatures:
"I express myself in expressing the world; in my
effort to decipher the sacredness of the world, I
explore my own".59
86. The universe as a whole, m all its manifold
relationships, shows forth the inexhaustible rich-
es of God. Saint Thomas Aquinas wisely noted
that multiplicity and variety "come from the in-
tention of the first agent" who wiled that "what
was wanting to one in the representation of the
divine goodness might be supplied by another",60
inasmuch as God's goodness "could not be rep-
resented fittingly by any one creature".61 Hence
we need to grasp the variety of things in their
multiple relationships.62 We understand better
the importance and meaning of each creature if
we contemplate it within the entirety of God's
plan. As the Catechism teaches: "God wills the
interdependence of creatures. The sun and the
moon, the cedar and the little flower, the eagle
and the sparrow: the spectacle of their countless
diversities and inequalities tells us that no crea-
bs Id., Catecbesis (2 August 2000), 3: Insegnamenti 23/2
(2000), 112.
"9 Paul Ricoeur, PMlosophie de la Volonte, t. II: Vinitude et
Culpabilite, Paris, 2009, 216.
Summa Theobgiae, I, q. 47, art. 1.
61 m.d,
c" Cf. Ibid., art. 2, ad 1; art. 3.
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turc is self-sufficient. Creatures exist only in de-
pendence on each other, to complete each other,
in the service of each other".6j
87. When we can see God reflected in all that
exists, our hearts are moved to praise the Lord
for all his creatures and to worship him in union
with them. This sentiment finds magnificent ex-
pression in the hymn of Saint Francis of Assisi:
Praised be you, my Lord, with all your creatures,
especially Sir Brother Sun,
who is the day
and through whom you give us light.
And he is beautiful and radiant
with great splendour;
and bears a likeness of you. Most High.
Praised be you, my Lord,
through Sister Moon and the stars,
in heaven you formed them clear
and precious and beautiful.
Praised be you, my Lord,
through Brother Wind,
and through the air, cloudy and serene,
and every kind of weather
through whom you give sustenance
to your creatures.
Praised be you, my Lord, through Sister Water,
who is very useful and humble
and precious and chaste.
Praised be you, my Lord, through Brother Fire,
through whom you light the night,
63 Catechism of the Catholic Church, 340.
64
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and he is beautiful and playful
and robust and strong".64
88. The bishops of Brazil have pointed out
that nature as a whole not only manifests God
but is also a locus of his presence. The Spirit of
life dwells in every living creature and calls us to
enter into relationship with him.63 Discovering
this presence leads us to cultivate the "ecologi-
cal virtues".66 This is not to forget that there is
an infinite distance between God and the things
of this world, which do not possess his fullness.
Otherwise, we would not be doing the creatures
themselves any good either, for we would be fail-
ing to acknowledge their right and proper place.
We would end up unduly demanding of them
something which the)-, in their smallness, cannot
give us.
V. A UNIVERSAL COMMUNION
89. The created things of this world are not
free of ownership: "For they are yours, O Lord,
who love the living" {Wis 11:26). This is the basis
of our conviction that, as part of the universe,
called into being by one bather, all of us are
linked by unseen bonds and together form a kind
64 Canticle of the Creatures, in Francis of Assist Early Docu-
ments, New York-London-Manila, 1999,113-114.
°5 C£ National Conference of the Bishops of Brazil,
A Igreja e a Queslao iicologica, 1992, 53-54.
f'c Ibid., 61.
65
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of universal family, a sublime communion which
fills us with a sacred, affectionate and humble
respect. Here I would reiterate that "God has
joined us so closely to the world around us that
wre can feel the desertification of the soil almost
as a physical ailment, and the extinction of a spe-
cies as a painful disfigurement".67
90. This is not to put all living beings oil the
same level nor to deprive human beings of their
unique worth and the tremendous responsibili-
ty it entails. Nor does it imply a divinization of
the earth which would prevent us from work-
ing on it and protecting it in its fragility. Such
notions would end up creating new imbalances
which would deflect us from the reality which
challenges us.68 At times we see an obsession
with denying any pre-eminence to the human
person; more zeal is shown in protecting other
species than in defending the dignity which all
human beings share in equal measure. Certainly,
wre should be concerned lest other living bemgs
be treated irresponsibly But we should be par-
ticularly indignant at the enormous inequalities
m our midst, whereby wTe continue to tolerate
some considering themselves more worthy than
others. We fail to see that some are mired in des-
perate and degrading poverty, with no way out,
67 Apostolic Exhortation Evanglii Gaudium (24 Novem-
ber 2013), 215: AAS 105 (2013), 1109.
68 Cf. Benedict XVI, Encyclical Letter Can!,as in Veriiale
(29 June 2009), 14: AAS 101 (2009), 650.
66
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while others have not the faintest idea of what
to do with their possessions, vainly showing off
their supposed superiority and leaving behind
them so much waste which, if it were the case
everywhere, would destroy the planet. In prac-
tice, we continue to tolerate that some consider
themselves more human than others, as if they
had been born with greater rights.
91. A sense of deep communion with die rest
of nature cannot be real if our hearts lack ten-
derness, compassion and concern for our fellow
human beings. It is clearly inconsistent to combat
trafficking in endangered species while remain-
ing completely indifferent to human trafficking;
unconcerned about the poor, or undertaking to
destroy another human being deemed unwant-
ed. This compromises the very meaning of our
struggle for the sake of the environment. It is 110
coincidence that, in the canticle in which Saint
Francis praises God for his creatures, he goes 011
to say: "Praised be you my Lord, through those
who give pardon for your love". Even-thing is
connected. Concern for the environment thus
needs to be joined to a sincere love for our fellow
human beings and an unwavering commitment
to resolving the problems of society'".
92. Moreover, when our hearts are authentical-
ly open to universal communion, this sense of
fraternity excludes nothing and no one. It follows
that our indifference or cruelty' towards fellow
67
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creatures of this world sooner or later affects the
treatment we mete out to other human beings.
We have only one heart, and the same wretch-
edness which leads us to mistreat an animal will
not be long in showing itself in our relationships
with other people. Every act of cruelty towards
any creature is "contrary to human dignity".69 We
can hardly consider ourselves to be fully loving if
we disregard any aspect of reality: "Peace, justice
and the preservation of creation are three abso-
lutely interconnected themes, which cannot be
separated and treated individually without once
again falling into reductionism". 0 Everything
is related, and we human beings are united as
brothers and sisters on a wonderful pilgrimage,
woven together by the love God has for each of
his creatures and which also unites us in fond
affection with brother sun, sister moon, brother
river and mother earth.
VI. The common destination of goods
93. Whether believers or not, we are agreed
today that the earth is essentially a shared inher-
itance, whose fruits are meant to benefit every-
one. For believers, this becomes a question of
fidelity to the Creator, since God created the
world for everyone. Hence every ecological ap-
proach needs to incorporate a social perspective
~'J Catechism of the Catholic Church, 2418.
/0 Conference of Dominican Bishops, Pastoral Letter
Sob re la relation del hombre con la naturale^a (21 January 1987).
68
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which takes into account the fundamental rights
of the poor and the underprivileged. The princi-
ple of the subordination of private property to
the universal destination of goods, and thus the
right of everyone to their use, is a golden rule
of social conduct and "the first principle of the
whole ethical and social order".71 The Christian
tradition has never recognized the right to pri-
vate property as absolute or inviolable, and has
stressed the social purpose of all forms of pri-
vate property. Saint John Paul II forcefully reaf-
firmed this teaching, stating that "God gave the
earth to the whole human race for the sustenance
of all its members, without excluding or favouring
anyone" J1 These are strong words. He noted that
"a type of development which did not respect
and promote human lights — personal and so-
cial, economic and political, including the rights
of nations and of peoples — would not be real-
ly worthy of man".''3 He clearly explained that
"the Church does indeed defend the legitimate
right to private property but she also teaches no
less clearly that there is always a social mortgage
on all private property m order that goods may
serve the general purpose that God gave them".'4
/: John Paul II, Encyclical Letter haborem Exercens (14
September 1981), 19: AAS 73 (1981), 626.
Encyclical Letter Centesimus Annus (1 May 1991), 31:
AAS 83 (1991), 831.
13 Encyclical Letter SoUicitndo Rei Sodalis (30 December
1987), 33: AAS 80 (1988), 557.
14 Address to Indigenous and Kurd People, Cuilapan, Mexico
(29 January 1979), 6: A AS 71 (1979), 209.
69
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Consequently, he maintained, "it is not in accord
with God's plan that this gift be used in such a
way that its benefits favour only a few".'5 This
calls into serious question the unjust habits of a
part of humanity'.76
94. The rich and the poor have equal dignity, for
"the Lord is the maker of them all" (Prov 22:2).
"Tie himself made both small and great" (Wis(xl),
and "he makes his sun rise on the evil and on the
good" (Alt 5:45). This has practical consequenc-
es, such as those pointed out by the bishops of
Paraguay: "Every campesino has a natural right to
possess a reasonable allotment of land where he
can establish his home, work for subsistence of
his family and a secure life. This right must be
guaranteed so that its exercise is not illusory but
real. That means that apart from the ownership
of property'1, rural people must have access to
means of technical education, credit, insurance,
and markets".7'
95. The natural environment is a collective
good, the patrimony of all humanity and the re-
sponsibility of everyone. If we make something
our own, it is only to administer it for the good
75 Homily at Mass for Farmers, Recife, Brazil (7 July 1980):
AAS 72 (1980): AAS 72 (1980), 926.
76 C£ Message for the 1990 World Day of Peace, 8: AAS 82
(1990), 152.
" Paraguayan Bishops' Conference, Pastoral letter B/
catnpesinoparaguajo y la tierra (12 June 1983), 2, 4, d.
70
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of all. If we do not, we burden our consciences
with the weight of having denied the existence
of others. That is why the New Zealand bishops
asked what the commandment "Thou shalt not
kill" means when "twenty percent of the world's
population consumes resources at a rate that
robs the poor nations and future generations of
what they need to survive".78
Vll. The gaze of Jesus
96. Jesus took up the biblical faith 111 Giod the
Creator, emphasizing a fundamental truth: God
is Father (cf. Mt 11:25). In talking with his disci-
ples, Jesus would invite them to recognize the pa-
ternal relationship God has with all his creatures.
With moving tenderness he w< mid remind them
that each one of them is important in God's eyes:
"Are not five sparrows sold for two pennies?
And not one of them is forgotten before God"
(LA 12:6). "Look at the birds of the air: they nei-
ther sow nor reap nor gather into barns, and yet
your heavenly Father feeds them" (Mt 6:26).
97. The Lord was able to invite others to be
attentive to the beauty that there is in the world
because he himself was in constant touch with
nature, lending it an attention full of fondness
and wonder. As he made his way throughout the
78 New Zf \t. vcd Cathot.tc Bishops Conference, State-
ment, on ILnvironmentd Issues (1 September 2006).
71
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land, he often stopped to contemplate the beauty
sown by his Father, and invited his disciples to
perceive a divine message 111 things: "Lift up your
eyes, and see how the fields are already white for
harvest" (Jn 4:35). "The kingdom of God is like
a grain of mustard seed which a man took and
sowed in his field; it is the smallest of all seeds,
but once it has grown, it is the greatest of plants"
(Ml 13:31-32).
98. Jesus lived in full harmony with creation,
and others were amazed: "What sort of man is
this, that even the winds and the sea obey him?"
(Aft 8:27). His appearance was not that of an as-
cetic set apart from the world, nor of an ene-
my to the pleasant things of life. Of himself he
said: "The Son of Man came eating and drinking
and they say, 'Look, a glutton and a drunkard!'"
(Aft 11:19). He was far removed from philoso-
phies which despised the body, matter and the
things of the world. Such unhealthy dualisms,
nonetheless, left a mark on certain Christian think-
ers in the course of history and disfigured the Gos-
pel. Jesus worked with his hands, in daily contact
with the matter created by God, to which he gave
form by his craftsmanship. It is striking that most
of his life was dedicated to diis task in a simple
life which awakened no admiration at all: "Is not
this the carpenter, the son of Mary?" (Aft 6:3). In
diis way he sanctified human labour and endowed
it with a special significance for our development.
As Saint John Paul II taught, "by enduring the toil
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of work in union with Christ crucified for us, mail
in a way collaborates with the Soil of God for the
redemption of humanity".79
99. In the Christian understanding of the world,
the destiny of all creation is bound up with the
mystery of Christ, present from the beginning:
"All things have been created though him and for
him" (G?/1:16).80 The prologue of die Gospel of
John (1:1-18) reveals Christ's creative work as the
Divine Word (Logos). But then, unexpectedly, the
prologue goes on to say that this same Word "be-
came flesh" (J/?1:14). One Person of the Trinity
entered into the created cosmos, throwing in his
lot with it, even to the cross. From the begin-
ning of the world, but particularly through the
incarnation, the mystery of Christ is at work in a
hidden manner in the natural world as a whole,
without thereby impinging on its autonomy.
100. The New Testament does not only tell us
of the earthly Jesus and his tangible and loving
relationship with the world. It also shows him
risen and glorious, present throughout creation
by his universal Lordship: "For m him all the full-
ness of God was pleased to dwell, and through
him to reconcile to himself all things, whether oil
earth or in heaven, making peace by the blood of
19 Encyclical Letter Laborem Exercens (14 September
1981), 27: AAS 73 (1981), 645.
80 Hence Saint Justin could speak of "seeds of the Word"
m the world; cf. II Apologia 8, 1-2; 13, 3-6: PG 6, 457-458, 467.
73
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his cross" (Col 1:19-20). This leads us to direct
our gaze to the end of time, when the Son will
deliver all things to the Father, so that "God may
be everything to every one" (/ Cor 15:28). Thus,
the creatures of this world no longer appear to
us under merely natural guise because the risen
One is mysteriously holding them to himself and
directing them towards fullness as their end. The
verv flowers of the field and the birds which his
j
human eyes contemplated and admired are now
imbued with his radiant presence.
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CHAPTER 'THREE
THE HUMAN ROOTS
OF THE ECOLOGICAL CRISIS
101. It would hardly be helpful to describe
symptoms without acknowledging the human
origins of the ecological crisis. A certain way
of understanding human life and activity has
gone awry, to the serious detriment of the world
around us. Should we not pause and consid-
er this? At this stage, I propose that we focus
on the dominant technocratic paradigm and the
place of human beings and of human action in
the world.
I. Technology: creativity and power
102. Humanity has entered a new era in which
our technical prowess has brought us to a cross-
roads. We are the beneficiaries of two centuries
of enormous waves of change: steam engines,
railways, the telegraph, electricity, automobiles,
aeroplanes, chemical industries, modern medi-
cine, information technology and, more recently,
the digital revolution, robotics, biotechnologies
and nanotechnologies. It is right to rejoice in
these advances and to be excited bv the immense
j
possibilities which they continue to open up be-
fore us, for "science and technology are wonder-
75
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ful products of a God-given human creativity".81
The modification of nature for useful purposes
has distinguished the human family from the be-
ginning; technology itself "expresses the inner
tension that impels man gradually to overcome
material limitations".82 Technology has reme-
died countless evils which used to harm and lim-
it human beings. How can we not feel gratitude
and appreciation for this progress, especially in
the fields of medicine, engineering and commu-
nications? How could wTe not acknowledge the
work of many scientists and engineers who have
provided alternatives to make development sus-
tainable?
103. Technoscience, when well directed, can
produce important means of improving the
quality of human life, from useful domestic ap-
pliances to great transportation systems, bridges,
buildings and public spaces. It can also produce
art and enable men and women immersed in the
material world to "leap" into the world of beau-
ty. Who can deny the beauty of an aircraft or
a skyscraper? Valuable works of art and music
now make use of new technologies. So, in the
beauty intended by the one who uses new tech-
nical instruments and in the contemplation of
35 John Paul II, Address to Scientists and Representatives of
the United Nations University, Hiroshima (25 February 1981), 3:
AAS 73 (1981), 422.
82 Benedict XVT, Encyclical Letter Cantos in Verilale (29
June 2009), 69: AAS 101 (2009), 702.
76
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such beauty, a quantum leap occurs, resulting in a
fulfilment which is uniquely human.
104. Yet it must also be recognized that nucle-
ar energy, biotechnology, information technol-
ogy, knowledge of our DNA, and many other
abilities which we have acquired, have given us
tremendous power. More precisely, they have
given those with the knowledge, and especially
the economic resources to use them, an impres-
sive dominance over the whole of humanity and
the entire world. Never has humanity had such
power over itself, yet nothing ensures that it will
be used wisely particularly when we consider
how it is currently being used. We need but think
of the nuclear bombs dropped in the middle of
the twentieth century, or the array of technolo-
gy which Nazism, Communism and other total-
itarian regimes have employed to kill millions of
people, to say nothing of the increasingly deadly
arsenal of weapons available for modern war-
fare. In whose hands does all this power lie, or
will it eventually end up? It is extremely risky for
a small part of humanity to have it.
105. There is a tendency to believe that every
increase in p< nver means "an increase of 'pro-
gress' itself", an advance in "security, usefulness,
welfare and vigour; ...an assimilation of new
values into the stream of culture",83 as if reality,
83 Romano Guardini, DasEnde derNeurit, 9th e<±, Wiirz-
burg, 1965, 87 (English: 'The Hud of the Modem World, Wilming-
ton, 1998, 82). '
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goodness and truth automatically flow from tech-
nological and economic power as such. The fact
is that "contemporary man has not been trained
to use power well",84 because our immense tech-
nological development has not been accompa-
nied by a development in human responsibility,
values and conscience. Each age tends to have
only a meagre awareness of its own limitations.
It is possible that we do not grasp the gravity of
the challenges now before us. "The risk is grow-
ing day by day that man will not use his power as
he should"; m effect, "power is never considered
in terms of the responsibility of choice which is
inherent in freedom" since its "only norms are
taken from alleged necessity, from either utility
or security".83 But human beings are not com-
pletely autonomous. Our freedom fades when
it is handed over to the blind forces of the un-
conscious, of immediate needs, of self-interest,
and of violence. In this sense, we stand naked
and exposed m the face of our ever-increasing
power, lacking the wherewithal to control it. We
have certain superficial mechanisms, but we can-
not claim to have a sound ethics, a culture and
spirituality genuinely capable of setting limits
and teaching clear-minded self-restraint.
II. The globalization
OF THE TECHNOCRATIC PARADIGM
106. The basic problem goes even deeper: it is
the way that humanity has taken up technology
84 Ibid.
8-' Ibid., 87-88 (The Utid of the Modem World. 83).
78
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and its development according to an undifferentiated
and one-dimensional paradigm. This paradigm exalts
the concept of a subject who, using logical and
rational procedures, progressively approaches
and gains control over an external object. This
subject makes every effort to establish the scien-
tific and experimental method, which in itself is
already a technique of possession, mastery and
transformation. It is as if the subject were to
find itself in the presence of something form-
less, completely open to manipulation. Men and
women have constantly intervened in nature, but
for a long time this meant being in tune with and
respecting the possibilities offered by the things
themselves. It was a matter of receiving what na-
ture itself allowed, as if from its own hand. Now,
by contrast, we are the ones to lay our hands 011
things, attempting to extract everything possible
from them while frequently ignoring or forget-
ting the reality in front of us. Human beings and
material objects no longer extend a friendly hand
to one another; the relationship has become
confrontational. This has made it easy to accept
the idea of infinite or unlimited growth, which
proves so attractive to economists, financiers and
experts in technology. It is based on the lie that
there is an infinite supply of the earth's goods,
and this leads to the planet being squeezed dry
beyond every limit. It is the false notion that
"an infinite quantity of energy and resources
are available, that it is possible to renew them
quickly, and that the negative effects of the ex
79
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ploitation of the natural order can be easily ab-
sorbed".86
107. It can be said that many problems of
today's world stem from the tendency, at times
unconscious, to make the method and aims of
science and technology an epistemologica.1 par-
adigm which shapes the lives of individuals and
the workings of society The effects of imposing
this model on reality as a whole, human and so-
cial, are seen in the deterioration of the environ-
ment, but this is just one sign of a reductionism
which affects every aspect of human and social
life. We have to accept that technological prod-
ucts are not neutral, for they create a framework
which ends up conditioning lifestyles and shap-
ing social possibilities along the lines dictated by
the interests of certain powerful groups. Deci-
sions wThich may seem purely instrumental are
in reality decisions about the kind of society we
want to build.
108. The idea of promoting a different cultural
paradigm and employing technology as a mere
instrument is nowadays inconceivable. The tech-
nological paradigm has become so dominant diat
it would be difficult to do without its resources
and even more difficult to utilize them without
being dominated by their internal logic. It has be-
come countercultural to choose a lifestyle whose
86 Pontific/vt. Council for Justice and Pf,acf, CompencE-
um of the Social Doctrine of the Church, 462.
80
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goals are even partly independent of technology,
of its costs and its power to globalize and make
us all the same. Technology tends to absorb
everything into its ironclad logic, and those who
are surrounded with technology "know full well
that it moves forward in the final analysis neither
for profit nor for the well-being of the human
race", that "in the most radical sense of the term
power is its motive — a lordship over all".8 As a
result, "man seizes hold of the naked elements
of both nature and human nature".88 Our capaci-
ty for making decisions, a more genuine freedom
and the space for each one's alternative creativity-
are diminished.
109. The technocratic paradigm also tends to
dominate economic and political life. The econ-
omy accepts every advance in technology with
a view to profit, without concern for its poten-
tially negative impact 011 human beings. Finance
overwhelms the real economy. The lessons of
the global financial crisis have not been assimilat-
ed, and we are learning all too slowly the lessons
of environmental deterioration. Some circles
maintain that current economics and technol-
ogy will solve all environmental problems, and
argue, in popular and non-technical terms, that
the problems of global hunger and poverty will
be resolved simply by market growth. They are
87 Romano Guardini, Das Ende der Neurit, 63-64 (The
find of the Modem World, 56).
88 Ibid., 64 (The End of the Modern World, 56).
81
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less concerned with certain economic theories
which today scarcely anybody dares defend, than
with their actual operation in the functioning of
the economy They may not affirm such theo-
ries with words, but nonetheless support them
with their deeds by showing 110 interest in more
balanced levels of production, a better distribu-
tion of wealth, concern for the environment and
the rights of future generations. Their behav-
iour shows that for them maximizing profits is
enough. Yet by itself the market cannot guaran-
tee integral human development and social inclu-
sion.89 At the same time, we have "a sort of 'su-
perdevelopment' of a wasteful and consumerist
kind which forms an unacceptable contrast with
the ongoing situations of dehumanizing depri-
vation",90 while we are all too slow in developing
economic institutions and social initiatives which
can give the poor regular access to basic resourc-
es. We fail to see the deepest roots of our pres-
ent failures, which have to do with the direction,
goals, meaning and social implications of tech-
nological and economic growth.
110. The specialization which belongs to tech-
nology makes it difficult to see the larger picture.
The fragmentation of knowledge proves helpful
for concrete applications, and yet it often leads
39 Cf. Benedict XVI, Encyclical Letter Caritas in Veritate
(29 June 2009), 35: A AS 101 (2009), 671.
90 Ibid., 22: p. 657.
82
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to a loss of appreciation for the whole, for the
relationships between things, and for the broad-
er horizon, which then becomes irrelevant. This
very fact makes it hard to find adequate ways of
solving the more complex problems of today's
world, particularly those regarding the environ-
ment and the poor; these problems cannot be
dealt with from a single perspective or from a
single set of interests. A science which would of-
fer solutions to the great issues would necessarily
have to take into account the data generated by
other fields of knowledge, including philosophy
and social ethics; but this is a difficult habit to
acquire today. Nor are there genuine ethical ho-
rizons to which one can appeal. Life gradually
becomes a surrender to situations conditioned
by technology, itself viewed as the principal key
to the meaning of existence. In the concrete sit-
uation confronting us, there are a number of
symptoms which point to what is wrong, such as
environmental degradation, anxiety, a loss of the
purpose of life and of community living. Once
more we see that "realities are more important
than ideas".91
111. Ecological culture cannot be reduced to
a series of urgent and partial responses to the
immediate problems of pollution, environmen-
tal decay and the depletion of natural resources.
91 Apostolic Exhortation livangeEi Gaudium (24 Novem-
ber 2013), 231: AAS 105 (2013), 1114.
83
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There needs to be a distinctive way of looking at
things, a way of thinking, policies, an education-
al programme, a lifestyle and a spirituality which
together generate resistance to the assault of the
technocratic paradigm. Otherwise, even the best
ecological initiatives can find themselves caught
up in die same globalized logic. To seek only a
technical remedy to each environmental problem
which comes up is to separate what is in reality
interconnected and to mask the true and deepest
problems of the global system.
112. Yet we can once more broaden our vision.
We have the freedom needed to limit and direct
technology; we can put it at the service of an-
other type of progress, one which is healthier,
more human, more social, more integral. Liber-
ation from the dominant technocratic paradigm
does in fact happen sometimes, for example,
when cooperatives of small producers adopt
less polluting means of production, and opt for
a non-consumerist model of life, recreation and
community. Or when technology is directed pri-
marily to resolving people's concrete problems,
truly helping them live with more dignity and less
suffering. Or indeed when the desire to create
and contemplate beauty manages to overcome
reductionism through a kind of salvation which
occurs in beauty and 111 those who behold it. An
authentic humanity calling for a new synthesis,
seems to dwell in the midst of our technologi-
cal culture, almost unnoticed, like a mist seeping
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gently beneath a closed door. Will the promise
last, in spite of everything, with all that is authen-
tic rising up in stubborn resistance?
113. There is also the fact that people no longer
seem to believe in a happy future; they no longer
have blind trust in a better tomorrow based on
the present state of the world and our technical
abilities. There is a growing awareness that scien-
tific and technological progress cannot be equated
with the progress of humanity and history, a grow-
ing sense that the way to a better future lies else-
where. This is not to reject the possibilities which
technology continues to offer us. But humanity
has changed profoundly, and the accumulation
of constant novelties exalts a superficiality which
pulls us in one direction. It becomes difficult to
pause and recover depth in life. If architecture
reflects the spirit of an age, our megastructures
and drab apartment blocks express die spirit of
globalized technology where a constant flood of
new products coexists with a tedious monotony
Let us refuse to resign ourselves to this, and con-
tinue to wonder about the purpose and meaning
of everything. Otherwise wTe would simply legiti-
mate the present situation and need new forms of
escapism to help us endure the emptiness.
114. All of this shows the urgent need for us
to move forward in a bold cultural revolution.
Science and technology are not neu tral; from the
beginning to the end of a process, various inten-
85
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tions and possibilities are in play and can take on
distinct shapes. Nobody is suggesting a return to
the Stone Age, but we do need to slow down and
look at reality in a different way, to appropriate
the positive and sustainable progress which has
been made, but also to recover the values and
the great goals swept away by our unrestrained
delusions of grandeur.
III. The crisis and effects
OF MODERN ANTHROPOCENTRISM
115. Modern anthropocentrism has paradoxi-
cally ended up prizing technical thought over real
ity, since "the technological mind sees nature as an
insensate order, as a cold body of facts, as a mere
'given', as an object of utility'', as raw material to be
hammered into useful shape; it views the cosmos
similarly as a mere 'space' into which objects can
be throw7n with complete indifference".92 The in-
trinsic dignity of the world is thus compromised.
When human beings fail to find their true place
in this world, they misunderstand themselves and
end up acting against themselves: "Not only has
God given the earth to man, who must use it with
respect for the original good purpose for which
it was given, but, man too is God's gift to man.
He must therefore respect die natural and moral
structure with which he has been endowed".93
92 Romano Guardini, Das Ende der Neurit, 63 (The End of
the Modern World, 55).
33 John Paut, II, Encyclical L-etter Cenlesimus Annus
(1 May 1991), 38: AAS 83 (1991), 841.
86
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116. Modernity has been marked by an exces-
sive anthropocentrism which today, under anoth-
er guise, continues to stand in the way of shared
understanding and of any effort to strengthen
social bonds. The time has come to pay renewed
attention to reality and the limits it imposes; this
in turn is the condition for a more sound and
fruitful development of individuals and society*
An inadequate presentation of Christian anthro-
pology gave rise to a wrong understanding of
the relationship between human beings and the
world. Often, what was handed on was a Pro-
methean vision of mastery over the world, which
gave the impression that the protection of na-
ture was something that only the faint-hearted
cared about. Instead, our "dominion" over the
universe should be understood more properly in
the sense of responsible stewardship.94
117. Neglecting to monitor die harm done to
nature and the environmental impact of our de-
cisions is only the most striking sign of a disre-
gard for the message contained in the structures
of nature itself. When we fail to acknowledge as
part of reality the worth of a poor person, a hu-
man embryo, a person with disabilities — to offer
just a few examples — it becomes difficult to hear
the cry of nature itself; everything is connected.
Once the human being declares independence
94 C£ Love for Creation. An Asian Response to the Lcokgical
Crisis, Declaration of the Colloquium sponsored by the Fed-
eration of Asian Bishops' Conferences (Tagatay, 31 January-5
February 1993), 3.3.2.
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from reality and behaves with absolute dominion,
the very foundations of our life begin to crumble,
for "instead of carrying out his role as a cooper-
ator with God m the work of creation, man sets
himself up in place of God and thus ends up pro-
voking a rebellion on the part of nature".93
'118. This situation has led to a constant schiz-
ophrenia, wherein a technocracy which sees no
intrinsic value in lesser beings coexists with the
other extreme, which sees no special value in
human beings. But one cannot prescind from
humanity. There can be no renewal of our re-
lationship with nature without a renewal of hu-
manity itself. There can be no ecology without
an adequate anthropology. When the human
person is considered as simply one being among
others, the product of chance or physical deter-
minism, then "our overall sense of responsibility
wanes".96 A misguided anthropocentrism need
not necessarily yield to "biocentrism", for that
wrould entail adding yet another imbalance, fail
mg to solve present problems and adding new
ones. Human beings cannot be expected to feel
responsibility for the world unless, at the same
time, their unique capacities of knowledge, will,
freedom and responsibility are recognized and
valued.
95 John Paul II, Encyclical Letter Centesimus Annus
(1 May 1991), 37: AAS 83 (1991), 840.
36 Benedict XVI, Message for I,he 2010 World Day of Peace,
2: AAS 102 (2010), 41.
88
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119. Nor must the critique of a misguided an-
thropocentrism underestimate the importance
of interpersonal relations. If the present ecolog-
ical crisis is one small sign of the ethical, cultural
and spiritual crisis of modernity, we cannot pre-
sume to heal our relationship with nature and
the environment without healing all fundamen-
tal human relationships. Christian thought sees
human beings as possessing a particular dignity
above other creatures; it thus inculcates esteem
for each person and respect for others. Out-
openness to others, each of whom is a "thou"
capable of knowing, loving and entering into
dialogue, remains the source of our nobility as
human persons. A correct relationship with the
created world demands that we not weaken this
social dimension of openness to others, much
less the transcendent dimension of our openness
to the "Thou" of God. Our relationship with the
environment can never be isolated from our re-
lationship with others and with God. Otherwise,
it would be nothing more than romantic individ-
ualism dressed up in ecological garb, locking us
into a stifling immanence.
120. Since everything is interrelated, concern
for the protection of nature is also incompatible
with the justification of abortion. How can we
genuinely teach the importance of concern for
other vulnerable beings, however troublesome or
inconvenient they may be, if we fail to protect
a human embryo, even when its presence is 1111-
89
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comfortable and creates difficulties? "If person-
al and social sensitivity towards the acceptance
of the new life is lost, then other forms of ac-
ceptance that are valuable for society also wither
away".9'
121. We need to develop a new synthesis ca-
pable of overcoming the false arguments of re-
cent centuries. Christianity', in fidelity to its own
identity and the rich deposit of truth which it has
received from jesus Christ, continues to reflect
on these issues in fruitful dialogue with chang-
ing historical situations. In doing so, it reveals its
eternal newness.98
Practical relativism
122. A misguided anthropocentrism leads to
a misguided lifestyle. In the Apostolic Exhorta-
tion Evangelii Gaudium, I noted that the practical
relativism typical of our age is "even more dan-
gerous than doctrinal relativism".99 When hu-
man beings place themselves at the centre, they
give absolute priority to immediate convenience
and all else becomes relative. Hence we should
not be surprised to find, in conjunction with the
omnipresent technocratic paradigm and the cult
"7 Id., Encyclical Letter Cantos in Vmtafc (29 June 2009),
28: AAS 101 (2009), 663.
93 Cf. Vincent of Lerins, Commonitorimn Primmn, cli. 23:
PL 50, 688: "Ut annis scilicet consolidetur, dilatetur tempore,
sublimetur aetate".
99 No. 80: AAS 105 (2013), 1053.
90
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of unlimited human power, the rise of a relativ-
ism which sees everything as irrelevant unless it
serves one's own immediate interests. There is a
logic in all this whereby different attitudes can
feed 011 one another, leading to environmental
degradation and social decay.
123. The culture of relativism is the same disor-
der which drives one person to take advantage of
another, to treat others as mere objects, impos-
ing forced labour on them or enslaving them to
pay their debts. The same kind of thinking leads
to the sexual exploitation of children and aban-
donment of the elderly who 110 longer serve our
interests. It is also the mindset of those who sav:
j
Let us allow the invisible forces of the market to
regulate the economy, and consider their impact
on society and nature as collateral damage. In the
absence of objective truths or sound principles
other than the satisfaction of our own desires
and immediate needs, what limits can be placed
on human trafficking, organized crime, the drug
trade, commerce in blood diamonds and the fur
of endangered species? Is it not the same rela-
tivistic logic which justifies buying the organs of
the poor for resale or use in experimentation, or
eliminating children because they are not what
their parents wanted? This same "use and throw
away" logic generates so much waste, because
of the disordered desire to consume more than
what is really necessary. We should not think that
political efforts or the force of law will be suffi-
91
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cient to prevent actions which affect the environ-
ment because, when the culture itself is corrupt
and objective truth and universally valid principles
are no longer upheld, then laws can only be seen
as arbitrary impositions or obstacles to be avoided.
The need to protect employment
124. Any approach to an integral ecology, which
by definition does not exclude human beings,
needs to take account of the value of labour, as
Saint John Paul II wisely noted in his Encyclical
Laborem Exercens. According to the biblical ac-
count of creation, God placed man and woman in
the garden he had created (cf. Gen 2:15) not only
to preserve it ("keep") but also to make it fruitful
("till"). Labourers and craftsmen thus "maintain
the fabric of the world" (Sir 38:34). Developing
the created world in a prudent way is the best way
of caring for it, as this means that we ourselves
become the instrument used by God to bring
out the potential which he himself inscribed in
things: "The Lord created medicines out of the
earth, and a sensible man will not despise them"
(JVr 38:4).
'125. If we reflect on the proper relationship
between human beings and the world around us,
we see the need for a correct understanding of
work; if we talk about the relationship between
human beings and things, the question arises as
to the meaning and purpose of all human activ-
ity. This has to do not only with manual or agri-
92
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cultural labour but with any activity involving a
modification of existing reality, from producing
a social report to die design of a technological
development. Underlying every form of work is
a concept of the relationship which we can and
must have with what is other than ourselves. To-
gether with the awe-filled contemplation of crea-
tion which we find in Saint Francis of Assisi, the
Christian spiritual tradition has also developed a
rich and balanced understanding of the meaning
of work, as, for example, in the life of Blessed
Charles de Foucauld and his followers.
126. We can also look to the great tradition of
monasticism. Originally, it was a kind of flight
from the world, an escape from the decadence
of the cities. The monks sought the desert,
convinced that it was the best place for encoun-
tering the presence of God. Later, Saint Benedict
of Norcia proposed that his monks live in com-
munity, combining prayer and spiritual reading
with manual labour (ora et labor a). Seeing manual
labour as spiritually meaningful proved revolu-
tionary. Personal growth and sanctification came
to be sought in the interplay of recollection and
work. This way of experiencing work makes us
more protective and respectful of the environ-
ment; it imbues our relationship to the world
with a healthy sobriety.
127. We are convinced that "man is the source,
the focus and the aim of all economic and social
93
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life".100 Nonetheless, once our human capacity
for contemplation and reverence is impaired, it
becomes easy for the meaning of work to be mis-
understood.101 We need to remember that men
and women have "the capacity to improve their
lot, to further their moral growth and to develop
their spiritual endowments".1"2 Work should be
the setting for this rich personal growth, where
many aspects of life enter into play: creativity,
planning for die future, developing our talents,
living out our values, relating to others, giving
glory to God. It follows that, in the reality of
today's global society it is essential that "we con-
tinue to prioritize the goal of access to steady
employment for everyone",l1" no matter the lim-
ited interests of business and dubious economic
reasoning.
128. We were created with a vocation to work.
The goal should not be that technological pro-
gress increasingly replace human work, for this
wrould be detrimental to humanity Work is a ne-
cessity; part of the meaning of life on this earth,
a path to growth, human development and per
100 Second Vatican Ecumenical Council, Pastoral Con-
stitution on the Church in the Modern World Gaudium et Spes,
63.
"lul C£ John Paul II, Encyclical Letter Centesimus Annus
(1 May 1991), 37: AAS 83 (1991), 840.
102 Paul VI, Encyclical Letter I'opulorum Prqgressio (26
March 1967), 34: AAS 59 (1967), 274.
103 Benedict XVI, Encyclical Letter Cantos in Verilate
(29 June 2009), 32: AAS 101 (2009), 666.
94
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sonal fulfilment. Helping the poor financially
must always be a provisional solution in the face
of pressing needs. The broader objective should
always be to allc >\v them a dignified life through
work. Yet the orientation of the economy has fa-
voured a kind of technological progress in which
the costs of production are reduced by laying
off workers and replacing them with machines.
This is yet another way in which we can end up
working against ourselves. The loss of jobs also
has a negative impact on the economy "through
the progressive erosion of social capital: the net-
work of relationships of trust, dependability, and
respect for rules, all of which are indispensable
for any form of civil coexistence".104 In other
words, "human costs always include economic
costs, and economic dysfunctions always involve
human costs".103 To stop investing in people, in
order to gam greater short-term financial gam, is
bad business for society.
129. In order to continue providing employ-
ment, it is imperative to promote an economy
which favours productive diversity and business
creativity. For example, there is a great variety
of small-scale food production systems which
feed the greater part of the world's peoples, us-
ing a modest amount of land and producing less
waste, be it in small agricultural parcels, in or-
chards and gardens, hunting and wild harvesting
104 ibid.
105 ibid.
95
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or local fishing. Economies of scale, especially
111 the agricultural sector, end up forcing small-
holders to sell their land or to abandon their tra-
ditional crops. Their attempts to move to other,
more diversified, means of production prove
fruitless because of the difficulty of linkage with
regional and global markets, or because the infra-
structure for sales and transport is geared to larg-
er businesses. Civil authorities have the right and
duty to adopt clear and firm measures in support
of small producers and differentiated produc-
tion. To ensure economic freedom from which
all can effectively benefit, restraints occasionally
have to be imposed on those possessing great-
er resources and financial power. To claim eco-
nomic freedom while real conditions bar many
people from actual access to it, and while possi-
bilities for employment continue to shrink, is to
practise a doublespeak which brings politics into
disrepute. Business is a noble vocation, directed
to producing wealth and improving our world.
It can be a fruitful source of prosperity for the
areas in which it operates, especially if it sees the
creation of jobs as an essential part of its service
to the common good.
New biological technologies
130. In the philosophical and theological vi-
sion of the human being and of creation which
T have presented, it is clear that the human per-
son, endowed with reason and knowledge, is not
an external factor to be excluded. While human
96
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intervention on plants and animals is permissi-
ble when it pertains to the necessities of human
life, the Catechism of the Catholic Church teaches
that experimentation on animals is morally ac-
ceptable only "if it remains within reasonable
limits [and] contributes to caring for or saving
human lives".106 The Catechism firmly states that
human power has limits and that "it is contrary
to human dignity to cause animals to suffer or
die needlessly".107 All such use and experimenta-
tion "requires a religious respect for the integrity
of creation".108
131. Here I would recall the balanced position
of Saint John Paul II, who stressed the benefits
of scientific and technological progress as evi-
dence of "the nobility of the human vocation
to participate responsibly in God's creative ac-
tion", while also noting that "we cannot inter-
fere in one area of the ecosystem without pay-
ing due attention to the consequences of such
interference in other areas".109 He made it clear
that die Church values the benefits which result
"from the study and applications of molecular
biology, supplemented by other disciplines such
as genetics, and its technological application in
agriculture and industry".110 But he also point
1"6 Catechism of the Catholic Church, 2417.
107 Ibid., 2418.
108 Ibid., 2415.
109 Message for the 1990 World Day of Peace, 6: AAS 82
(1990), 150.
1Ul Address to the Pontifical Academy of Sciences (3 October
1981), 3: Insegnamenti 4/2 (1981), 333.
97
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ed out that this should not lead to "indiscrimi-
nate genetic manipulation"111 which ignores the
negative effects of such interventions. Human
creativity cannot be suppressed. If an artist can-
not be stopped from using his or her creativity,
neither should those who possess particular gifts
for the advancement of science and technology
be prevented from using their God-given talents
for the service of others. We need constantly to
rethink the goals, effects, overall context and eth-
ical limits of this human activity, which is a form
of power involving considerable risks.
132. This, then, is the correct framework for
any reflection concerning human intervention on
plants and animals, which at present includes ge-
netic manipulation by biotechnology for the sake
of exploiting the potential present in material re-
ality. The respect owed by faidi to reason calls for
close attention to what the biological sciences,
through research uninfluenced by economic in-
terests, can teach us about biological structures,
their possibilities and their mutations. Any legiti-
mate intervention will act on nature only in order
"to favour its development in its own line, that
of creation, as intended by God".112
133. It is difficult to make a general judgement
about genetic modification (GM), whether veg-
111 Message for the 1990 World Day of Peace, 7: AAS 82
(1990), 151.
iU John Paut, II, Address to the 35th General Assembly of the
World Medical Association (29 October 1983), 6: AAS 76 (1984), 394.
98
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etable or animal, medical or agricultural, since
these vary greatly among themselves and call
for specific considerations. The risks involved
are not always due to the techniques used, but
rather to their improper or excessive application.
Genetic mutations, in fact, have often been, and
continue to be, caused by nature itself. Nor are
mutations caused by human intervention a mod-
ern phenomenon. The domestication of animals,
the crossbreeding of species and other older and
universally accepted practices can be mentioned
as examples. We need but recall that scientific de-
velopments in GM cereals began with the obser-
vation of natural bacteria which spontaneously
modified plant genomes. In nature, however, this
process is slow and cannot be compared to the
fast pace induced by contemporary technological
advances, even when the latter build upon several
centuries of scientific progress.
134. Although no conclusive proof exists that
GM cereals may be harmful to human beings, and
in some regions their use has brought about eco-
nomic growth which has helped to resolve prob-
lems, there remain a number of significant diffi-
culties which should not be underestimated. In
many places, following the introduction of these
crops, productive land is concentrated in the
hands of a few owners due to "the progressive
disappearance of small producers, who, as a con-
sequence of the loss of the exploited lands, are
99
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obliged to withdraw from direct production".113
The most vulnerable of these become temporary
labourers, and many rural workers end up mov-
ing to poverty-stricken urban areas. The expan-
sion of these crops has the effect of destroying
the complex network of ecosystems, diminishing
the diversity of production and affecting region-
al economies, now and in the future. In various
countries, we see an expansion of oligopolies for
the production of cereals and other products
needed for their cultivation. This dependency
would be aggravated were the production of in-
fertile seeds to be considered; the effect would
be to force farmers to purchase them from larger
producers.
135. Certainly, these issues require constant at-
tention and a concern for their ethical implica-
tions. A broad, responsible scientific and social
debate needs to take place, one capable of con-
sidering all the available information and of call-
ing things by their name. It sometimes happens
that complete information is not put on the table;
a selection is made on the basis of particular in-
terests, be they politico-economic or ideological.
This makes it difficult to reach a balanced and
prudent judgement on different questions, one
which takes into account all the pertinent vari-
ables. Discussions are needed in which all those
directly or indirectly affected (farmers, cotisum-
113 Episcopal Commission for Pastoral Concerns in
Argentina, Una tierrapara todos (June 2005), 19.
100
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ers, civil authorities, scientists, seed producers,
people living near fumigated fields, and others)
can make known their problems and concerns,
and have access to adequate and reliable infor-
mation in order to make decisions for the com-
mon good, present and future. This is a complex
environmental issue; it calls for a comprehensive
approach which would require, at the very least,
greater efforts to finance various lines of inde-
pendent, interdisciplinary research capable of
shedding new light 011 the problem.
136. On the other hand, it is troubling that,
when some ecological movements defend the
integrity of the environment, rightly demanding
that certain limits be imposed on scientific re-
search, they sometimes fail to apply those same
principles to human life. There is a tendency to
justify transgressing all boundaries when exper-
imentation is carried out on living human em-
bryos. We forget that die inalienable worth of
a human being transcends his or her degree of
development. In the same way, when technology
disregards the great ethical principles, it ends up
considering any practice whatsoever as licit. As
we have seen in this chapter, a technology sev-
ered from ethics will not easily be able to limit its
own power.
101
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A4 p.459
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CHAPTER FOUR
INTEGRAL ECOLOGY
137. Since everything is closely interrelated,
and today's problems call for a vision capable
of taking into account every aspect of the glob-
al crisis, I suggest that we now consider some
elements of an integral ecology, one which clearly
respects its human and social dimensions.
I. Environmental, economic
AND SOCIAL ECOLOGY
'138. Ecology studies the relationship between
living organisms and the environment in which
they develop. This necessarily entails reflection
and debate about the conditions required for
the life and survival of society, and the honesty
needed to question certain models of develop-
ment, production and consumption. It cannot be
emphasized enough how everything is intercon-
nected. Time and space are not independent of
one another, and not even atoms or subatom-
ic particles can be considered in isolation. Just
as the different aspects of the planet — physical,
chemical and biological — are interrelated, so too
living species are part of a network which we will
never fully explore and understand. A good part
of our genetic code is shared by many living be
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ings. It follows that the fragmentation of knowl-
edge and the isolation of bits of information can
actually become a form of ignorance, unless they
are integrated into a broader vision of reality.
139. When we speak of the "environment",
what we really mean is a relationship existing
between nature and the society which lives in it.
Nature cannot be regarded as something sepa-
rate from ourselves or as a mere setting in which
we live. We are part of nature, included in it and
thus in constant interaction with it. Recognizing
the reasons why a given area is polluted requires
a study of the workings of society, its economy,
its behaviour patterns, and the ways it grasps re-
ality. Given the scale of change, it is no longer
possible to find a specific, discrete answer for
each part of the problem. It is essential to seek
comprehensive solutions which consider the in-
teractions within natural systems themselves and
with social systems. We are faced not with two
separate crises, one environmental and the other
social, but rather with one complex crisis which
is both social and environmental. Strategies for a
solution demand an integrated approach to com-
bating poverty, restoring dignity to the excluded,
and at the same time protecting nature.
'140. Due to the number and variety of factors
to be taken into account when determining the
environmental impac t of a concrete under taking,
it is essential to give researchers their due role, to
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facilitate their interaction, and to ensure broad
academic freedom. Ongoing research should
also give us a better understanding of how dif-
ferent creatures relate to one another in making
up the larger units which today we term "ecosys-
tems". We take these systems into account not
only to determine how bes t to use them, but also
because they have an intrinsic value independent
of their usefulness. Each organism, as a creature
of God, is good and admirable in itself; the same
is true of the harmonious ensemble of organ-
isms existing in a defined space and functioning
as a system. Although we are often not aware
of it, we depend on these larger systems for our
own existence. We need only recall how ecosys-
tems interact 111 dispersing carbon dioxide, puri-
fying water, controlling illnesses and epidemics,
forming soil, breaking down waste, and in many
other ways which we overlook or simply ignore.
Once they become conscious of this, many peo-
ple realize that we live and act on the basis of
a reality which has previously been given to us,
which precedes our existence and our abilities.
So, when we speak of "sustainable use", consid-
eration must always be given to each ecosystem's
regenerative ability m its different areas and as-
pects.
'141. Economic growth, for its part, tends
to produce predictable reactions and a certain
standardization with the aim of simplifying pro-
cedures and reducing costs. This suggests the
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need for an "economic ecology" capable of ap-
pealing to a broader vision of reality. The pro-
tection of the environment is in fact "an integral
part of the development process and cannot be
considered in isolation from it".114 We urgendy
need a humanism capable of bringing togeth-
er the different fields of knowledge, including
economics, in die service of a more integral and
integrating vision. Today, the analysis of envi-
ronmental problems cannot be separated from
the analysis of human, family, work-related and
urban contexts, nor from how individuals relate
to themselves, which leads in turn to how they
relate to others and to the environment. There
is an interrelation between ecosystems and be-
tween the various spheres of social interaction,
demonstrating yet again that "the whole is great-
er than the part".115
142. If everything is related, then the health of a
society's institutions has consequences for the en-
vironment and the quality of human life. "Every
violation of solidarity and civic friendship harms
the environment".116 In this sense, social ecology
is necessarily institutional, and gradually extends
to the whole of society7, from the primary social
group, the family, to the wider local, national and
114 Rio Declaration on Environment and Development (14 June
1992), Principle 4.
Apostolic Exhortation Hvangelii Gaudium (24 Novem-
ber 2013), 237: AAS 105 (2013), 1116.
116 Benedict XVI, Encyclical Letter Carilas in Ventale (29
June 2009), 51: AAS 101 (2009), 687.
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international communities. Within each social
stratum, and between them, institutions develop
to regulate human relationships. Anything which
weakens those institutions has negative conse-
quences, such as injustice, violence and loss of
freedom. A number of countries have a relatively
low level of institutional effectiveness, which re-
sults 111 greater problems for their people while
benefiting those wTho profit from this situation.
Whether in the administration of the state, the
various levels of civil society, or relationships be-
tween individuals themselves, lack of respect for
the law is becoming more common. Laws may-
be well framed yet remain a dead letter. Can we
hope, then, that in such cases, legislation and reg-
ulations dealing with die environment will real-
ly prove effective? We know, for example, that
countries which have clear legislation about the
protection of forests continue to keep silent as
they watch laws repeatedly being broken. More-
over, what takes place in any one area can have a
direct or indirect influence on other areas. Thus,
for example, drug use in affluent societies creates
a continual and growing demand for products
imported from poorer regions, where behaviour
is corrupted, lives are destroyed, and the envi-
ronment continues to deteriorate.
II. Cultural ecology
143. Together with the patrimony of nature,
there is also an historic, artistic and cultural pat
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rimony which is likewise under threat. This patri-
mony is a part of the shared identity of each place
and a foundation upon which to build a habitable
city It is not a matter of tearing down and build-
ing new cities, supposedly more respectful of the
environment yet not always more attractive to
live in. Rather, there is a need to incorporate the
history, culture and architecture of each place,
thus preserving its original identity. Ecology,
then, also involves protecting the cultural trea-
sures of humanity in the broadest sense. More
specifically, it calls for greater attention to local
cultures when studying environmental problems,
favouring a dialogue between scientific-technical
language and the language of the people. Culture
is more than what we have inherited from the
past; it is also, and above all, a living, dynamic
and participatory present reality, which cannot be
excluded as we rethink the relationship between
human beings and the environment.
144. A consumerist vision of human beings,
encouraged by the mechanisms of today's glo-
balized economy, has a levelling effect on cul-
tures, diminishing the immense variety which
is the heritage of all humanity Attempts to re-
solve all problems through uniform regulations
or technical interventions can lead to overlook-
ing the complexities of local problems which
demand the active participation of all members
of the community-. New processes taking shape
cannot always fit into frameworks imported
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from outside; they need to be based m the local
culture itself. As life and die world are dynamic
realities, so our care for the world must also be
flexible and dynamic. Merely technical solutions
run the risk of addressing symptoms and not
the more serious underlying problems. There is
a need to respect the rights of peoples and cul-
tures, and to appreciate that the development of
a social group presupposes an historical process
which takes place within a cultural context and
demands the constant and active involvement of
local people from within their proper culture. Nor can
the notion of the quality of life be imposed from
without, for quality of life must be understood
within the world of symbols and customs proper
to each human group.
145. Many intensive forms of environmental
exploitation and degradation not only exhaust
the resources which provide local communities
with their livelihood, but also undo the social
structures which, for a long time, shaped cultural
identity and their sense of the meaning of life
and community. The disappearance of a cul-
ture can be just as serious, or even more serious,
than the disappearance of a species of plant or
animal. The imposition of a dominant lifestyle
linked to a single form of production can be just
as harmful as the altering of ecosystems.
146. In this sense, it is essential to show spe-
cial care for indigenous communities and their
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cultural traditions. They are not merely one mi-
nority among others, but should be the principal
dialogue partners, especially when large projects
affecting their land are proposed. For them, land
is not a commodity but rather a gift from God
and from their ancestors who rest there, a sacred
space with which they need to interact if they
are to maintain their identity and values. When
they remain on their land, they themselves care
for it best. Nevertheless, in various parts of the
world, pressure is being put on them to abandon
their homelands to make room for agricultural
or mining projects which are undertaken without
regard for the degradation of nature and culture.
III. Ecology of daily life
147. Authentic development includes efforts
to bring about an integral improvement in the
quality of human life, and this entails considering
the setting in which people live their lives. These
settings influence the way we think, feel and act.
In our rooms, our homes, our workplaces and
neighbourhoods, we use our environment as a
way of expressing our identity. We make every
effort to adapt to our environment, but when it
is disorderly, chaotic or saturated with noise and
ugliness, such overstimulation makes it difficult
to find ourselves integrated and happy.
148. An admirable creativity and generosity is
shown by persons and groups who respond to
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environmental limitations by alleviating the ad-
verse effects of their surroundings and learning
to live their lives amid disorder and uncertainty.
For example, in some places, where the facades
of buildings are derelict, people show great care
for the interior of their homes, or find content-
ment in the kindness and friendliness of others.
A wholesome social life can light up a seemingly
undesirable environment. At times a commend-
able human ecology is practised by the poor
despite numerous hardships. The feeling of as-
phyxiation brought on by densely populated resi-
dential areas is countered if close and warm rela-
tionships develop, if communities are created, if
the limitations of the environment are compen-
sated for in the interior of each person who feels
held within a network of solidarity and belong-
ing. In this way, any place can turn from being a
hell on earth into the setting for a dignified life.
149. The extreme poverty'- experienced in ar-
eas lacking harmony, open spaces or potential
for integration, can lead to incidents of brutality
and to exploitation by criminal organizations. In
the unstable neighbourhoods of mega-cities, the
daily experience of overcrowding and social ano-
nymity can create a sense of uprootedness which
spawns antisocial behaviour and violence. None-
theless, I wish to insist that love always proves
more powerful. Many people in these conditions
are able to weave bonds of belonging and to-
getherness which convert overcrowding into an
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experience of community in which the walls of
the ego are torn down and the barriers of selfish-
ness overcome. This experience of a communi-
tarian salvation often generates creative ideas for
the improvement of a building or a neighbour-
hood.117
150. Given the interrelationship between living
space and human behaviour, those who design
buildings, neighbourhoods, public spaces and
cities, ought to draw on the various disciplines
which help us to understand people's thought
processes, symbolic language and ways of act-
ing. It is not enough to seek the beauty of de-
sign. More precious still is the service we offer to
another kind of beauty: people's quality of life,
their adaptation to the environment, encounter
and mutual assistance. Here too, we see how7 im-
portant it is that urban planning always take into
consideration the views of those who will live in
these areas.
151. There is also a need to protect those com-
mon areas, visual landmarks and urban land-
scapes which increase our sense of belonging,
of rootedness, of "feeling at home" within a
city which includes us and brings us together.
Some authors have emphasized the values frequent-
ly found, for example, in the villas, chabolas or favelas of Latin
America: cf. Juan Carlos Scannone, S.J., "La irrupcion del po-
bre y la logica de la gratuidad", in Juan Carlos Scannone and
Marcf.lo Perine (eds.), Irruption delpobrey quehacerfdosofico. Hatia
una nueva rationalidacl Buenos Aires, 1993, 225-230.
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It is important that the different parts of a city-
be well integrated and that those who live there
have a sense of the whole, rather than being con-
fined to one neighbourhood and failing to see
the larger city as space which they share with oth-
ers. Interventions which affect the urban or ru-
ral landscape should take into account how var-
ious elements combine to form a whole which
is perceived by its inhabitants as a coherent and
meaningful framework for their lives. Others will
then no longer be seen as strangers, but as part
of a "we" which all of us are working to create.
For this same reason, in both urban and rural set-
tings, it is helpful to set aside some places which
can be preserved and protected from constant
changes brought by human intervention.
152. Lack of housing is a grave problem in
many parts of the world, both in rural areas and
in large cities, since state budgets usually cover
only a small portion of the demand. Not only
the poor, but many other members of society as
well, find it difficult to own a home. Having a
home has much to do with a sense of person-
al dignity and the growth of families. This is a
major issue for human ecology. In some places,
where makeshift shanty towns have sprung up,
this will mean developing those neighbourhoods
rather than razing or displacing them. When the
poor live in unsanitary slums or in dangerous
tenements, "in cases where it is necessary to re-
locate them, in order not to heap suffering upon
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suffering, adequate information needs to be giv-
en beforehand, with choices of decent housing
offered, and the people directly involved must be
part of the process".118 At the same time, crea-
tivity should be shown 111 integrating rundown
neighbourhoods into a welcoming city: "How
beautiful diose cities which overcome paralyz-
ing mistrust, integrate diose who are different
and make this very integration a new factor of
development! I Tow attractive are those cities
which, even in their architectural design, are full
of spaces which connect, relate and favour the
recognition of others!"119
153. The quality of life in cities has much to
do with systems of transport, which are often
a source of much suffering for those who use
them. Many cars, used by one or more people,
circulate in cities, causing traffic congestion,
raising the level of pollution, and consuming
enormous quantities of non-renewable energy.
This makes it necessary to build more roads and
parking areas which spoil the urban landscape.
Many specialists agree on the need to give prior-
ity to public transportation. Yet some measures
needed will not prove easily acceptable to society
unless substantial improvements are made in the
systems themselves, which in many cities force
118 Pontifical Council For Justice And Peace, Compen-
dium of the Social Doctrine of the Church, 482.
Apostolic Exhortation Ylvangelii Gaudium (24 Novem-
ber 2013), 210: AAS 105 (2013), 1107.
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people to put up with undignified conditions due
to crowding, inconvenience, infrequent service
and lack of safety.
154. Respect for out dignity as human beings
often jars with the chaotic realities that people
have to endure in city life. Yet this should not
make us overlook the abandonment and ne-
glect also experienced by some rural populations
which lack access to essential services and where
some workers are reduced to conditions of servi-
tude, without rights or even the hope of a mote
dignified life.
155. Human ecology also implies another pro-
found reality: the relationship between human
life and the moral law, which is inscribed in our
nature and is necessary for the creation of a mote
dignified environment. Pope Benedict XVI spoke
of an "ecology of man", based on the fact that
"man too has a nature that he must respect and
that he cannot manipulate at will".120 It is enough
to recognize that our body itself establishes us in
a direct relationship with the environment and
with other living beings. The acceptance of out-
bodies as God's gift is vital for welcoming and
accepting the entire world as a gift from the Fa-
ther and our common home, whereas thinking
that we enjoy absolute power over our own bod
120 Address to the German Bundestag, Berlin (22 September
2011): AAS 103 (2011), 668.
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ies turns, often subtly, into thinking that we enjoy
absolute power over creation. Learning to accept
our body, to care for it and to respect its fullest
meaning, is an essential element of any genuine
human ecology. Also, valuing one's own body in
its femininity or masculinity is necessary if I am
going to be able to recognize myself in an en-
counter with someone who is different. In this
way we can joyfully accept the specific gifts of
another man or woman, the work of God the
Creator, and find mutual enrichment. It is not
a healthy attitude which would seek "to cancel
out sexual difference because it no longer knows
how to confront it".121
IV. The principle of the common good
156. An integral ecology is inseparable from
the notion of the common good, a central and
unifying principle of social ethics. The common
good is "the sum of those conditions of social
life which allow social groups and their individu-
al members relatively thorough and ready access
to their own fulfilment".122
157. Underlying the principle of the common
good is respect for the human person as such,
endowed with basic and inalienable rights or-
521 Catechesis (15 April 2015): UOsservatore Romano, 16
April 2015, p. 8.
122 Second Vatican Ecumenical Council, Pastoral Con-
stitution on the Church in the Modern World Gaudium el Spes,
26.
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dered to his or her integral development. It has
also to do with the overall welfare of society and
the development of a variety of intermediate
groups, applying the principle of subsidiarity.
Outstanding among those groups is the family,
as the basic cell of society. Finally, the common
good calls for social peace, the stability and secu-
rity provided by a certain order which cannot be
achieved without particular concern for distrib-
utive justice; whenever this is violated, violence
always ensues. Society as a whole, and the state
in particular, are obliged to defend and promote
the common good.
158. In the present condition of global soci-
ety, where injustices abound and growing num-
bers of people are deprived of basic human
rights and considered expendable, the principle
of the common good immediately becomes,
logically and inevitably, a summons to solidarity
and a preferential option for the poorest of our
brothers and sisters. This option entails recog-
nizing the implications of the universal destina-
tion of the world's goods, but, as I mentioned in
the Apostolic Exhortation Evangelii Gaudium,123 it
demands before all else an appreciation of the
immense dignity of the poor in the light of our
deepest convictions as believers. We need only
look around us to see that, today, this option is in
fact an ethical imperative essential for effectively
attaining the common good.
1:" C£ Nos. 186-201: AAS 105 (2013), 1098-1105.
117
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V. Justice between the generations
159. The notion of the common good also ex-
tends to future generations. The global economic
crises have made painfully obvious the detrimen-
tal effects of disregarding our common destiny,
which cannot exclude those who come after us.
We can 110 longer speak of sustainable devel-
opment apart from intergenerational solidarity
Once we start to think about the kind of world
we are leaving to future generations, we look at
things differently; we realize that the world is a
gift which we have freely received and must share
with others. Since the world has been given to
us, we can no longer view reality in a purely util-
itarian way, 111 which efficiency and productivi-
ty are entirely geared to our individual benefit.
Intergenerational solidarity is not optional, but
rather a basic question of justice, since the world
we have received also belongs to those who will
follow us. The Portuguese bishops have called
upon us to acknowledge this obligation of jus-
tice: "The environment is part of a logic of re-
ceptivity It is on loan to each generation, which
must then hand it on to the next".124 An integral
ecology is marked by this broader vision.
160. What kind of world do we want to leave
to those who come after us, to children who are
now growing up? This question not only concerns
124 Portuguese Bishops' Conference, Pastoral Letter Re-
sponsaUHdade Sotidariapelo Bern Comum (15 September 2003), 20.
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the environment in isolation; the issue cannot be
approached piecemeal. When we ask ourselves
what kind of world we want to leave behind, we
think in the first place of its general direction, its
meaning and its values. Unless we struggle with
these deeper issues, I do not believe that our con-
cern for ecology will produce significant results.
But if those issues are courageously faced, we
are led inexorably to ask other pointed questions:
What is the purpose of our life in this world?
Why are we here? What is the goal of our work
and all our efforts? What need does the earth
have of us? It is no longer enough, then, simply
to state that wTe should be concerned for future
generations. We need to see that what is at stake
is our own dignity Leaving an inhabitable planet
to future generations is, first and foremost, up to
us. The issue is one which dramatically affects us,
for it has to do with the ultimate meaning of our
earthly sojourn.
161. Doomsday predictions can 110 longer be
met with irony or disdain. We may wTell be leav-
ing to coming generations debris, desolation and
filth. The pace of consumption, waste and envi-
ronmental change has so stretched the planet's
capacity that our contemporary lifestyle, unsus-
tainable as it is, can only precipitate catastrophes,
such as those which even now periodically occur
in different areas of the world. The effects of the
present imbalance can only be reduced by our
decisive action, here and now. We need to reflect
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on our accountability before those who will have
to endure the dire consequences.
162. Our difficulty in taking up this challenge
seriously has much to do with an ethical and cul-
tural decline which has accompanied the deteri-
oration of the environment. Men and women of
our postmodern world run the risk of rampant
individualism, and many problems of society
are connected with today's self-centred culture
of instant gratification. We see this in the crisis
of family and social ties and the difficulties of
recognizing the odier. Parents can be prone to
impulsive and wasteful consumption, which then
affects their children who find it increasingly dif-
ficult to acquire a home of their own and build
a family. Furthermore, our inability to think se-
riously about future generations is linked to our
inability to broaden the scope of our present in-
terests and to give consideration to those who
remain excluded from development. Let us not
only keep the poor of the fixture in mind, but
also today's poor, whose life on this earth is brief
and who cannot keep on waiting. Hence, "in ad-
dition to a fairer sense of intergenerational sol-
idarity there is also an urgent moral need for a
renewed sense of intragenerational solidarity".125
12b Benedict XVI, Message for the 2010 World Day of Peace,
8: AAS 102 (2010), 45.
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CHAPTER FIVE
LINES OF APPROACH AND ACTION
163. So far I have attempted to take stock of
our present situation, pointing to the cracks in
the planet that we inhabit as well as to the pro-
foundly human causes of environmental degra-
dation. Although the contemplation of this re-
ality in itself has already shown the need for a
change of direction and other courses of action,
now we shall try to outline the major paths of
dialogue which can help us escape the spiral of
self-destruction which currently engulfs us.
1. Dialogue on the environment
IN THE INTERNATIONAL COMMUNITY
164. Beginning in the middle of the last cen-
tury and overcoming many difficulties, there has
been a growing conviction that our planet is a
homeland and that humanity is one people living
in a common home. An interdependent world
not only makes us more conscious of the neg-
ative effects of certain lifestyles and models of
production and consumption which affect us all;
more importantly, it motivates us to ensure that
solutions are proposed from a global perspective,
and not simply to defend the interests of a few
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countries. Interdependence obliges us to think
of one world with a common plan. Yet the same inge-
nuity which has brought about enormous tech-
nological progress has so far proved incapable
of finding effective ways of dealing with grave
environmental and social problems worldwide. A
global consensus is essential for confronting the
deeper problems, which cannot be resolved by
unilateral actions on the part of individual coun-
tries. Such a consensus could lead, for example,
to planning a sustainable and diversified agri-
culture, developing renewable and less polluting
forms of energy, encouraging a more efficient
use of energy, promoting a better management
of marine and forest resources, and ensuring
universal access to drinking water.
165. We know that technology based on the use
of highly polluting fossil fuels — especially coal,
but also oil and, to a lesser degree, gas — needs
to be progressively replaced without delay. Until
greater progress is made in developing widely ac-
cessible sources of renewable energy, it is legiti-
mate to choose the less harmful alternative or to
find short-term solutions. But the international
community has still not reached adequate agree-
ments about the responsibility for paying the
costs of this energy transition. In recent decades,
environmental issues have given rise to consider-
able public debate and have elicited a variety of
committed and generous civic responses. Politics
and business have been slow to react in a way
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commensurate with the urgency of the challeng-
es facing our world. Although the post-industrial
period may well be remembered as one of the
most irresponsible in history, nonetheless there
is reason to hope that humanity at the dawn of
the twenty-first century will be remembered for
having generously shouldered its grave responsi-
bilities.
166. Worldwide, the ecological movement has
made significant advances, thanks also to the ef-
forts of many organizations of civil society It is
impossible here to mention them all, or to review
the history of their contributions. But thanks to
their efforts, environmental questions have in-
creasingly found a place 011 public agendas and
encouraged more far-sighted approaches. This
notwithstanding, recent World Summits on the
environment have not lived up to expectations
because, due to lack of political will, they were
unable to reach truly meaningful and effective
global agreements on the environment.
167. The 1992 Earth Summit in Rio de Janeiro
is worth mentioning. It proclaimed that "human
beings are at the centre of concerns for sustain-
able development".126 Echoing the 1972 Stock-
holm Declaration, it enshrined international co-
operation to care for the ecosystem of the entire
earth, the obligation of those who cause pollu-
126 Rio Declaration on linvironmenl and Development (14 June
1992), Principle 1.
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tion to assume its costs, and the duty to assess
the environmental impact of given projects and
works. It set the goal of limiting greenhouse gas
concentration in the atmosphere, in an effort to
reverse the trend of global warming. It also drew
up an agenda with an action plan and a conven-
tion on biodiversity, and stated principles regard-
ing forests. Although the summit was a real step
forward, and prophetic for its time, its accords
have been poorly implemented, due to the lack
of suitable mechanisms for oversight, periodic
review and penalties in cases of non-compliance.
The principles which it proclaimed still await an
efficient and flexible means of practical imple-
mentation.
168. Among positive experiences in this regard,
we might mention, for example, the Basel Con-
vention on hazardous wastes, with its system of
reporting, standards and controls. There is also
the binding Convention on international trade in
endangered species of wild fauna and flora, which
includes on-site visits for verifying effective com-
pliance. Thanks to the Vienna Convention for the
protection of the ozone layer and its implementa-
tion through the Montreal Protocol and amend-
ments, the problem of the layer's thinning seems
to have entered a phase of resolution.
169. As far as the protection of biodiversity and
issues related to desertification are concerned,
progress has been far less significant. With re-
gard to climate change, the advances have been
124
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regrettably few. Reducing greenhouse gases re-
quires honest); courage and responsibility, above
all on the part of those countries which are more
powerful and pollute the most. The Conference
of the United Nations on Sustainable Develop-
ment, "Rio+20" (Rio de Janeiro 2012), issued a
wide-ranging but ineffectual outcome document.
International negotiations cannot make signifi-
cant progress due to positions taken by countries
which place their national interests above the
global common good. Those who will have to
suffer the consequences of what we are trying to
hide will not forget diis failure of conscience and
responsibility Even as this Encyclical was being
prepared, the debate was intensifying. We believ-
ers cannot fail to ask God for a positive outcome
to die present discussions, so that future gener-
ations will not have to suffer the effects of our
ill-advised delays.
170. Some strategies for lowering pollutant gas
emissions call for the internationalization of en-
vironmental costs, which would risk imposing
on countries with fewer resources burdensome
commitments to reducing emissions comparable
to those of the more industrialized countries.
Imposing such measures penalizes those coun-
tries most in need of development. A further in-
justice is perpetrated under the guise of protect-
ing the environment. Here also, the poor end up
paying the price. Furthermore, since the effects
of climate change will be felt for a long time to
'125
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come, even if stringent measures are taken now,
some countries with scarce resources will require
assistance in adapting to the effects already being
produced, which affect their economies. In this
context, there is a need for common and differ-
entiated responsibilities. As the bishops of Bo-
livia. have stated, "the countries which have ben-
efited from a high degree of industrialization, at
the cost of enormous emissions of greenhouse
gases, have a greater responsibility for providing
a solution to the problems they have caused".12''
171. The strategy of buying and selling "car-
bon credits" can lead to a new form of specula-
tion which would not help reduce the emission
of polluting gases worldwide. This system seems
to provide a quick and easy solution under the
guise of a certain commitment to the environ-
ment, but 111 no way does it allow for the radi-
cal change which present circumstances require.
Rather, it may simply become a ploy which per-
mits maintaining the excessive consumption of
some countries and sectors.
172. For poor countries, the priorities must be
to eliminate extreme poverty and to promote the
social development of their people. At the same
time, they need to acknowledge the scandalous
level of consumption in some privileged sectors
121 Bolivian Bishops' Conference, Pastoral Letter on the
Environment and Human Development in Bolivia HI universo,
don de Diospara la vida (March 2012), 86.
126
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of their population and to combat corruption
more effectively. They are likewise bound to de-
velop less polluting forms of energy production,
but to do so they require the help of countries
which have experienced great growth at the cost
of the ongoing pollution of the planet. Taking
advantage of abundant solar energy will require
the establishment of mechanisms and subsi-
dies which allow developing countries access
to technology transfer, technical assistance and
financial resources, but in a way which respects
their concrete situations, since "the compatibility?
of [infrastructures] with the context for which
they have been designed is not always adequate-
ly assessed".128 The costs of this would be low,
compared to the risks of climate change. In any
event, these are primarily ethical decisions, root-
ed m solidarity between all peoples.
'173. Enforceable international agreements are
urgently needed, since local authorities are not
always capable of effective intervention. Rela-
tions between states must be respectful of each
other's sovereignty, but must also lay down mu-
tually agreed means of averting regional disasters
which would eventually affect everyone. Global
regulatory norms are needed to impose obliga-
tions and prevent unacceptable actions, for ex-
ample, when powerful companies or countries
128 Pontifical Council for ]usttcf, and Peace, Energy
justice and Peace. IY, 1, Vatican City (2014), 53.
127
A4 p.484
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dump contaminated waste or offshore polluting
industries in other countries.
174. Let us also mention the system of gov-
ernance of the oceans. International and regional
conventions do exist, but fragmentation and the
lack of strict mechanisms of regulation, control
and penalization end up undermining these ef-
forts. The growing problem of marine waste and
the protection of the open seas represent par-
ticular challenges. What is needed, in effect, is
an agreement on systems of governance for the
whole range of so-called "global commons".
175. The same mindset which stands in the
way of making radical decisions to reverse the
trend of global warming also stands in die way
of achieving die goal of eliminating poverty. A
more responsible overall approach is needed to
deal with both problems: the reduction of pol-
lution and the development of poorer coun-
tries and regions. The twenty-first century, while
maintaining systems of governance inherited
from the past, is witnessing a weakening of the
power of nation states, chiefly because the eco-
nomic and financial sectors, being transnation-
al, tends to prevail over the political. Given this
situation, it is essential to devise stronger and
more efficiently organized international institu-
tions, with functionaries who are appointed fairly
by agreement among national governments, and
empowered to impose sanctions. As Benedict
XVI has affirmed in continuity with the social
128
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teaching of the Church: "To manage the global
economy; to revive economies hit by the crisis; to
avoid any deterioration of the present crisis and
the greater imbalances that would result; to bring
about integral and timely disarmament, food se-
curity and peace; to guarantee the protection of
the environment and to regulate migration: for
all this, there is urgent need of a true world po-
litical authority, as my predecessor Blessed John
XXIII indicated some years ago".129 Diplomacy
also takes 011 new importance in the work of de-
veloping international strategies which can antic-
ipate serious problems affecting us all.
11. Dialogue for new national
AND LOCAL POLICIES
176. There are not just winners and losers
among countries, but within poorer countries
themselves. TIence different responsibilities
need to be identified. Questions related to the
environment and economic development can no
longer be approached only from the standpoint
of differences between countries; they also call
for greater attention to policies on the national
and local levels.
177. Given the real potential for a misuse of
human abilities, individual states can no longer
ignore their responsibility for planning, coordi-
m' Benedict XVI, Encyclical letter Cantos in Veritale (29
June 2009), 67: AAS 101 (2009).
129
A4 p.486
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nation, oversight and enforcement within their
respective borders. How can a society plan and
protect its future amid constantly developing
technological innovations? One authoritative
source of oversight and coordination is the law,
which lays down rules for admissible conduct in
the light of the common good. The limits which
a healthy, mature and sovereign society must
impose are those related to foresight and scat
rity, regulatory norms, timely enforcement, the
elimination of corruption, effective responses
to undesired side-effects of production process-
es, and appropriate intervention where potential
or uncertain risks are involved. There is a grow-
ing jurisprudence dealing with the reduction of
pollution by business activities. But political and
institutional frameworks do not exist simply to
avoid bad practice, but also to promote best
practice, to stimulate creativity in seeking new
solutions and to encourage individual or group
initiatives.
178. A politics concerned with immediate re-
sults, supported by consumerist sectors of the
population, is driven to produce short-term
growth. In response to electoral interests, gov-
ernments are reluctant to upset the public with
measures which could affect the level of con-
sumption or create risks for foreign investment.
The myopia of power politics delays the inclu-
sion of a far-sighted environmental agenda with-
in the overall agenda of governments. Thus we
130
A4 p.487
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forget that "time is greater than space",130 that
we are always more effective when we generate
processes nil her than holding on to positions of
powTer. True statecraft is manifest when, in diffi-
cult times, we uphold high principles and think
of the long-term common good. Political pow-
ers do not find it easy to assume this duty- m the
work of nation-building.
179. In some places, cooperatives are being
developed to exploit renewable sources of en-
ergy which ensure local self-sufficiency and even
the sale of surplus energy. This simple example
shows that, while the existing world order proves
powerless to assume its responsibilities, local in-
dividuals and groups can make a real difference.
They are able to instil a greater sense of respon-
sibility, a strong sense of community, a readi-
ness to protect others, a spirit of creativity and a
deep love for the land. They are also concerned
about what they will eventually leave to their chil-
dren and grandchildren. These values are deeply
rooted in indigenous peoples. Because the en-
forcement of laws is at times inadequate due to
corruption, public pressure has to be exerted in
order to bong about decisive political action. So-
ciety'-, through non-governmental organizations
and intermediate groups, must put pressure on
governments to develop more rigorous regula-
tions, procedures and controls. Unless citizens
,3W Apostolic Exhortation iivangelii Gauttium (24 Novem-
ber 2013), 222: AAS 105 (2013), 1111.
131
A4 p.488
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control political power — national, regional and
municipal — it will not be possible to control
damage to the environment. Local legislation
can be more effective, too, if agreements exist
between neighbouring communities to support
the same environmental policies.
180. There are 110 uniform recipes, because
each country or region has its own problems
and limitations. It is also true that political real-
ism may call for transitional measures and tech-
nologies, so long as these are accompanied by
the gradual framing and acceptance of binding
commitments. At the same time, 011 the nation-
al and local levels, much still needs to be done,
such as promoting ways of conserving energy
These would include favouring forms of indus-
trial production with maximum energy efficiency
and diminished use of raw materials, removing
from the market products which are less energy
efficient or more polluting, improving transport
systems, and encouraging the construction and
repair of buildings aimed at reducing their ener-
gy consumption and levels of pollution. Political
activity on the local level could also be directed to
modifying consumption, developing an economy
of waste disposal and recycling, protecting cer-
tain species and planning a diversified agriculture
and the rotation of crops. Agriculture in poor-
er regions can be improved through investment
in rural infrastructures, a better organization of
local or national markets, systems of irrigation,
132
A4 p.489
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and the development of techniques of sustain-
able agriculture. New forms of cooperation and
community organization can be encouraged in
order to defend the interests of small producers
and preserve local ecosystems from destruction.
Truly, much can be done!
181. Here, continuity is essential, because poli-
cies related to climate change and environmental
protection cannot be altered with every change
of government. Results take time and demand
immediate outlays which may not produce tan-
gible effects within any one government's term.
That is why, in the absence of pressure from the
public and from civic institutions, political au-
thorities will always be reluctant to intervene, all
the more when urgent needs must be met. To
take up these responsibilities and the costs they
entail, politicians will inevitably clash with the
mindset of short-term gain and results which
dominates present-day economics and politics.
But if they are courageous, they will attest to
their God-given dignity and leave behind a testi-
mony of selfless responsibility. A healthy politics
is sorely needed, capable of reforming and co-
ordinating institutions, promoting best practices
and overcoming undue pressure and bureaucratic
inertia. It should be added, though, that even the
best mechanisms can break down when there
are no worthy goals and values, or a genuine and
profound humanism to serve as the basis of a
noble and generous society.
133
A4 p.490
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III. Dtat,oguf. and transparency
IN DECISION-MAKING
182. An assessment of the environmental im-
pact of business ventures and projects demands
transparent political processes involving a free
exchange of views. On the other hand, the forms
of corruption which conceal the actual environ-
mental impact of a given project, in exchange for
favours, usually produce specious agreements
which fail to inform adequately and to allow for
full debate.
183. Environmental impact assessment should
not come after the drawing up of a business
proposition or the proposal of a particular poli-
cy, plan or programme. It should be part of the
process from the beginning, and be carried out
in a way which is interdisciplinary, transparent
and free of all economic or political pressure.
It should be linked to a study of working con-
ditions and possible effects on people's physical
and mental health, on the local economy and on
public safety". Economic returns can thus be fore-
cast more realistically, taking into account poten-
tial scenarios and the eventual need for further
investment to correct possible undesired effects.
A consensus should always be reached between
the different stakeholders, who can offer a varie-
ty of approaches, solutions and alternatives. The
local population should have a special place at
the table; they are concerned about their own fu-
ture and that of their children, and can consider
134
A4 p.491
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goals transcending immediate economic interest.
We need to stop thinking in terms of "inter-
ventions" to save the environment in favour of
policies developed and debated by all interested
parties. The participation of the latter also entails
being fully informed about such projects and
their different risks and possibilities; this includes
not just preliminary decisions but also various
follow-up activities and continued monitoring.
Honesty and truth are needed in scientific and
political discussions; these should not be limited
to the issue of whether or not a particular project
is permitted by law.
184. In the face of possible risks to the envi-
ronment which may affect the common good
now and in the future, decisions must be made
"based on a comparison of the risks and benefits
foreseen for the various possible alternatives".131
This is especially the case when a project may
lead to a greater use of natural resources, higher
levels of emission or discharge, an increase of
refuse, or significant changes to the landscape,
the habitats of protected species or public spac-
es. Some projects, if insufficiently studied, can
profoundly affect the quality of life of an area
due to very different factors such as unforeseen
noise pollution, the shrinking of visual horizons,
the loss of cultural values, or the effects of nu-
clear energy use. The culture of consumerism,
131 Pontifical Council for Justice and Pf.acf, Compendi-
um of the Social Doctrine of the Church, 469.
135
A4 p.492
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which prioritizes short-term gain and private in-
terest, can make it easy to rubber-stamp authori-
zations or to conceal information.
185. In any discussion about a proposed ven-
ture, a number of questions need to be asked in
order to discern whether or not it will contrib-
ute to genuine integral development. What will
it accomplish? Why? Where? When? How? For
whom? What are the risks? What are the costs?
Who will pay those costs and how? In this dis-
cernment, some questions must have higher pri-
ority. For example, we know that water is a scarce
and indispensable resource and a fundamental
right which conditions the exercise of other hu-
man rights. This indisputable fact overrides any
other assessment of environmental impact on a
region.
186. The Rio Declaration of 1992 states diat
"where there are threats of serious or irreversible
damage, lack of full scientific certainty shall not
be used as a pretext for postponing cost-effective
measures"1'2 which prevent environmental deg-
radation. This precautionary principle makes it
possible to protect those who are most vulner-
able and whose ability to defend their interests
and to assemble incontrovertible evidence is lim-
ited. If objective information suggests that seri-
ous and irreversible damage may result, a project
132 Rio Declaration on the linvironment and Development (14
June 1992), Principle 15.
136
A4 p.493
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should be halted or modified, even in the absence
of indisputable proof. Here the burden of proof
is effectively reversed, since in such cases objec-
tive and conclusive demonstrations will have to
be brought forward to demonstrate that the pro-
posed activity will not cause serious harm to the
environment or to those who inhabit it.
187. This does not mean being opposed to any
technological innovations which can bring about
an improvement in the quality of life. But it does
mean that profit cannot be the sole criterion to
be taken into account, and that, when significant
new information comes to light, a reassessment
should be made, with the involvement of all in-
terested parties. The outcome may be a decision
not to proceed with a given project, to modify it
or to consider alternative proposals.
'188. There are certain environmental issues
where it is not easy to achieve a broad consensus.
Here I would state once more that the Church
does not presume to settle scientific questions
or to replace politics. But I am concerned to en-
courage an honest and open debate so that par-
ticular interests or ideologies will not prejudice
the common good.
IV. Politics and economy in dialogue
FOR HUMAN FULFILMENT
189. Politics must not be subject to the econ-
omy, nor should the economy be subject to the
137
A4 p.494
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dictates of an efficiency-driven paradigm of tech-
nocracy. Today, in view of the common good,
there is urgent need for politics and economics
to enter into a frank dialogue in the service of
life, especially human life. Saving banks at any
cost, making the public pay the price, foregoing
a firm commitment to reviewing and reforming
the entire system, only reaffirms die absolute
power of a financial system, a power which has
no future and will only give rise to new crises af-
ter a slow, costly and only apparent recovery. The
financial crisis of 2007-08 provided an opportu-
nity to develop a new economy, more attentive
to ediical principles, and new ways of regulating
speculative financial practices and virtual wealth.
But die response to the crisis did not include
rethinking the outdated criteria which continue
to rule the world. Production is not always ra-
tional, and is usually tied to economic variables
which assign to products a value that does not
necessarily correspond to their real worth. This
frequendy leads to an overproduction of some
commodities, with unnecessary impact on the
environment and with negative results on region-
al economies.133 The financial bubble also tends
to be a productive bubble. The problem of the
real economy is not confronted with vigour, yet
it is the real economy which makes diversifica-
tion and improvement in production possible,
133 C£ Mexican Bishops' Conference, Episcopal Com-
mission for Pastoral and Social Concerns, jesucrisU), vidaj es-
peratt^a de Los indtgenas e campesinos (14 January 2008).
138
A4 p.495
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helps companies to function well, and enables
small and medium businesses to develop and
create employment.
190. Here too, it should always be kept in mind
that "environmental protection cannot be as-
sured solely on the basis of financial calculations
of costs and benefits. The environment is one
of those goods that cannot be adequately safe-
guarded or promoted by market forces".134 Once
more, we need to reject a magical conception of
the market, which would suggest that problems
can be solved simply by an 111crea.se 111 the profits
of companies or individuals. Is it realistic to hope
that those who are obsessed with maximizing
profits will stop to reflect on the environmental
damage which they will leave behind for future
generations? Where profits alone count, there
can be no thinking about the rhythms of na-
ture, its phases of decay and regeneration, or the
complexity of ecosystems which may be gravely
upset by human intervention. Moreover, biodi-
versity is considered at most a deposit of eco-
nomic resources available for exploitation, with
no serious thought for the real value of things,
their significance for persons and cultures, or the
concerns and needs of the poor.
191. Whenever these questions are raised,
some react by accusing others of irrationally at-
134 Pontifical Council for Justice and Pf.acf, Compendi-
um of the Social Doctrine of the Church, 470.
139
A4 p.496
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tempting to stand in the way of progress and hu-
man development. But we need to grow in the
conviction that a decrease in the pace of pro-
duction and consumption can at times give rise
to another form of progress and development.
Efforts to promote a sustainable use of natural
resources are not a waste of money, but rather
an investment capable of providing other eco-
nomic benefits in the medium term. If we look
at the larger picture, wTe can see that more diver-
sified and innovative forms of production which
impact less on the environment can prove very
profitable. It is a matter of openness to different
possibilities which do not involve stifling human
creativity and its ideals of progress, but rather
directing that energy along new channels.
192. For example, a path of productive devel-
opment, which is more creative and better direct-
ed, could correct the present disparity between
excessive technological investment in consump-
tion and insufficient investment in resolving ur-
gent problems facing die human family It could
generate sensible and profitable ways of reusing,
revamping and recycling, and it could also im-
prove the energy efficiency of cities. Productive
diversification offers the fullest possibilities to
human ingenuity to create and innovate, while at
the same time protecting the environment and
creating more sources of employment. Such cre-
ativity would be a worthy expression of our most
noble human qualities, for we would be striving
140
A4 p.497
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intelligently, boldly and responsibly to promote
a sustainable and equitable development within
the context of a broader concept of quality of
life. On the other hand, to find ever new ways
of despoiling nature, purely for the sake of new
consumer items and quick profit, would be, in
human terms, less worthy and creative, and more
superficial.
193. In any event, if in some cases sustaina-
ble development were to involve new forms of
growth, in other cases, given the insatiable and
irresponsible growth produced over many dec-
ades, we need also to think of containing growth
by setting some reasonable limits and even re-
tracing our steps before it is too late. We know
how unsustainable is the behaviour of those who
constantly consume and destroy, while others are
not yet able to live in a way worthy of their human
dignity. That is why the time has come to accept
decreased growth in some parts of the world, in
order to provide resources for other places to ex-
perience healthy growth. Benedict XVI has said
that "technologically advanced societies must
be prepared to encourage more sober lifestyles,
while reducing their energy consumption and
improving its efficiency".135
194. For new models of progress to arise, there
is a need to change "models of global develop-
13i Message for ihe 2010 World Day of Peace, 9: A AS 102
(2010), 46.
141
A4 p.498
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ment";136 this will entail a responsible reflection
on "the meaning of the economy and its goals
with an eye to correcting its malfunctions and
misapplications".13' It is not enough to balance,
in the medium term, the protection of nature
with financial gain, or the preservation of the en-
vironment with progress. Halfway measures sim-
ply delay the inevitable disaster. Put simply, it is
a matter of redefining our notion of progress. A
technological and economic development which
does not leave in its wake a better world and an
integrally higher quality of life cannot be consid-
ered progress. Frequently, in fact, people's quality
of life actually diminishes — by the deterioration
of the environment, the low quality of food or
the depletion of resources — in the midst of eco-
nomic growth. In this context, talk of sustaina-
ble growth usually becomes a way of distracting
attention and offering excuses. It absorbs the
language and values of ecology into the catego-
ries of finance and technocracy, and the social
and environmental responsibility of businesses
often gets reduced to a series of marketing and
image-enhancing measures.
195. The principle of the maximization of
profits, frequently isolated from other consider-
ations, reflects a misunderstanding of the very
concept of the economy. As long as production
136 Ibid.
1J/ Ibid., 5: p. 43.
142
A4 p.499
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is increased, little concern is given to whether it
is at the cost of future resources or the health of
the environment; as long as the clearing of a for-
est increases production, no one calculates the
losses entailed in the desertification of the land,
the harm done to biodiversity or the increased
pollution. In a word, businesses profit by calcu-
lating and paying only a fraction of the costs in-
volved. Yet only when "the economic and social
costs of using up shared environmental resourc-
es are recognized with transparency and fully
borne by those who incur diem, not by other
peoples or future generations",138 can those ac-
tions be considered ethical. An instrumental way
of reasoning, which provides a purely static anal-
ysis of realities in the service of present needs,
is at work whether resources are allocated by the
market or by state central planning.
'196. What happens with politics? Let us keep
in mind the principle of subsidiarity, which
grants freedom to develop the capabilities pres-
ent at every level of society, while also demand-
ing a greater sense of responsibility for the com-
mon good from those who wield greater power.
Today, it is the case that some economic sectors
exercise more power than states themselves. But
economics without politics cannot be justified,
since this would make it impossible to favour
138 Benedict XVI, Encyclical letter Cantos in Veritale (29
June 2009), 50: AAS 101 (2009), 686.
143
A4 p.500
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other ways of handling the various aspects of
the present crisis. The mindset which leaves no
room for sincere concern for the environment is
the same mindset which lacks concern for the in-
clusion of the most vulnerable members of so-
ciety. For "the current model, with its emphasis
on success and self-reliance, does not appear to
favour an investment in efforts to help the slow,
the weak or the less talented to find opportuni-
ties in life".139
197. What is needed is a politics which is far-
sighted and capable of a new, integral and inter-
disciplinary approach to handling the different
aspects of the crisis. Often, politics itself is re-
sponsible for die disrepute m which it is held,
on account of corruption and the failure to en-
act sound public policies. If in a given region the
state does not carry out its responsibilities, some
business groups can come forward in the guise
of benefactors, wield real power, and consider
themselves exempt from certain rules, to the
point of tolerating different forms of organized
crime, human trafficking, the drug trade and vio-
lence, all of which become very difficult to erad-
icate. If politics shows itself incapable of break-
ing such a perverse logic, and remains caught up
in inconsequential discussions, we will continue
to avoid facing the major problems of humani-
l3'J Apostolic Exhortation Ylvangelii Gaudimi (24 Novem-
ber 2013), 209: AAS 105 (2013), 1107.
144
A4 p.501
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ty. A strategy for real change calls for rethinking
processes in their entirety, for it is not enough
to include a few superficial ecological consider-
ations while failing to question the logic which
underlies present-day culture. A healthy politics
needs to be able to take up this challenge.
198. Politics and the economy tend to blame
each other when it comes to poverty and envi-
ronmental degradation. It is to be hoped that
they can acknowledge their own mistakes and
find forms of interaction directed to the com-
mon good. While some are concerned only with
financial gam, and others with holding on to or
increasing their power, what we are left with are
conflicts or spurious agreements where the last
thing either party is concerned about is caring for
the environment and protecting those who are
most vulnerable. Here too, we see how true it is
that "unity is greater than conflict".140
V. Religions in dialogue with science
199. It cannot be maintained that empirical sci-
ence provides a complete explanation of life, the
interplay of all creatures and the whole of reality.
This wTould be to breach the limits imposed by-
its own methodology. If we reason only within
the confines of the latter, little room would be
left for aesthetic sensibility, poetry, or even rea-
140 Ibid., 228: AAS 105 (2013), 1113.
145
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son's ability to grasp the ultimate meaning and
purpose of things.1"11 I would add that "religious
classics can prove meaningful in every age; they
have an enduring power to open new horizons...
Is it reasonable and enlightened to dismiss cer-
tain writings simply because they arose in the
context of religious belief?"142 It would be quite
simplistic to think that ethical principles present
themselves purely m the abstract, detached from
any context. Nor does the fact that they may be
couched in religious language detract from their
value in public debate. The ethical principles ca-
pable of being apprehended by reason can al-
ways reappear in different guise and find expres-
sion in a variety of languages, including religious
language.
200. Any technical solution which science
claims to offer will be powerless to solve the se-
141 C£ Encyclical Letter 'Lumen Fidei (29 June 2013), 34:
AAS 105 (2013), 577: "Nor is the light of faith, joined to the
truth of love, extraneous to the material world, for love is al-
ways lived out m body and spirit; the light of faith is an incar-
nate light radiating from the luminous life of Jesus. It also illu-
mines the material world, trusts its inherent order, and knows
that it calls us to an ever widening path of harmony and under-
standing The gaze of science thus benefits from faith: faith
encourages the scientist to remain constantly open to reality in
all its inexhaustible richness. Faith awakens the critical sense by
preventing research from being satisfied with its own formulae
and helps it to realize that nature is always greater. By stimu-
lating wonder before the profound mystery of creation, faith
broadens the horizons of reason to shed greater light on the
world which discloses itself to scientific investigation".
142 Apostolic Exhortation Ylvangelii Gaudimi (24 Novem-
ber 2013), 256: AAS 105 (2013), 1123.
146
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rious problems of our world if humanity loses
its compass, if we lose sight of the great motiva-
tions which make it possible for us to live in har-
mony, to make sacrifices and to treat others well.
Believers themselves must constantly feel chal-
lenged to live in a way consonant with their faith
and not to contradict it by their actions. They
need to be encouraged to be ever open to God's
grace and to draw constantly from their deep-
est convictions about love, justice and peace. If
a mistaken understanding of our own principles
has at times led us to justify mistreating nature,
to exercise tyranny over creation, to engage m
war, injustice and acts of violence, we believers
should acknowledge that by so doing we were
not faithful to the treasures of wisdom which we
have been called to protect and preserve. Cultur-
al limitations in different eras often affected the
perception of these ethical and spiritual treas-
ures, yet by constantly returning to their sources,
religions will be better equipped to respond to
today's needs.
201. The majority? of people living on our
planet profess to be believers. This should spur
religions to dialogue among themselves for the
sake of protecting nature, defending the poor,
and building networks of respect and fraternity.
Dialogue among the various sciences is likewise
needed, since each can tend to become enclosed
in its own language, while specialization leads to a
certain isolation and the absolutization of its own
147
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field of knowledge. This prevents us from con-
fronting environmental problems effectively. An
open and respectful dialogue is also needed be-
tween the various ecological movements, among
which ideological conflicts are not infrequently
encountered. The gravity of the ecological crisis
demands that we all look to the common good,
embarking on a path of dialogue which requires
patience, self-discipline and generosity, always
keeping in mind that "realities are greater than
ideas".143
i4? Ibid., 231: p. 1114.
148
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CHAPTER SIX
ECOLOGICAL EDUCATION
AND SPIRITUALITY
202. Many tilings have to change course, but
it is we human beings above all who need to
change. We lack an awareness of our common
origin, of our mutual belonging, and of a future
to be shared with everyone. This basic awareness
would enable the development of new convic-
tions, attitudes and forms of life. A great cultur-
al, spiritual and educational challenge stands be-
fore us, and it will demand that we set out on the
long path of renewal.
I. Towards a new lifestyle
203. Since the market tends to promote ex-
treme consumerism in an effort to sell its
products, people can easily get caught up in a
whirlwind of needless buying and spending.
Compulsive consumerism is one example of
how the techno economic paradigm affects indi-
viduals. Romano Guardim had already foreseen
this: "The gadgets and technics forced upon him
by the patterns of machine production and of
abstract planning mass man accepts quite simply;
they are the forms of life itself. To either a great-
er or lesser degree mass man is convinced that
149
A4 p.506
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his conformity is both reasonable and just".144
This paradigm leads people to believe that they
are free as long as they have the supposed free-
dom to consume. But those really free are the mi-
nority who wield economic and financial power.
Amid tins confusion, postmodern humanity has
not yet achieved a new self-awareness capable of
offering guidance and direction, and this lack of
identity is a source of anxiety. We have too many
means and only a lew insubstantial ends.
204. The current global situation engenders a
feeling of instability and uncertainty, which in
turn becomes "a seedbed for collective selfish-
ness".145 When people become self-centred and
self-enclosed, their greed increases. The empti-
er a person's heart is, die more he or she needs
things to buy, own and consume. It becomes al-
most impossible to accept the limits imposed by
reality. In this horizon, a genuine sense of the
common good also disappears. As these attitudes
become more widespread, social norms are re-
spected only to the extent that they do not clash
with personal needs. So our concern cannot be
limited merely to the threat of extreme weather
events, but must also extend to the catastrophic
consequences of social unrest. Obsession with a
"*4" Romano Guard in i, Das Ende der Neurit, 9L"' edition,
Wiirzburg, 1965, 66-67 (English: The End of the Modem World,
Wilmington, 1998, 60).
:4i John P/vut, II, Messagefor the 1990 World Day of Peace, 1:
AAS 82 (1990), 147.
150
A4 p.507
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consumerist lifestyle, above all when few people
are capable of maintaining it, can only lead to
violence and mutual destruction.
205. Yet all is not lost. Human beings, while
capable of the worst, are also capable of rising-
above themselves, choosing again what is good,
and making a new start, despite their mental and
social conditioning. We are able to take an hon-
est look at ourselves, to acknowledge our deep
dissatisfaction, and to embark on new paths to
authentic freedom. No system can completely
suppress our openness to what is good, true and
beautiful, or our God-given ability to respond to
his grace at wxork deep in our hearts. I appeal to
everyone throughout the world not to forget this
dignity which is ours. No one has the right to
take it from us.
206. A change m lifestyle could bring healthy
pressure to bear on those who wield political,
economic and social power. This is what consum-
er movements accomplish by boycotting certain
products. They prove successful in changing the
way businesses operate, forcing them to consider
their environmental footprint and their patterns
of production. When social pressure affects their
earnings, businesses clearly have to find ways to
produce differently This shows us the great need
for a sense of social responsibility on the part
of consumers. "Purchasing is always a moral —
151
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and not simply economic — act".146 Today, in a
word, "the issue of environmental degradation
challenges us to examine our lifestyle".14,
207. The Earth Charter asked us to leave be-
hind a period of self-destruction and make a new
start, but we have not as yet developed a universal
awareness needed to achieve this. Here, I would
echo that courageous challenge: "As never before
in history, common destiny beckons us to seek a
new beginning... Let ours be a time remembered
for the awakening of a new reverence for life, the
firm resolve to achieve sustamability, the quick-
ening of the struggle for justice and peace, and
the joyful celebration of life".148
208. We are always capable of going out of
ourselves towards the other. Unless we do this,
other creatures will not be recognized for their
true worth; wTe are unconcerned about caring for
things for the sake of others; we fail to set lim-
its on ourselves in order to avoid the suffering
of others or the deterioration of our surround-
ings. Disinterested concern for others, and the
rejection of every form of self-centeredness and
self-absorption, are essential if we truly wish to
care for our brothers and sisters and for die nat-
546 Benedict XVI, Encyclical Letter Cantos in Veritate
(29 June 2009), 66: AAS 101 (2009), 699.
!4' Id., Message for the 2010 World Day of Peace, 11: AAS
102 (2010), 48.
148 Earth Charter, The Hague (29 June 2000).
152
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ural environment. These attitudes also attune us
to the moral imperative of assessing the impact
of our every action and personal decision on the
world around us. If we can overcome individu-
alism, we will truly be able to develop a different
lifestyle and bring about significant changes in
society.
II. Educating for the covenant
BETWEEN HUMANITY AND THE ENVIRONMENT
209. An awareness of the gravity of today's cul-
tural and ecological crisis must be translated into
new habits. Many people know that our current
progress and the mere amassing of tilings and
pleasures are not enough to give meaning and joy
to the human heart, yet they feel unable to give
up what the market sets before them. In those
countries which should be making the greatest
changes in consumer habits, young people have
a new ecological sensitivity and a generous spirit,
and some of them are making admirable efforts
to protect the environment. At the same time,
they have grown up in a milieu of extreme con-
sumerism and affluence which makes it difficult
to develop other habits. We are faced with an ed-
ucational challenge.
210. Environmental education has broadened
its goals. Whereas in the beginning it was main-
ly centred on scientific information, conscious-
ness-raising and the prevention of environmen-
tal risks, it tends now to include a critique of the
153
A4 p.510
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"myths" of a modernity grounded in a utilitarian
mindset (individualism, unlimited progress, com-
petition, consumerism, the unregulated market).
It seeks also to restore the various levels of eco-
logical equilibrium, establishing harmony within
ourselves, with others, with nature and other liv-
ing creatures, and with God. Environmental ed-
ucation should facilitate making the leap towards
the transcendent which gives ecological ethics
its deepest meaning. It needs educators capable
of developing an ethics of ecology, and helping
people, through effective pedagogy, to grow in
solidarity, responsibility and compassionate care.
211. Yet this education, aimed at creating an
"ecological citizenship", is at times limited to
providing information, and fails to instil good
habits. The existence of laws and regulations is
insufficient in the long run to curb bad conduct,
even when effective means of enforcement are
present. If the laws are to bring about significant,
long-lasting effects, the majority of the members
of society- must be adequately motivated to accept
them, and personally transformed to respond.
Only by cultivating sound virtues will people be
able to make a selfless ecological commitment. A
person who could afford to spend and consume
more but regularly uses less heating and wears
warmer clothes, shows the kind of convictions
and attitudes which help to protect the environ-
ment. There is a nobility in the duty to care for
creation through little daily actions, and it is won-
154
A4 p.511
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derful how education can bring about real chang-
es in lifestyle. Education in environmental re-
sponsibility can encourage ways of acting which
directly and significantly affect the wrorld around
us, such as avoiding the use of plastic and paper,
reducing water consumption, separating refuse,
cooking only what can reasonably be consumed,
showing care for other living beings, using public
transport or car-pooling, planting trees, turning
off unnecessary lights, or any number of oth-
er practices. All of these reflect a generous and
worthy creativity which brings out die best in hu-
man beings. Reusing something instead of im-
mediately discarding it, when done for the right
reasons, can be an act of love which expresses
our own dignity
212. We must not think that these efforts are
not going to change the world. They benefit so-
ciety, often unbeknown to us, for they call forth
a goodness which, albeit unseen, inevitably tends
to spread, furthermore, such actions can restore
our sense of self-esteem; thev can enable us to
live more fully and to feel that life on earth is
worthwhile.
213. Ecological education can take place in a
variety of settings: at school, in families, in the
media, in catechesis and elsewhere. Giood educa-
tion plants seeds when we are young, and these
continue to bear fruit throughout life. Here,
though, I would stress the great importance of
the family, which is "the place in which life — the
155
A4 p.512
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gift of God — can be properly welcomed and
protected against the many attacks to which it
is exposed, and can develop in accordance with
what constitutes authentic human growth. In the
face of the so-called culture of death, the family
is the heart of the culture of life".149 In the family
we first learn how to show love and respect for
life; we are taught the proper use of things, order
and cleanliness, respect for the local ecosystem
and care for all creatures. In die family we receive
an integral education, which enables us to grow
harmoniously in personal maturity In the family
we learn to ask without demanding, to say "thank
you" as an expression of genuine gratitude for
what we have been given, to control our aggres
sivity and greed, and to ask forgiveness when
we have caused harm. These simple gestures
of heartfelt courtesy help to create a culture of
shared life and respect for our surroundings.
214. Political institutions and various other
social groups are also entrusted with helping to
raise people's awareness. So too is the Church.
All Christian communities have an important
role to play in ecological education. It is my hope
that our seminaries and houses of formation will
provide an education in responsible simplicity of
life, in grateful contemplation of God's world,
and in concern for die needs of the poor and
the protection of the environment. Because the
l*' John P/vut, II, Encyclical Letter Cenlesimus Annus (1
May 1991), 39: AAS 83 (1991), 842.
156
A4 p.513
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stakes are so high, we need institutions empow-
ered to impose penalties for damage inflicted on
the environment. But we also need the personal
qualities of self-control and willingness to learn
from one another.
215. In this regard, "the relationship between a
good aesthetic education and the maintenance of
a healthy environment cannot be overlooked".15"
By learning to see and appreciate beauty, we learn
to reject self-interested pragmatism. If someone
has not learned to stop and admire something
beautiful, we should not be surprised if he or
she treats everything as an object to be used
and abused without scruple. If we want to bring
about deep change, we need to realize that cer-
tain mindsets really do influence our behaviour.
Our efforts at education will be inadequate and
ineffectual unless we strive to promote a new
way of thinking about human beings, life, society
and our relationship with nature. Otherwise, the
paradigm of consumerism will continue to ad-
vance, with the help of the media and the highly
effective workings of the market.
III. Ecological conversion
216. The rich heritage of Christian spiritual-
ity, die fruit of twenty centuries of personal and
communal experience, has a precious contribu-
15,J Id., Message for the 1990 World Day of Peace, 14: A AS 82
(1990), 155.
157
A4 p.514
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tion to make to the renewal of humanity Here, I
would like to offer Christians a few suggestions
for an ecological spirituality grounded 111 the con-
victions of our faith, since the teachings of the
Gospel have direct consequences for our way of
thinking, feeling and living. More than m ideas
or concepts as such, I am interested in how such
a spirituality can motivate us to a more passion-
ate concern for the protection of our world. A
commitment this lofty cannot be sustained by
doctrine alone, without a spirituality capable of
inspiring us, without an "interior impulse which
encourages, motivates, nourishes and gives
meaning to our individual and communal activi-
ty".151 Admittedly, Christians have not always ap-
propriated and developed the spiritual treasures
bestowed by God upon the Church, where the
life of the spirit is not dissociated from the body
or from nature or from worldly realities, but lived
in and with them, in communion with all that
surrounds us.
217. "The external deserts in the world are
growing, because the internal deserts have be-
come so vast".152 For this reason, the ecological
crisis is also a summons to profound interior
conversion. It must be said that some committed
and prayerful Christians, with the excuse of real-
151 Apostolic Exhortation Evangels Gaudinm (24 Nov
2013), 261: AAS 105 (2013), 1124.
152 Benedict XVI, Homily for the Solemn Inauguration of the
Petrine Ministry (24 April 2005): AAS 97 (2005), 710.
158
A4 p.515
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ism and pragmatism, tend to ridicule expressions
of concern for the environment. Others are
passive; they choose not to change their habits
and thus become inconsistent. So what they all
need is an "ecological conversion", whereby the
effects of their encounter with Jesus Christ be-
come evident in their relationship with the world
around them. Living our vocation to be protec-
tors of God's handiwork is essential to a life of
virtue; it is not an optional or a secondary aspect
of our Christian experience.
218. In calling to mind the figure of Saint Fran-
cis of Assisi, we come to realize that a healthy
relationship with creation is one dimension of
overall personal conversion, which entails the
recognition of our errors, sins, faults and fail-
ures, and leads to heartfelt repentance and de-
sire to change. The Australian bishops spoke of
the importance of such conversion for achieving
reconciliation with creation: "To achieve such
reconciliation, we must examine our lives and ac-
knowledge die ways m which we have harmed
God's creation through our actions and our fail-
ure to act. We need to experience a conversion,
or change of heart".153
219. Nevertheless, self-improvement on the
part of individuals will not by itself remedy the
extremely complex situation facing our world to-
153 Australian Catholic Bishops' Conference, A New
liatih — The iinvironmental Challenge (2002).
159
A4 p.516
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day. Isolated individuals can lose their ability and
freedom to escape the utilitarian mindset, and
end up prey to an unethical consumerism bereft
of social or ecological awareness. Social problems
must be addressed by community networks and
not simply by the sum of individual good deeds.
This task "will make such tremendous demands
of man that he could never achieve it by indi-
vidual initiative 01* even by the united effort of
men bred in an individualistic way. The work of
dominating the world calls for a union of skills
and a unity of achievement that can only grow
from quite a different attitude".1>1 The ecological
conversion needed to bring about lasting change
is also a community conversion.
220. This conversion calls for a number of at-
titudes which together foster a spirit of generous
care, full of tenderness. First, it entails gratitude
and gratuitousness, a recognition that the world
is God's loving gift, and that we are called quiet-
ly to imitate his generosity 111 self-sacrifice and
good works: "Do not let your left hand know
what your right hand is doing... and your Father
who sees in secret will reward you" (Mt 6:3-4). It
also entails a loving awareness that we are not dis-
connected from the rest of creatures, but joined
in a splendid universal communion. As believ-
ers, we do not look at die world from without
but from within, conscious of the bonds with
:b4 Romano Guardini, Das Ende der Neu^eil, 72 (The End
of the Modem Worldt 65-66).
160
A4 p.517
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which the Father has linked us to all bemgs. By
developing our individual, God-given capacities,
an ecological conversion can inspire us to greater
creativity and enthusiasm in resolving the world's
problems and in offering ourselves to God "as a
living sacrifice, holy and acceptable" (Ram 12:1).
We do not understand our superiority as a reason
for personal glory or irresponsible dominion, but
rather as a different capacity which, in its turn,
entails a serious responsibility stemming from
our faith.
221. Various convictions of our faith, developed
at the beginning of this Encyclical can help us
to enrich the meaning of this conversion. These
include the awareness that each creature reflects
something of God and has a message to convey
to us, and the security that Christ has taken unto
himself this material world and now; risen, is inti-
mately present to each being, surrounding it with
his affection and penetrating it with his light. Then
too, there is the recognition that God created the
world, writing into it an order and a dynamism
that human beings have 110 right to ignore. We
read in the Gospel that Jesus says of the birds of
the air that "not one of them is forgotten before
God" (Lk 12:6). How then can we possibly mis-
treat them or cause them harm? I ask all Christians
to recognize and to live fully this dimension of
their conversion. May die power and the light of
the grace we have received also be evident in our
relationship to other creatures and to the world
161
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around us. In this way, we will help nurture that
sublime fraternity with all creation which Saint
Francis of Assisi so radiantly embodied.
IV Joy and peace
222. Christian spirituality proposes an alterna-
tive understanding of the quality of life, and en-
courages a prophetic and contemplative lifestyle,
one capable of deep enjoyment free of the ob-
session with consumption. We need to take up an
ancient lesson, found in different religious tradi-
tions and also in die Bible. It is die conviction that
"less is more". A constant flood of new consumer
goods can baffle the heart and prevent us from
cherishing each thing and each moment, lb be se-
renely present to each reality, however small it may
be, opens us to much greater horizons of under-
standing and personal fulfilment. Christian spirit-
uality proposes a growth marked by moderation
and the capacity to be happy with little. It is a re-
turn to that simplicity which allows us to stop and
appreciate the small things, to be grateful for die
opportunities which life affords us, to be spirit-
ually detached from what we possess, and not to
succumb to sadness for what we lack. This implies
avoiding the dynamic of dominion and the mere
accumulation of pleasures.
223. Such sobriety when lived freely and con-
sciously, is liberating. Tt is not a lesser life or one
lived with less intensity. On the contrary-, it is
a way of living life to the full. In reality, those
162
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who enjoy more and live better each moment are
those who have given up dipping here and there,
always on the look-out for what they do not
have. They experience what it means to appre-
ciate each person and each thing, learning famil-
iarity with die simplest things and how to enjoy
them. So they are able to shed unsatisfied needs,
reducing their obsessiveness and weariness. Even
living 011 little, they can live a lot, above all when
they cultivate other pleasures and find satisfac-
tion in fraternal encounters, in service, 111 devel-
oping their gifts, in music and art, 111 contact with
nature, in prayer. Happiness means knowing how
to limit some needs which only diminish us, and
being open to the many different possibilities
which life can offer.
224. Sobriety and humility were not favoura-
bly regarded in the last century. And yet, when
there is a general breakdown in the exercise of a
certain virtue 111 personal and social life, it ends
up causing a number of imbalances, including
environmental ones. That is why it is 110 longer
enough to speak only of the integrity of ecosys-
tems. We have to dare to speak of the integrity
of human life, of the need to promote and unify
all the great values. Once we lose our humility,
and become enthralled with the possibility of
limitless mastery over everything, we inevitably
end up harming society and the environment. It
is not easy to promote this kind of healthy hu-
mility or happy sobriety when we consider our-
163
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selves autonomous, when we exclude God from
our lives or replace him with our own ego, and
think that our subjective feelings can define what
is right and what is wrong.
225. On the other hand, no one can cultivate
a sober and satisfying life without being at peace
with him or herself. An adequate understand-
ing of spirituality consists in filling out what we
mean by peace, which is much more than the
absence of war. Inner peace is closely related
to care for ecology and for the common good
because, lived out authentically, it is reflected in
a balanced lifestyle together with a capacity for
wonder which takes us to a deeper understanding
of life. Nature is filled with words of love, but
how can we listen to them amid constant noise,
interminable and nerve- wracking distractions,
or the cult of appearances? Many people today
sense a profound imbalance which drives them
to frenetic activity- and makes them feel bus}7, m
a constant hurry which in turn leads them to ride
rough-shod over everything around them. This
too affects how they treat the environment. An
integral ecology includes talcing time to recover
a serene harmony with creation, reflecting on
our lifestyle and our ideals, and contemplating
the Creator who lives among us and surrounds
us, whose presence "must not be contrived but
found, uncovered".15:5
:5i Apostolic Exhortation Ylvangelii Gaudimi (24 Novem-
ber 2013), 71: AAS 105 (2013), 1050.'
164
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226. We are speaking of an attitude of the
heart, one which approaches life with serene
attentiveness, which is capable of being fully
present to someone without thinking of what
comes next, which accepts each moment as a gift
from God to be lived to the full. Jesus taught us
this attitude when he invited us to contemplate
the lilies of the field and the birds of the air, or
when seeing the rich young man and knowing
his restlessness, "he looked at him with love"
(Mk 10:21). He was completely present to every-
one and to everything, and in this way he showed
us the way to overcome that unhealthy anxiety
which makes us superficial, aggressive and com-
pulsive consumers.
227. One expression of this attitude is when
we stop and give thanks to God before and after
meals. I ask all believers to return to this beautiful
and meaningful custom. That moment of bless-
ing, however brief, reminds us of our depend-
ence on God for life; it strengthens our feeling
of gratitude for the gifts of creation; it acknowl-
edges those who by their labours provide us with
these goods; and it reaffirms our solidarity with
those m greatest need.
V. Civic and political love
228. Care for nature is part of a lifestyle which
includes the capacity for living together and
communion. Jesus reminded us that we have
G od as our common Father and that this makes
165
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us brothers and sisters. Fraternal love can only be
gratuitous; it can never be a means of repaying
others for what they have done or will do for us.
That is why it is possible to love our enemies.
This same gratuitousness inspires us to love and
accept the wind, the sun and the clouds, even
though we cannot control them. In this sense,
we can speak of a "universal fraternity?".
229. We must regain the conviction that we
need one another, that we have a shared re-
sponsibility for others and the world, and diat
being good and decent are worth it. We have
had enough of immorality and the mockery of
ethics, goodness, faith and honesty. It is time
to acknowledge that light-hearted superficiality
has done us no good. When the foundations of
social life are corroded, what ensues are battles
over conflicting interests, new forms of violence
and brutality', and obstacles to the growth of a
genuine culture of care for the environment.
230. Saint Therese of Lisieux invites us to
practise the little way of love, not to miss out on
a kind word, a smile or any small gesture which
sows peace and friendship. An integral ecology
is also made up of simple daily gestures which
break with the logic of violence, exploitation and
selfishness. In the end, a world of exacerbated
consumption is at the same time a world which
mistreats life in all its forms.
231. Love, overflowing with small gestures
of mutual care, is also civic and political, and
166
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it makes itself felt in every action that seeks to
build a better world. Love for society and com-
mitment to the common good are outstanding
expressions of a chanty which affects not only
relationships between individuals but also "mac-
ro-relationships, social, economic and political
ones".156 That is why die Church set before the
world the ideal of a "civilization of love".157 So-
cial love is the key to authentic development: "In
order to make society more human, more worthy
of the human person, love m social life — polit-
ical, economic and cultural — must be given re-
newed value, becoming the constant and highest
norm for all activity".158 In this framework, along
with the importance of little everyday gestures,
social love moves us to devise larger strategies
to halt environmental degradation and to en-
courage a "culture of care" which permeates all
of society. When we feel that God is calling us
to intervene with others in these social dynam-
ics, we should realize that this too is part of our
spirituality which is an exercise of charity and, as
such, matures and sanctifies us.
232. Not everyone is called to engage direct-
ly in political life. Society is also enriched by a
coundess array of organizations which work to
15° Benedict XVI, Encyclical Letter Cantos in Veritate (29
June 2009) 2: AAS 101 (2009), 642.
15' Paul VI, Message for the 1977 World Day of Peace: AAS
68 (1976), 709.
158 Pontifical Council for Justice and Peace, Compendi-
um of the Social Doctrine of the Church, 582.
167
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promote the common good and to defend the
environment, whether natural or urban. Some,
for example, show concern for a public place (a
building, a fountain, an abandoned monument, a
landscape, a square), and strive to protect, restore,
improve or beautify it as something belonging to
everyone. Around these community actions, rela-
tionships develop or are recovered and a new so-
cial fabric emerges. Thus, a community can break
out of the indifference induced by consumerism.
These actions cultivate a shared identity, with a
story which can be remembered and handed on.
In this way, the world, and the quality of life of
the poorest, are cared for, with a sense of sol-
idarity which is at the same time aware that we
live in a common home which God has entrust-
ed to us. These community actions, when they
express self-giving love, can also become intense
spiritual experiences.
VI. Sacramental signs
AND THE CELEBRATION OF REST
233. The universe unfolds in God, who fills it
completely Hence, there is a mystical meaning
to be found in a leaf, in a mountain trail, in a
dewdrop, in a poor person's face.1"'9 The ideal is
559 The spiritual writer Ali al-Ivhawas stresses from his
own experience the need not to put too much distance between
the creatures of the world and the interior experience of God.
As he puts it: "Prejudice should not have us criticize those who
seek ecstasy in music or poetry There is a subtle mystery in
168
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not only to pass from the exterior to the interior
to discover the action of God in die soul, but
also to discover God in all things. Saint Bonaven-
ture teaches us that "contemplation deepens the
more we feel the working of G od's grace within
our hearts, and the better we learn to encounter
God in creatures outside ourselves".160
234. Saint John of the Cross taught that all the
goodness present in the realities and experienc-
es of this world "is present in God eminently
and infinitely, or more properly, in each of these
sublime realities is God".161 This is not because
the finite things of this world are really divine,
but because the mystic experiences the intimate
connection between God and all beings, and thus
feels that "all things are God".162 Standing awe-
struck before a mountain, he or she cannot sepa-
rate this experience from God, and perceives that
the interior awe being lived has to be entrusted
to the Lord: "Mountains have heights and they
are plentiful, vast, beautiful, graceful, bright and
fragrant. These mountains are what my Beloved
is to me. Lonely valleys are quiet, pleasant, cool,
each of the movements and sounds of this world. The initiate
will capture what is being said when the wind blows, the trees
sway, water flows, flies buzz, doors creak, birds sing, or in the
sound of strings or flutes, the sighs of the sick, the groans of
the afflicted..." (Eva De Vitray-Meyerovitch [ed.], Anthologie
du soufisme, Paris 1978, 200).
160 In II Sent., 23, 2, 3.
161 Canlico lispinlual, XIV, 5.
162 Ibid.
169
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shady and flowing with fresh water; in the va-
riety of their groves and in the sweet song of
the birds, they afford abundant recreation and
delight to the senses, and in their solitude and si-
lence, they refresh us and give rest. These valleys
are what my Beloved is to me".163
235. The Sacraments are a privileged way in
which nature is taken up by God to become a
means of mediating supernatural life. Through
our worship of God, we are invited to embrace
the world on a different plane. Water, oil, fire and
colours are taken up in all their symbolic power
and incorporated in our act of praise. The hand
that blesses is an instrument of God's love and a
reflection of the closeness of jesus Christ, who
came to accompany us on the journey of life.
Water poured over the body of a child in Baptism
is a sign of new life. Encountering God does not
mean fleeing from this world or turning our back
on nature. This is especially clear in the spirit-
uality of the Christian East. "Beauty, which in
the East is one of the best loved names express-
ing the divine harmony and the model of hu-
manity transfigured, appears everywhere: in the
shape of a church, in the sounds, in the colours,
in the lights, in the scents".164 For Christians, all
the creatures of the material universe find their
163 Ibid, XIV, 6-7.
164 John Paul II, Apostolic Letter Orientak Ijmen (2 May
1995), 11: AAS 87 (1995), 757.
170
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true meaning in the incarnate Word, for the Son
of God has incorporated in his person part of
the material world, planting in it a seed of defini-
tive transformation. "Christianity does not reject
matter. Rather, bodiliness is considered in all its
value in die liturgical act, whereby the human
body is disclosed in its inner nature as a temple
of the Holy Spirit and is united with the Lord
Jesus, who himself took a body for the world's
salvation".165
236. It is in the Eucharist that all that has been
created finds its greatest exaltation. Grace, which
tends to manifest itself tangibly", found unsur-
passable expression when God himself became
man and gave himself as food for his creatures.
The Lord, in the culmination of the mystery
of the Incarnation, chose to reach our intimate
depths through a fragment of matter. Tie comes
not from above, but from within, he comes that
we might find him in this world of ours. In the
Eucharist, fullness is already achieved; it is the
living centre of the universe, the overflowing
core of love and of inexhaustible life. Joined to
the incarnate Son, present in the Eucharist, the
whole cosmos gives thanks to God. Indeed the
Eucharist is itself an act of cosmic love: "Yes,
cosmic! Because even when it is celebrated 011
the humble altar of a country church, the Eucha-
rist is always in some way celebrated on the al-
16 5 Ibid.
171
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tar of the world".166 The Eucharist joins heaven
and earth; it embraces and penetrates all creation.
The world which came forth from God's hands
returns to him in blessed and undivided adora-
tion: m the bread of the Eucharist, "creation is
projected towards divinization, towards the holy
wedding feast, towards unification with the Cre-
ator himself".167 Thus, the Eucharist is also a
source of light and motivation for our concerns
for the environment, directing us to be stewards
of all creation.
237. Oil Sunday, our participation in the
Eucharist has special importance. Sunday, like
the Jewish Sabbath, is meant to be a day which
heals our relationships with God, with ourselves,
with others and with the world. Sunday is the day
of the Resurrection, the "first day" of the new
creation, whose first fruits are the Lord's risen
humanity, the pledge of the final transfiguration
of all created reality It also proclaims "man's
eternal rest in God".168 In tins way, Christian
spirituality incorporates the value of relaxation
and festivity. We tend to demean contemplative
rest as something unproductive and unnecessary,
but this is to do away with the very thing which
is most important about work: its meaning. We
160 Id., Encyclical Letter Ecclesia de Eucharistia (17 April
2003), 8: AAS 95 '(2003), 438.
Benedict XVI, Homily for the Mass of Corpus Domini
(15 June 2006): AAS 98 (2006),'513.
', cs Catechism of the Catholic Church, 2175.
172
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are called to include in our work a dimension of
receptivity and gratuity, which is quite different
from mere inactivity. Rather, it is another way of
working, winch forms part of our very essence.
It protects human action from becoming empty
activism; it also prevents that unfettered greed
and sense of isolation which make us seek per-
sonal gain to the detriment of all else. The law of
weekly rest forbade work on the seventh day, "so
that your ox and your donkey may have rest, and
the son of your maidservant, and the stranger,
may be refreshed" (Ex 23:12). Rest opens our
eyes to the larger picture and gives us renewed
sensitivity to die rights of others. And so the day
of rest, centred on the Eucharist, sheds it light
011 the whole week, and motivates us to greater
concern for nature and die poor.
VII. The Trinity and the relationship
BETWEEN CREATURES
238. The Father is the ultimate source of
everything, the loving and self-communicating
foundation of all that exists. The Son, his reflec-
tion, through whom all things were created, unit
ed himself to this earth when he was formed in
the womb of Mary. The Spirit, infinite bond of
love, is intimately present at the very heart of the
universe, inspiring and bringing new pathways.
The world was created by the three Persons act-
ing as a single divine principle, but each one of
them performed this common work in accord-
173
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ance with his own personal property. Conse-
quently, "when we contemplate with wonder the
universe in all its grandeur and beaut)5, we must
praise the whole Trinity".169
239. For Christians, believing in one God who
is tnnitarian communion suggests that the Trinity
has left its mark 011 all creation. Saint Bonaven-
ture went so far as to say that human beings,
before sin, were able to see how7 each creature
"testifies that God is three". The reflection of
the Trinity was there to be recognized in nature
'when that book wras open to man and our eyes
had not yet become darkened".170 The Francis-
can saint teaches us that each creature bears in it-
self a specifically Trinitarian structure, so real that it
could be readily contemplated if only the human
gaze were not so partial, dark and fragile. In this
way, he points out to us the challenge of trying to
read reality in a Trinitarian key.
240. The divine Persons are subsistent rela-
tions, and the world, created according to the di-
vine model, is a web of relationships. Creatures
tend towards God, and in turn it is proper to
every living being to tend towards other things,
so that throughout the universe we can find any
number of constant and secretly interwoven re-
j
169 John Paul II, Catechesis (2 August 2000), 4: Insegnamenti
23/2 (2000), 112.
"" Quaes!. Disp. de Myst. Trinitatis, 1, 2 concl.
174
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lationships.171 This leads us not only to marvel at
the manifold connections existing among crea-
tures, but also to discover a key to our own ful-
filment. The human person grows more, matures
more and is sanctified more to the extent that he
or she enters into relationships, going out from
themselves to live in communion with God, with
others and with all creatures. In this way, they
make their own that trinitarian dynamism which
God imprinted in them when they were created.
Everything is interconnected, and this invites us
to develop a spirituality of that global solidarity
which flows from the mystery of the Trinity.
VIII. Queen of all creation
241. Mar}?, the Mother who cared for Jesus, now
cares with maternal affection and pain for this
wounded world, just as her pierced heart mourned
die death of Jesus, so nowT she grieves for die suf-
ferings of the crucified poor and for the creatures
of this world laid waste by human power. Com-
pletely transfigured, she now7 lives with Jesus, and
all creatures sing of her fairness. She is the Wom-
an, "clothed in the sun, with die moon under her
feet, and on her head a crown of twelve stars"
(Rep 12:1). Carried up into heaven, she is the
Mother and Queen of all creation. In her glori-
fied body, together with die Risen Christ, part of
creation has reached the fullness of its beauty. She
1/1 Cf. Thomas Aquinas, Summa Theologiae, I, q. 11, art. 3;
q. 21, art. 1, ad 3; q. 47, art. 3.
175
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treasures the entire life of Jesus in her heart (cf.
Lk 2:19,51), and now understands the meaning of
all things. Hence, we can ask her to enable us to
look at this world with eyes of wisdom.
242. At her side in the Holy Family of Naza-
reth, stands the figure of Saint Joseph. Through
his w< jrk and generous presence, he cared for
and defended Mary and jesus, delivering them
from the violence of the unjust by bringing
them to Egypt. The Gospel presents Joseph as
a just man, hard-working and strong. But he also
shows great tenderness, which is not a mark of
the weak but of those who are genuinely strong,
fully aware of reality and ready to love and serve
in humility. That is why he was proclaimed cus-
todian of the universal Church. He too can teach
us how to show care; he can inspire us to work
with generosity and tenderness in protecting this
world which God has entrusted to us.
IX. Beyond the sun
243. At die end, we will find ourselves face to
face with the infinite beauty of (> (>d (cf. / Cor
13:12), and be able to read with admiration and
happiness the mystery of the universe, which with
us will share in unending plenitude. Even now we
are journeying towards the sabbath of eternity,
the new Jerusalem, towards our common home
in heaven. Jesus says: "I make all things new" (Rev
21:5). Eternal life will be a shared experience of
176
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awe, m which each creature, resplendency trans-
figured, will take its rightful place and have some-
thing to give those poor men and women who
will have been liberated once and for all.
244. In the meantime, we come together to
take charge of this home which has been entrust-
ed to us, knowing that all the good which exists
here will be taken up into the heavenly feast. In
union with all creatures, we journey through this
land seeking God, for "if the world has a begin-
ning and if it has been created, we must enquire
who gave it diis beginning, and who was its Cre-
ator".1'2 Let us sing as we go. May our struggles
and our concern for this planet never take away
the joy of our hope.
245. God, who calls us to generous commit-
ment and to give him our all, offers us the light
and the strength needed to continue on our way.
In the heart of this world, the Lord of life, who
loves us so much, is always present. He does not
abandon us, he does not leave us alone, for he
has united himself definitively to our earth, and
his love constantly impels us to find new ways
forward. Praise be to him\
* * *
246. At the conclusion of this lengthy reflection
which has been both joyful and troubling, I pro-
1 n Basil the Great, Horn, in Hexaemeron, I, 2, 6: PG 29, 8.
177
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pose that we offer two prayers. The first we can
share with all who believe in a God who is the
all-powerful Creator, while in the other we Chris-
tians ask for inspiration to take up the commit-
ment to creation set before us by the Gospel of
Jesus.
-A prayer for our earth
All p< nvcrtul God,
you are present in the whole universe
and in the smallest of your creatures.
You embrace with your tenderness all that exists.
Pour out upon us the power of your love,
that we may protect life and beauty.
Fill us with peace, that we may live
as brothers and sisters, harming no one.
O God of the poor,
help us to rescue the abandoned
and forgotten of this eardi,
so precious in your eyes.
Bring healing to our lives,
that we may protect the world and not prey 011 it,
that we may sow beauty,
not pollution and destruction.
Touch the hearts
of those who look only for gain
at the expense of the poor and the earth.
Teach us to discover the worth of each thing,
to be filled with awe and contemplation,
to recognize that we are profoundly united
with everv creature
j
as we journey towards your infinite light.
We thank you for being with us each day
178
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Encourage us, we pray, m our struggle
for justice, love and peace.
A Christian prayer in union with creation
Father, we praise you with all your creatures.
They came forth from your all-powerful hand;
they are yours, filled with your presence and your
tender love.
Praise be to you!
Son of God, Jesus,
through you all things were made.
You were formed in the womb of Mary our
Mother,
you became part of this earth,
and you gazed upon this world with human eyes.
Today you are alive in every creature
in your risen glory.
Praise be to you!
Holy Spirit, by your light
you guide this world towards the bather's love
and accompany creation as it groans in travail.
You also dwell in our hearts
and you inspire us to do what is good.
Praise be to you!
Triune Lord,
wondrous community of infinite love,
teach us to contemplate you
in the beauty of the universe,
for all things speak of you.
Awaken our praise and thankfulness
179
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for every being that you have made.
Give us the grace to feel profoundly joined
to everything that is.
God of love, show us our place m diis world
as channels of your love
for all the creatures of this earth,
for not one of them is forgotten in your sight.
Enlighten those who possess power and money
that diey may avoid the sin of indifference,
that they may love the common good,
advance the weak,
and care for this w< jrld in which we live.
The poor and the earth are crying out.
(3 Lord, seize us with your power and light,
help us to protect all life,
to prepare for a better future,
for the coming of your Kingdom
of justice, peace, love and beauty.
Praise be to you!
Amen.
Given m Rome at Saint Peter's on 24 May,
the Solemnity of Pentecost, in the year 2015, the
third of my Pontificate.
180
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TABLE OF CONTENTS
Laudato si', mi' Signore [1-2] 3
Nothing in this world is indifferent to us [3-6] . . 4
United by the same concern [7-9] 7
Saint Francis of Assisi [10-12] 9
My appeal [13-16]. ........... 12
Chapter one
WHAT IS HAPPENING
TO OUR COMMON HOME [17-6:1]
I. Pollution and climate change [20-26] 16
Pollution, waste and the throwaway culture [20-22] 16
Climate as a common good [23-26] ... 18
II. The issue of water [27-31] 22
III. Loss of biodiversity [32-42] .... 24
TV. Decline in the quality of human life
AND THE BREAKDOWN OF SOCIETY [43-47] 31
'V. Global inequality [48-52] 33
YI. Weak responses [53-59] ...... 39
VII. A VARIETY" OF OPINIONS [60-61] . ... 43
Chapter two
THE GOSPEL OF CREATION [62-100]
I. The light offered by faith [63-64], . 45
II. The wisdom of the biblical accounts
[65-75] ............ 46
III. The mystery of the universe [76-83] 55
IV. The message of each creature in the
HARMONY'OF CREATION 184-881 ... 61
181
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V. A UNIVERSAL COMMUNION [89-92] . . . 65
VI. The common destination of goods
[93-95] 68
VII. The gaze of Jesus [96-100] ..... 71
Chapter three
THE HUMAN ROOTS
OF THE ECOLOGICAL CRISIS [101-136]
I. Technology: creativity and power
[102-105] ........... 75
II. The globalization of the technocra-
tic PARADIGM [106-114] 78
III. The crisis and effects of modern
ANTHROPOCENTRISM [115-136] ... 86
Practical relativism \122-123] .... 90
The need to protect employment [124-129] 92
~New biological technologies \130-136] . . 96
Chapter four
INTEGRAL ECOLOGY [137-162]
I. Environmental, economic and social
ecology' [138-142] 103
II. Cultural ecology [143-146] .... 107
III. Ecology of daily life [147-155] . . 110
IV. The principle of the common good
[156-158] ........... 116
V. Justice between the generations
[159-162] 118
Chapter five
LINES OF APPROACH AND ACTION [163-201]
I. Dialogue on the environment in the
INTERNATIONAL COMMUNITY [164-175] 121
182
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II. Dialogue for new national and lo-
cal policies [176-181] ...... 129
III. Dialogue and transparency in deci-
sion-making [182-188] ...... 134
IV. Politics and economy in dialogue
FOR human fulfilment [189-198]. . 137
V. Religions in dialogue with science
[199-201] ........... 145
Chapter six
ECOLOG1C AL ED U CATION
AND SPIRITUALITY [202-246]
I. Towards a new lifestyle [203-208]. . 149
II. Educating for the covenant betwe-
en HUMANITY AND THE ENVIRONMENT
[209-215] ........... 153
III. Ecological conversion [216-221] . . 157
IV. Joy and peace [222-227] ...... 162
V. Civic and political love [228-232]. . 165
VI. Sacramental signs and the celebra-
tion of rest [233-237] . ..... 168
VII. The Trinity and the relationship
between creatures [238-240] ... 173
VIII. Queen of all creation [241-242] . . 175
IX. Beyond the sun [243-246] ..... 176
A pray erf or our earth. .......... 178
A Christian prayer in union with creation . . . . 179
A4 p.540
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VATICAN PRESS
A4 p.541
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Pentagon relies on antiquated, dangerous methods for
hazardous waste disposal
Gulf Coast Environmental Defense is a grassroots environmental
organization that has advocated for the health of the Florida Panhandle
community for more than 30 years.
It's a shocking case of arrested development. In a nation that prides itself
on high technology, our federal government is burning and detonating
hazardous waste in the open air, using stone age disposal methods long
ago outlawed for private companies.
How did this happen? In the 1980s, when our federal hazardous waste
rules were written, a special exemption was created for waste military
explosives. This loophole has a catch: it was only for waste explosives
"which cannot be safely disposed of through other modes of treatment."
After decades of technological progress, safer alternative technology is
available and has been endorsed by the Department of Defense Explosives
Safety Board and the National Academy of Sciences.
Why isn't the Department of Defense using it?
The Pentagon, known for its technologically sophisticated weaponry and
communication systems, is relying on the most antiquated methods for
ridding itself of waste munitions: open burning and open detonation
(OB/OD). This isn't only backward; it's dangerous.
Currently, at more than 60 sites across the United States, millions of
pounds of unneeded explosives such as bombs, artillery shells, propellants,
tactical missiles, rockets, pyrotechnics, igniters, cartridges, rounds,
incendiaries such as napalm, land mines, flares and smoke canisters are
burned and exploded in the open air.
OB/OD spews heavy metals, including extremely fine particles of easily
breathable lead, depleted uranium and other heavy metals; energetic
compounds and perchlorate; dioxins and other organic compounds, often
spreading far beyond the point of release, washing into creeks, rivers and
bays and leaching into groundwater, exposing service members and
A4 p.542
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nearby communities. These contaminants can cause cancer, birth defects,
cardiac and immune system deterioration, and severe brain damage.
Eglin Air Force Base in Okaloosa County, Florida, is the OB/OD disposal
site for waste explosives and munitions generated at Hurlburt Field, Tyndall
Air Force Base, Pensacola Naval Air Station, and Navy Support Activity
Panama City, as well as Eglin itself. A Florida Department of Environmental
Protection (FDEP) permit allows nearly 9 million pounds of these wastes to
go up in smoke and come down in air and water pollution.
Although open burning (OB) at Eglin has been authorized for decades, a
new FDEP draft permit omits OB. This appears to be a significant
improvement, but it continues open detonation (OD) unabated.
Three important information gaps suggest that Eglin's OB/OD may have
even greater negative effects on nearby military and civilian communities.
First, it is assumed that Eglin groundwater can be sacrificed to munitions
disposal. Already there is enormous pressure on Florida's potable water
supplies from rapid development and saltwater intrusion; it is likely that
Eglin groundwater and surface water will eventually be needed for drinking
water use. Protecting it should be a priority.
Over the years, FDEP records show rapidly increasing levels of poisoned
groundwater at Eglin. Levels above the state's excess cancer risk have
been recorded since 2006 and continue to rise, doubling between in
concentration between 2017 and 2018 at one location. But even this data
may understate the danger, since FDEP acknowledges that Eglin's
groundwater monitoring has been inadequate to measure the actual threat
to onsite workers and residents.
Second, there is no monitoring of Eglin's air emissions. Since OB/OD
contamination travels through air, as well as soil, to reach groundwater in
these high concentrations, the air pathway must be measured in real time.
Third, both poisoned irrigation water and air deposition may also be
exposing local populations through contaminants in garden produce and
seafood.
A4 p.543
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While sites in other states are prohibited from OB/OD of certain wastes
such as depleted uranium, dioxins, RGBs, napalm, pesticides, red
phosphorus, nerve agents, nuclear devices, riot control gear, asbestos,
chemical warfare materiel, and biological agents, there are no such
prohibitions at Eglin. And transport of hazardous waste from the other four
facilities shares the roads civilian and commercial interests use daily to
travel throughout Northwest Florida, risking accidental release that could
affect thousands of people along and near by the Interstatel 0 /Highway 98
corridor between Pensacola and Panama City.
GCED has worked with the Pensacola Bay Area and the Okaloosa and
Walton chapters of the League of Women Voters and joined in urging that
FDEP require Eglin to begin phasing out OB/OD immediately. Northwest
Florida families, military and civilian, should not be subjected to the
unnecessary risk of cancer, birth defects, cardiac and immune system
deterioration, and severe brain damage so that Eglin can continue its
antiquated ways. It's time to move into the 21st century.
Enid Sisskin, PhD, is a director of Gulf Coast Environmental Defense
esisskin@gmail. com
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UNITED STATES ENVIRONMENTAL PROTECTION AGENCY
,;7' REGION 2 . "
' 290 BROADWAY '
- • ¦ NEW YORK, NY 10007-1866 -
JUL 1 3 2010
Arnold P, Wendroff, Ph.D.
544 Eighth Street
Brooklyn, New York 11215-4201
Dear Dr. Wendroff:
Thank you for your correspondence of May 27, 2010 regarding ritualistic
mercury use. As always, we appreciate your continuous interest, concern
and involvement to raise awareness on issues concerning the ritualistic use
of mercury. As was stated in previous communications with you, the EPA
has worked well with others to raise awareness on the issue and take action
within the current legal framework of our authorities. We will continue to do
so in the future. EPA has an ongoing concern about potential mercury (Hg)
exposure associated with its use in ritualistic practices. Conceivably, such
exposures can even extend to non-users through a scenario where ritualistic
Hg practices by previous occupants of residential dwellings have
contaminated the living space of the current unsuspecting residents. EPA
Region 2 is exploring ways to characterize this potential exposure scenario.
As part of our efforts to find a way to study potential mercury exposure
associated with its use in ritualistic practices, we are pursuing the Regional
Applied Research Effort (RARE) Program. The RARE Program is one approach
EPA takes to promote collaboration between the Regions and EPA's Office of
Research and Development (ORD). The goals of the program are to:
1) Provide the Regions with near-term research on high-priority,
region-specific science needs,
2) Improve collaboration between Regions and ORD laboratories, and
3) Build a foundation for future scientific interaction.
ORD provides $200,000 per year to each Region to develop a research topic,
which is then submitted to a specific ORD laboratory or center as an
extramural research proposal. Once approved, the research is conducted as
a joint effort with ORD researchers and regional staff working together to ;
meet region-specific.needs. *
RARE grants are competitively awarded so it's critically important to insure as
sound and scientifically rigorous a proposal as possible. Due to the
competitive nature of the RARE Program process, there is no guarantee that
Internet Address (URL) • http://www.epa.gov
Recycled/Recyclable 'Printed with Vegetable Oil Based Inks on 100% Postconsumer, Process Chlorine Free Recycled Paper
A4 p.545
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any given proposal will be selected. Ultimately, the fate of a RARE-proposal
is governed by the rigor and regional importance of the study as judged by
the members of the Regional.Science Council and EPA's" Senior Management
Team. RARE grants.follow a-regimented time line - the deadline for the
current submission is July 31, 2010. Region 2 is also in active discussion
with our colleagues in Region 1 to identify ways in which we can work
collaboratively on issues surrounding ritualistic use of mercury. We have
discussed with them our draft RARE grant proposals (see below) and are
exploring the possibility of a joint proposal.
Studying the prevalence of ritualistic Hg use and its potential for
contaminating residential dwellings .poses logistic challenges, both legal and
cultural. Access agreements would be needed to gain entry into residential
dwellings. EPA has explored accessing vacant NYC Housing Authority
apartments as a way to obviate this requirement. Another approach would
be to expand on a ritualistic Hg study that NJDEP performed in Union City,
N.J., where building common spaces (hallways, vestibules, etc.) rather than
apartments were sampled. However, getting to an apartment entrance and
not beyond does limit the usefulness of the sampling data. Perhaps most
promising is an ongoing children's health study being conducted at the
Columbia University School of Public Health. The study, which has a sizable
Dominican cohort, is primarily focused on asthma triggers and pesticides.
Access agreements are already in place; thus, it may be possible to
incorporate residential Hg vapor sampling into the study design, although
there may be cultural sensitivity associated with sampling to identify
ritualistic practices. Issues such as this need to be considered as part of a
robust research proposal.
Thank you for your continued interest in public health intervention strategies
related to ritualistic Hg use. For any follow-up queries on this issue, please
contact Mark Maddaloni of my staff. Mark can be reached at (212) 637-3590
rmaddaloni.mark@epa.gov).
Sincerely,
ft Judith A. Enck
Regional Administrator
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U.S. EPA / Region 2/Office of Research and Development
FY11 Regional Applied Research Effort Proposal
PROJECT TITLE AND REGIONAL CONTACT: Mercury Vapor Sampling in Targeted Housing: Investigation
of Ritualistic Mercury Use. Mark Maddaloni - Office of Strategic Programs, Office of the Regional Administrator
(212) 637-3590
DIRECTOR'S NAME: Pat Evangelista - Director, Office of Strategic Programs (212) 637-4447
ORD CONTACT:
Matt Lobber - National Center for Environmental Assessment (202) 564-3243 lorber.matt@epa.qov
PROJECT DESCRIPTION:
Science and Environmental Issues: Elemental mercury plays a role in several related Afro-Caribbean religions
including Santeria (NJDEP, 2003). Such practices include the sprinkling of mercury in residential dwellings. Air
monitoring data in the hallways of buildings in areas with a large Afro-Caribbean population in NJ have provided
strong evidence that at least 2% of apartments in these areas have an ongoing or historic presence of mercury,
consistent with such cultural use, that exceeds the background in non Afro-Caribbean areas (NJDEP, 2003;
NJDEP, 2007). Such uses potentially pose a health hazard, not only to those who engage in these practices, but to
subsequent occupants of these dwellings.
Research Objectives and Expected Outcomes: Despite knowledge of the existence of ritualistic practices involving
mercury, no data exist on levels of in-dwelling exposure. A study conducted previously by NJDEP relied on indirect
indicators outside apartments of conditions inside apartments and could not provide an estimate of the airborne
concentration of mercury inside the apartments. Measurement of mercury vapor inside a dwelling, at the point
of exposure, is the best environmental indicator of potential hazard. This pilot level study of targeted
housing will inform the potential extent and magnitude of mercury vapor contamination secondary to
ritualistic practices by directly measuring mercury vapor concentration in targeted housing units.
Approach: EPA Region 2 and the Office of Research and Development will collaborate with the NJDEP-Office of
Science, the Hudson Regional Health Commission (HRHC), the NJ Dept. of Health and Senior Services (NJDHSS),
the NJ Dept. of Community Affairs (NJDCA) and UMDNJ (Dr. Michael Gochfeld, M.D., Ph.D.). The study tasks are
as follows:
Sampling Design - EPA,NJDEP, NJDCA and HRHC will coordinate to construct a sampling schedule for Union
City/West New York, NJ that will coincide with NJDCA's regular inspection of apartment buildings in those areas.
Control apartments will be identified from inspections in non Afro-Caribbean communities.
Sampling - HRHC will accompany NJDCA inspectors to apartments where real-time readings for mercury vapor
will be conducted using a Lumex portable sampling device. NJDEP owns such a device, and HRHC has extensive
experience with its use from the previously-referenced studies.
Response Plan - EPA. NJDHSS, NJDEP and UMDNJ will review the scientific medical literature to derive a graded
response plan to be used in the event that above-background levels of mercury vapor are detected in an
apartment.
Medical Follow-Up - In the event that a significant exposure is discovered in an occupied apartment, UMDNJ (Dr.
Gochfeld) will conduct an initial medical evaluation to determine the need for medical follow-up.
Data Analysis/Report Preparation - In coordination with EPA, NJDEP will take the lead in conducting statistical
analysis of the data and in preparation of a draft and final report. All collaborators will review and comment on the
draft report.
Estimated Budget and Timetable: Expenses for this study are limited to the following areas:
Partial salaries for HRHC, UMDNJ personnel
A4 p.547
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Transportation for HRHC
Preparation/printing of educational materials
Possible incentives for occupants
Approximate budget for the study is $40,000-50,000.
Study Duration
Given the estimate from the previously-referenced studies that approximately 2% of apartments in the target
communities may have current or historical contamination from cultural uses of mercury, we anticipate the need to
sample in 250-300 apartments in order to get a representative sample of mercury vapor exposure levels in
impacted apartments.
The rate of inspection of apartments in this study is constrained by NJDCA's inspection schedule (as feasible, we
will work with NJDCA to temporarily give precedence to inspections in Union City/West New York). Given these
two considerations, we anticipate that the field portion of this study will extend over two years.
References
NJDEP (2003). Cultural Uses of Mercury in New Jersey - Research Project Summary
(http://www.state.ni.us/dep/dsr/research/mercury-cultural.pdf).
NJDEP (2007). Cultural Uses of Mercury in New Jersey - Year 2 Mercury Vapor in Residential Buildings -
Comparison of Communities That Use Mercury for Cultural Purposes with a Reference Community
(http://www.state.ni.us/dep/dsr/research/mercury-cultural-yr2.pdf).
A4 p.548
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BORIJ. PRES. Fax:718-537-3583 Apr 24 '00 9:25 P. 02
h
FERNANDO FERR
BOROUGH PRESI] I-N l
April 7, 2000
Antonia tovello, M.D.
Commis- ioner
New Yoi < State Department of Health
Corning ?ower
Empire S tate Plaza
Albany,: }Y 12237
Dear Co; imissioner Novello:
It has been brought to my attention that the sale of unlabeled elemental mercury
continue to take place in New York City, despite previous publicity of this problem. People
who pun hase mercury, a legal substance that is sometimes improperly labeled, often use the
substanc in ways that put their health at risk.
I ' light of the known health-related dangers of mercury, I urge the State to conduct a
public ot treach and education campaign on the toxic effects of elemental mercury and to enforce
the sale < f improperly labeled mercury. .
1 i.e Department of Health's primary mission is the prevention of illnesses. I ask that you
incorpor i.e the issue of mercury poisoning into carrying out your missions.
FERNANDO FERRER
BPB9m
FF/mn
-QEEI£E_QEJJjyE_BRONX BOROUGH PRF.5iinF.NT
The Bronx County Building
851 Grand Concourse
Bronx, New York 10451
590-3500 CtXTrla"
lllllf
A4 p.549
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OFFICE OF THE BRONX BOROUGH PRESIDENT
THE BRONX COUNTY BUILDING
TEL. 718-590-3500
851 GRAND CONCOURSE tdd: 71S-59O-7096
FERNANDO FERRER BRONX, NEW YORK 10451 FAX. 7l3.s9o-3S37
BOROUGH PRESIDENT
July 23, 1997
Benjamin Mojica, MD, MPH
Acting Commissioner of Health
New York City Department of Health
125 Worth Street
New York, NY 10013
Dear Commissioner Mojica:
It has recently been brought to my attention that the sale of unlabeled elemental mercury
is still ongoing in New York City. I understand that in the past the New York City Department
of Health (NYCDOH) has taken steps to raise public awareness on this issue and to educate
communities across the City about the dangers associated with this hazardous chemical.
In light of the recent warnings issued by the Agency for Toxic Substances and Disease
Registry (ATSDR) and the Environmental Protection Agency (EPA), I urge the NYCDOH to
once again conduct a public outreach and education campaign on the toxic effects of elemental
mercury, particularly for pregnant women and children. As reported last year m the American
Journal of Public Health, it is quite easy to purchase mercury in New York City. Purchasers,
however, should be made aware of the risks involved and your role in raising public awareness
is important.
I also understand that you will be meeting with the EPA and the NewYork State
Department of Health to further discuss this issue. I would appreciate being kept informed ot
your continued efforts in this area.
BHHSDC #7116
A4 p.550
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Fluoridation Policy:
An Annotated Bibliography of Published Science
A sampling of the scientific studies and reports relevant to water fluoridation published
since the HHS 2015 recommendation to lower the fluoridation target to 0.7 ppm is listed below.
I suggest these items provide compelling evidence that 0.7 ppm is neither optimal nor safe
and that any claims to the contrary are ill-founded. Moreover, protests that more study is
required before banning fluoridation is a tacit endorsement of human experimentation
without individual consent which is medical assault - Karen F. Spencer
2021
BENCHMARK DOSE ANALYSIS: Using fluoride studies from MIREC and ELEMENT projects
as input, the results of which are consistent with other studies, authors identify 0.2 mg/L as
having an adverse impact on neurodevelopment. "The prospective studies offer strong evidence
of prenatal neurotoxicity, and the benchmark results should inspire a revision of water-fluoride
recommendations aimed at protecting pregnant women and young children."
https://Dubmed.ncbi.nlm.nih.gov/34101876/
Grandjean P, Hu H, Till C, Green R, Bashash M, Flora D, Tellez-Rojo MM, Song P, Lanphear
B, Budtz-Jorgensen E. A Benchmark Dose Analysis for Maternal Pregnancy Urine-Fluoride
and IQ in Children. Risk Analysis. 8 June 2021.
LIFETIME EXPOSURE: Fluoridation is the primary source of fluoride exposure for 1,629
Canadians between 3 and 79 that finds substantially higher lifetime fluoride exposure in
fluoridated communities using CHMS data, increasing with age. Vulnerable subpopulations to
adverse effects of fluoride noted as the young, those who are iodine deficient, and post-
menopausal women, https://www.mdpi.com/1660-4601/18/12/6203/htm
• Julia K. Riddell, Ashley J. Malin, Hugh McCague, David B. Flora, and Christine Till.
Urinary Fluoride Levels among Canadians with and without Community Water Fluoridation.
Int. J. Environ. Res. Public Health 2021, 18(12), 6203.
KIDNEYS: This study of 1,070 adults found every 1 mg/L increment in the urinary fluoride
concentrations was associated with significant increases of 22.8% in the risk of kidney function
injury after adjusting for potential confounding factors. Authors conclude that long-term fluoride
exposure is associated with compromised kidney function in adults, and that urinary NAG is a
sensitive and robust marker of kidney dysfunction caused by fluoride exposure.
https://pubmed.ncbi.nlm.nih.gov/34478979/
• Wu L, Fan C, Zhang Z, Zhang X, et al. Association between fluoride exposure and kidney
function in adults: A cross-sectional study based on endemic fluorosis area in China.
Ecotoxicol Environ Saf. 2021 Aug 31:225:112735.
BEHAVIORAL CHANGES: Children in Cincinnati Childhood Allergy and Air Pollution Study
(CCAA PS) assessed at age 12. Boys in particular did not experience significant anxiety or
depression, yet had somatic behaviors based on their childhood urinary fluoride (CUF)
concentrations, "seven times more likely to exhibit 'at-risk' internalizing symptomology."
https://pubmed.ncbi.nlm.nih.gov/34755609/
• Adkins EA, Yolton K, Strawn JR, Lippert F, Ryan PH, Brunst KJ. Fluoride exposure during
early adolescence and its association with internalizing symptoms. Environ Res. 2021 Oct
29:112296.
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20 December 2021
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Fluoridation Policy:
An Annotated Bibliography of Published Science
CRITICAL WINDOWS: Using urine samples and test scores from 596 mother-child Canadian
pairs in the MIREC prospective cohort, researchers found evidence that developmental
neurological damage was based on timing of fluoride exposure and gender, "Associations
between fluoride exposure and PIQ (performance IQ) differed based on timing of exposure. The
prenatal window may be critical for boys, whereas infancy may be a critical window for girls."
https://Dubmed.ncbi.nlm.nih.gov/34051202/
Farmus L, Till C, Green R, Hornung R, Martinez-Mier EA, Ayotte P, Muckle G, Lanphear B,
Flora D. Critical Windows of Fluoride Neurotoxicity in Canadian Children. Environ Res. 2021
May 26:111315.
GENES: Several genes make individuals more vulnerable to the neurotoxic impact with gender
differences, also affecting mitochondria and suggesting vulnerability to dementia. Chinese study
of 952 school children between 7 and 13 using water, urinary, hair and nail fluoride identified
multiple neurodevelopmental metabolic pathways that result in adverse effects from low fluoride
exposures. https://www.sciencedirect.com/science/article/Dii/S0160412021003Q68
• Yu X, Xia L, Zhang S, et al. Fluoride exposure and children's intelligence: Gene-environment
interaction based on SNP-set, gene and pathway analysis, using a case-control design
based on a cross-sectional study. Environ Int. 2021 Jun 4:155:106681.
GENETIC VULNERABILITY: Dopamine relative genes affect the susceptibility of individuals to
fluoride toxicity even in safe water concentrations which result in lowered IQ so that low-
moderate fluoride exposure is inversely related to children's IQ."
https://pubmed.ncbi.nlm.nih.gov/33360592/
• Zhao L, Yu C, Lv J, et al. Fluoride exposure, dopamine relative gene polymorphism and
intelligence: A cross-sectional study in China. Ecotoxicology and Environmental Safety. 2021
Feb:209:111826.
BRITTLE BONES: "In this cohort of postmenopausal women, the risk of fractures was
increased in association with two separate indicators of fluoride exposure. Our findings are
consistent with RCTs and suggest that high consumption of drinking water with a fluoride
concentration of -1 mg/L may increase both BMD (bone mineral density) and skeletal fragility in
older women." https://pubmed.ncbi.nlm.nih.gov/33822648/
Helte E, Donat Vargas C, Kippler M, Wolk A, Michaelsson K, Akesson A. Fluoride in Drinking
Water, Diet, and Urine in Relation to Bone Mineral Density and Fracture Incidence in
Postmenopausal Women. Environ Health Perspect. 2021 Apr;129(4):47005.
OSTEOARTHRITIS: Identifies fluoride as an environmental chemical that has adverse effects
on articular cartilage and osteoarthritis (OA) risk. "In full sample analysis, a 1 mg/L increase in
UF (urinary fluoride) level was associated with a 27% higher risk of OA."
https://link.springer.com/article/10.1007/s12011-021-Q2937-2
Sowanou, A., Meng, X., Zhong, N. et al. Association Between Osteoarthritis and Water
Fluoride Among Tongyu Residents, China, 2019: a Case-Control of Population-Based
Study. Biol Trace Elem Res (2021).
NO BENEFIT FOR PRESCHOOLERS: Polish study finds 'optimal' fluoride concentrations in
water provide no dental benefit. Dental caries experience depended on oral hygiene and diet.
https://www.sciencedirect.com/science/article/abs/pii/S0946672X2100Q16X
Opydo-Szymaczek J, et al. Fluoride exposure and factors affecting dental caries in
preschool children living in two areas with different natural levels of fluorides. Journal of
Trace Elements in Medicine and Biology. Volume 65. 2021.
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20 December 2021
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Fluoridation Policy:
An Annotated Bibliography of Published Science
ALTERNATIVE: This systematic review and meta-analysis concludes that biomimetic
hydroxyapatite-containing, fluoride-free oral care products are effective in reducing dental
decay, especially in children without the risk of dental fluorosis and neurotoxicity inherent in
topical use of fluoridated products. https://files.cdha.ca/Drofession/iournal/2752.pdf
Hardy Limeback, BSc, PhD, DOS; Joachim Enax, Dr; Frederic Meyer, Dr. Biomimetic
hydroxyapatite and caries prevention: a systematic review and meta-analysis. | Can J Dent
Hyg 2021:55(3): 148-159.
AMERICAN KIDNEYS: Using U.S. NHANES data from two recent cycles, finds 'optimal'
amounts of fluoridated water results in high incidence of uric acid in adolescents suggesting
higher risk of kidney disease and other illnesses. Identifies dose-response trend in plasma
fluoride of teens.
https://www.sciencedirect.com/science/article/pii/S0147651320315074
• Yudan Wei, Jianmin Zhu, Sara Ann Wetzstein. Plasma and water fluoride levels and
hyperuricemia among adolescents: A cross-sectional study of a nationally representative
sample of the United States for 2013-2016. Ecotoxicology and Environmental Safety.
Volume 208. 15 January 2021.
TODDLERS: The Programming Research in Obesity, Growth, Environment and Social
Stressors (PROGRESS) cohort included 948 mother-child pairs from Mexico City. Blinded
testing of children between one and 24 months to examine associations between maternal
fluoride intake from food and beverages during pregnancy and offspring neurodevelopment in
this prospective and longitudinal study found, "higher exposure to fluoride from food and
beverage consumption in pregnancy was associated with reduced cognitive outcome, but not
with language and motor outcome in male offspring over the first two years of life."
https://fluoridealert.org/wp-content/uploads/cantoral-2021.final .pdf
• Alejandra Cantoral, Martha M. Tellez-Rojo, Ashley J. Malin, Lourdes Schnaas d,
ErikaOsorio-Valencia, Adriana Mercadob, E. Angeles Martinez-Mier, Robert O. Wright,
Christine Till. Dietary fluoride intake during pregnancy and neurodevelopment in toddlers: A
prospective study in the progress cohort. Neurotoxicology 87 (2021) 86-93.
NO SAFE DOSE: Study of Mexican children and their mothers using measurements of urinary
fluoride and water concentrations associated dental fluorosis and lowered IQ with fluoride dose
consistent with findings of larger studies in other countries. Authors declare WHO fluoride
guidelines are unsafe and hypothesize that 0.045 F- mg/day is a protective exposure
https://www. mdpi. com/1660-4601/18/21/11490/htm
Farias P, Estevez-Garcia JA, Onofre-Pardo EN, Perez-Humara ML, Rojas-Lima E, Alamo-
Hernandez U, Rocha-Amador DO. Fluoride Exposure through Different Drinking Water
Sources in a Contaminated Basin in Guanajuato, Mexico: A Deterministic Human Health
Risk Assessment. International Journal of Environmental Research and Public Health. 2021:
18(21): 11490.
BABY BRAIN POISON: Exposure to fluoridated water (10 mg/L & 50 mg/L) beginning on the
first day of pregnancy and continuing through the last day of breastfeeding shows chemical
imbalances, cellular damage and changes in the hippocampus of Wstar rat offspring that would
affect neurological development.
https://pubmed.ncbi.nlm.nih.gov/33096359/
Ferreira MKM, Aragao WAB, Bittencourt LO, Puty B, Dionizio A, Souza MPC, Buzalaf MAR,
de Oliveira EH, Crespo-Lopez ME, Lima RR. Fluoride exposure during pregnancy and
lactation triggers oxidative stress and molecular changes in hippocampus of offspring rats.
Ecotoxicology and Environmental Safety. 2021 Jan 15:208:111437.
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Fluoridation Policy:
An Annotated Bibliography of Published Science
BAD TEETH - BAD BRAIN: Chinese study confirm 1.6 ppm v. 0.1 ppm results in children with
both damaged teeth and lower IQ. Authors validate that fluoride affects thyroid function,
neurotransmitters and mitochondrial energy enzymes. There were no students with low IQ
found in the area with low F level. There was high IQ among the 96.6% of the students who did
not experience fluorosis.
https://www.sciencedirect.com/science/article/Dii/S0213911121001965
• Yani SI, Seweng A, Mallongi A, et al. The influence of fluoride in drinking water on the
incidence of fluorosis and intelligence of elementary school students in Palu City. Gac Sanit.
2021:35 Suppl 2:S159-S163.
GUTS & BRAINS: Memory function was reduced and gut microbiota structure was significantly
altered in fluoride-exposed mice.
https://www.sciencedirect.com/science/article/Dii/S014765132100219Q
• Xin J, Wang H, Sun N, Bughio S, Zeng D, Li L, Wang Y, Khalique A, Zeng Y, Pan K, Jing B,
Ma H, Bai Y, Ni X. Probiotic alleviate fluoride-induced memory impairment by reconstructing
gut microbiota in mice. Ecotoxicol Environ Saf. 2021 Jun 1:215:112108
INFLAMED GUTS: Exposure to fluoridated water at both doses (10 mg/L & 50 mg/L) inflame
guts in rats and alters the gut microbiome as compared to control (0 mg/L).
https://Dubmed.ncbi. nlm.nih.aov/33508686/
Dionizio A, Uyghurturk DA, Melo CGS, Sabino-Arias IT, Araujo TT, Ventura TMS, Perles
JVCM, Zanoni JN, Den Besten P, Buzalaf MAR. Intestinal changes associated with fluoride
exposure in rats: Integrative morphological, proteomic and microbiome analyses.
Chemosphere. 2021 Jan 11:273:129607.
HARMFUL ADEQUATE INTAKE (Al): Study found "the levels of dietary F- intake were below
the current Al, were greater towards the end of gestation and in women who were moderately
and highly compliant with Mexican dietary recommendation" in ELEMENT cohort and
recommended changing future dietary recommendations due to evidence of developmental
neurotoxicity at even low dose exposure, https://pubmed.ncbi.nlm.nih.gov/33602354/
Castiblanco-Rubio, G., Munoz-Rocha, T., Cantoral, A., Tellez-Rojo, M., Ettinger, A.,
Mercado-Garcia, A., Peterson, K.E., Hu, H., Martinez-Mier, E. (2021). Dietary Fluoride
Intake Over the Course of Pregnancy in Mexican Women. Public Health Nutrition, 1-25.
CALCIUM & FLUORIDE IN PREGNANCY: Calcium intake during pregnancy lowers urinary
fluoride (UF) concentrations by some unknown mechanism in ELEMENT cohort.
https://pubmed.ncbi.nlm.nih.gov/34176079/
Castiblanco-Rubio GA, Munoz-Rocha TV, Tellez-Rojo MM, Ettinger AS, Mercado-Garcia A,
Peterson KE, Hu H, Cantoral A, Martinez-Mier EA. Dietary Influences on Urinary Fluoride
over the Course of Pregnancy and at One-Year Postpartum. Biol Trace Elem Res. 2021 Jun
26.
SAFETY: Evidence of dental fluorosis and other adverse effects to bodies and brains from
supposed safe concentrations is alarming. "The safety of public health approach of drinking
water fluoridation for global dental caries reduction are urgently needed further research."
https://www.sciencedirect.com/science/article/pii/S014765132100551Q7via%3Dihub
Dong H, Yang X, Zhang S, Wang X, Guo C, Zhang X, Ma J, Niu P, Chen T. Associations of
low level of fluoride exposure with dental fluorosis among U.S. children and adolescents,
NHANES 2015-2016. Ecotoxicol Environ Saf. 2021 Jun 22:221:112439.
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Fluoridation Policy:
An Annotated Bibliography of Published Science
SKELETAL FLUOROSIS: This Chinese study of the pathogenetic progression of skeletal
fluorosis, details how local signaling pathways, hormones, promoter DNA hypermethylation,
RNA expression etc. are affected by fluoride exposure leading to pain and disability.
https://www.mdpi.com/1422-0067/22/21/11932/htm
Qiao L, Liu X, He Y, Zhang J, Huang H, Bian W, Chilufya MM, Zhao Y, Han J. Progress of
Signaling Pathways, Stress Pathways and Epigenetics in the Pathogenesis of Skeletal
Fluorosis. International Journal of Molecular Sciences. 2021; 22(21): 11932.
DEPRESSION: Animal study finds negative changes in brain structure and behavior with
exposure to sodium fluoride (NAF). https://pubmed.ncbi.nlm.nih.gov/34735150/
• Zhou G, Hu Y, Wang A, Guo M, Du Y, Gong Y, Ding L, Feng Z, Hou X, Xu K, Yu F, Li Z, Ba Y.
Fluoride Stimulates Anxiety- and Depression-like Behaviors Associated with SIK2-CRTC1
Signaling Dysfunction. J Agric Food Chem. 2021 Nov 4. PMID: 34735150.
DECEPTION: This historical analysis documents how the ADA suppressed the established
science that vitamin D was necessary for healthy teeth and bones in order to promote falsely
fluoride which was and is more profitable for their membership. "Public health may well depend
on looking at professional societies no different than the way we look at the pharmaceutical
industry—conflicted organizations with a power to shape conventional wisdom based on fragile
evidence." https://www.mdpi.eom/2072-6643/13/12/4361/htm#
Hujoel PE. How a Nutritional Deficiency Became Treated with Fluoride. Nutrients. 2021.
2020
AMERICAN FETAL EXPOSURE: Study on pregnant women in California and Montana find,
"Fluoride concentrations in urine, serum, and amniotic fluid from women were positively
correlated to public records of community water fluoridation" and that concentration is consistent
with findings of Canadian studies that find these concentrations are associated with increased
learning disabilities and lower IQ in offspring.
h.ttfis.;//www,.n.c.b..Ln..^
• Abduweli Uyghurturk D, Goin DE, Martinez-Mier EA, Woodruff TJ, DenBesten PK. Maternal
and fetal exposures to fluoride during mid-gestation among pregnant women in northern
California. Environ Health. 2020 Apr 6; 19( 1 ):38.
BLOOD: Canadian Health Measures Survey (CHMS) collects extensive biomonitoring data
used to assess the exposure of Canadians to environmental chemicals finds higher fluoride in
urine associated with significantly higher blood lead, urinary lead, etc. Also finds urinary
selenium is significantly lower in fluoridated Canadian communities, "this is the first study where
biomonitoring data from multiple cycles of CHMS were combined in order to generate robust
estimates for subsets of the Canadian population. Such assessments can contribute to a
regional-level prioritization of control measures to reduce the exposure of Canadians to
chemicals in their environment."
h.ttfis.;//www,ncb..Ln..^
• Valcke M, Karthikeyan S, Walker M, Gagne M, Copes R, St-Amand A. Regional variations
in human chemical exposures in Canada: A case study using biomonitoring data from the
Canadian Health Measures Survey for the provinces of Quebec and Ontario. Int J Hyg
Environ Health. 2020 Jan 20:225:113451.
THYROID & IQ: Concentrations of fluoride in drinking water considered optimal and safe in the
US result in altered thyroid function and lowered IQ in Chinese children.
httfis.;//www,.sc|mcedire^
• Wang M, Liu L, Li H, et al.Thyroid function, intelligence, and low-moderate fluoride exposure
among Chinese school-age children. Environment International. Volume 134, January 2020.
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An Annotated Bibliography of Published Science
OVERDOSED CANADIAN BABIES: MIREC study documents Canadian bottle-fed babies have
lower IQ in optimally fluoridated communities while breast fed babies have extremely low F and
significantly higher IQ. https://www.sciencedirect.com/science/article/Dii/S0160412019326145
• Till C, Green R, Flora D, Hornung R, Martinez-Miller EA, Blazer M, Farmus L, Ayotte P,
Muckle G, Lanphear B. Fluoride exposure from infant formula and child IQ in a Canadian
birth cohort. Environment International. 2020.
BIASED NARRATIVES: Canadian researchers comment on "expert" attacks on the high quality
studies that contradict the dental CWF narrative, i.e. political suppression of scientific facts.
https://www.nature.com/articles/s41390-020-Q973-8
• Till, C., Green, R. Controversy: The evolving science of fluoride: when new evidence doesn't
conform with existing beliefs. Pediatr Res (2020).
BONE HEALTH: Low to moderate fluoride exposure weakens and damages bones in women.
https://www.sciencedirect.com/science/article/abs/pii/S01476513203087Q8
Minghui Gao et al, Association between low-to-moderate fluoride exposure and bone
mineral density in Chinese adults: Non-negligible role of RUNX2 promoter methylation.
Ecotoxicology and Environmental Safety. Volume 203, 15 October 2020.
BONES: Found an age-specific association between fluoride exposure and altered CALCA
methylation in adult women, affecting bone health, https://pubmed.ncbi.nlm.nih.gov/32283421/
• Sun R, Zhou G, Liu L, Ren L, Xi Y, Zhu J, Huang H, Li Z, Li Y, Cheng X, Ba Y. Fluoride
exposure and CALCA methylation is associated with the bone mineral density of Chinese
women. Chemosphere. 2020 Aug;253:126616.
SEX HORMONES IN FLUORIDATED US: "The data indicated gender- and age-specific inverse
associations of fluoride in plasma and water with sex steroid hormones of total testosterone,
estradiol and SHBG in U.S. children and adolescents."
https://www.sciencedirect.com/science/article/pii/S0269749119357963
Bai, R., Huang, Y., Wang, F., & Guo, J. (2020). Associations of fluoride exposure with sex
steroid hormones among U.S. children and adolescents, NHANES 2013-2016.
Environmental Pollution, 114003
NERVOUS SYSTEM: The enteric nervous system (ENS) is called the second brain and governs
the gastrointestinal track. Includes dopamine & serotonin function. Study finds "fluoride
exposure during pregnancy and lactation might induce ENS developmental defects."
https://link.sprinaer.com/article/10.1007/s12011-020-Q2249-x
Sarwar, S., Quadri, J.A., Kumar, M. et al. Apoptotic and Degenerative Changes in the
Enteric Nervous System Following Exposure to Fluoride During Pre- and Post-natal Periods.
Biol Trace Elem Res (2020).
ENDOCRINE SYSTEM REVIEW: The endocrine system includes the pineal gland,
hypothalamus, pituitary gland, thyroid with parathyroid glands, thymus, pancreas (partial
endocrine function), adrenal glands, as well as male and female gonads (testes and ovaries)
which are adversely effected by exposure to fluoride.
https://www.sciencedirect.com/science/article/abs/pii/S00456535203176Q4
Marta Skorka-Majewicz et al, Effect of fluoride on endocrine tissues and their secretory
functions - review. Chemosphere, Volume 260, December 2020, 127565.
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An Annotated Bibliography of Published Science
WHO IGNORES KIDNEYS: WHO guidelines of safety below 1.5 ppm fluoride concentration is
wrong. "The available guidelines for drinking water are solely based on healthy populations with
normal renal function. But, it is evident that once the kidney function is impaired, patients enter a
vicious cycle as fluoride gradually accumulates in the body, further damaging the kidney tissue."
https://www.sciencedirect.com/science/article/abs/Dii/S0045653520313795
Shanika Nanayakkara, et al. The Influence of fluoride on chronic kidney disease of uncertain
aetiology (CKDu) in Sri Lanka. Chemosphere. Volume 257, October 2020, 127186
PEDIATRIC BONE DISEASE: Identifies fluoride concentrations in water above 1.2 ppm as
"dangerously high" that can cause pediatric bone disease. Urine measurements of fluoride in
those afflicted are below the fluoride concentrations in women living in optimally fluoridated
communities per 2017 Canadian study by Green et al.
https://Dubmed.ncbi.nlm.nih.gov/32692054/
Nipith Charoenngam, Muhammet B Cevik, Michael F Holick. Diagnosis and management of
pediatric metabolic bone diseases associated with skeletal fragility. Curr Opin Pediatr. 2020
Aug:32(4):560-573.
EPA ON ENVIRONMENTAL STRESS: EPA authors find that exposure to fluoride has the
greatest adverse impact on cognitive ability in children, even more than lead.
https://www.mdpi.com/1660-4601/17/15/5451/htm
Frances M. Nilsen, Jazmin D.C. Ruiz and Nicolle S. Tulve. A Meta-Analysis of Stressors
from the Total Environment Associated with Children's General Cognitive Ability. Int. J.
Environ. Res. Public Health 2020, 17(15), 5451.
SOURCE: Compared MIREC, ELEMENT & PROGRESS data. MIREC & ELEMENT differed
from PROGRESS in that "daily food and beverage fluoride intake was not associated with CUF
in PROGRESS" but study "found that CUF (child urinary fluoride) levels are comparable among
children in Mexico City and fluoridated Canadian communities, despite distinct sources of
exposure." https://pubmed.ncbi.nlm.nih.gov/33233802/
Green, R., Till, C., Cantoral Preciado, A. D. J., Lanphear, B., Angeles Martinez-Mier, E.,
Ayotte, P., Wright, R. O., Tellez-Rojo, M. M., & Malin, A. J. (2020). Associations between
urinary, dietary, and water fluoride concentrations among children in Mexico and Canada.
Toxics, 8(4), 1-11. [110],
DENTAL FLUOROSIS & CWF CESSATION: Dental literature review by dentists finds "a
significant decrease in the prevalence of fluorosis post cessation or reduction in the
concentration of fluoride added to the water supply."
https://pubmed.ncbi.nlm.nih.gov/32598322/
Nor Azlida Mohd Nor, Kuala Lumpur, Barbara L. Chadwick, Damian JJ. Farnell, Ivor G.
Chestnutt. The impact of stopping or reducing the level of fluoride in public water supplies on
dental fluorosis: a systematic review. Reviews on Environmental Health. 2020.
2019
SLEEP & PINEAL GLAND: "Chronic low-level fluoride exposure may contribute to changes in
sleep cycle regulation and sleep behaviors among older adolescents in the US."
httRs;//ehioum
Malin, A.J., Bose, S., Busgang, S.A. et al. Fluoride exposure and sleep patterns among
older adolescents in the United States: a cross-sectional study of NHANES 2015-2016.
Environ Health 18, 106 (2019)
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ADHD: Youth in optimally fluoridated Canadian communities are almost 3 times more likely to
be diagnosed with ADHD and have significantly higher rates of other learning disabilities as
compared to their counterparts in non-fluoridated communities on a dose-response trend line.
https://www.sciencedirect.com/science/article/Dii/S0160412019315971
Riddell JK, et al. Association of water fluoride and urinary fluoride concentrations with
attention deficit hyperactivity disorder in Canadian youth. Environment International. Volume
133, Part B, December 2019.
ASD: Increased exposure to fluoride is associated with higher incidence of ASD in regions with
fluoridated water or endemic fluorosis. Based on biological plausibility and incidence, authors
hypothesize that increased fluoride exposure is an environmental risk factor for autism.
https://www.mdpi.com/1660-4601/16/18/3431/htm
Strunecka A, Strunecky O. Chronic Fluoride Exposure and the Risk of Autism Spectrum
Disorder. Int. J. Environ. Res. Public Health 2019, 16(18), 3431.
PRENATAL: Three measurements in high quality NIH sponsored prospective cohort study
(MIREC) found significantly lowered IQ in offspring of mostly white, well-educated Canadian
women living in 'optimally' fluoridated communities.
https://iamanetwork.com/iournals/iamapediatrics/fullarticle/2748634
Green R, Lanphear B, Hornung R, etal. (2019) Association Between Maternal Fluoride
Exposure During Pregnancy and IQ Scores in Offspring in Canada. JAMA Pediatrics. 2019.
KIDNEY & LIVER: Researchers at Mt. Sinai Medical School find American teens in optimally
fluoridated American towns have markers for altered kidney & liver parameters that puts them at
higher risk for kidney & liver disease as adults.
https://www.sciencedirect.com/science/article/pii/S01604120193Q9274
Malin AJ, Lesseur C, Busgang SA, Curtin P, Wright RO, Sanders AP. Fluoride exposure and
kidney and liver function among adolescents in the United States: NHANES, 2013-2016.
Environment International. August 8, 2019.
GUTS: Animal study on microbiome health and immunity documents fluoride causes serious
damage to rectal structure and significantly inhibits proliferation of rectal epithelial cells.
https://www.ncbi.nlm.nih.aov/pubmed/31885060/
• Wang H., Miao C., Liu J. et al. Fluoride-induced rectal barrier damage and microflora
disorder in mice. Environ Sci Pollut Res (2019).
TEETH: An analysis of the dental fluorosis data in three U.S. NHANES reports noted that more
than half of American teens have fluoride damaged teeth as the result of too much fluoride
consumption during childhood. This results in costly cosmetic dentistry in young adulthood for
millions as well as increased decay in the more severely affected.
(20% very mild + 15% mild + 28% moderate + 3% severe = 65% afflicted per 2011-12 data)
http://fluoridealert.org/wp-content/uploads/neurath.2019-1.pdf
Neurath C, Limeback H, Osmunson Bm et al. (2019) Dental Fluorosis Trends in US Oral
Health Surveys: 1986 to 2012. JDR Clinical & Translational Research.
ALZHEIMER'S: Even low concentrations of fluoride in drinking water at or below concentrations
deemed optimal or safe by the WHO result in a pattern of increased dementia.
https://www.ncbi.nlm.nih.gov/pubmed/30868981
Russ TC, Killin LOJ, Hannah J, Batty GD. Aluminium and fluoride in drinking water in
relation to later dementia risk. The British Journal of Psychology. March 2019.
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DNA DAMAGE: Mitochondrial dysfunction associated with dental fluorosis observed in Chinese
children with fluoride concentrations in water identified as optimal or safe per U.S. authorities.
Gender differences to the fluoride induced oxidative stress also noted.
https://www.sciencedirect.com/science/article/Dii/S01604120183262917via%3Dihub
• Zhou G, Yang L, Luo C, et al. Low-to-moderate fluoride exposure, relative mitochondrial
DNA levels, and dental fluorosis in Chinese children. Environment International. Volume
127, June 2019, Pages 70-77.
DEMENTIA: Describes mechanism by which the effectiveness of the two most popular drugs
used to treat Alzheimer's & other neurodegenerative dementia disease is reduced or blocked by
fluoride, https://www.mdpi.eom/1660-4601/16/1/10/htm
Marta Goschorska, Izabela Gutowska, Irena Baranowska-Bosiacka, Katarzyna Piotrowska,
Emilia Metryka, Krzysztof Safranow, Dariusz Chublek. Influence of Acetylcholinesterase
Inhibitors Used in Alzheimer's Disease Treatment on the Activity of Antioxidant Enzymes
and the Concentration of Glutathione in THP-1 Macrophages under Fluoride-Induced
Oxidative Stress. Int. J. Environ. Res. Public Health, 2019, 16(1), 10.
ADULT BRAINS: First long term NaF animal study (10 weeks) using moderate levels of fluoride
finds a number of histological changes including in parts of the brain associated with memory
and learning. https://www.sciencedirect.com/science/article/pii/S0045653518317508
Pei Jiang, Gongying Li, Xueyuan Zhou, Changshui Wang, Yi Qiao, Dehua Liao, Dongmei
Shi. Chronic fluoride exposure induces neuronal apoptosis and impairs neurogenesis and
synaptic plasticity: Role of GSK-3b/b-catenin pathway.Chemosphere. Volume 214, January
2019, Pages 430-435.
DELAYED MALE PUBERTY: This 4th study from the NIH sponsored ELEMENT investigation of
the prenatal impact of low-dose prenatal exposure found a significant pattern of delayed puberty
for boys associated with maternal fluoride as measured in urine samples. Female data showed
non-significant trend towards earlier menarche. More study needed to determine the impact on
sexual development, https://www.ncbi.nlm.nih.aov/pubmed/30922319
Liu Y, Tellez-Rojo M, Hu H, et al. Fluoride exposure and pubertal development in children
living in Mexico City. Environ Health. 2019 Mar 29;18(1):26.
ANXIETY & DEPRESSION: Both rats and children experience changes in brain chemistry from
extended exposure to fluoride which affects mood. Serotonin and the prefrontal cortex are
impacted. Studies that only examine short-term exposure are inadequate to detect these
changes which are more pronounced in females.
https://www.sciencedirect.com/science/article/abs/pii/S0031938418309375
Lu F, Zhang Y, Trevedi A, et al. (2019) Fluoride related changes in behavioral outcomes may
relate to increased serotonin. Physiology & Behavior.
EYE DISEASE: Fluoride is a poison that has biological impact on consumers in any dose,
contributing to the development of cataracts, glaucoma and macular degeneration.
https://www.mdpi.eom/1660-4601/16/5/856
• Waugh DT. The Contribution of Fluoride to the Pathogenesis of Eye Diseases: Molecular
Mechanisms and Implications for Public Health. Int. J. Environ. Res. Public Health. 2019,
16(5), 856.
BONES & GENES: This 30 day animal study at 8 mg/L fluoride documents DNA & RNA
damage that inhibits gene expression which can be passed on through generations affecting
bone development and contributing to weak bones, blood & bone cancers and skeletal fluorosis.
https://www.sciencedirect.com/science/article/pii/S01476513183117347via%3Dihub
• Atule P. Daiwile, Prashant Tarale, Saravanadevi Sivanesan, et al. Role of fluoride induced
epigenetic alterations in the development of skeletal fluorosis. Ecotoxicology and
Environmental Safety. Volume 169, March 2019, Pages 410-417.
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BRAIN INJURY: Fluoride interferes with calcium metabolism which impacts brain chemistry and
poisons the hippocampus. "The imbalance of calcium metabolism caused by fluorosis may be a
pathogenesis of brain injury induced by fluoride."
https://www.sciencedirect.com/science/article/Dii/S00456535183240Q7
Qiuli Yu, Dandan Shao. Rui Zhang, Wei Ouyang, Zigui Zhang. Effects of drinking water
fluorosis on L-type calcium channel of hippocampal neurons in mice. Chemosphere. Volume
220, April 2019, Pages 169-175. [Online Ahead of Print]
BRAIN DAMAGE: Prenatal & postnatal animal experiment using 10, 50 and 100 mg/Lto
simulate human experience documents mitochondrial damage and neuronal death as
mechanism that result in learning and memory impairments.
https://www.ncbi.nlm.nih.aov/pubmed/30659323
• Zhao, G., Niu, Q., Chen, J. et al. Roles of mitochondrial fission inhibition in developmental
fluoride neurotoxicity: mechanisms of action in vitro and associations with cognition in rats
and children. Arch Toxicol (2019).
IODINE: Identifies and discusses the biochemical and hormonal impact of fluoride and
fluoridation policy on iodine metabolism with consideration of related neurodevelopmental and
pathological disorders, https://www.mdpi.com/1660-4601 /16/6/1086
• Waugh DT. Fluoride Exposure Induces Inhibition of Sodium/Iodide Symporter (NIS)
Contributing to Impaired Iodine Absorption and Iodine Deficiency: Molecular Mechanisms of
Inhibition and Implications for Public Health. Int. J. Environ. Res. Public Health 2019, 16,
1086.
BIOLOGY OF POISON: Deep dive into the biological impact of fluoride that affects metabolism,
hormones, immune function, etc. "Moreover, the findings of this study further suggest that there
are windows of susceptibility over the life course where chronic F exposure in pregnancy and
early infancy may impair Na+ , K+ -ATPase activity with both short- and long-term implications
for disease and inequalities in health." https://www.mdpi.com/1660-4601/16/8/1427
• Waugh DT. Fluoride Exposure Induces Inhibition of Sodium-and Potassium-Activated
Adenosine Triphosphatase (Na+, K+-ATPase) Enzyme Activity: Molecular Mechanisms and
Implications for Public Health. Int. J. Environ. Res. Public Health 2019, 16(8), 1427
DOSE RESPONSE: Three month study on adult rats found "fluoride can impair the learning
ability of rats, which may be related to the induction of autophagy in rat hippocampal neurons."
https://www.ncbi.nlm.nih.aov/pubmed/31111310
• Zhang C, Huo S, Fan Y, Gao Y, Yang Y, Sun D. Autophagy May Be Involved in Fluoride-
Induced Learning Impairment in Rats. Biol Trace Elem Res. 2019 May 20.
GENETIC SUSCEPTIBILITY: Review of recent scientific literature on biological impact. Same
exposure in same population affect individuals differently, suggesting genetic vulnerability.
https://onlinelibrarv.wilev.eom/doi/full/10.1111/icmm.14185
• Wei, W, Pang, S, Sun, D. The pathogenesis of endemic fluorosis: Research progress in the
last 5 years. J Cell Mol Med. 2019: 23: 2333- 2342.
MITOCHONDRIA: Prenatal and postnatal exposure to fluoride results in mitochondrial
abnormalities, autophagy and apotheosis contributing to neuronal death.
https://www.NCBI.nlm.nih.gov/pubmed/30659323
• Zhao, G., Niu, Q., Chen, J. et al. Roles of mitochondrial fission inhibition in developmental
fluoride neurotoxicity: mechanisms of action in vitro and associations with cognition in rats
and children. Arch Toxicol (2019).
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NUTRITION: The f-ion is a poison but the bioavailability of CaF is different than NaF as calcium
is the antidote to fluoride poisoning. In addition to being in water and dental products, 20% of
pharma and 40% of agrichemicals have a fluoride base. Consequently, people are exposed to
excessive amounts of fluoride which contributes to chronic disease.
https://iournals.matheo.si/index.php/ACSi/article/view/4932/2095
Stepec D, Ponikvar-Svet M. Fluoride in Human Health & Nutrition. Acta Chim SIov. 2019, 66.
2018
THYROID: 18% of people drinking 'optimally' fluoridated water in Canadian communities have a
heightened risk of low thyroid function because fluoride interferes with iodine metabolism. Many
of them will be sub-clinical and not know they are mildly hypothyroid, which nevertheless
increases their risk for diabetes, high cholesterol, and other problems. Study excluded those
already diagnosed with thyroid disease. (CHMS)
httDSLZ/wymscto
• Ashley J. Malin, Julia Riddell, Hugh McCague, Christine Till. Fluoride exposure and thyroid
function among adults living in Canada: Effect modification by iodine status. Environment
International. Volume 121, Part 1, December 2018, Pages 667-674.
THYROID: Even 0.5 ppm fluoride in water has an adverse impact on thyroid hormones. Water is
currently fluoridated to 0.7 ppm, a reduction from up to 1.2 ppm in 2015.
https://www.NCBI.nlm.nih.aov/pmc/articles/PMC5805681/
Z. Kheradpisheh et al. (2018) Impact of Drinking Water Fluoride on Human Thyroid Hormones: A
Case-Control Study. Scientific Reports, volume 8.
OVERDOSED BABIES: Over one third of babies (37%) in fluoridated American communities
consume amounts of fluoride in excess of the upper limits of fluoride considered safe per
government regulations. Even 4% of babies in non-fluoridated communities are overdosed on
fluoride due to consumption of products made with fluoridated water. At the very least, this puts
these children at high risk for developing dental fluorosis. Dental fluorosis is associated with
increased incidence of learning disabilities, broken bones and kidney disease.
Claudia X Harriehausen, Fehmida Z Dosani, Brett T Chiquet, Michelle S Barratt, and Ryan L
Quock. Fluoride Intake of Infants from Formula. Journal of Clinical Pediatric Dentistry. 2018.
GOVERNMENT BIAS: A National Toxicology Program animal experiment studying the impact of
fluoride consumption used the wrong rats, the wrong dose, and the wrong study design in order
to manufacture a finding of no prenatal or postnatal effect.
Karen Favazza Spencer, Hardy Limeback. Blood is Thicker Than Water: Flaws in a National
Toxicology Program Study. Medical Hypotheses. Volume 121. December 2018. Pages
160-163.
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PREGNANT WOMEN: Pregnant Canadian women drinking 'optimally' fluoridated water had
twice the fluoride exposure per individual testing as compared to pregnant women in non-
fluoridated Canadian communities - and consistent with the range in the Mexican women in the
ELEMENT cohort whose children had up to 6 points lowered IQ based on prenatal exposure to
fluoride (from salt). The Canadian study excluded those with health conditions such as kidney
disease as well as considered confounding factors such as tea consumption.
https://ehp.niehs.nih.gov/doi/Ddf/10.1289/EHP3546
Christine Till, Rivka Green, John G. Grundy, Richard Hornung, Raichel Neufeld, E. Angeles
Martinez-Mier, Pierre Ayotte, Gina Muckle, and Bruce Lanphear. Community Water
Fluoridation and Urinary Fluoride Concentrations in a National Sample of Pregnant Women
in Canada. Environmental Health Perspectives. October 2018.
LEARNING DISABILITIES: Over 200 children were individually tested. Study found attention
deficit disorder apparently caused by their prenatal exposure to fluoride specific to dose. This is
the 3rd report out of the NIH sponsored 12 year ELEMENT project that has confirmed low dose
prenatal exposure to fluoride consistent with exposure in 'optimally' fluoridated communities
causes subtle but permanent brain damage for many consumers. Excluded those with history
of mental illness or conditions such as diabetes and renal disease.
https://www.sciencedirect.com/science/article/pii/S0160412018311814
Morteza Bashash, Maelle Marchand, Howard Hu, ChristineTill, Angeles Martinez-Mier, Brisa
N. Sanchez, Niladri Basu, Karen Peterson, Rivka Green, Lourdes Schnaas, Adriana
Mercado-Garcia, Mauricio Hernandez-Avila, Martha Maria Tellez-Rojo. Prenatal fluoride
exposure and attention deficit hyperactivity disorder (ADHD) symptoms in children at 6™
12 years of age in Mexico City. Environment International. Volume 121, Part 1, December
2018, Pages 658-666.
ALZHEIMER'S DISEASE: Describes impact of fluoride-induced stress and inflammation in the
development of Alzheimer's disease and demonstrates the mechanism for cell death in its
worsening over time. https://www.mdpi.com/1422-0067/19/12/3965
Goschorska M, et al. Potential Role of Fluoride in the Etiopathogenesis of Alzheimer's
Disease. Int. J. Mol. Sci. 2018, 19 (12), 3965.
CANCER: Researchers who include an IARC scientist find esophageal cancer is 9.4 times more
prevalent among those with dental fluorosis in the endemic fluorosis regions of Kenya. Provides
biological plausibility that inflammatory fluoride affects microbiome and other biological
mechanisms. Recommends more study, https://www.ncbi.nlm.nih.aov/pubmed/30582155/
Menya D, Maina SK, Kibosia C, Kigen N, Oduor M, Some F, Chumba D3, Ayuo P, Middleton
DR, Osano O, Abedi-Ardekani B, Schuz J, McCormack V. Dental fluorosis and oral health in
the African Esophageal Cancer Corridor: Findings from the Kenya ESCCAPE case-control
study and a pan-African perspective. Int J Cancer. 2018 Dec 23.
KIDNEYS: Fluoride is a common exposure that is selectively toxic to the kidneys.
https://www.sciencedirect.com/science/article/pii/S0270929518301827
Lash LH. Environmental and Genetic Factors Influencing Kidney Toxicity. Seminars in
Nephrology. Volume 39, Issue 2, March 2019, Pages 132-140.
IQ & DF: Between 0.5 and 3.9 mg/L, found every 0.1 mg/L increased dental fluorosis by 2.24%
and every 0.5 mg/L decreases IQ by 2.67 points. Also found half as many kids with high IQ
children with higher F- dose. https://www.NCBI.nlm.nih.aov/pubmed/29870912
• Yu X et al. Threshold effects of moderately excessive fluoride exposure on children's health:
A potential association between dental fluorosis and loss of excellent intelligence. Environ
Int. 2018 Jun 2:118:116-124.
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2017
REVIEW: Concludes that fluoridation schemes whether from water, food or salt programs "pose
risks of various diseases in the asthmatic-skeletal, neurological, endocrine and skin systems.
Dental and skeletal fluorosis are signs of chronic and excessive ingestion of fluoride."
httD.s://yi^^^
• Verena Romero, Frances J. Norris, Juvenal A. Rfos, Isel Cortes, Andrea Gonzalez,
Leonardo Gaete, Andrei N. Tchernitchin. The impact of tap water fluoridation on human
health. Rev. med. Chile vol.145 no.2 Santiago Feb. 2017.
DOSE-RESPONSE: Validated that IQs of children are lowered on a dose-response trend line
correlated with the amount of fluoride exposure as measured via urine tests of their mothers
during pregnancy and individualized IQ tests of offspring. In the range consistent with doses in
optimally fluoridated communities, there was up to a 6 point difference in IQ. This NIH
sponsored 12 year longitudinal study conducted by researchers at world class American &
Canadian universities excluded diabetics as well as those with kidney disease or pregnancy
complications and allowed for many confounders.
hMs;//www!sciencM^
Morteza Bashash, Deena Thomas, Howard Hu, et al. Prenatal Fluoride Exposure and
Cognitive Outcomes in Children at 4 and 6-12 Years of Age in Mexico. Environ Health
Perspect. Sept 2017. Vol 125, Issue 9.
IQ & DF: Every 0.1 mg/L increased dental fluorosis by 2.24% and Every 0.5 mg/L decreases IQ
by 2.67 points. There are half as many high IQ children in higher fluoride dose group.
httfis.://wftwJN^
• Yu X et al. Threshold effects of moderately excessive fluoride exposure on children's health:
A potential association between dental fluorosis and loss of excellent intelligence. Environ
Int. 2018 Jun 2; 118:116-124.
GENES & BONES: "This study provides evidence that chronic oxidative and inflammatory
stress may be associated with the fluoride-induced impediment in osteoblast differentiation and
bone development." Mfi.://!..i.n.^
Gandhi, D., Naoghare, P.K., Bafana, A. et al. Fluoride-Induced Oxidative and Inflammatory
Stress in Osteosarcoma Cells: Does It Affect Bone Development Pathway? Biol Trace Elem
Res (2017) 175: 103.
PRESCHOOL DIET: Diet of two year olds contain unsafe levels of fluoride.
htto://onlinelibrarv.wilev.com/doi/10.1111 /cdoe. 12283/full
Martinez-Mier EA, Spencer KL, Sanders BJ, Jones JE, Soto-Rojas AE, Tomlin AM, Vinson
LA, Weddell JA, and Eckert GJ. Fluoride in the diet of 2-years-old children. Community Dent
Oral Epidemiol. 2017:00:1-7.
APOPTOSIS: "Enamel fluorosis is a developmental disturbance caused by intake of
supraoptimal levels of fluoride during early childhood.The enamel defects consist of horizontal
thin white lines, opacities (subsurface porosities), discolorations, and pits of various sizes. The
molecular mechanism underlying enamel fluorosis is still unknown We can hypothesize that
fluorosis is due to a combination of direct cytotoxic effects causing cell death, the delayed
development of tight junctions, which are necessary to form a sealed barrier between apical and
basolateral surfaces, and a direct inhibitory effect of fluoride on vectorial calcium and/or
bicarbonate transport." Mta.§://tt^,NC.B.I,n^
Racz, Robert et al. "No Change in Bicarbonate Transport but Tight-Junction Formation Is
Delayed by Fluoride in a Novel Ameloblast Model." Frontiers in Physiology. 2017: 8: 940.
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DNA: Finds that "prolonged fluoride intake at chosen concentrations caused imbalance of the
cellular oxidative state, affected DNA and disrupted cellular homeostasis... It is recommended
that fluoride supplementation requires a fresh consideration in light of the current study."
https://www.NCBI.nlm.nih.gov/pubmed/28089781
F.D. Campos-Pereira, L. Lopes-Aguiar, F.L. Renosto, et al. Genotoxic effect and rat
hepatocyte death occurred after oxidative stress induction and antioxidant gene
downregulation caused by long term fluoride exposure. Chem Biol Interact. 2017 Feb
25;264:25-33.
PRENATAL POISON: "F can pass through the cord blood and breast milk and may have
deleterious impact on learning and memory of the mouse pups."
http://iournals.saaepub.eom/doi/abs/10.1177/0960327117693067
• Y Zhang, XXue, R Niu, J Wang. Maternal fluoride exposure during gestation and lactation
decreased learning and memory ability, and glutamate receptor mRNA expressions of
mouse pups. Z Sun, Human & Experimental Toxicology. February 13, 2017.
IMMUNITY: Prenatal and early postnatal exposure to fluoride impairs spleen function and
development which damages spleen and lifelong immunity.
https://www.NCBI.nlm.nih.gov/pubmed/28846973/
• Yanqin Ma, Kankan Zhang, Fengjun Ren, Jundong Wang, Developmental fluoride exposure
influenced rat's splenic development and cell cycle via disruption of the ERK signal pathway,
In Chemosphere, Volume 187, 2017, Pages 173-180
NEUROINFLAMMATION: Toxic effects of fluoride on the central nervous system and immunity.
https://link.springer.com/article/10.1007/s10753-017-Q556-v
Chen R, Zhao LD, Liu H. et al. Fluoride Induces Neuroinflammation and Alters Wnt
Signaling Pathway in BV2 Microglial Cells. Inflammation. 2017;40: 1123.
2016
CRITIQUE HHS RECOMMENDATION: Pro-fluoridation team of dental researchers determined
that the Department of Health and Human Services reduction of the optimal fluoride
concentration to a single 0.7 ppm target is lacking in sound science, i.e. that "policy need to be
cognizant of the balancing of risk and protective exposures across the entire population and
potentially all ages and to be based on recent data that are purposefully collected, critically
analyzed and carefully interpreted... (the recommendation seems) premature in terms of its
rationale and its use and interpretation of sometimes dated data." These authors' bias is to
maintain 1 ppm; nevertheless, their rationale against the HHS document is appropriate. The
HHS document is political, not scientific.
https://www.NCBI.nlm.nih.gov/pubmed/26710669
Spencer AJ, Do LG. Caution needed in altering the 'optimum' fluoride concentration in
drinking water. Community Dent Oral Epidemiol. 2016 Apr;44(2):101-8.
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OSTEOPOROSIS: "Consequently, although the World Health Organization continues to support
F schemes for caries prevention despite a lack of scientific proof, the F schemes are not able to
improve the crystal quality but rather contribute adversely to affect tooth development and
increases the risk of developing postmenopausal osteoporosis."
http://dx.doi.ora/10.4172/2379-1764.1000170
Mitsuo Kakei, Masayoshi Yoshikawa and Hiroyuki Mishima. Fluoride Exposure May
Accelerate the Osteoporotic Change in Postmenopausal Women: Animal Model of Fluoride-
induced Osteoporosis. Adv Tech Biol Med 2016, 4:1
DIABETES: Fluoridation policy significantly increases incidence of age related type 2 diabetes.
https://www.NCBI.nlm.nih.gov/Dubmed/27740551
K. Fluegge. Community water fluoridation predicts increase in age-adjusted incidence and
prevalence of diabetes in 22 states from 2005 and 2010. Journal of Water and Health, 2016.
IBD: Crohn's disease and ulcerative colitis increases after fluoridation begins in multiple
countries. http://www.NCBI.nlm.nih.gov/pubmed/27199224
Follin-Arbelet B, Mourn B. Fluoride: a risk factor for inflammatory bowel disease? Scand J
Gastroenterol. 2016 May 19:1-6.
PROPAGANDA: Assisted by the media, fluoridationists misrepresent historical and scientific
fact in order to achieve a political end. https://www.researchaate.net/publication/305985332
• Anat Gesser-Edelsburg and Yaffa Shir-Raz. Communicating risk for issues that involve
'uncertainty bias': what can the Israeli case of water fluoridation teach us? Journal of Risk
Research. August 2016.
2015
COCHRANE CWF REVIEW: Estimates that 12% of the children living in fluoridated
communities with 0.7 ppm fluoridation have aesthetically objectionable dental fluorosis with a
total dental fluorosis effect of 40%. The effects were 47% & 15% for 1 ppm, only a minor impact
on incidence of dental fluorosis and consistent with the findings of the 2000 York Review.
http://www.cochrane.ora/CD010856/ORAL water-fluoridation-to-prevent-tooth-decav
Iheozor-Ejiofor Z, Worthington HV, Walsh T, O'Malley L, Clarkson JE, Macey R, Alam R,
Tugwell P, Welch V, Glenny A. Water fluoridation for the prevention of dental caries.
Cochrane Database of Systematic Reviews 2015, Issue 6.
THYROID: Diagnoses of low thyroid significantly higher in 'optimally' fluoridated regions.
https://www.NCBI.nlm.nih.gov/pubmed/25714098
S Peckham, D Lowery, S Spencer. Are fluoride levels in drinking water associated with
hypothyroidism prevalence in England? A large observational study of GP practice data and
fluoride levels in drinking water. J Epidemiol Community Health. 24 February 2015.
ADHD: Researchers found between 67k and 131k more 11 year olds with ADHD in fluoridated
regions of the U.S.
http://www.ehiournal.net/content/pdf/s12940-015-0003-1.pdf
• A Malin and C Till. Exposure to fluoridated water and attention deficit hyperactivity disorder
prevalence. Environmental Health 2015, 14:17
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CWF INFLAMMATIONS: Found that "even in small concentrations fluoride changes the
amounts and activity of COX-1 and COX-2 enzymes taking part in the initiating and
development of inflammatory process."
http://www.sciencedirect.com/science/article/Dii/S08872333150016Q5
I. Gutowskaa, et al. Fluoride as a factor initiating and potentiating inflammation in THP1
differentiated monocytes/macrophages. Toxicology in Vitro. Volume 29, Issue 7, October
2015, Pages 1661-1668.
NEUROTOXICANT: EPA scientists classify fluoride as a 'gold standard' developmental
neurotoxicant with substantial evidence of harm.
http://www.sciencedirect.com/science/article/pii/S089203621530Q362
• William R. Mundy, Stephanie Padilla, Joseph M. Breier, at al. Expanding the test set:
Chemicals with potential to disrupt mammalian brain development. Neurotoxicology and
Teratology. Volume 52, Part A, November-December 2015, Pages 25-35.
PROPAGANDIZING: The proponents of fluoridation ignored concerning evidence and did not
deliver on their promise of dental benefit then, and now. Neither did they do the expected due
diligence re harms. https://doi.ora/10.2105/AJPH.2015.302660
Carstairs C. (2015). Debating Water Fluoridation Before Dr. Strangelove. American journal
of public health, 105(8), 1559-1569.
NOT COST EFFECTIVE: Reveals errors in cost-benefit analysis (CBA) used by CDC. Best
case scenario after corrections is a $3 benefit which is more than wiped out by any
consideration of dental fluorosis. Fluoridated drinking water results in an economic loss to
communities. http://www.NCBI.nlm.nih.gov/pubmed/25471729
Lee Ko & Kathleen M. Thiessen (2015) A critique of recent economic evaluations of
community water fluoridation, International Journal of Occupational and Environmental
Health, 21:2, 91-120
compiled by KSpencer
20 December 2021
page 16
A4 p.566
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Fluoridation Policy:
An Annotated Bibliography of Published Science
Additional items of note:
2017 IAOMT Position Paper: httfiMiamiLm/iaom^
2018 Open Letter: http://www.multibriefs.com/briefs/icim/nutrition.pdf
2019 Children's Health Defense Statement: https://childrenshealthdefense.org/news/u-s-
water-fluoridation-a-forced-experiment-that-needs-to-end/
2020 Expert Opinion: h.ttm://www,.eM,o.ra/fluM
"...fluoride is presumed to be a cognitive neurodevelopmental hazard to humans..."
- Draft Monograph from National Toxicology Program, "Systematic Review of Fluoride Exposure
and Neurodevelopmental and Cognitive Health Effects" (Sept 6. 2019)
Fluoridation policy poses a hazard to an unsuspecting public
**************************
DEFINITIONS:
Endorsement: An endorsement is an authoritative statement reflecting a point of view
for the purpose of exerting influence. An endorsement is not an expert opinion.
• Authoritative statement: An opinion that interprets a rule, law or policy for the
purpose of guiding, influencing, or mandating action. Authoritative statements are not
inherently trustworthy or reliable, but they are inherently manipulative. "Testimonial
propaganda" utilizes authoritative statements in marketing and in politics. The slogan
•question authority" was intended to encourage critical thinking in order to combat
the blind acceptance of biased authoritative statements that endorse policy and/or
sanctioned narratives. (Logical Fallacies: Appeal to Authority)
Expert Opinion: An expert opinion is dependent on evidence and the due diligence of
someone with substantial study in a field. The Daubert Standard is a legal process that
validates the trustworthiness of experts offering opinion in a court of law.
EXAMPLES:
ENDORSEMENT: The April 2015 HHS statement recommending 0.7 ppm fluoride
concentration in drinking water for 'safe & effective' prevention of tooth decay promoted the
long standing fluoridation policy of the agency,
vs.
EXPERT OPINION: The June 2015 Cochrane report finds no reliable evidence of dental
benefit to adults or low income children, but documents substantially higher rates of
dental fluorosis, some of which will likely result in costly cosmetic dentistry.
The 2019 National Toxicology Program systematic review offered an expert opinion
based on the evidence that fluoride is a presumed hazard to human health
specific to neurotoxic impact when exposure is pre- or post-natal.
compiled by KSpencer
20 December 2021
page 17
A4 p.567
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Water Fluoridation and Environmental Justice
a report submitted to the
Environmental Justice Interagency Working Group
from
The Fluoride Action Network
http://fluoridealert.org/
September 25, 2015
A4 p.568
-------
Do you want them
drinking a
neurotoxic chemical ?
i
3*
i '
FluorideAlert.org
p 569
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3
Water Fluoridation and Environmental Justice
This report was prepared by Neil Carmen, Ellen Connett and Paul Connett, with
contributions from other members of the Fluoride Action Network, including David
Kennedy, Chris Neurath, John Graham, Tara Blank, and Dan Stockin.
The following individuals and organizations support the sentiments and arguments
presented in the Executive Summary and the supporting document:
Audrey Adams, Board member, Washington Action for Safe Water, President, King County
Citizens Against Fluoridation, Washington
Kenji Akiniwa, General Secretary, The Japanese Society for Fluoride Research, Japan
Phillip Alexander, Fluoride Free Charlotte, North Carolina
American Environmental Health Science Project, Inc. (AEHSP), Essex Junction, Vermont
James S. Beck, MD, PhD, Professor Emeritus of Medical Biophysics, University of Calgary, Canada
Jane Beck, BSc MBBS, Thames, NZ
Ruth Bednar RHN, RNCP, Muskoka Citizens Opposing Fluoridation, Gravenhurst, Ont., Canada
Tara Blank, PhD, Ridgefield, Washington
Jane Bremmer, Chair, Alliance for a Clean Environment, Western Australia
Mr. Pat Buckley, Fluoride Free Wellington, New Zealand
Anna Maria Caldara, author and activist, Bangor, Pennsylvania
Cara L. Campbell, Chair, Ecology Party of Florida
Suzie Canales, Citizens For Environmental Justice, Corpus Christi, Texas
Neil Carman, PhD, Sierra Club Lone Star Chapter (for I.D. purposes only), Austin, Texas
Paul Carr, Chairman, Fluoride Free Cumbria, England
Liesa Cianchino, Concerned Residents of Peel to End Fluoridation, Peel, Ontario, Canada
Clean Water California
Stuart Cooper, Fluoride Free New Hampshire
Ronnie Cummins, Organic Consumers Association
Todd M. Davison, Fluoride Free Nebraska
Michael F. Dolan, PhD, Public Notice on Water Fluoridation, Amherst, Massachusetts
Rev. Dr. Gerald L. Durley, Pastor Emeritus, Providence Missionary Baptist Church, Atlanta GA
Michael Finley, Fluoride Free Illinois
Barbara Loe Fisher, Co-founder & President, National Vaccine Information Center
Fluoride Free Thames, Thames, NZ
Clint Griess, Safe Water San Francisco and International Fluoride Free Teleconference
Crystal Harvey, Arkansas
Emeritus Professor C. V. Howard, MB. ChB. PhD. FRCPath., Nano Systems Biology
Centre for Molecular Bioscience, University of Ulster, Coleraine, UK
Regina Imburgia, Fluoride Action North Texas, Dallas, Texas
Lynn Jordan, New Zealand Health Professionals Opposing Fluoridation
Charles Keil, PhD, activist, author and music maker, Lakeville, Connecticut
Hilton Kelley, Executive Director, CIDA Inc., 2011 Goldman Prize winner, Port Arthur, Texas
Barry S. Kendler, PhD, FACN, CNS.
David Kennedy, DDS, Fluoride Information Officer for the International Academy of Oral
Medicine and Toxicology
King County Citizens Against Fluoridation, Washington
Water Fluoridation and Environmental Justice - a report submitted to the
EJ Interagency Working Group on September 25, 2015, from Fluoride Action Network
A4 p.570
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4
Carol Kopf, MS, New York State Coalition Opposed to Fluoridation
Dan Knapp, PhD, sociologist and CEO, Urban Ore, Inc., Berekely, California
Hardy Limeback, PhD, DDS, Professor Emeritus, Faculty of Dentistry, University of Toronto
John Lusk, MSc., PhD, President, Citizens Against Fluoridation Inc., Port Macquarie, NSW,
Australia
Chuck Matzker, Fluoride Free Framingham, Framingham, Massachusetts
Donna Mayne, Fluoride Free Windsor, Ontario
Howard W. Mielke, PhD, Department of Pharmacology, Tulane University, New Orleans,
Louisiana
Moms Against Fluoridation
Peter Montague, PhD
Jeffrey Morris, PhD, Environmental Economist, Sound Resource Management, Olympia,
Washington
Rick North, Clean Water Oregon
Rae Nadler Olenick, Fluoride Free Austin, Austin, Texas
Organic Consumers Association
Bill Osmunson DDS, MPH
Laura Pressley, PhD, Austin, Texas
Jay Sanders, Clean Water California, San Francisco, California
Nestor B Shapka, BSc, DDS, President of the Canadian Council of Oral Medicine and Toxicology,
Joan Seeman, Denver, Colorado
Diane Sprules, BSc, MSc., Halton Hills, Ontario, Canada
Daniel Stockin, MPH, The Lillie Center for Energy and Health Studies, Ellijay, Georgia
Unifor Durham Regional Environment Council, Oshawa, Ontario, Canada
Bridget Eileen Walsh, Denver, Colorado
Joy Warren, BSc. (Hons) Environmental Science, Coordinator of West Midlands Against
Fluoridation, UK
Washington Action for Safe Water, Washington
Worldwide Alliance to End Water Fluoridation
Water Fluoridation and Environmental Justice - a report submitted to the
EJ Interagency Working Group on September 25, 2015, from Fluoride Action Network
A4 p.571
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5
Fluoride Action Network
http://fluoridealert.org/
September 25, 2015
To the Environmental Justice Interagency Working Group
Re: Water Fluoridation and Environmental Justice
We are submitting these comments to the EJ Interagency Working Group in support of the
formation and agenda goals of this group. We believe that the attached report (Water
Fluoridation and Environmental Justice) gives a clear example of how such an interagency group
working cooperatively together can right a bad policy for poor families and communities of
color.
Hitherto, water fluoridation has fallen through the cracks as far as regulation by federal agencies
has been concerned. The Food and Drug Administration has never regulated fluoridation nor
have they ever tested the safety of fluoride. Their position is that fluoride is an "unapproved
drug." The Environmental Protection Agency's Office of Water, since 1985, has had no
jurisdiction over any chemical ADDED to water, only contaminants. The Department of Health
and Human Services promotes fluoridation through the Division of Oral Health at the Centers for
Disease Control and Prevention.
Here is the nub of the problem that needs correcting by interagency action. The CDC's Oral
Health Division has become a "rogue elephant" as far as this practice is concerned. Their mission
is to promote fluoridation - and they do so effectively and aggressively - but the problem is that
they have a conflict of interest when it comes to monitoring or even questioning the safety of
this practice. That has led them into performing with gross negligence in regards to the adverse
effects of fluoridation on the poor and communities of color for several decades. Moreover, the
expertise in this department is largely dental. Few if any of their personnel have training in other
areas of medicine, toxicology or health risk assessment.
Since 1950, when fluoridation was approved, the role of federal agencies has been only to
support the policy and in so doing they have had to dismiss and discredit anyone or any of the
thousands of studies that reveal the inherent risks in this anti-science experiment.
For over 60 years-American citizens have been treated to Public Relations and propaganda
rather than a dispassionate and objective analysis of either the effectiveness or safety of this
practice.
Now that serious health effects have been documented - particularly fluoride's neurotoxic
effects - it is time to end this practice. Very seldom can the simple turning off a tap (i.e. the
spigot at the public water works) do so much good for so many.
We urge you to continue on the trajectory you have started. Working together you may be able
to right many wrongs and in so doing regain the respect and trust of the American people.
Neil Carman, Ellen and Paul Connett
and other members of the Fluoride Action Network
Water Fluoridation and Environmental Justice - a report submitted to the
EJ Interagency Working Group on September 25, 2015, from Fluoride Action Network
A4 p.572
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6
"Federal agencies must identify and address, as appropriate,
disproportionately high and adverse human health or environmental
effects of their programs, policies, and activities on minority
populations and low-income populations
(Presidential Executive Order 12898
of February 11, 1994)
TABLE OF CONTENTS
EXECUTIVE SUMMARY
1. Abstract
2. Introduction. Water fluoridation
3. Why are some people opposed to fluoridation?
4. Fluoridation and Environmental Justice.
5. Timeline on dental fluorosis and U.S. water fluoridation program
6. Has fluoridation helped reduce tooth decay in the Inner City?
7. Why are African Americans more sensitive to fluoride's toxicity?
8.Reckless assumptions underpin fluoridation promotion
9. Pro-fluoridation governments have undertaken very few studies to seriously investigate
fluoride's potential to cause both short-term health effects in children or long-term health
effects in adults.
10. Non-fluoridated countries lead research effort on fluoride's toxicity
11. National Research Council review of 2006 (NRC)
12. NRC and Endocrine Disruption
13. NRC on Thyroid Function
14. Hypothyroid and fluoride study from UK
15. Fluoride and brain function
16. Fluoridation and ADHD
17. African Americans already have a greater burden to neurotoxins (e.g., lead and mercury)
Water Fluoridation and Environmental Justice - a report submitted to the
EJ Interagency Working Group on September 25, 2015, from Fluoride Action Network
A4 p.573
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18. Association of pre-term births in upstate New York with community water fluoridation
19. State Oral Health Reports have provided little or no information on dental fluorosis and
warnings to communities of color on their extra vulnerabilities
20. Civil Rights Leaders mobilize to end fluoridation's threat to minority communities.
21. The emergency "fluoridation-defense" meeting held at Morehouse College
22. A better way of tackling tooth decay in the inner city as well as address other EJ issues
23. FAN responds to HHS Jan 7, 2011 proposal to lower recommended level of fluoride
24. FAN's critique of the EPA's initial steps to determine a new MCLG for fluoride
25. The EPA's false characterization of fluoride as a nutrient
26. Fluoride has no known role in nutrition or biochemistry (a summary)
27. HHS ruling in 2015 uses sleight of hand to dismiss concerns on fluoride's neurotoxicity
28. Summary
29. Recommendations
Water Fluoridation and Environmental Justice - a report submitted to the
EJ Interagency Working Group on September 25, 2015, from Fluoride Action Network
-------
8
WATER FLUORIDATION and ENVIRONMENTAL JUSTICE
Executive Summary
Evidence is presented that artificial water fluoridation as promoted by federal agencies has
been ineffective in fighting tooth decay and in addition causes "disproportionately high and
adverse human hea!th...effects...on minority populations and low-income populations," in
violation of Presidential Executive Order 12898 of February 11,1994. This problem has been
seriously compounded by the failure of these same agencies to warn communities of color of
their special vulnerabilities to fluoride exposure in general and the water fluoridation program
in particular. The agencies' actions are fueling calls by civil rights and environmental
leaders for investigative hearings by Congress.
The way the EPA Office of Water is approaching its requirement to establish a safe level of
fluoride in drinking water is not scientifically defendable, is politically compromised and
makes absolutely no attempt to address numerous environmental justice issues that arise
from water fluoridation.
There are more positive, effective, and comprehensive ways of fighting tooth decay, which
also prevent disproportionate harm to poor families and communities of color and do not
violate their civil rights.
Those who promote fluoridation correctly claim that most of tooth decay is concentrated in low-
income families and those from communities of color. That is why it is tragic that 80% of
dentists in the U.S. refuse to treat children on Medicaid. The poor need special and focused
attention. Putting a toxic substance into everyone's drinking water is a very poor substitute.
Water fluoridation has not evened-up the playing field as evidenced by the numerous reports of
the dental crises being reported among low-income and communities of color in large U.S. cities
that have been fluoridated for over 20 years. Far from helping low-income families and
communities of color fluoridation causes them disproportionate harm.
Officials in the US Public Health Service knew as early as 1962 that African-Americans had a
higher prevalence of dental fluorosis than whites. Dental researchers have continued to report
this over many decades. In 2005 the CDC reported that both Blacks and Hispanic children had
higher rates of dental fluorosis particularly in its most disfiguring categories (moderate and
severe). However, in all this time neither the CDC nor any other federal agency that promotes
water fluoridation has sought to warn communities of color of their particular vulnerability with
respect to this permanent visually objectionable injury from systemic exposure to fluoride. Nor
have they indicated what this means: their children have been over-exposed to fluoride before
their permanent teeth have erupted and this over-exposure might indicate they have been
damaged in other ways. This failure to warn communities of color of this problem is a clear
example of environmental injustice.
When the US Public Health Service endorsed fluoridation in 1950 (before any trial had been
completed or any meaningful health study had been published) it quickly fossilized into a policy
that was considered beyond debate. Although the FDA has never approved any fluoride
containing substance intended to be ingested for the purpose of reducing tooth decay it has
rejected fluoride-containing vitamins stating that, "there is no substantial evidence of drug
Water Fluoridation and Environmental Justice - a report submitted to the
EJ Interagency Working Group on September 25, 2015, from Fluoride Action Network
A4 p.575
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9
effectiveness as prescribed, recommended, or suggested in its labeling." Drug therapy 1975.
Water fluoridation has never been subjected to an individual-based random control trial (RCT)
for either effectiveness or safety. Very few basic health studies have been conducted in
fluoridated countries and only in recent years have some of the studies of serious toxic and
health effects of fluoride (e.g. lowered IQ) been published, and mainly in non-fluoridated
countries.
Fluoride is not an essential nutrient. There is no need to swallow it: fluoride's beneficial action
can be achieved with direct application of fluoridated toothpaste onto the tooth surface. Tooth
decay in children from low-income families is not caused by too little fluoride but poor nutrition,
including far too much sugar.
The EJ issue goes beyond just dental fluorosis and the failure of the government agencies to
warn communities of color about their vulnerability. Fluoridation penalizes families of low-
income in the following ways.
1) They cannot afford to avoid fluoridated water if they want to do so because both
removal equipment and bottled water (for drinking and cooking) is very expensive.
2) They cannot afford the expensive treatments to conceal the effects of dental fluorosis (a
discoloration and mottling of the enamel).
3) Dental fluorosis rates are higher in fluoridated communities especially in Black and
Hispanic populations than White.
4) Fluoride's toxicity is made worse by poor nutrition.
5) Lactose intolerance is more frequent among Blacks and other ethnic groups than white,
and less consumption of dairy products means lower exposure to calcium, which helps
to protect against absorption of fluoride from the gut.
6) Low-income families from communities of color are less likely to breast-feed their
children. Low fluoride ready-to-feed formula is more expensive as is distilled water
therefore when baby formula is made up with fluoridated water, the baby gets over 100
times more fluoride than a breast-fed child.
7) Fluoride has been associated with lowered IQ in children in 45 studies (as of Sept 2015).
8) Children living in the inner cities are more likely to be exposed to lead from flaking old
paint, air pollution, etc. leading to cognitive damage. Exposure to fluoride adds to this
toxic burden. Research from the University of North Carolina demonstrated that the
chemicals used in fluoridation increase the leaching of lead from brass plumbing fixtures
into drinking water.
9) Communities of color have a greater incidence of kidney disease. Because poor kidney
function makes it more difficult for the body to get rid of fluoride kidney patients must
avoid as much exposure to fluoride as possible.
10) Communities of color have a greater incidence of diabetes, which can lead to increased
consumption of water, which in turns leads to a greater consumption of fluoride.
Water Fluoridation and Environmental Justice - a report submitted to the
EJ Interagency Working Group on September 25, 2015, from Fluoride Action Network
A4 p.576
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10
Two strategic goals in the Interagency Working Group on environmental justice (EJ IWG) action
agenda for fiscal years 2016- 2018, create a very positive framework within which we can move
forward on this issue. These strategic goals are:
I. Enhance communication and coordination to improve the health, q u a I ity-of-l if e, and
economic opportunities in overburdened communities;
II. Enhance multi-agency support of holistic community-based solutions to solve
environmental justice issues;
These goals challenge us to find a plan not just to fight tooth decay in children but also to
improve their "health, quality of life and economic opportunities" and to do so with
"community-based solutions," which will involve "multi-agency support."
We have taken up this challenge in our 5-step alternative plan to water fluoridation.
Our positive, creative and holistic plan aims to fight tooth decay in low-income children but also
find ways to improve their health, their fitness, their quality of life, their intellectual
development and possibly even their employment within the community. We would like to go
further. Our plan also works on other aspects of community development, including its food
supply, its discarded resources, its local employment and business opportunities and the need
to lower its carbon footprint.
In our 5-step program we are proposing that we start with ending water fluoridation in step 1
and then use the money saved on chemicals, equipment and promotion to finance step 2. This
second step involves an educational program for young children modeled after programs in
Scotland and Denmark. One aim of this is to reduce sugar consumption. If that is done well it will
also help to fight obesity and that over the long-term will produce huge savings in health costs.
This should encourage the HHS to provide additional funding needed for step 2 and some of the
funding for steps 3 and 4. Here is a summary of the 5 steps:
1) End water fluoridation. The EPA's Office of Water could do this swiftly if they were
instructed to determine a safe level of fluoride to protect all children from lowered
IQ. This would not only remove a threat to children's intellectual development and
future economic potential, but it would also end a number of extra and unnecessary
health threats for communities of color, especially for people with poor kidney
function; borderline iodine deficiency and diabetes. Never has turning off a tap
promised so much.
2) Establish the equivalent of both Scotland's very successful Childsmile program and
the Danish program for pre-schoolers, in all pre-school programs, kindergarten and
primary schools (and possibly churches) and WIC programs in low-income areas.
3) Set up dental clinics either in schools or stand-alone facilities in the inner city and
other low-income areas. In these we should use trained dental nurses to restore
decay-damaged teeth and to remove infected ones.
4) Expand these dental clinics into community centers aimed at improving the child's
overall health. They could support better nutrition, physical fitness and cultural
activities. Ideally these community centers would be linked to local community
gardens and farms close to the city.
Water Fluoridation and Environmental Justice - a report submitted to the
EJ Interagency Working Group on September 25, 2015, from Fluoride Action Network
A4 p.577
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11
5) Further expand these community centers into job-creating operations and a
foundation for local business opportunities. One concrete way of doing this is to
integrate a "reuse and repair" operation into the Zero Waste approach for handling
discarded materials.
More than anything else a scientifically balanced approach allows the transition from the politics
of "no" to the politics of "yes." Once we get off the shortsighted notion that we can battle tooth
decay by putting a neurotoxic chemical into the public drinking water, we can unleash not only
the full potential of the children from low-income communities, but also of the communities
themselves. The three key words are education, nutrition and justice. We need education (not
fluoridation) to fight tooth decay and obesity. We need better nutrition to keep our children and
ourselves as healthy as possible and we need Environmental Justice for all.
Water Fluoridation and Environmental Justice - a report submitted to the
EJ Interagency Working Group on September 25, 2015, from Fluoride Action Network
A4 p.578
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12
1. Abstract
Evidence is presented that artificial water fluoridation as promoted by federal agencies has been
ineffective at helping fight tooth decay in the inner cities and in addition causes
"disproportionately high and adverse human health...effects...on minority populations and low-
income populations," in violation of Presidential Executive Order 12898 of February 11, 1994.
This problem has been seriously compounded by the failure of these same agencies to warn
minority populations of their special vulnerabilities to fluoride exposure in general and the
water fluoridation program in particular. The current ongoing determination by the
Environmental Protection Agency's (EPA) Office of Water of a new Maximum Contaminant Level
Goal (MCLG) and the Maximum Contaminant Level (MCL) for fluoride as reported in 2011 is
scientifically flawed and betrays an insensitivity to Environmental Justice issues. There are more
positive and creative ways of fighting tooth decay in the inner city, which also address other EJ
issues in a holistic fashion.
2. Introduction
Water fluoridation is the deliberate addition of a fluoride-containing compound to the water
supply to produce a concentration of free fluoride ions at about 1 ppm (i.e. 1.0 milligram of
fluoride per liter). As of April, 2015 the new recommended level by the U.S. Department of
Health and Human Services (HHS) is 0.7 ppm. The stated purpose of this practice is to help fight
tooth decay.
Fluoridation began in the U.S. and Canada in 1945 (see timeline below). This is a very unusual
practice as it is the only time that the public water supply has been used as a vehicle to deliver
medical or human treatment. All the other chemicals added to water are added to make the
water safe or palatable to drink.
While fluoridation is widely practiced in the USA most countries do not fluoridate their water.
97% of the European population does not drink fluoridated water (a few countries fluoridate
their salt, which allows the consumer the choice of whether to buy it or not). Yet according to
World Health Organization (WHO) data (available online) there is little difference in tooth decay
in 12-year-olds between fluoridated and non-fluoridated countries today.
In 1999 the CDC published a figure (see Figure 1) that suggests that dental caries was being
reduced in 12-year-olds from the 1960's to the 1990's as the percentage of the US population
drinking fluoridated water had increased.
Water Fluoridation and Environmental Justice - a report submitted to the
EJ Interagency Working Group on September 25, 2015, from Fluoride Action Network
A4 p.579
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13
Figure 1
FIGURE 1. Percentage of population residing in areas with fluoridated community
water systems and mean number of decayed, missing (because of caries), or filled
permanent teeth (DMFT) among children aged 12 years — United States, 1967-1992
£ ioo
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Figure 1: A copy of Figure 1 in the CDC review, TITLE CDC (1999),
However, in Figure 2, World Health Organization (WHO) data is plotted for tooth decay in 12-
year-olds for both fluoridated and non-fluoridated countries, and it can seen that the decay
rates have been coming down as fast, if not faster, in the non-fluoridated countries as the
fluoridated countries. It is surprising therefore the CDC should conclude that the declines in the
US have been caused by fluoridation.
Water Fluoridation and Environmental Justice - a report submitted to the
EJ Interagency Working Group on September 25, 2015, from Fluoride Action Network
A4 p.580
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14
Tooth Decay Trends: Fluoridated vs. Unfluoridated Countries
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Figure 2: WHO data on tooth decay in 12-year-olds for 18 countries, 4 Fluoridated, 13 non-
fluoridated and 1 (UK) partially fluoridated, plotted from the 1960s to 2000's (Graph by Chris
Neurath; see FAN, 2012a).
We would do well to study the ways that European countries have achieved reduction of tooth
decay in low-income families without forcing their citizens to swallow fluoride. Of particular
interest are the Childsmile program in Scotland and the Nex0 Program in Denmark.
3. Why are some people opposed to the practice of Water fluoridation?
The arguments given by many citizens and scientists opposed to fluoridation include the
following.
1) Once added to the water there is no way that the dose each individual receives can
be controlled.
2) Nor can we control who receives the treatment - it goes to everyone regardless of
age, health or nutritional status.
3) It violates the individual's right to informed consent to human treatment.
4) It is difficult and expensive to avoid, as cheap filters don't remove the fluoride. This
makes this doubly unethical for low-income families who don't want this treatment.
5) No doctors are overseeing the treatment or monitoring side-effects.
6) The Food and Drug Administration (FDA) has never regulated fluoride for ingestion.
According to the FDA fluoride is an "unapproved drug".
Water Fluoridation and Environmental Justice - a report submitted to the
EJ Interagency Working Group on September 25, 2015, from Fluoride Action Network
A4 p.
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15
7) Incredibly, after 70 years there has not been one single individually-based
randomized control trial (RCT) to demonstrate safety or effectiveness
8) Fluoride is not an essential nutrient. No one has ever shown that if an animal is
starved of fluoride in its diet that it develops a disease. An individual can have perfectly
good teeth without fluoride. Tooth decay is not caused by too little fluoride but by poor
dental hygiene and a poor diet, including too much sugar.
9) There is not one biological process in the body that needs fluoride to function
properly but many that are harmed by it. Fluoride inhibits enzymes and interferes with
G-proteins, which carry important messages across cell membranes. See Barbier et al.
(2010) for a review of the biochemical mechanisms of fluoride's toxic action.
10) Nature in her wisdom has kept fluoride away from the baby. The level in mothers'
milk is very low (0.004 ppm, NRC, 2006; 0.004 to 0.008, Sener, 2007) Thus the breast-fed
baby is protected from fluoride, but that protection is removed by water fluoridation. A
bottle-fed baby where the formula is made up with fluoridated tap water (at the new
recommended guideline of 0.7 ppm fluoride) gets over 100 times more fluoride than a
breast-fed baby.
11) Even promoters of fluoridation now admit the predominant mechanism of fluoride's
beneficial action on the teeth is topical not systemic (CDC, 1999). In other words one
does not need to swallow this toxic substance to get the purported benefit. Brushing the
teeth with fluoridated toothpaste is a more rational delivery system, which minimizes
exposure to other tissues and does not force it on people who don't want it.
12) Fluoridation promoters have wildly exaggerated the benefits of swallowing fluoride.
A recent Cochrane review (the gold standard for evidence-based medicine) concluded
that the scientific studies that have purported to demonstrate effectiveness have been
of a very poor quality (Iheozor-Ejiofor et al., 2015 ).
13) Fluoridation poses many health risks.
14) Of particular concern is the large number of animal and human studies that indicate
that fluoride is neurotoxic (i.e. it can enter and interfere with brain chemistry) including
45 (out of 51) studies that have associated fairly modest exposure to fluoride and
lowered IQ in children.
15) The last children in the USA that need their IQ lowered are children from low-
income families, who are precisely those who have been targeted by those promoting
this practice.
16) There are many other health concerns. These include lowered thyroid function
(Peckham et al., 2015); accumulation in the human pineal gland (Luke 1997, 2001);
ADHD (Malin and Till, 2015); accumulation in the bone (arthritis, NRC, 2006, increased
hip fractures in the elderly, Li et al, 2001) and an increased risk of osteosarcoma in
young boys when exposed in their 6th -8th years (Bassin et al, 2006).
17) U.S. children are being hugely over-exposed to fluoride from all sources as
evidenced by the prevalence of dental fluorosis, which now impacts 41% of 12-15 year
olds (Beltran-Aguilar et al., 2010). The rates are higher for Black and Hispanics (Beltran-
Aguilar et al., 2005).
18) Now that it has become clear that low-income and minority communities are more
Water Fluoridation and Environmental Justice - a report submitted to the
EJ Interagency Working Group on September 25, 2015, from Fluoride Action Network
A4 p.582
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16
vulnerable to dental fluorosis and probably fluoride's other toxic effects fluoridation has
become a major Environmental Justice issue and needs to be re-assessed from that
perspective.
4. Fluoridation and Environmental Justice.
Those who promote fluoridation often do so based upon equity considerations. They correctly
claim that most of tooth decay is concentrated in low-income families and especially in
communities of color. In the United States, according to Kaste at al. (1996), 25 percent of
children and adolescents experience 80 percent of all dental decay occurring in permanent
teeth. However, the evidence suggests that promoters were being overly optimistic when they
thought that forcing everyone to swallow fluoride would even-up the playing field when it
comes to these dental inequalities.
As we explain below fluoridation far from helping low-income families is actually hurting them.
In fact fluoridation is a rather graphic example of environmental injustice.
Fluoridation penalizes families of low-income, especially communities of color in the following
ways.
1) Low-income families cannot afford to avoid fluoridated water if they want to do so
because both removal equipment and bottled water (for drinking and cooking) is
very expensive.
2) Low-income families cannot afford the expensive treatments to conceal the damage
that fluoride can cause to the enamel (dental fluorosis).
3) Dental fluorosis rates are higher in Black and Hispanic communities than White
communities especially in the more severe forms that require treatment (Beltran-
Aguilar et al., 2005).
4) Fluoride is more toxic when exposure is accompanied by poor nutrition. Poor
nutrition is more likely to occur in low-income families than those with higher
incomes. This is what was said about this issue in a 1952 article that appeared in the
Journal of the American Dental Association:
"The data from this and other investigations suggest that malnourished infants
and children, especially if deficient in calcium intake, may suffer from the effects
of water containing fluorine while healthy children would remain
unaffected...Thus low levels of fluoride ingestion which are generally considered
to be safe for the general population may not be safe for malnourished infants
and children. Therefore, the nutritional status must be carefully assessed and
guarded in areas with endemic fluorosis. Nutritional studies should be included
in any comprehensive program of fluoridation of water with special attention to
chronically ailing infants and children." (Massler & Schour 1952).
5) Lactose intolerance is more frequent among Blacks and other ethnic groups than
white, and less consumption of dairy products typically means lower exposure to
calcium. Calcium in the diet helps to a certain extent to protect against absorption
of fluoride from the gut.
Water Fluoridation and Environmental Justice - a report submitted to the
EJ Interagency Working Group on September 25, 2015, from Fluoride Action Network
A4 p.583
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17
6) Minority families are less likely to breast-feed their children. When baby formula is
made up with fluoridated water it leads to over 100 times more exposure to fluoride
than breast-feeding.
7) Fluoride is neurotoxic and in 45 studies it has been associated with lowered IQ in
children. The last children that need their IQ lowered are children from low-income
families.
8) Low-income and minority groups living in the inner city are likely to have a greater
exposure to lead. Fluoride appears to enhance the toxicity of lead. Lead increases
the risk of dental fluorosis. Both lead and fluoride are neurotoxic.
9) Children from low-income families are more likely to get mercury amalgam fillings
than families with higher income. Mercury is neurotoxic. The combined impact of
mercury and fluoride on a child's mental development may be greater than either
acting alone.
10) Minority communities have a greater incidence of kidney disease. Poor kidney
function increases fluoride's uptake into the bone, which is likely to increase the
rates of arthritis and hip fractures (over a lifetime).
11) Minority communities have a greater incidence of diabetes, some forms of which
lead to an increased consumption of water, which in turns leads to a greater
consumption of fluoride.
Many of these issues are discussed in more detail and documented in the text below.
5. The history of the water fluoridation program with a special emphasis on dental
fluorosis and environmental justice issues
A timeline from the early 1900's to 2015
In the early 1900's a handful of dentists, particularly Frederick McKay (1916, 1928) and G.V.
Black & McKay (1916) were interested in what was causing a condition (which was prominent in
both Texas and Colorado), which led to discoloration and marking of the teeth. The condition
was called "dental mottling." McKay described dental mottling as "the most poorly constructed
enamel of which there is any record in the history of dentistry."
1925
Norman Ainsworth in a study of 4000 children in Essex County in England reported a lowered
prevalence of dental caries in Maldon and Heybridge, which were areas endemic for "dental
mottling" (now known as areas with high natural levels of fluoride in the water) - (see Mullen,
2005).
1928
Frederick Mckay (1928) noted that while the discoloration and marking of the teeth in cases of
"dental mottling" looked very bad it did not appear to increase the child's susceptibility to tooth
Water Fluoridation and Environmental Justice - a report submitted to the
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A4 p.584
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18
decay, in fact there appeared to be less tooth decay among children with dental mottling than
those without.
1931
In 1931 three separate research teams (Smith et al., 1931; Churchill et al, 1931 and Vehu, 1931)
identified the cause of this condition as fluoride in the drinking water and the name was
changed to "dental fluorosis/' which literally means "poisoning of the teeth by fluoride." It was
quickly recognized that dental fluorosis was a "systemic" not a "topical" effect. It can only be
contracted before the permanent teeth have erupted. It is occasionally seen in the primary
teeth (Warren et al., 1999) but it is most frequently observed in the secondary teeth.
1930 and 40's
Under the leadership of H. Trendley Dean the US Public Health Service (PHS) studied the
occurrence of this condition throughout the USA. In addition to this mapping exercise Dean
subsequently published his famous classification of the different levels of severity of this
condition: very mild, mild, moderate and severe. According to Dean et al. (1934, 1935):
Very mild ranged from white patches on the cusp of the teeth to up to 25% of the
enamel impacted.
Mild impacted between 25 and 50% of the enamel.
Moderate impacted 100% of the enamel.
Severe impacted 100% of enamel with pitting and chipping.
Pictures illustrating these four levels of dental fluorosis are given in Figure 3
Water Fluoridation and Environmental Justice - a report submitted to the
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A4 p.585
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"Very Mild" "Mild"
"Moderate" "Severe"
Figure 3. Pictures of the four levels of dental fluorosis. (Photographs by Dr. Hardy Limeback and
Dr. lain Pretty, et al. - see more photos)
1942.
In 1941-1942, Dean and his colleagues published his famous 21-city study which purported to
show that as the fluoride level in the water went from about 0.1 to 2.6 ppm tooth decay fell.
Most of reduction occurred between 0.1 and 0.9 ppm, with only a modest further decrease
occurring between 0.9 and 2.6 ppm. He further noted that there was little noticeable dental
fluorosis occurring below 1 ppm. Thus was born the notion that the "optimal level" for reducing
tooth decay while minimizing the risk of dental fluorosis was 1 ppm. Dean later indicated that at
1 ppm only about 10% of children would have dental fluorosis and only in the very mild
category. Dean later testified in the US Congress that mild dental fluorosis would not be an
acceptable trade off for lowered tooth decay. This is what he said to the Delaney Committee in
1952:
Water Fluoridation and Environmental Justice - a report submitted to the
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A4 p.586
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"We don't want any 'mild' [fluorosis] when we are talking about fluoridation. We don't
want to go that high...I don't want to recommend any fluoridation where you get any
'mild'". (Connett et al., 2010, page 110).
All the children in Dean's 21-City study were white: there were no Blacks or Hispanics in the
7,257 children studied.
RELATION BETWEEN ThE AMOUNT OF DENTaL CARIES
(PERMANENT TEETH) OBSERVED IN 7257 SELECTED 12 - 14
YEAR OLD WHITE SCHOOL CHILDREN OF 21 CITIES OF A STATES
AND THE FLUORIDE
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600
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FLUORIDE (F) CONTENT OF THE WATER IN P.P.M.
3.0
Figure 4: Dean's famous 21-city plot of Dental caries experience in each community versus the
concentration of fluoride in the community's water supply in ppm (Dean et al., 1941, 1942)
1945
By 1945 Dean and others were convinced that natural levels of fluoride in the water lowered
tooth decay and there were no side effects other than dental fluorosis. The question became:
could one deliberately add a fluoride-containing compound to the public water supply and
achieve the same result? The PHS decided to run a series of experiments to check this out.
Instead of these experiments being conducted in the form of randomized control trials on
Water Fluoridation and Environmental Justice - a report submitted to the
EJ Interagency Working Group on September 25, 2015, from Fluoride Action Network
A4 p.587
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21
individual volunteers they were launched on whole cities. In their discussions the early
promoters did not want to use the word experiment because as they said, "people don't like to
be experimented upon!" They also saw them more as demonstrations - demonstrating that
what they had seen with natural fluoride could be reproduced with artificial fluoride. These
fluoridation experimental trials began in 1945 in Grand Rapids, Ml; Newburgh, NY and
Brantford, Ontario, Canada using sodium fluoride at 1 ppm (1 mg fluoride/liter of water). Most
now agree that the methodology used in these experiments would not be acceptable by modern
epidemiological standards but nevertheless they provided the foundation for the widely
accepted belief in this practice for many decades. Dr. Philip Sutton wrote two monographs and a
whole book on the inadequacies of these experimental trials, and his arguments have never
been successfully rebutted by proponents (Sutton, 1959, 1960, 1996).
1950
The trials were meant to last for 10 years, but before any of them had been completed the PHS
endorsed fluoridation in 1950 and over the next two years with little science on the table it was
endorsed by nearly every dental, public health and medical body in the country. Despite their
lack of science these endorsements have been used heavily by promoters ever since.
1956
In 1956, Schlesinger et al. published the health findings for the Newburgh, NY (control city
Kingston, NY) experiment. They reported that young men in fluoridated Newburgh had a
significantly greater number of cortical bone defects than non-fluoridated Kingston (about 2 to
1). There was no follow-up on this finding, which is surprising because the cortical bone is the
outside layer of the bone and protects against fracture. However, Dr. Caffey who examined the
X-rays said in 1955 that the age, sex and anatomical distribution of these defects were
remarkably similar to osteosarcoma. 20 years later this comment prompted the National
Academy of Science (NAS) in 1977 to recommend that researchers check to see if there was an
increase in osteosarcoma in young men under 30 in fluoridated communities (NAS, 1977). The
other finding by Schlesinger was that young girls were menstruating on average 5 months earlier
in the fluoridated community than in the non-fluoridated one. This observation was not
considered important at the time but today it is intriguing in the context of Luke's findings, a)
that fluoride accumulates in the human pineal gland (Luke, 2001) and b) lowers melatonin
production in animals and shortens the time to puberty (Luke, 1997).
1962
A January 10, 1962 internal memorandum, from a top PHS official, F.J. Maier, in connection
with the first fluoridation trial, revealed that, "negroes in Grand Rapids had twice as much
[dental] fluorosis than others." Based on this, Maier asked, "In a community with a larger
number of negroes (say in Dekalb County, Georgia) would this tend to change our optimum
fluoride levels?"(Maier, 1962).
1983
In 1983 the U.S. Surgeon General convened a panel to review the literature as part of the
process of determining a safe drinking water standard for fluoride (the MCL, or Maximum
Water Fluoridation and Environmental Justice - a report submitted to the
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22
Contaminant level). One member of the panel on reviewing pictures of dental fluorosis stated
that, "You would have to have rocks in your head to allow your child much more than two parts
per million (Grossman, 1990 - see Appendix A)..." Over-exposure to fluoride damages teeth as
the photos of the various stages of dental fluorosis above, also known as enamel fluorosis,
clearly show.
1985
When the EPA published its rationale for both a MCL and MCLG (goal) at the very high level of 4
ppm they did not include dental fluorosis as an adverse health effect but as a "cosmetic effect"
(for which they produced a non-enforceable secondary standard of 2 ppm). Instead of dental
fluorosis the EPA used skeletal fluorosis as the health effect of concern - even so, they did not
use the first signs of skeletal fluorosis (which are identical to arthritis) but the terminal stages in
which the patient is crippled, i.e. crippling skeletal fluorosis. Choosing the gross end point of the
problem conflicts with the normal way that the EPA comes up with protective standards.
Normally they determine the Lowest Observable Adverse Effect Level (LOAEL) and then apply
safety factors to that. Note also that U.S. standard of 4 ppm is about three times the WHO
guideline of 1.5 ppm, which is the standard adopted by Canada, Mexico and most of the rest of
the world.
Professionals at the EPA who witnessed this process have stated that the level of 4 ppm was
chosen for political not scientific reasons. It was chosen to accommodate concerns of states like
South Carolina which did not want to spend a lot of money removing high natural fluoride levels
from drinking water if a lower level were chosen (Grossman, 1990 in Appendix A; and FAN,
2007).
1985
In a Texas survey, published in 1985, Butler et al. reported that the prevalence of dental
fluorosis among African-American children was greater than for Hispanic and non-Hispanic
white children. The reported Odds Ratio was 2.3.
1986-7
The National Institute of Dental Research (NIDR) conducted one of the largest surveys of tooth
decay and dental fluorosis ever carried out in the USA. They looked at the teeth of
approximately 39,000 children in 84 communities. The dental caries results were reported in
1990 by Brunelle and Carlos but the dental fluorosis data was not reported until 1997 by Heller
et al. The latter reported 29.9% of the children living in communities with fluoride levels
between 0.7 and 1.2 ppm had some form of dental fluorosis. Of these 22.5 % had very mild,
5.8% had mild, 1.3% had moderate and none were in the severe category.
As far as dental caries was concerned Brunelle & Carlos found that for children aged 5-17, who
had lived all their lives in a fluoridated versus a non-fluoridated community, the average saving
in tooth decay was 0.6 of one tooth surface (see their Table 6). There are 4 and 5 surfaces for
the "cutting" and "chewing" teeth respectively, and by the time all the child's teeth have
erupted there are a total of 128 tooth surfaces. Even this very modest saving of 0.6 of one tooth
Water Fluoridation and Environmental Justice - a report submitted to the
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A4 p.589
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23
surface was not shown by the authors to be statistically significant, but this did not stop them
declaring:
"The results show that water fluoridation has played a dominant role in the decline of
caries and must continue to be a major prevention methodology."
Brunellle and Carlos also noted that, "Contrary to some earlier observations, however, white
children had lower mean DMFS scores than non-whites (blacks and all others) at most ages (Fig,
In 1988, Bette Hileman, in an important review in Chemical and Engineering News reported
disagreements among dental researchers as to whether dental fluorosis rates were increasing
among children in the U.S.:
"Dennis Leverett, chairman of the department of community dentistry at the Eastman
Dental Center in Rochester, N.Y., claims that the prevalence of dental fluorosis today in
communities with fluoridated water is twice the level that H. Trendley Dean, a dental
surgeon in the Public Health Service, reported in 1942 ... In contrast, William S. Driscoll,
acting chief of the disease prevention and health promotion branch at the National
Institute of Dental Research (NIDR), and his coworkers report that surveys in 1980
"suggest that no important changes in the prevalence and severity of fluorosis have
taken place" since Dean's studies. However, Driscoll did find eight children with either
moderate or severe fluorosis in a community with a fluoride level of 1 ppm..." (Hileman,
1988)
In 1990, Williams and Zwemer in a study from Georgia, reported that dental fluorosis was more
severe among African-American children than white children. As the following table shows,
16.7% of black children in Augusta, Georgia had moderate/severe fluorosis versus 9.1% of white
children. In Richmond County, the respective rates were 3.3% vs 0% (see Table 1)
7)."
1988
1990
Table 1. Dental Fluorosis Rates in Augusta & Richmond County, Georgia
Residence/Race
No Fluorosis Very Mild/Mild Fluorosis Moderate/Severe Fluorosis
(TSIF Score = 0) (TSIF Score = 1-3) (TSIF Score = 4-7)
City/Black 19.6%
City/White 18.2%
County/Black 47.8%
County/White 44.9%
55.1%
63.7%
48.9%
72.7%
16.7%
9.1%
3.3%
0%
SOURCE: Williams JE, Zwemer JD. (1990).
Water Fluoridation and Environmental Justice - a report submitted to the
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A4 p.590
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In 1990 the long-awaited animal cancer study (requested by Congress) was published by the
National Toxicology Program (NTP, 1990). This report caused great consternation because the
authors reported a statistically significant increase in a bone cancer (osteosarcoma) in the male
rats, which was "equivocal" evidence that fluoride was carcinogenic.
1991
Soon after the 1990 NTP study was published a cover story was published in the Journal of the
American Dental Association speculating that fluoridation may actually be protective against
cancer (McGuire et al., 1991). It was clear from the comments in this article that the authors
were more worried that a finding that fluoride caused cancer would end water fluoridation,
than it might be killing a few young men each year. They wrote:
"An incorrect inference implicating fluoride carcinogenicity and its removal from our
water systems would be detrimental to the oral health of most Americans...a disruption
in the delivery of fluoride through municipal water systems would increase decay rates
over time...Linking of fluoride ingestion and cancer initiation could result in a large-scale
defluoridation of municipal water systems under the Delaney clause." (Connett et al.,
2010, p. 187)
One of the authors of this report was Professor Chester Douglass, chairman of the Harvard
dental department. In 1994 he received a large grant from the National Institute of
Environmental Health Sciences to investigate the possible connection between fluoridation and
osteosarcoma. This raises serious questions about why an investigation that had the potential to
end fluoridation was given a) to a dental school and b) to a dental professor who was known to
be pro-fluoridation and was simultaneously a consultant for Colgate (FAN, 2006).
Despite these doubts in 2001, Douglass's graduate student, Elise Bassin, as part of her doctoral
thesis, discovered in a carefully matched case control study that young boys exposed to
fluoridated water in their 6th, 7th or 8th years had a 5-7-fold increased risk of succumbing to
osteosarcoma by the age of 20. Over the next three years, Douglass - given several
opportunities - hid this finding from his peers, his funders and the National Research Council of
the National Academies (NRC) review panel. Bassin's thesis (2001) was not "found" until 2004.
For the rest of this intriguing story see the Harvard/Bone Cancer files (FAN, 2006); Harvard
Crimson, 2006; Connett et al., 2010, chapter 18.
1997
Heller et al. (1997) paper published (see above)
1997 also saw the publication of a controversial report from the Institute of Medicine (IOM).
The title of the report included fluoride in a list of well-known nutrients needed for healthy bone
growth: calcium, magnesium, phosphate and vitamin D (IOM, 1997). In response to a letter from
a number of scientists complaining about this false classification of fluoride as a nutrient, Dr.
Bruce Alberts, President of the National Academies, and Dr. Kenneth Shine, President of the
IOM, wrote:
Water Fluoridation and Environmental Justice - a report submitted to the
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A4 p.591
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First, let us reassure you with regard to one concern. Nowhere in the report is it stated
that fluoride is an essential nutrient. If any speaker or panel member at the September
23rd workshop referred to fluoride as such, they misspoke. As was stated in
Recommended Dietary Allowances 10th Edition, which we published in 1989: "These
contradictory results do not justify a classification of fluoride as an essential element,
according to accepted standards. Nonetheless, because of its valuable effects on dental
health, fluoride is a beneficial element for humans." (Alberts and Shine, 1998).
We return to this story in section 26 where we challenge the EPA Office of Water for using the
IOM report to support their false claim that fluoride is a nutrient in a 2010 report (EPA, 2010b,
page 39).
1999 - 2000
Kumar et al. (1999) reported that "African-American children studied [in Newburgh and
Kingston, NY] in 1995 were at higher risk for dental fluorosis than children of other racial groups.
. . . The higher risk for dental fluorosis observed among African-American children is consistent
with several other studies."
In 2000 Kumar et al. noted, "The results support our earlier findings that African-American
children were at higher risk for dental fluorosis in the fluoridated area. Even in the
nonfluoridated area, there was a suggestion that African-American children were at higher risk.
Whetherthis higher risk for African-American children is the result of their lower threshold for
fluoride or due to other unknown sources of fluoride is not known. It has been reported that
African-American children in the United States drink more water and less milk compared to
white children. In Newburgh, this difference in the fluid consumption may have resulted in a
higher prevalence of fluorosis in African-American children. . . . Because a race fluorosis
association could have important policy implications, a large-scale study in a representative
sample should be conducted to test specifically the hypothesis that African-American children
are at higher risk for fluorosis."
2003 -2006
The US EPA Office of Water asked the National Research Council of the National Academies to
review their safe water standards for fluoride. A 12-membered panel (unusually for official
reviews on fluoride, the panel was balanced with 3 pro-fluoridation, 3 anti-fluoridation and 6
undeclared) was appointed by the National Research Council of the National Academies to do
this. The panel reported back in 2006 with a landmark 500-page review (NRC, 2006).
The NRC panel concluded that the safe drinking water goal and standard for fluoride in water
(MCLG and MCL) of 4 ppm was not protective of health and a new risk assessment needed to be
performed to determine a new MCLG (maximum contaminant level goal).
The panel had this to say on dental fluorosis:
"Severe enamel fluorosis is characterized by dark yellow to brown staining and discrete
and confluent pitting, which constitutes enamel loss... Severe enamel fluorosis
compromises that health-protective function by causing structural damage to the tooth.
Water Fluoridation and Environmental Justice - a report submitted to the
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A4 p.592
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The damage to teeth caused by severe enamel fluorosis is a toxic effect that is
consistent with prevailing risk assessment definitions of adverse health effects...
"Severe enamel fluorosis occurs at an appreciable frequency, approximately 10% on
average, among children in U.S. communities with water fluoride concentrations at or
near the current MCLG [maximum contaminant level goal] of 4 mg/L. Thus, the MCLG is
not adequately protective against this condition...
"The committee finds that it is reasonable to assume that some individuals will find
moderate enamel fluorosis on front teeth to be detrimental to their appearance and
that it could affect their overall sense of well-being. However, the available data are not
adequate to categorize moderate enamel fluorosis as an adverse health effect on the
basis of structural or psychological effects.
"Since 1993, there have been no new studies of enamel fluorosis in U.S. communities
with fluoride at 2 mg/L in drinking water. Earlier studies indicated that the prevalence of
moderate enamel fluorosis at that concentration could be as high as 15%..." (NRC, 2006)
However, even though the NRC panel concluded that severe dental fluorosis constituted an
adverse health effect no federal or state agency has gone to any lengths to inform the public
that this is the case. Nor have they warned the African-American and Mexican American
communities with a total population of 101 million people (Colby & Ortman, U.S. Census, Table
2, 2015) that they are particularly vulnerable to this condition,
2005
In 2005, the Centers for Disease Control and Prevention (Beltran-Aguilar et al. See Table 2
below) acknowledged for the first time publicly that the black community has higher rates of
dental fluorosis than the white community. It took a Freedom of Information Act request,
however, to learn the full extent of this disparity. 58% of black children were diagnosed with
dental fluorosis in CDC's 1999-2004 national survey, versus 36% of white children. (Gracia, 2011;
see also Stockin, 2015).
Table 2: A copy of Table 23. Enamel fluorosis* among persons aged 6- 39 years, by selected
characteristics United States, National Health and Nutrition Examination Survey, 1999- 2002.
Source: Beltran-Aguilar et al., 2005 (CDC, 2005)
http://fluoridealert.org/content/table-23-enamel-fluorosis-among-persons-aged-6-39-
mmwr-2005/
Water Fluoridation and Environmental Justice - a report submitted to the
EJ Interagency Working Group on September 25, 2015, from Fluoride Action Network
A4 p.593
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27
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28
Figure 3. Change in dental fluorosis prevalence among children aged 12-15 participating in two national surveys:
United States, 1986-1987 and 1999-2004
NOTES: Dental fluorosis is defined as having very mild, mild, moderate, or severe forms and is based on Dean's Fluorosis Index. Percentages do not sum to 100
due to rounding. Error bars represent 95% confidence intervals.
SOURCES: CDC/NCHS. National Health and Nutrition Examination Survey, 1999-2004 and Nationd Institute of Dental Research. National Survey of Oral Health
In U.S. School Children, 1986-1987.
Figure 6: Change in dental fluorosis prevalence among children aged 12-15 participating in
two national surveys: United States, 1986-1987 and 1999-2004, 3 from Beltran -Aguilar et al.
(2010).
2011
On January 7 the U.S. Department for Health and Human Services and EPA held a joint press
conference in Washington, DC (HHS, 2011a). The HHS announced its proposal to lower its
recommended fluoride level in water to fight tooth decay from a range of 0.7 - 1.2 ppm to 0.7
ppm, largely because of the escalating prevalence of dental fluorosis among US children.
At this same press conference EPA's Office of Water announced that it had begun its
determination of a new safe drinking water standard for fluoride (recommended by the NRC
panel in March of 2006). While stating that they wanted to find a safe level for fluoride in
drinking water (their federal responsibility), they also stated that they were interested in
protecting children's teeth {not their federal responsibility). According to EPA Assistant
Administrator for the Office of Water Peter Silva.
""EPA's new analysis will help us make sure that people benefit from tooth decay
prevention while at the same time avoiding the unwanted health effects from too much
fluoride (HHS, 2011a)." (our emphasis)
Water Fluoridation and Environmental Justice - a report submitted to the
EJ Interagency Working Group on September 25, 2015, from Fluoride Action Network
A4 p.595
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29
EPA at this juncture threw away its objectivity in the setting of a "safe" Maximum Contaminant
Level goal (MCLG) for fluoride in drinking water. In other words they were indicating that they
were going to select the safe level for fluoride as a contaminant that would not conflict with the
HHS recommended level for fluoride in the fluoridation program. Clearly that is a political
judgment. However, from a legal point of view no consideration of any perceived benefit of a
contaminant should be allowed to interfere with the EPA's obligation to determine a safe
Maximum Contaminant Level Goal (MCLG). According to the Safe Drinking Water Act the MCLG
should be determined based on a known or reasonably anticipated harmful effect, with
appropriate safety factors applied to protect everyone in society, including vulnerable subsets.
Such calculations should be scientifically determined and should not be compromised by
accommodating some perceived benefit.
2015
The HHS formally announced its new recommended level of 0.7 ppm fluoride in water
claiming that it would lower tooth decay, while minimizing the prevalence of the more
objectionable stages of dental fluorosis (HHS, 2015). In so doing they continued their 60-year
plus denial of any other potential health effect other than dental fluorosis at the doses
experienced by any American, including the most vulnerable, drinking fluoridated water and
getting fluoride from other common sources such as dental products (see section 25 for our
response to this).
SUMMARY: DENTAL FLUOROSIS IN THE U.S. 1945-2015
In 1945 Dean estimated that about 10% of children would develop dental fluorosis in
communities fluoridated at 1 ppm. Since then children are being exposed to fluoride not only in
fluoridated water but also from all the beverages and processed foods made with fluoridated
water, and from many other sources including dental products, and pesticide residues on food,
including EPA permitted fluoride residues -from the fumigant sulfuryl fluoride - of 900 ppm
fluoride in powdered eggs, 130 ppm fluoride in wheat flour, and 70 ppm fluoride in 99.99% of all
processed food (FAN, 2005). As a result the rates of dental fluorosis are getting significantly
worse across the U.S. However, the CDC's Division of Oral Health continues to promote artificial
water fluoridation despite its disproportionate impact on communities of color and low-income
groups. Studies sponsored by this CDC division in 2005 and 2007 confirm the growing epidemic
of dental fluorosis in minority populations. It is an open question as to whether reducing the
fluoride levels from a range of 0.7 to 1.2 ppm across the country to a single value of 0.7 ppm,
will have a major effect on decreasing the prevalence of this condition in general or in minority
communities in particular. A larger question is whether the level of 0.7 ppm will cause other
health problems, but for the CDC's Division of Oral Health that is a mute question since they
adamantly deny that any other tissue is harmed by water fluoridation or from all sources
combined.
Meanwhile, at no time have federal government officials ever taken steps to warn black
communities of their heightened fluorosis risk.
Water Fluoridation and Environmental Justice - a report submitted to the
EJ Interagency Working Group on September 25, 2015, from Fluoride Action Network
A4 p.596
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30
Dental Fluorosis Rates in the United States:
1950 through 2004
19
C
—
o
c
fir
o
w
V
a.
50-
45—
40-
35-
30-
25 -
1950
1999-2004
41%
National Average for
12-15 year olds
V
1960
10%
Children in Fluoridated
Communities
1986-1987
23%
National Average for
12-15 year olds
1930
I
1970
1980 1990
Years 1950 through 2004
3000
201D
• Bel Iran ED, oral (2010). Prevalence and Severity of Dental Fluorosis in Itie United Slates, >999-2004
NCHS Data Brief No 53. Figure 2.
• National Research Council (1993). health Effects of friges led Fluoride, National Academy Press.
Washington DC. p. 4 5
(Graph by Fluoride Action Networks
Figure 7: Dental fluorosis rates in the United States: 1950 through 2004 (FAN).
Water Fluoridation and Environmental Justice - a report submitted to the
EJ Interagency Working Group on September 25, 2015, from Fluoride Action Network
A4 p.597
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31
S0
Fluoridation, Tooth Decay, and Dental Fluorosis
What was predicted vs. what has actually occurred
What was predicted in 1950*
-10
Tooth Decay
Fluorosis Index
Water Fluoride Level (ppm)
Water Fluoridation and Environmental Justice - a report submitted to the
EJ Interagency Working Group on September 25, 2015, from Fluoride Action Network
A4 p.598
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32
1 o
09
03
07
a
05
04
-03
-02
-0 1
What has actually occurred**
0 0.2 0 4 0.8 0.6 1.0 1.2 1.4 1
Water Fluoride Level (ppm)
x
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'Hodge HC. (1950). The concentration of fluorides in drinking water to give the point of minimum
caries with maximum safety Journal of the American Dental Association 40 436-19
"Holier KE, et ml (1997) Dental canes and dental fluorosis at varying water fluoride concentrations
Journal of Public Health Dentistry 57:136 143, Figures 1 & 2.
Figure 8; What was predicted in 1950 (top graph) vs. What has actually occurred (bottom
graph). Legend: Black line is tooth decay measured as DMFT. Red Line is the Community
Fluorosis Index. (FAN),
6. Has fluoridation helped reduce tooth decay in the Inner City?
While it is clear that the fluoridation program has failed to limit the prevalence of dental
fluorosis to levels anticipated in 1945, what about the other half of the program? Has it reduced
tooth decay? And in the context of this discussion has it reduced tooth decay in low-income
families and minority communities especially in the inner city?
Despite the laudable aim to reduce the inequalities in dental care, putting fluoride in everyone's
water to reduce tooth decay among inner city children has not been the magic bullet it was
expected to be. Story after story in the media of major fluoridated cities in the US tell the same
story: we still have a dental crisis among America's inner city children especially among poor and
minority families. In Table 3 we summarize these reports from New Haven CT; Washington DC;
Detroit Ml; Boston MA; Concord NH; Manhattan and the Bronx in NY; Cincinnati OH; Pittsburgh
PA; and San Antonio IX.
Water Fluoridation and Environmental Justice - a report submitted to the
EJ Interagency Working Group on September 25, 2015, from Fluoride Action Network
A4 p.599
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33
TABLE 3: Communities with water fluoridation and high dental decay
Fluoridation
Status
Detail
CONNECTICUT
Mandatory
Fluoridation since
1965 for water
systems servicing
a population of
20,000 or more
90.3% of the
population
receive
fluoridated water
as of 2012
... Peters [director of New Haven Public Schools school health centers] said
this past June New Haven Public schools screened 484 Troup students, from
kindergarten on up to grade 8, and found that 35 percent had moderate to
severe dental needs.
"The need for dental care is very clear in Connecticut and New Haven,"
Peters said at Troup Wednesday. "Tooth decay is the most common
childhood disease. It is five times more common than asthma and its the
leading reason for missed school across the state." ...
2015. Markeshia Ricks M. The dentist comes to Troup. New Haven
Independent. September 11.
CONNECTICUT
See above
"Dental decay remains the most common chronic disease among
Connecticut's children. Poor oral health causes Connecticut children to lose
hundreds of thousands of school days each year. One in four Connecticut
children is on Medicaid, but two of three Connecticut children receive no
dental care. And DSS continues to exploit the seriously stretched public
health providers and the few remaining private providers. There is an oral
health crisis in Connecticut."
2005. Slate R. State must fund plan to provide oral health care for the
poor. New Haven Register. May 5.
DISTRICT OF
COLUMBIA
Fluoridated since
1952
Washington DC has "one of the highest decay rates in children in the
country." The "typical new patient, age 6, has five or six teeth with cavities
— a 'staggering" number'" at the Children's National Medical Center.
2002. Morse S. Bottled Water: Tustadd Fluoride. Washington Post. March
5.
DISTRICT OF
COLUMBIA
Fluoridated since
1952
• Low-income Children in Washington, DC are at High Risk for Poor Oral
Health and Consequently Inadequate School Readiness
• a large proportion (44 percent) of the 144 students examined had a
history of dental caries,
• Examined students are primarily from some of the most impoverished
Wards (5, 6, 7, & 8) and exhibit high caries incidence
2007. Issue Brief: Oral Health is Critical to the School Readiness of
Children in Washington, DC. By Altarum Institute.
ILLINOIS
Thousands of low-income children and adults in Illinois suffer from
untreated dental disease. They can't eat or sleep properly, do their best at
Water Fluoridation and Environmental Justice - a report submitted to the
EJ Interagency Working Group on September 25, 2015, from Fluoride Action Network
A4 p.600
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34
Fluoridation is
mandatory
98.5% of the
state's
population
receive
fluoridated water
(as of 2012)
school or work or smile and are at risk for other serious health problems...
... Illinois has among the lowest rates in the nation for government funded
dental care. As a result we face an oral health care crisis... Illinois currently
has just one clinic per 8,400 children who rely on government insurance...
2009. Support Bill HB 388 for dental care. Bv Lauri Frichtl, Executive
Director, Illinois Head Start. Pioneer Press.
INDIANA
94.8% of the
state's
population
receive
fluoridated water
(as of 2012)
Results from the 2006 BRFSS also indicated that 47 percent of Hoosiers ages
18 and older have had permanent teeth extracted—a percentage that was
significantly higher than the national median of 44 percent (see Figure 2).
Groups with the highest prevalence of tooth extractions included blacks;
individuals with an annual household income of less than $35,000; and
individuals with lower educational attainment. Prevalence of extractions
was highly associated with age - as age increased so did the percentage of
Hoosiers who reported having had any permanent teeth extracted.
... The elderly, minorities, and low income citizens often face the
unfortunate need to have some or all of their teeth extracted.
2009. Oral Health Needs in Indiana: Developing an Effective and Diverse
Workforce. Center for Health Policv. Mav.
MICHIGAN
Detroit
Fluoridated since
1967
Excerpt from abstract: To describe the epidemiology of dental caries among
low-income African American children 5 years old and younger in the City of
Detroit.
Conclusion: Dental Caries in primary teeth in children 5 years of age and
younger in Detroit is a major dental public health problem.
2006. Severity of Dental Caries Among African American Children in Detroit.
By Ismail Al, Tellez M, Sohn W. Presented at the 35th Annual Meeting &
Exhibition of the American Assoc. for Dental Research in Orlando, Florida.
March.
MICHIGAN
Detroit
Fluoridated since
1967
From abstract: The aim of this study was to examine the relationship
between dietary patterns and caries experience in a representative group of
low-income African-American adults. Participants were residents of Detroit,
Michigan, with household incomes below 250% of the federally-established
poverty level (n = 1,021)... This population had severe caries, poor oral
hygiene, and diets that are high in sugars and fats and low in fruits and
vegetables. Apart from tap water, the most frequently consumed food item
by adults of all ages was soft drinks; 19% of all energy from sugar came from
soft drinks alone.
2006: Dietarv Patterns Related to Caries in a Low-income Adult
Population. Bv Burt BA, Kolker JL, Sandretto AM, et al. Caries Research
40(6):473-80.
Water Fluoridation and Environmental Justice - a report submitted to the
EJ Interagency Working Group on September 25, 2015, from Fluoride Action Network
A4 p.601
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35
MASSACHUSETTS
70.4% of the state
residents receive
fluoridated water
Children from low-income families and children from certain racial/ethnic
groups not only have a much higher prevalence of oral disease but are also
less likely to have had their dental caries treated. (Page 4)
Significant racial, ethnic and socioeconomic disparities exist within all oral
health indicators, at each grade level, and among the state's 14 counties,
(page 5)
Kindergarten
• 39.4% of non-Hispanic Black kindergarten children have been affected by
dental caries, 1.7 times higher than non-Hispanic white kindergarten
children;
• 40.9% of Hispanic kindergarten children have been affected by dental
caries, 1.8 times higher than non-Hispanic white kindergarten children; and
• 41.5% of kindergarten children from low-income families have been
affected by dental caries, 1.9 times higher than kindergarten children from
families with higher incomes.
2008. The Oral Health of Massachusetts' Children. Bv White BA, Monopoli
MP, Souza BS. Catalyst Institute. January.
MASSACHUSETTS
70.4% of the state
residents receive
fluoridated water
..."Children are going to school with cavities, gum infections, rotting teeth. 1
don't think people know how serious a problem it is," said Ms. Cepeda, who
has served as coordinator of the volunteer committee.
The problem is one that a special state legislative commission last year
called an oral health crisis in Massachusetts: Not enough dentists are
available for people on MassHealth, the state's health plan that includes
Medicaid and the Children's Health Insurance Program...
2001. Fluoridated Water Not Preventing Rampant Decav Among
Southbridge's Poor. Telegram & Gazette (Massachusetts). October 14.
NEW
HAMPSHIRE
Concord
Fluoridated since
1978
"It's overwhelming," said Deb Bergschneider, dental clinic coordinator at
the Concord center. "Because we serve the uninsured, we see the lower
level of the community and the need is just astronomical. ... By the time
they get to us, their mouths are bombed out. They are all emergency
situations. It's a severe, severe, problem. It's sad."
2005. Gerth U. Nothing to smile about. Fosters Dailv Democrat, Mav 22.
NEW YORK
Manhattan
Fluoridated since
1965
The level of untreated decay, %d/ dft, was 91%, significantly higher than the
US national population which is 76% overall, and 76% for African Americans
and Mexican Americans within the US national population.
CONCLUSIONS: The children in this population have higher caries
prevalence and a higher level of untreated caries than the national means
as reported in NHANES III. The high level of untreated decay found in this
particularly disadvantaged community suggests that enhanced dental
services targeting the very young are needed in these communities.
Water Fluoridation and Environmental Justice - a report submitted to the
EJ Interagency Working Group on September 25, 2015, from Fluoride Action Network
A4 p.602
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2002. Dental caries among disadvantaged 3- to 4-vear old children in
northern Manhattan. Bv Albert DA, Park K, Findlev S, et al. Pediatric
Dentistry, Mav;24(3):229-33. http://fluoridealert.org/studvtracker/19188/
NEW YORK
Bronx
Fluoridated since
1965
"Bleeding gums, impacted teeth and rotting teeth are routine matters for
the children 1 have interviewed in the South Bronx. Children get used to
feeling constant pain. They go to sleep with it. They go to school with it.
Sometimes their teachers are alarmed and try to get them to a clinic. But
it's all so slow and heavily encumbered with red tape and waiting lists and
missing, lost or canceled welfare cards, that dental care is often long
delayed. Children live for months with pain that grown-ups would find
unendurable. The gradual attrition of accepted pain erodes their energy and
aspiration. 1 have seen children in New York with teeth that look like
brownish, broken sticks. 1 have also seen teen-agers who were missing half
their teeth. But, to me, most shocking is to see a child with an abscess that
has been inflamed for weeks and that he has simply lived with and accepts
as part of the routine of life. Many teachers in the urban schools have seen
this. It is almost commonplace."
1991. Kozol J. Savage Inequalities. Harper Perennial.
OHIO
Cincinnati
Fluoridated since
1969-1970
"We cannot meet the demand," says Dr. Larry Hill, Cincinnati Health
Department dental director.
"It's absolutely heartbreaking and a travesty. We have kids in this
community with severe untreated dental infections. We have kids with self-
esteem problems, and we have kids in severe pain and we have no place to
send them in Cincinnati. People would be shocked to learn how bad the
problem has become."
... An estimated 43 percent of the city's 8-year-olds living in low-income
homes have significant teeth decay. The rate of infection stood at 37
percent in 1996.
2002. Solvig E. Special Report: Cincinnati's Dental Crisis. The Enauirer
(Cincinnati, Ohio). October 6.
PENNSYLVANIA
Pittsburgh
Fluoridated since
1952
"Nearly half of children in Pittsburgh between 6 and 8 have had cavities,
according to a 2002 state Department of Health report. More than 70
percent of 15-year-olds in the city have had cavities, the highest percentage
in the state. Close to 30 percent of the city's children have untreated
cavities. That's more than double the state average of 14 percent."
2005. Law V. Sink your teeth into health care. Pittsburgh Tribune-
Review February 13.
TEXAS
San Antonio
"After 9 years and $3 million of adding fluoride, research shows tooth decay
hasn't dropped among the poorest of Bexar County's children it has only
increased—up 13 percent this year. One out of two children in the Head
Water Fluoridation and Environmental Justice - a report submitted to the
EJ Interagency Working Group on September 25, 2015, from Fluoride Action Network
A4 p.603
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37
Fluoridated since
2002
Start program who were checked for cavities had some last year."
2011. Conger J. Added to our drinking water: A chemical more toxic than
lead? KENS 5. November 11.
So despite being fluoride-overdosed, it's not working for poor families and communities of color
in the U.S. as they still suffer from higher rates of tooth decay in fluoridated communities (see
Table 3 and also FAN, 2013a). Many poor and minority communities suffer from what health
officials have called a "silent epidemic" of untreated tooth decay.
According to Kaste et al. (1996), national data indicate that 80% of tooth decay in children is
concentrated in 25% of the child population, with low-income children and racial/ethnic
minority groups having more untreated decay on average than the U.S. population as a whole.
Little has changed since 1996. According to Dye et al. (2015): "Untreated tooth decay was higher
for Hispanic (36%) and non-Hispanic black (42%) adults compared with non-Hispanic white
(22%) and non-Hispanic Asian (17%) adults aged 20-64."
This is not just the opinion of handful of dental researchers it is also the view of the number one
promoter of fluoridation in the country: the CDC's Division of Oral Health. In 2012, according to
the CDC, the total population on fluoridated drinking water systems was 210,655,401 Americans
or 67.1% of the population (CDC, 2012). Even with this astounding number, dental health
disparities continue to thrive for communities of color and society's poorest - the very groups
that fluoridation was meant to serve. In the words of the CDC (2015):
• Oral health disparities are profound in the United States. Despite major
improvements in oral health for the population as a whole, oral health disparities exist
for many racial and ethnic groups, by socioeconomic status, gender, age and geographic
location.
• Overall. Non-Hispanic blacks, Hispanics, and American Indians and Alaska Natives
generally have the poorest oral health of any racial and ethnic groups in the United
States.
• Children and Tooth Decay. The greatest racial and ethnic disparity among children
aged 2-4 years and aged 6-8 years is seen in Mexican American and black, non-Hispanic
children.
• Adults and Untreated Tooth Decay. Blacks, non-Hispanics, and Mexican Americans
aged 35-44 years experience untreated tooth decay nearly twice as much as white, non-
Hispanics.
So fluoridation is not working for poor families and communities of color in the U.S.
Why is this the case? The simple truth is that tooth decay is not caused by not enough ingested
fluoride but by poor diet and too much sugar as well as too little intervention from dental
professionals. This is what the Senate Subcommittee on Primary Health and Aging said about
Water Fluoridation and Environmental Justice - a report submitted to the
EJ Interagency Working Group on September 25, 2015, from Fluoride Action Network
A4 p.604
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38
the lack of access to dental care in 2012. Millions of Americans are "unable to get even the
basic dental care they need."(Sanders, 2012)
Poor nutrition and lack of access to professional dental care goes hand in hand with poverty.
Sadly 80% of dentists in the US will not treat children on Medicaid because the financial
returns are so low (FAN, 2013b).
Some of the children that need the most care get the least.
Fluoridation simply cannot compensate for poor diet, lack of early professional interventions
and poor practices like baby's sucking on bottles of sugared water, juice, milk and even fizzy
drinks for hours on end leading to baby bottle tooth decay (BBTD) which ravages the infant's
first teeth. Such abuse of the primary teeth cannot be prevented with fluoridation but the
prevalence can be reduced with better education.
Even though fluoridation promoters know that BBTD cannot be prevented by fluoridation - or
should know -that doesn't stop them using pictures of BBTD as a scare tactic to persuade
communities to start or to continue fluoridation. In Figure 9, a Medical Office of Health from
Canada holds up a picture of BBTD falsely implying that fluoridation will address this problem. It
won't. Such propaganda exercises are bad enough in the hands of rabid fluoridation promoters;
they are even worse when practiced by civil servants whose salaries are paid for by the
taxpayer.
Figure 9: In Canada. Medical Officer of Health Dr. Hazel Lynn holds up a picture of Baby
Bottle Tooth decay (BBTD1. Lvnn claimed in Owen Sound's Sun Times flan 31. 2014") that
water fluoridation prevents tooth decay and is a safe practice. The implication is
Water Fluoridation and Environmental Justice - a report submitted to the
EJ Interagency Working Group on September 25, 2015, from Fluoride Action Network
A4 p.605
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39
fluoridation will mitigate against BBTD. It won't! Photo: James Masters/QMI Agency
("Langlois. 20141
7. Why are African Americans more sensitive to fluoride's toxicity?
As discussed above African Americans and Hispanics have been shown to be at an increased risk
of developing dental fluorosis, and have a higher risk of suffering from the more severe forms of
this condition (Russell, 1962; Butler et al., 1985; Williams & Zwemer, 1990; Beltran-Aguilar et al.,
2005, 2010; Martinez-Mier & Soto-Rojas, 2010).
It is not yet known why blacks suffer higher rates of dental fluorosis. According to the CDC, it
may be a result of "biologic susceptibility or greater fluoride intake." (Beltran-Aguilar et al.,
2005). Whatever the explanation, it is clear that the black community is being
disproportionately harmed by current fluoride policies in the United States.
Here are a few possible explanations:
1) African Americans consume significantly more total fluids and plain water, and thus receive
more fluoride from drinking water, than white children (Sohn et al., 2009).
2) According to CDC, African Americans are less likely to breastfeed than most other racial
groups: "non-Hispanic blacks had a lower prevalence of breastfeeding initiation than non-
Hispanic whites in all but two states..."-(CDC, 2010). As human milk contains very low levels of
fluoride (Ekstrand et al., 1981, 1984; Sener et al., 2007), babies fed formula made with
fluoridated water at 0.7 -1.2 mg/L will receive 100 to 200 times more fluoride than a human-
fed baby simply through consumption of the water. If the parent reduces the amount of formula
in a fluoridated community to save money as many poor parents do (Stein 2008; Egemen et al.,
2002; Parraga et al., 1988), and adds more water than recommended, these children will receive
even higher levels of fluoride.
3) Another possible explanation was suggested by a study by Leite et al. (2011). The authors
found that rats treated with both lead and fluoride had worse dental fluorosis than rats treated
with fluoride alone. Thus it is possible that children with lead exposure will be more susceptible
to developing dental fluorosis. African-Americans in the inner-city have had more exposure to
lead than white children. In 1995 Stevens reported, "Of impoverished black children aged three
to five living in American inner cities, 90% have elevated blood-lead levels." CDC in 2003 stated,
"Of the children reported with confirmed elevated [blood lead levels] between 1997 and 2001,
approximately 17% were non-Hispanic whites, 60% were non-Hispanic blacks, 16% were
Hispanic, and 7% were of other races or ethnicities. As reported by the MMWR in 2013:
This report summarizes the results of that analysis, which indicated that the percentage
of children aged 1-5 years with BLLs at or above the upper reference interval value of 5
jUg/dL calculated using the 2007-2010 NHANES cycle was 2.6%. Thus, an estimated
535,000 U.S. children aged 1-5 years had BLLs >5 jUg/dL based on the U.S. Census
Bureau 2010 count of the number of children in this age group. (MMWR, 2013)
No federal agency has investigated or published studies on the interaction of neurotoxicants
such as lead and fluoride on children in fluoridated inner-cities or anywhere else.
Water Fluoridation and Environmental Justice - a report submitted to the
EJ Interagency Working Group on September 25, 2015, from Fluoride Action Network
A4 p.606
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4) Fluoride's toxicity is exacerbated by inadequate nutrition, including lower intakes of
iodine and calcium (see studies at FAN, 2012).
5) Certain racial groups are more likely to be lactose intolerant than others. Included among
these are Central and East Asians (80-100% lactose intolerant; de Vrese et al., 2001), Native
Americans (80-100% lactose intolerant; National Institute of Child Health and Human
Development, 2006), African Americans (75% lactose intolerant), and Southern Indians (70%
lactose intolerant; de Vrese et al., 2001). The elevated incidence of lactose intolerance may
indicate lower rates of milk consumption, and higher consumption rates of water or other
beverages, than Whites (21% lactose intolerant; Scrimshaw, 1988). Thus these groups may be
more heavily exposed to fluoride in water and other beverages than are Caucasian Americans,
and their calcium intakes may be compromised. Calcium in the diet is partially protective of
fluoride because it lowers uptake of fluoride from the gut.
8. Reckless assumptions underpin fluoridation promotion
Dental fluorosis is a clear indicator that the child has been over-exposed to fluoride before their
permanent teeth have erupted. This can be compared to the purple-blue line on the gums of
those who have been over-exposed to lead. Both markers tell a story. But not all fluoride
exposure outcomes are so easily recognizable as dental fluorosis.
One of the most reckless assumptions made by those who endorsed fluoridation in 1950 was
the notion that while fluoride was interfering with some biochemical mechanism in the growing
tooth cells causing the damage to the enamel which we call dental fluorosis, that it was not
causing damage to any other developing tissue in a baby's body.
It was also reckless to ignore the fact that nature provides only a miniscule amount of fluoride in
mothers' milk.
It was also reckless to ignore the fact that there is not one biochemical process in the body that
needs fluoride to function properly.
It is even more reckless to ignore the fact that fluoride is highly toxic to many fundamental
biological processes, see Barbier et al., 2010, The Biochemical Mechanisms of Fluoride's Toxicity.
If fluoride limits its toxic effects to the cells laying down the enamel in our teeth (Den Besten &
Li, 2011), we have been extremely lucky and undeservedly so considering the recklessness of
exposing a huge population to this toxic substance every day of their lives for a whole lifetime
with every glass of water they drink.
9. Pro-fluoridation governments have undertaken very few studies to seriously
investigate fluoride's potential to cause both short-term health effects in children or
long-term health effects in adults.
Water Fluoridation and Environmental Justice - a report submitted to the
EJ Interagency Working Group on September 25, 2015, from Fluoride Action Network
A4 p.607
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The consequences of the reckless assumptions discussed in section 8 above have been largely
hidden form the public and media because of an atrocious lack of basic research on fluoride's
health effects until fairly recent years.
Once the Public Health Service had endorsed fluoridation in 1950 the U.S. government showed
little interest in funding studies to investigate the health of fluoridated communities. The same
has been true in other (largely English speaking) fluoridated countries.
Based on what has been reported in the scientific literature one would have expected a
responsible government that has endorsed the experiment of fluoridation to have carefully
investigated a possible association of the following conditions with an increased exposure to
fluoride:
a) Arthritis rates
b) Decreased thyroid function
c) Lowered IQ in children
d) Increased ADHD rates in children.
e) Reduced time to puberty
f) Reproductive health
g) Alzheimer's disease
A responsible government would have also:
Attempted to put the anecdotal reports of people claiming to be sensitive to fluoride on
a scientific level using double-blind studies;
Further investigated Bassin et al.'s (2006) suggested age window of vulnerability to
osteosarcoma in young boys;
Attempted to reproduce Jennifer Luke's findings of fluoride's accumulation in the
human pineal gland and lowered melatonin production in fluoride-treated animals
(Luke, 1997, 2001), and
Made a comprehensive effort to monitor fluoride levels in urine, blood and bone to
establish a baseline for future research. One simple strategy would have been to have
collected the hip-bone of patients undergoing hip replacement (of which there are many
thousands each year) and monitored them for fluoride. This was done in one small
Canadian study and it was found that the levels were considerably higher in the bones
collected in fluoridated Toronto compared to unfluoridated Montreal (Chachra et al.,
2010). We need more studies like this.
Used dental fluorosis as a biomarker for exposure to probe any possible correlation with
bone fractures, osteosarcoma, age of puberty, even IQ scores.
Most of this research should have started 70 years ago before this reckless fluoridation
experiment was begun. But Instead of basic scientific research like this the public has been
treated to over 60 years of promotion, propaganda and PR. The central plank of which is the
Water Fluoridation and Environmental Justice - a report submitted to the
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foolish notion that "the absence of study is the same as the absence of harm." According to Paul
Connett, PhD, retired chemistry professor, "When policy is king, science becomes a slave."
Another way that the pro-fluoridation health establishment in the U.S. has kept western
scientists in the dark about fluoride's toxicity is the exclusion of the journal Fluoride from Pub
Med, the largest online search engine for biomedical papers and maintained by the National
Institutes of Health (NIH). Pub Med refuses to index the only scientific journal dedicated to all
aspects of fluoride research. It is published by the International Society for Fluoride Research
(ISFR) four times a year, and all issues are available online for free at
http://www.fluorideresearch.org/backissues.pdf (see section 15 below).
Despite its exclusion from PubMed many studies published in Fluoride have been widely cited by
scientists in the field — including U.S. government researchers. A review of the references in the
landmark report on the toxicology of fluoride by the National Research Council of the National
Academies in 2006 reveals an important story: the journal Fluoride had the highest number of
references -see table 4 for the top 10 journals referenced by the NRC
Table 4: The top ten journals cited in the NRC (2006) review
Name of Journal
Fluoride
Journal of Dental Research
# of Citations
56
34
Community Dentistry and Oral
Epidemiology
(31
Journal of Public Health Dentistry
31
Journal of the American Dental Association 23
Journal of Bone and Mineral Research 21
Calcified Tissue Research 19
Caries Research
18
Bone
13
Pediatric Dentistry
12
The feeble excuses offered by the NIH for keeping Fluoride out of Pub Med is that the ISFR is
anti-fluoridation (and therefore biased). But a) the ISFR has never taken a formal position
against fluoridation and b) there is far more to fluoride research than the issue of water
fluoridation so why deprive scientists access to that other research? It is true that the editors of
Fluoride over many years have been anti-fluoridation, but if that is the reason for exclusion from
Pub Med the NIH has exercised a glaring double standard here because the editors of every
major dental journal are pro-fluoridation but that hasn't kept their journals out of Pub Med.
10. Non-fluoridated countries lead research effort on fluoride's toxicity
The understanding of fluoride's dangers and the potential risks posed by water fluoridation by
independent scientists (outside government agencies) in the western world is changing because
of research efforts in countries like India, China, Iran, and Mexico. These countries have high
natural levels of fluoride in regions of their countries and are genuinely interested in finding out
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what level of fluoride in water is safe to drink. Moreover, they do not have a fluoridation
program to protect and their researchers are not worried about offending those who promote
this practice. (There are also areas in the U.S. where drinking water contains high fluoride levels
(FAN, 2007).
A great deal of this research effort was revealed to the Western world by the landmark review
of fluoride's toxicity by the U.S. National Research Council of the National Academies report in
2006.
11. National Research Council of the National Academies review of 2006
It is hard to overstate the significance of this review titled, Fluoride in Drinking Water: A
Scientific Review of EPA's Standards (NRC, 2006).
First and foremost the panel put together by the NRC was truly balanced which was most
unusual for official reviews of fluoride's toxicity. In the 12-membered panel three were known
to be pro-fluoridation, three anti-fluoridation and six undeclared.
Second, the panel was expected to take about one year to complete their review but they ended
up spending three and half years on this task.
Third, the panel did not limit themselves to human epidemiological studies, they looked at
animal studies, biochemical studies, clinical trials, case studies, epidemiological studies and even
theoretical modeling in the case of fluoride's impact on the bone.
In short, they looked at everything that pertained to understanding fluoride's toxicity. Nor did
they shun the use of the huge database provided by the journal Fluoride, which has published
research papers on fluoride since 1968.
As a result the NRC's final report, which is 507 pages long, with over 1100 references, is a
veritable textbook on the toxicology on fluoride. What they did not do was to review the
practice or the purported benefits of water fluoridation, which they were asked not to do by the
EPA. They described their mission as follows,
The committee was charged to review toxicologic, epidemiologic, and clinical data on
fluoride—particularly data published since the NRC's previous (1993) report—and
exposure data on orally ingested fluoride from drinking water and other sources.
On the basis of its review, the committee was asked to evaluate independently the
scientific basis of EPA's MCLG of 4 mg/L and SMCL (secondary maximum contaminant
level—a concentration intended to avoid cosmetic damage) of 2 mg/L in drinking water,
and the adequacy of those guidelines to protect children and others from adverse
health effects. The committee was asked to consider the relative contribution of various
fluoride sources (e.g., drinking water, food, dental-hygiene products) to total exposure.
The committee was also asked to identify data gaps and to make recommendations for
future research relevant to setting the MCLG and SMCL for fluoride. Addressing
questions of artificial fluoridation, economics, risk-benefit assessment, and water-
treatment technology was not part of the committee's charge [emphasis added] (see
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also Donahue, 2003).
The enormous breadth covered by this panel is revealed by the chapter titles:
1. Introduction
2. Measures of Exposures to Fluoride in the United States
3.Pharmakinetics of Fluoride
4. Effects of Fluoride on Teeth
5. Musculoskeletal effects
6. Reproductive and Development Effects of Fluoride
7. Neurotoxicity and Neurobehavioral Effects
8. Effects on the Endocrine System
9. Effects of the Gastrointestinal, Renal, Hepatic and Immune Systems
10. Genotoxicity and Carcinogenicity
11. Drinking Water Standards for Fluoride
This important publication can be searched online without charge at
http://www.nap.edu/catalog/11571/fluoride-in-drinking-water-a-scientific-review-of-
epas-standards
Based on this massive review the NRC panel concluded that the current MCLG (the maximum
contaminant level goal) and MCL (maximum contaminant level) for fluoride (4 ppm) was not
protective of health and recommended that the EPA's Office of Water (that commissioned the
review) conduct a new risk assessment for fluoride to determine a new (and safer) MCLG.
The MCLG is supposed to be the safe level based upon the best science available on harmful
effects with the application of appropriate safety factors to protect everyone including
vulnerable subsets of the population from "known and reasonably anticipated" harm. The MCLG
is an ideal goal. Once the MCLG has been identified the MCL (a federally enforceable standard)
is determined and takes into account the economic costs of reaching this standard in a situation
where there are high natural levels in the water, either naturally or from industrial pollution.
The NRC recommendation was made in March 2006, but as of September 2015 the
determination of the MCLG (and hence the MCL) has still has not been completed by the EPA
Office of Water (OW) and the U.S. continues to operate with an unsafe standard nearly three
times higher than the WHO recommended safe level of 1.5 ppm, which has been adopted by
nearly every other country in the world.
While not discounting any of the other health concerns revealed in the eleven chapters of the
report, the authors singled out three clinical conditions that they believed triggered the need for
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a new health risk assessment:
1. Clinical stage II skeletal fluorosis: "The committee judges that stage II is also an adverse health
effect, as it is associated with chronic joint pain, arthritic symptoms, slight calcification
of ligaments, and osteosclerosis of cancellous [porous] bones."
2. Bone fractures: "The majority of the committee concluded that the MCLG is not likely to be
protective against bone fractures."
3. Severe dental fluorosis: "After reviewing the collective evidence, including studies conducted
since the early 1990s, the committee concluded unanimously that the present MCLG of
4 mg/L for fluoride should be lowered. Exposure at the MCLG clearly puts children at
risk of developing severe enamel fluorosis."
In addition to these end points the NRC panel pointed to many gaps in the literature and
recommended numerous research questions that needed to be addressed. An independent
observer should wonder why after over 60 years of fluoridation (as of 2006) there should be so
many gaps in the literature. We have attempted to answer that question in section 9 above. This
is what the chairman of the NRC panel had to say about this in a Scientific American article in
January 2008:
"What the committee found is that we've gone with the status quo regarding fluoride
for many years—for too long really—and now we need to take a fresh look ... In the
scientific community people tend to think this is settled. I mean, when the U.S. surgeon
general comes out and says this is one of the top 10 greatest achievements of the 20th
century, that's a hard hurdle to get over. But when we looked at the studies that have
been done, we found that many of these questions are unsettled and we have much
less information than we should, considering how long this (fluoridation) has been going
on." (Fagin, 2008)
On the day that the NRC (2006) was published the American Dental Association (ADA) rushed in
to deny its relevance to fluoridation and six days later the CDC's Division of Oral Health did the
same. This was an extraordinary position to take because in chapter 2 the NRC panel provided
an exposure analysis, which clearly demonstrates that certain subsets of the population are
exceeding the EPA's safe reference dose for fluoride (0.06 mg/kg/day) drinking fluoridated
water. These subsets included high water drinkers, people with poor kidney function, people
with borderline iodine deficiency and bottle-fed babies. The latter case is illustrated by figure
2.8 that appears on page 85 of the report.
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0.09
0.08
0.07
u.
1 0.06
-X
%
E
I 0.05
£
0.04
0.03
0.02
FIGURE 2-8 Estimated average intake of fluoride from all sources, at 1 mg/L
in drinking water (based on Table 2-1 1). Horizontal lines indicate an intake
of 0.05-0.07 mg/kg/day.
Figure 10: Copy of Figure 2-8 in NRC (2006), p.85.
More studies since 2006
Because of the huge delay in the EPA Office of Water completing the recommended risk
assessment - its now been 9 years - more studies have been published since 2006, which further
underline the need and urgency for a new more protective MCLG. These include many more
studies on neurotoxicity, a key study on thyroid function, another on ADHD and an important
study on osteosarcoma. Had these been available at the time of the NRC review it is more than
likely that these would have been added to the list of endpoints cited above by the panel that
should be considered in a new risk assessment.
The EPA's Office of Water in 2011 claimed that the end point of severe dental fluorosis will also
protect against arthritic symptoms, bone fractures and harm to any other tissue.
Here we will start with some of the findings in the NRC review and update them with more
recent studies.
t
Average fluoride intake
from all sources
(1 mg/L in drinking water)
*5cym + 2
s'isaE£~a
f S 1 2 | | | I
- 0 0**3
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12. NRC and Endocrine Disruption
The NRC panel labeled fluoride an endocrine disruptor. The authors state:
"The chief endocrine effects of fluoride exposures in experimental animals and in
humans include decreased thyroid function, increased calcitonin activity, increased
parathyroid hormone activity, secondary hyperparathyroidism, impaired glucose
intolerance, and possible effects on the timing of sexual maturity. Some of these effects
are associated with fluoride intake that is achievable at fluoride concentrations in
drinking water of 4 mg/L or less, especially for young children or for individuals with
high water intake, (p. 8, NRC 2006)
"In summary, evidence of several types indicates that fluoride affects normal endocrine
function or response; the effects of the fluoride-induced changes vary in degree and
kind in different individuals. Fluoride is therefore an endocrine disruptor in the broad
sense of altering normal endocrine function or response, although probably not in the
sense of mimicking a normal hormone." (p. 266, NRC 2006)
The 2006 NRC report notes that six prior major reviews (1991, 1993, 1999, 2000, 2002, 2003) of
the health effects of fluoride did not consider the endocrine system in detail apart from the
reproductive system.
13. NRC on Thyroid Function
On thyroid function, the NRC panel reported: "Fluoride exposure in humans is associated with
elevated TSH concentrations, increased goiter prevalence, and altered T4 and T3
concentrations; similar effects in T4 and T3 are reported in experimental animals, but TSH has
not been measured in most studies." (p. 262)
The panel also indicated that affects on the thyroid have been observed at very low levels. They
state that, "In humans, effects on thyroid function were associated with fluoride exposures of
0.05-0.13 mg/kg/day when iodine intake was adequate and 0.01-0.03 mg/kg/day when iodine
intake was inadequate (Table 8-2)." (p. 263, NRC 2006).
To reach these dosages (which depend on bodyweight) it takes remarkably little fluoride. For
those with borderline iodine deficiency it would only take the consumption of 0.1 to 0.3 mg of
fluoride per day for a 10 kg infant and 0.7 to 2.1 mg/day for a 70 kg adult. These are easily
exceeded in a fluoridated community. For someone whose iodine levels are adequate for a 10
kg infant it would take between 0.5 and 1.3 mg /day and for a 70 kg adult it would take 3.5 mg
to 9.1 mg/day. The lower end of these ranges would be reached by some people in a fluoridated
community.
These statements have been recently buttressed by new research conducted in the UK and
published in 2015.
14. Hypothyroid and fluoride study from UK
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This study by Peckham et al., 2015 used the records of over 98% of the General practices in
England on the numbers of patients treated for hypothyroidism and examined the prevalence of
this condition as a function of the fluoride levels in the local drinking water supplies. The authors
noted that:
"Approximately, six million people (10%) in England live in areas where drinking water
contains natural fluoride or which has been artificially fluoridated at a target
concentration of 1 ppm (1 mg/L). Using prevalence data from the UK QOF, an analysis
was undertaken to determine whether prevalence was affected by practice populations
being situated in fluoridated areas at >0.7 mg/L and areas with lower levels of fluoride.
While there are other sources of fluoride in people's diet (e.g., tea), drinking water is the
most significant source of ingested fluorides in the UK." (Peckham et al, 2015)
The UK research team found that higher levels of fluoride in drinking water was a useful
predictor of the prevalence of hypothyroidism. They found that general medical practices
located in the West Midlands (a wholly fluoridated area) are nearly twice as likely to report high
hypothyroidism prevalence in comparison to Greater Manchester (non-fluoridated area).
(Peckham et al, 2015)
They concluded:
"In many areas of the world, hypothyroidism is a major health concern and in addition
to other factors—such as iodine deficiency— fluoride exposure should be considered as
a contributing factor. The findings of the study raise particular concerns about the
validity of community fluoridation as a safe public health measure." (Peckham et al,
2015)
It is hard to overstate the significance of these findings.
First, Peckham's findings are not totally unexpected. Scientific and medical research stretching
back to the 1920s has shown that fluoride can affect the thyroid. In fact from the 1930s to the
1950s doctors in Argentina, France and Germany used fluoride to lower thyroid function in
hyperactive thyroid patients. The levels of fluoride used overlap with the levels of exposure
known to occur in some people drinking artificially fluoridated water today (Galletti & Joyet,
1958).
Second, hypothyroidism is a very common disorder in the US. In fact, one of the most
prescribed drugs in the USA is synthroid, which is used to treat hypothyroidism. It can have
serious adverse health effects. For a further discussion of the extent and concern about
hypothyroidism in the USA see Appendix B.
Third, race may be a factor in sensitivity to certain thyroid diseases, which may make
communities of color more vulnerable to fluoride's impacts on thyroid function (see Appendix
C).
Fourth, reduced thyroid function in pregnant women is linked to reduced IQ in their children
and there is accumulating evidence that fluoride, at levels within the range to which fluoridated
populations are exposed, is associated with lowered IQ. Fluoride's effect on thyroid function
Water Fluoridation and Environmental Justice - a report submitted to the
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might be the mechanism by which it lowers IQ.
15. Fluoride and brain function
Whether or not the mechanism for fluoride's ability to lower IQ is caused by fluoride's
interference with thyroid function in pregnant women or not, there is a huge body of evidence
from animal, fetal and human studies that fluoride is a potent developmental neurotoxin (see
http://fluoridealert.org/issues/health/brain/). The NRC examined some of that evidence in
2006 but much more has been published (or translated) since then. For example, in 2006 the
NRC panel reviewed 5 IQ studies, there have been - as of Sept 2015 - 45 studies (out of 52
studies) that have found an association between lowered IQ and exposure to fairly modest
levels of fluoride.
27 of these IQ studies were subjected to a meta-analysis by a team from Harvard University,
which included Philippe Grandjean (Choi et al., 2012). While they noted that many of the studies
had weaknesses (particularly control of a number of conflicting variables) they also noted that
the results were remarkably consistent considering the investigations had been conducted in
different countries (China and Iran) in widely different geographical areas, at different times and
by different research teams. 26 out of the 27 studies found a lowered IQ in the "high-fluoride"
village compared with the low-fluoride village. The average lowering was 7 IQ points. Such a
downward shift in a large population would have huge ramifications. It would halve the number
of geniuses and double the number of mentally handicapped. This in turn would have enormous
social and economic consequences.
In a press release from Harvard University that accompanied the Choi et al., 2012 meta-analysis,
co-author Philippe Grandjean was quoted as saying that, "Fluoride seems to fit in with lead,
mercury, and other poisons that cause chemical brain drain."
When one considers the pains that our society has taken to either eliminate or drastically
reduce the use of lead and mercury (e.g. banning lead in paint, solder, and gasoline and the
phasing out the use of mercury in industrial switches, thermometers and other medical
equipment, as a fungicide in paint, use in alkaline batteries, limiting emissions from coal-fired
power stations and incinerators, fish advisories and in some countries the use in dental fillings)
all in the name of protecting children and pregnant women from known neurotoxins, it is
absolutely bizarre that we should continue to knowingly add this neurotoxin (i.e. fluoride) every
day to the drinking water of over 200 million people.
In a radio debate with Dr. Howard Pollick, a well-known promoter of fluoridation, Grandjean
was more succinct when he said:
"Because I've worked in this field long enough to know that with time, we have always
found that lead, mercury and pesticides were more toxic than we originally thought. I
am not willing to sit here and say, OK, let's expose the next generation's brains and just
hope for the best." (WBUR, 2015)
Fluoridation promoters have done their best to dismiss the Choi et al. 2012 findings claiming
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that the fluoride concentrations in the High-Fluoride villages made the findings irrelevant to
artificial water fluoridation programs. It is true that in two of the studies the fluoride
concentrations ranged as high as 11 and 11.5 ppm, but this was the exception not the rule.
Table 5 gives the fluoride concentrations in the 20 studies where the fluoride exposure was from
water not coal and for which the concentrations was given.
Table 5: A listing of the Fluoride concentrations in the "high-fluoride" villages in 20 of the 27
studies subjected to a meta-analysis by Choi et al., 2012. The data was compiled by Paul
Connett from Table 1 in the Choi paper.
Awfeorfyear npm ir, Hi«h F Ullage
Chen 199!
4,55
Lii: iw
0 SH
An 1992
2 . tmcan
Xu 1 ¦
; .X
Yaw 1994
2.97
Li 1995
1.11 - 2.69 (mean - 2.25)
Yso 1996
2 1; imcan 51
Zhao 19%
J, :2
Yao iff?
7
Lu2000
3.i5
Hang 2001
2.90
Wang 2(
Xiang 2003
0.5? -S.5 (mean 2,5-* i
Semi 200t,
2.5
Wang 2006
' • 5.88 i : ,52
Fan 2007
XX'm2007
.3,;:.5 ! mean 7.651
Li 2010
2 J "J • 0.75 | , 72 V22 !
I'ouicsliitr... 201 I
2.3*
.. -L is.fj . mean 4
Mean oi'20 results fusing means) 20" 3.52
Taken from Choi c; a*„ 2012 Tabic I. pr <2* 2t\
From Table 5 it can be seen that many of the studies had fluoride concentrations less than 3
ppm and that the mean for all the studies combined was 3.52 ppm, which is lower than the
current safe drinking water standard in the USA (4 ppm). Such levels offer no adequate margin
of safety to protect all children in a large population drinking fluoridated water (and getting
fluoride from other sources) sufficient to protect against this serious harmful effect.
Such a conclusion becomes even more obvious when we look at the details of one particularly
well-conducted study (Xiang et al. 2003a,b.).
Xiang controlled for iodine intake (Xiang et al, 2003a) and lead exposure (Xiang 2003,b) and
retrospectively for arsenic. The average level of fluoride in the well water for the Low-fluoride
village was 0.36 ppm (range 0.18 -0.76 ppm) and the average level in the High Fluoride was 2.5
Water Fluoridation and Environmental Justice - a report submitted to the
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51
ppm (range 0.57- 4.5 ppm). The average drop in IQ was 5-10 IQ points across the whole age
range. Xiang et al also sub-divided the High- Fluoride village into 5 sub-groups (A,B,C,D and E)
with mean fluoride concentrations of 0.75, 1.53, 2.46, 3.28 and 4.16 ppm. As can be seen from
his Table 8 (reproduced below as our Table 6) as the fluoride concentration increases in these 5
sub-groups the mean IQ decreases in an apparent linear fashion (see the results plotted
graphically in Figure 11.
Table 6: A reproduction of Table 8 in Xiang et al., 2003a
Level oi" wivivjl i «i « '-** H »*• i > J\.« f stawl Mi %jr» iil v** HQs
IQ and rale of retardation
Village
. .......
Group
No.
"wSlir f Jiii'
No
IQ
Rate of
samples
(MeantSD)
ciiiiareii
(Mean±SD)
IQ<«i (%)
Xinhtttii
F
290
0.36±0.15
290
100.41±13.21
§55
Wamiao
A
9
0.75±0-14
9
99.56114.13
000
B
42
1.53+0.27
42
U.V.?it12 22'
9.52
C
111
2.4610.30
111
92.19112.9#
14 41 *
D
52
3.28+0.25
52
8i.88±11.i8f
21 15*
E
8
4 18+0 22
8
78.3S±12..i8f
37.50*
7>;0 05 Tp « 00! compared with group F
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IQ vs Water F
(for "high F" village Waimao, grouped by water F category)
105
100
95
01
E 90
8S
80
75
0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 4.5
Water F, mean (mg/L)
Figure 11: A plot of the mean IQ versus the mean IQ in the 5 sub-groups (A- E) in the high
fluoride village, data taken from Table B in Xiang et a I, 2003a.
From this plot one can see that IQ was lowered at a concentration somewhere between 0.75
and 1.5 ppm. This overlaps the range at which communities are fluoridated in the U.S. (0.7 to
1.2 ppm). This finding offers NO margin of safety to protect all children drinking fluoridated
water from this serious end point. To make matters worse still according to the authors the
children in these rural Chinese villages are unlikely to be using fluoridated toothpaste nor are
they likely to be bottle-fed. Thus if we take into account these two sources many American
children will be getting more fluoride from all sources combined than these Chinese children
whose IQwas lowered.
Xiang also found that as the fluoride concentration went up in the 5 sub-groups the percentage
of children with an IQ less than 80 (note that an IQ 70 -80 is borderline mentally handicapped
and below 70 is outright mentally handicapped) increases dramatically from 0% (at 0.75 ppm) to
37.5% at 4.16 ppm (see Xiang's Table 8 reproduced above in Table 6 ).
By sub-dividing the children in the high-fluoride village Xiang eliminated any confounding factors
that may have existed between the low and high-fluoride villages.
y = .
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Other studies demonstrating fluoride's neurotoxicity
The evidence that fluoride is neurotoxic does not rest entirely on the 45 !Q studies. These
findings are consistent with many animal studies that show that fluoride can enter the brain and
alter brain chemistry in several ways. Of particular relevance are the 31 (out of 33) studies that
show that when animals are placed in mazes they learn and memorize simple tasks less well
when exposed to fluoride (see http://fluoridealert.org/issues/health/brain/ ).
There are also other human studies that have been conducted on very young children (too
young to undertake IQtests). One of these techniques tests the child's ability to copy and
reproduce from memory drawings with a multiple of simple features. These have also shown
that child's cognitive function is impaired by fluoride exposure. One example of this was a well-
designed study from Mexico by Rocha Amador et al. (2009). They used the Rey-Osterrieth
Complex Test (see Figure 12 below). They found that approximately 9 out of 10 children
exposed to fluoride were unable to copy the ROCF as expected for their age. For Immediate
Recall, almost 6 out of 10 children were unable to draw the figure as expected for their age.
Figure 12: The Rey-Osterrieth Complex Figure Test used in the Rocha Amador et al. (2009)
study.
There have also been four studies of aborted fetuses form China, which show that those from
endemic fluorosis areas have impaired brain structures compared to non-fluorosis areas (Yu,
1996; Dong, 1989; Du, 1992; He, 1989J.
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The last children that need their IQ lowered in the US are children from low-income and
minority families
16. Fluoridation and ADHD.
Attention Deficit Hyperactivity Disorder (ADHD) has become one of the most commonly
diagnosed childhood behavioral disorders. Its basic characteristics are inattention, hyperactivity
and impulsivity. "ADHD often continues into adolescence and adulthood, which can lead to
medication dependency and a lifetime of treatment (Maddox, 2003)."
In early 2015 a study was published that examined the relationship between exposure to
fluoridated water and ADHD prevalence among children and adolescents, ages 4-17, in the
United States. The authors found that, "[s]tate prevalence of artificial water fluoridation in 1992
significantly positively predicted state prevalence of ADHD in 2003, 2007 and 2011, even after
controlling for socioeconomic status. A multivariate regression analysis showed that after
socioeconomic status was controlled each 1% increase in artificial fluoridation prevalence in
1992 was associated with approximately 67,000 to 131,000 additional ADHD diagnoses from
2003 to 2011. Overall state water fluoridation prevalence (not distinguishing between
fluoridation types) was also significantly positively correlated with state prevalence of ADHD for
all but one year examined." (Malin & Till, 2015). See figure 13 below
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Figure 13: Percent of children with ADHD (by U.S. state) for 2003, 2007 and 2011 plotted
against the % of population in each state fluoridated in 1992 (Malin & Till, 2015)
17. African Americans suffer greater exposure to other neurotoxins (lead and mercury)
LEAD
Lead exposure and lead poisoning have been concerns for decades in African American
communities. The Huffington Post cites a CDC report that says that lead poisoning is a disease
that primarily impacts African-Americans. According to the CDC (Jones et al.), children of color
whose families are poor and who live in housing built before 1950 have the highest lead
poisoning risk:
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On average, between 1999 and 2004, black children were 1.6 times more likely to test
positive for lead in their blood than white children. And among children who tested
positive for extremely high lead levels (>10 micrograms per deciliter), the disparity was
even more stark. Black children were nearly three times more likely than white children
to have highly elevated blood-lead levels, the type of lead poisoning where the most
damaging health outcomes occur. (Jones et al., 2009).
Combined Lead and fluoride exposure
As far we know, no federal agency has published anything on the synergistic effects of exposure
to fluoride and lead. The Agency for Toxic Substances and Disease Registry (ATSDR, 2004)
produced an "interaction profile" to exposures of the mixture containing uranium, fluoride,
cyanide and nitrate. However, no information was available on any interaction.
There are some experiments that have exposed animals to a combination of lead and fluoride.
These have reported the following:
• • Liu et al. (2008) reported that co-exposing rat pups to lead and fluoride resulted in
"alterations in testis morphology and sperm quality, including low viability and high abnormality,
thereby suggesting that disturbance of energy metabolism may be one of the mechanisms by
which F or Pb affects the male reproductive system."
• •In the animal study cited above by Leite et al. (2011), rats treated with both lead and fluoride
had worse dental fluorosis than rats treated with fluoride alone.
• • Niu et al. (2009) rat study: "Results showed that the learning abilities and hippocampus
glutamate levels were significantly decreased by F and Pb individually and the combined
interaction of F and Pb. The activities of AST and ALT (markers of lead toxicity) in treatment
groups were significantly inhibited, while the activities of GAD were increased, especially in rats
exposed to both F and Pb together. These findings suggested that alteration of hippocampus
glutamate by F and/or Pb may in part reduce learning ability in rats."
• • Niu et al. (2008) study with adult rats: "From results of the Y-maze test, we can see a
significant decrease in learning ability of animals in the HiF+HiPb (High fluoride with high lead)
group."
• • Panov et al. (2015) reported the following from a study where rats were exposed to both
fluoride and lead:
* Comparison of the values obtained for the groups of separate and combined exposure
shows that, for the majority of the toxicodynamic indices, the combined effect is more
marked than the effect of fluoride alone or lead alone.
* With a combined exposure of lead and fluoride (but not alone) significant reduction in
the thyrotropin level was observed. Thyrotropin is a hormone secreted by the pituitary
gland that regulates the production of thyroid hormones.
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* Neither fluoride nor lead produced a reduction in triiodothyronine level, but it was
reduced under the combined effect (i.e. overt synergism took place). On the contrary, at
exposure to lead alone or in combination with fluoride the level of thyroxine was raised.
In addition to the interaction between lead and fluoride is the additional problem that the
chemicals used to fluoridate water appear to interact with chloramine (a common disinfection
agent) to increase the dissolution of lead from brass fittings (see Appendix D).
MERCURY
According to Kaste et al. (1996), national data indicate that 80% of tooth decay in children is
concentrated in 25% of the child population, with low-income children and racial/ethnic
minority groups having more untreated decay on average than the U.S. population as a whole.
This means that they also have greater exposure to mercury via mercury amalgam fillings.
According to the Food & Drug Administration,
Dental amalgam is a mixture of metals, consisting of liquid (elemental) mercury and a
powdered alloy composed of silver, tin, and copper. Approximately 50% of dental
amalgam is elemental mercury by weight. The chemical properties of elemental
mercury allow it to react with and bind together the silver/copper/tin alloy particles to
form an amalgam.
Dental amalgam fillings are also known as "silver fillings" because of their silver-like
appearance. Despite the name, "silver fillings" do contain elemental mercury (FDA,
2015).
According to Counter & Buchanan (2011), "Children are particularly vulnerable to Hg
intoxication, which may lead to impairment of the developing central nervous system, as well as
pulmonary and nephrotic damage..." Exposures from dental amalgams "release Hg vapors, and
Hg2+ in tissues... [and] fetal/neonatal Hg exposure from maternal dental amalgam fillings." The
authors state:
It has been known for sometime that dental amalgam is a major source of Hg°
(elementary mercury) exposure in humans because Hg is the principal metal in most
dental fillings (approximately 50% Hg by weight) (Nadarajah et al., 1996). The health
effects of dental amalgam Hg have been a subject of considerable debate for years, with
no scientific consensus on an association between amalgam Hg exposure and adverse
health consequences, either in adults or children (Clarkson, 2002; Ratcliffe et al., 1996).
However, questions have been raised regarding a possible association between
maternal Hg dental fillings and the health of the developing fetus, neonate, and infant.
Significant levels of Hg have been measured in oral vapor, blood, and in organs of
animals and humans with Hg containing dental amalgam restorations (Abraham et
al., 1984; Snapp et al., 1989; Vimy et al., 1990, 1997). In the oral cavity, HgO vapor is
rapidly oxidized to inorganic divalent Hg (Hg2+) in vivo after release from dental
amalgam and absorbed through inhalation.
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18. Association of pre-term births in upstate New York with community water
fluoridation
According to the CDC:
In 2012, preterm birth affected more than 450,000 babies—that's 1 of every 9 infants
born in the United States. Preterm birth is the birth of an infant before 37 weeks of
pregnancy. Preterm-related causes of death together accounted for 35% of all infant
deaths in 2010, more than any other single cause. Preterm birth is also a leading cause
of long-term neurological disabilities in children. Preterm birth costs the U.S. health care
system more than $26 billion in 2005.
http://www.cdc.gov/reproductivehealth/MaternalInfantHealth/PretermBirth.htm
In November 2009, Hart et al. presented an abstract at the American Public Health Association
on the "Relationship between municipal water fluoridation and preterm birth in Upstate
New York." In part, the authors stated:
"The annual incidence of preterm birth (PTB) (<37 weeks gestation) in the United States
is approximately 10% and is associated with considerable morbidity and mortality.
Current literature suggests an association between periodontal disease and PTB.
Domestic water fluoridation is thought to have lessened the burden of dental disease.
Theoretically, one would expect water fluoridation to be protective against PTB. The aim
of our study was to examine the relationship between municipal water fluoridation and
PTB.
Domestic water fluoridation was associated with an increased risk of PTB (9545
(6.34%) PTB among women exposed to domestic water fluoridation versus 25278
(5.52%) PTB among those unexposed, p < 0.0001)). This relationship was most
pronounced among women in the lowest SES groups (>10% poverty) and those of non-
white racial origin. Domestic water fluoridation was independently associated with an
increased risk of PTB in logistic regression, after controlling for age, race/ethnicity,
neighborhood poverty level, hypertension, and diabetes (Hart et al., 2009).
In 2013, the Henry J. Kaiser Family Foundation reported that non-Hispanic blacks had the
highest rate for "Preterm Births as a Percent of All Births by Race/Ethnicity."
16.3% - Non-Hispanic Black
11.3% - Hispanic
10.2% - Non-Hispanic White
http://kff.org/other/state-indicator/preterm-births-bv-raceethnicitv/
19. State Oral Health Reports have provided little or no information on dental
fluorosis and no warnings to communities of color on their extra vulnerabilities
While the federal government has been grossly negligent about warning communities of color
about their findings that they are more vulnerable to dental fluorosis, at least they have
provided important dental fluorosis data on the national level which allows interested parties to
find out what is going on if they had the time and inclination to do so (Beltran-Aguilar, 2005,
2010).
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However, this has not happened to any significant extent at the state level. Most of the state
reports on oral health (many funded by the CDC's Division of Oral Health) have provided no
dental fluorosis rates and no racial breakdowns to the public. As a result practically no warnings
have emerged at the state level. In Appendix E we have presented what we were able to find on
these matters from reviewing 119 state reports published between 2000 and 2015. Incredibly,
109 of these reports contained not one mention of dental (or enamel) fluorosis. Of the
remaining 10 reports only two presented statistics on dental fluorosis. Two reports gave
statistics for "white spot lesions" in Head Start children. While no definition of "white spot
lesion" was given in the reports, it could include fluorosis as it is seen in the primary teeth
(Warren et al., 1999; Hong et al 2006a) but most frequently observed in the secondary teeth.
• The 2011 Washington state report gives the rate for White Spot Lesions in Head
Start/ECEAP Preschoolers at 20.5%, with African American children having the highest
percent.
• The 2007 Georgia report notes: "20% of 2 to 5 year old Georgia Head Start children
surveyed have white spot lesions."
A small non-profit called the Fluoride Action Network, not paid for, or funded by, any federal or
state agency working on infant health, childhood health, or oral health, succeeded in getting
New Hampshire to become the first state to require notification that infants under 6-months of
age should not be routinely fed infant formula mixed with fluoridated water. The law passed in
August 4, 2012, against the opposition of nearly every health and oral-health group in the state
(see list below), is a proactive approach to reduce fluorosis rates by notifying parents about the
risk posed to their infants by fluoridated water so they can take action to prevent a further
increase in overexposure to fluoride.
It was passed by the New Hampshire House, 253-23, unanimously by the Senate, and signed by
the Governor, the legislation (HB-1416) read:
"If a public water supply is fluoridated, the following notice shall be posted in the water
system's consumer confidence report: 'Your public water supply is fluoridated. According
to the Centers for Disease Control and Prevention, if your child under the age of 6
months is exclusively consuming infant formula reconstituted with fluoridated water,
there may be an increased chance of dental fluorosis. Consult your child's health care
provider for more information.'"
The law requires the above notice on all annual water consumer confidence reports in
fluoridated communities, which must be mailed to all water consumers, be posted on water
department websites, and available at city halls.
The legislation was initially introduced in 2011, but was killed in the House Health and Human
Services committee, which at the time was chaired by a retired dentist and proponent of
fluoridation. In 2012 the bill was sent to a different committee, the House Municipal and Public
Works committee, where it was approved by a 13-2 vote despite the same opposition it had
met a year earlier by more than a dozen groups, including the
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New Hampshire Dental Association
New Hampshire Oral Health Coalition
Delta Dental
American Water Works Association
Municipal Association
Oral Health Advocacy Taskforce
Dental Hygienists' Association
Partners for a Healthier Community
Health Law Advocates
PEW Charitable Trusts
Granite State Children's Alliance (PEW Grantee)
New Hampshire Department of Health and Human Services
The simplest explanation for this negligence is that those who specialize in oral health are far
more interested in promoting water fluoridation, than revealing its downside. However,
whatever the explanation, minority communities have every reason to feel let down by those
who are paid to protect their health.
In Appendix F we also examine the oral health reports prepared by private entities like the Pew
Foundation. Again we find little or no discussion of dental fluorosis or the different prevalence
for different races. Clearly their interest is in promoting fluoridation with little desire in
undermining their message that fluoridation is "safe and effective" and certainly no desire to
draw attention to the disproportionate harm this practice is causing poor and minority
communities.
20. Civil Rights Leaders mobilize to fight fluoridation because of the increased risks to
minority communities.
Beginning in March 2011 Civil Rights leaders began to speak out publicly about the lack of
warning from the CDC and other health agencies about the higher rates of dental fluorosis and
extra vulnerability of minority communities to fluoride's toxic effects. Below we provide
excerpts of the statements from prominent leaders on this issue. Links to the full text of each
statement listed below is in Appendix G.
We present them in chronological order starting with Rev. Durley's letter of March 9, 2011,
presented in full.
1) March 9, 2011. Letter from Dr. Gerald L. Durley, Pastor, Providence Baptist Church, to Senator
Chip Rogers, Senate Majority Leader, Georgia State Capital, Atlanta. Re: Repeal of Georgia's
Mandatory Fluoridation Law.
Dear Senator Rogers,
As a citizen, a minister, and a community leader, I am writing to state my opposition to
the practice of water fluoridation, and to ask that the current Georgia law mandating
water fluoridation throughout our state be repealed.
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First and foremost, water fluoridation takes away people's choice. We have a God-given
right to not have fluoride forced into our bodies or the bodies of our children.
Fluoridation supporters attempt to say that people are not forced to drink fluoridated
water, but that is a disingenuous statement that ignores reality. Many families do not
have funds to buy an expensive home water fluoride removal system, or to buy
unfluoridated bottled water for making their babies' milk formula, so in truth they are
forced to drink fluoride in their water simply because of their economic status or
household income.
Second, fluoridation disproportionately harms members of the black community. The
Centers for Disease Control's own information acknowledges that blacks have
significantly more "dental fluorosis" teeth staining than whites. For many, the stains are
not simply "barely visible" or "faint" in color, or "just a cosmetic issue" as fluoridation
promoters call it. Common sense tells us that if fluorides affect the teeth, which are the
hardest surfaces of the body to cause permanent staining, certainly other soft tissue
organs in the body are affected. Also, the National Research Council of the National
Academy of Science, has designated kidney patients, diabetics, seniors, and babies as
"susceptible subpopulations" that are especially vulnerable to harm from ingested
fluorides. Black citizens are disproportionately affected by kidney disease and diabetes,
and are therefore more impacted by fluorides.
Third, we cannot control the dose of fluoride people ingest if we put fluoride in drinking
water. Layered on top of this, we do not know what each person's medical history or
nutritional status is. Therefore, the "one size fits all" approach to fluoridation makes no
sense at all.
We need to focus on helping people get access to dentists. Lack of fluoride does not
cause cavities. Too many sugars on the teeth, lack of access to dental care, and lack of
dental health education -these cause cavities.
We also need to know why the full story about harm from fluorides is only just now
coming out. I support the holding of Fluoridegate hearings at the state and national
level so we can learn why we haven't been openly told that fluorides build up in the
body over time, why are government agencies haven't told the black community openly
that fluorides disproportionately harm black Americans, and why we've been told that
decades of extensive research show fluoridation to be safe, when the National Research
Council in 2006 listed volumes of basic research that has never been done. This is a
serious issue for all Americans, of every race and in every location.
2) March 29, 2011. Letter from Ambassador Andrew Young to Chip Rogers, Senate Majority
Leader, Georgia State Capitol, Atlanta, GA.
I am writing to convey my interest in seeing that Georgia's law mandating water
fluoridation for Georgia communities be repealed...
I am most deeply concerned for poor families who have babies: if they cannot afford
unfluoridated water for their babies milk formula, do their babies not count? Of course
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they do. This is an issue of fairness, civil rights, and compassion. We must find better
ways to prevent cavities, such as helping those most at risk for cavities obtain access to
the services of a dentist
3) April 6, 2011. Letter from Matt Young, DDS, President, International Academy of Oral
Medicine and Toxicology, to Thomas Frieden, MD, MPH, Director, Centers for Disease Control
and Prevention, Atlanta, GA. RE: Disproportionate Harm From Water Fluoridation to Babies,
Kidney Patients, and African Americans.
As President of the International Academy of Oral Medicine and Toxicology, I am writing
to communicate our organization's concern that the CDC-supported practice of water
fluoridation disproportionately harms certain subsets of the population: such as babies,
kidney patients, and African Americans.
There is much science we could cite here, but the purpose of this letter is to succinctly
summarize the basis for our conclusion that fluoridation must end.
4) June 2011. Alveda King, nationally known minister and niece of civil rights leader Martin
Luther King Jr.:
"This is a civil rights issue ... No one should be subjected to drinking fluoride in their
water, especially sensitive groups like kidney patients and diabetics, babies in their milk
formula, or poor families that cannot afford to purchase unfluoridated water. Black and
Latino families are being disproportionately harmed."
5) July 1, 2011. A Resolution on fluoridation was passed by the League of United Latin American
Citizens (LULAC) titled, Civil Rights Violation Regarding Forced Medication.
WHEREAS, minority communities are more highly impacted by fluorides as they
historically experience more diabetes and kidney disease; and...
WHEREAS, minorities are disproportionately harmed by fluorides as documented by
increased rates of dental fluorosis (disfiguration and discoloration of the teeth); and...
WHEREAS, the CDC now recommends that non-fluoridated water be used for infant
formula (if parents want to avoid dental fluorosis - a permanent mottling and staining
of teeth), which creates an economic hardship for large numbers of families, minority
and otherwise...
6) April 2013. Portland chapter of the NAACP voted to oppose the fluoridation of the public
water supply.
... Clifford Walker, chair of the branch veteran's committee, says he believes the vote
was unanimous. They had been debating the issue vigorously for several months,"
Walker says. "People with diabetes would be [affected] by adding fluoride to the water.
African-Americans have a higher rate of diabetes." The decision, he says, is "in the best
interest of our constituents."
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A key narrative of this spring's fluoridation campaign has been that fluoride supporters
had gathered a coalition of 80 groups representing low-income and minority
Portlanders, while the anti-fluoride campaign had none.
WW reported this morning that the pro-fluoridation campaign, Healthy Kids Healthy
Portland, has rewarded that support with cash payments totaling more than $119,000.
Groups like the Urban League, the Native American Youth and Family Center and the
Latino Network are using that money for "outreach," according to Evyn Mitchell, the
campaign manager for Healthy Kids. (Mesh, 2013)
7) November 11, 2014. A Resolution was passed by the Santa Rosa-Sonoma County NAACP
Opposing Fluoridation of Our Public Water Supply.
Whereas: Studies have found that in fluoridated communities, African-American and
Latino children are at greater risk for dental fluorosis (discolored teeth from damaged
tooth enamel caused by fluoride exposure) and,
Whereas: Former Ambassador Andrew Young, one of many civil rights leaders opposed
to fluoride, has pointed out that: "we...have a cavity epidemic today in our inner cities
that have been fluoridated for decades"
8) May 11, 2015: Letter from Rev. William (Bill) Owens, President of the Coalition of African
American Pastors to Rep. Barry Loudermilk, Chairman, House Subcommittee on Oversight /
Science, Space, & Technology Committee, Washington DC:
African Americans should have been told that we are disproportionately harmed by
"dental fluorosis," the disfigurement of teeth caused by overexposure to fluorides as a
young child. And who among us was told that kidney patients, diabetics, seniors, and
children are susceptible subgroups that are especially vulnerable to harm from
fluorides? There are more patients with kidney disease and diabetes in the black
community, and this is all the more reason federal officials should have told us that
kidney patients and diabetics are especially vulnerable to harm. Additionally, low-
income families often times lack the resources to purchase unfluoridated water or a
filtration system to remove fluoride from drinking water.
21. The emergency "fluoridation-defense" meeting held at Morehouse College
After the statements from civil rights leaders became public (Lillie Center, 2011; FAN, 2011c),
Ambassador Young and Rev Gerald Durley were invited to a hastily organized semi-confidential
meeting held at Morehouse College on June 1, 2011.
Freedom of Information documents reveal the enormous concern that the pro-fluoridation
lobby (both inside and outside government) had about the traction the statements by the Civil
Rights leaders were receiving both in the media and on the internet. An extraordinary number
of important and influential governmental and professional representatives were brought
together for this meeting.
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This "army of officials" was a magnified version of the "shock and awe" tactics used to
intimidate decision makers should they ever have the temerity to question the wisdom of the
fluoridation program. Council chambers are flooded by dentists, dental students, local and state
dental and health spokespersons claimingthat if they should end fluoridation they would be
threatening the future health and well-being of their children.
Those at the Morehouse meeting included the following (FAN, 2015a):
• Dr. David Satcher (former US Surgeon General)
• Dr. John Maupin, Morehouse School of Medicine
• Gwen Keyes Fleming, EPA, Administrator Region IV
• Dr. Ursula Bauer, Director, National Center for Chronic Disease Prevention and Health
promotion
• Dr. Scott Presson, CDC program services
• Dr. Gina Thornton-Evans - CDC oral health epidemiologist
• Dr. Desmond Williams, Lead, Chronic Kidney Disease Initiative
Department of Health and Human Services/Office of Minority Health
• Dr. Garth Graham -Deputy Assistant Director for Minority Health
• Dr. Rochelle Rollins, Director, Division of Policy and Data
• Dr. Arlene Lester, Regional Minority Health Consultant, Georgia State
National Dental Association
(The NDA represents over 6,000 Black dentists, and 30 million Black Americans)
• Dr. Elizabeth Lense, State Dental Director, NDA
• Dr. Sheila Brown, President, NDA
• Dr. Roy Irons, DDS
• Dr. Kim Perry, Chairman of the Board, NDA
• Mr. Robert Johns, ED
American Dental Association (ADA)
• Dr. Bill Cainon, Pres-Elect, ADA
• Dr. Leon Stanislav, former Chairman NFAC
• Judy Sherman, Washington DC office, ADA
This was a lot of muscle to use against the two Civil Rights leaders who attended this
meeting. It is a pity that a fraction of that muscle power has not gone into informing
minority communities about the special risks posed to them by fluoride and water
fluoridation. Some people might be impressed that so much effort is going into protecting
children's teeth, for others it is disheartening that the rest of their bodies cause so little
concern.
22. A better way of tackling tooth decay in the inner city and address other EJ issues
Here we offer a creative and positive holistic approach to address dental decay and other
aspects of Environmental Justice in the Inner City. Our suggestions are in line with items I and II
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of the "Action agenda on three collective and strategic goals for fiscal years 2016- 2018" of the
Inter Agency Working Group on Environment Justice (EJ IWG), namely:
I. Enhance communication and coordination to improve the health, quality-of-life, and
economic opportunities in overburdened communities;
II. Enhance multi-agency support of holistic community-based solutions to solve
environmental justice issues
Our 5-step alternative plan to water fluoridation for low-income areas and the inner
city.
1) End water fluoridation. This could be accomplished swiftly by the US EPA Office of Water
(OW). If OW were to determine the safe dose of fluoride that would protect all our children
from lowered IQ it would force an immediate end to fluoridation. Such protection against
fluoride's neurotoxic effects would improve the "health, quality-of-life, and economic
opportunities" for children and young people in many ways, especially from low-income
families.
2) Establish the equivalent of Scotland's very successful Childsmile program in all
kindergarten and primary schools (and possibly churches and WIC programs) in low-income
areas. In this program involving both teachers and parents, children are taught to brush
their teeth properly; are provided more nutritious snacks and beverages and encouraged to
reduce sugar consumption. The program also provides annual dental check-ups and
treatment if required. This could be combined with a program along the lines of the Danish
program for pre-school toddlers - see Appendix I.
3) Set up dental clinics either in schools or stand-alone facilities in the inner city and other low-
income areas. Recruit dentists, dental hygienists and nutritionists to provide part-time pro bono
services to these clinics and support the educational services in step 2.
4) Expand these dental clinics into community centers aimed at improving the child's overall
health, nutrition and physical fitness as well as stimulating other health supporting activities.
Such a center, depending on local interest and skills could include keep-fit equipment and
classes, community gardens, community composting, cooking, nutritional and canning advice.
Depending upon demand It might also be linked to local farms..
5) Expand these communities still further into job creating operations. One example we know
that works well is a "reuse and repair" operation to handle discarded appliances, furniture
and other reuseable items from the local and nearby communities. Reuse and repair can
also involve job training, skill-sharing, tool sharing, a community workbench and value
added enterprises. Such an operation can be linked to a Zero Waste strategy involving
source separation, composting, recycling and other waste reduction and prevention
initiatives. This strategy not only fights the pollution generated by landfills and incinerators
(which are often sited in low-income areas), it also provides many jobs and local business
opportunities. One of the authors of this report has lectured and written extensively in this
area, see The Zero Waste Solution: Untrashing the Planet One Community at a Time by Paul
Connett (Chelsea Green, 2013). There are many other creative schemes including
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community gardens, a community culinary school that teaches new chefs how to make food
that is inexpensive, tasty and nutritious, and many many more.
6) It is not difficult to see how many federal and local agencies could be involved with such an
ambitious scheme. These could include the HHS as well as the departments of Education
and Agriculture and the waste management folks at the EPA. Step 5 could be integrated
with the ongoing efforts along these lines in many municipalities. This is one of many ideas
that with a little creativity a community can embrace.
More than anything else a holistic approach allows the transition from the politics of "no" to the
politics of "yes." Once we get off the shortsighted notion that we can battle tooth decay by
putting a neurotoxic chemical into the public drinking water, we can unleash not only the full
potential of the child, but also of our communities and maybe even our civil and professional
services. The three key words are education, nutrition and justice. We need education not
fluoridation to fight tooth decay and obesity. We need healthy soil, to produce healthy food to
produce healthy people to produce a healthy economy and ultimately a healthy planet and we
need Environmental Justice for all. A great deal can be achieved with creativity and vision. A
threatened community is a strengthened community when people work together to solve their
problems in a creative and positive way..
23. FAN responds to HHS Jan 7, 2011 announcement proposing to lower
recommended level of fluoride in water to fight tooth decay
In a joint press release issued January 7, 2011, the Department of Health and Human Services
and the Environmental Protection Agency's Office of Water (OW) announced a recommendation
to lower the level of fluoride in community water fluoridation schemes to 0.7 mg/L (down from
the level set in 1962: 0.7 to 1.2 mg/L) (HHS, 2011). In this announcement Assistant Secretary for
Health Howard K. Koh said: "One of water fluoridation's biggest advantages is that it benefits
all residents of a community..." Simultaneous with this announcement the public was
encouraged to submit comments on this new recommendation. On April 19, 2011, the Fluoride
Action Network (FAN) responded with two submissions (a,b) and documented the issue of
Environmental Justice as it pertains to fluoridation and African Americans (FAN, 2011a).
On April 19,2011 FAN sent a letter to the then director of HHS Kathleen Sebelius. Subsequently
approximately 18,000 people sent in emails in support of this letter. A full copy of the letter can
be found in Appendix H. Below is a shortened version.
Fluoride Action Network
February 4, 2011
To HHS and Honorable Secretary Sebelius
In response to your request for comments on the recent change in your recommended level of
fluoride added to community drinking water, I respectfully submit the following points
Water Fluoridation and Environmental Justice - a report submitted to the
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supporting the stance that a reduction in fluoride levels is not sufficient, and that the United
States should follow the approach of western Europe and end water fluoridation completely:
• Fluoride is not a nutrient, nor is it essential for healthy teeth...
• Using the water supply to mass medicate the population is unethical...
• The benefit and safety of ingested fluoride has never been proved by accepted medical
standards...
• Any benefits of fluoride are primarily topical, not systemic...
• Americans will still be over-exposed to fluoride at 0.7 ppm.,.
• African-American children and low-income children will not be protected...
• HHS has failed to consider fluoride's impact on the brain...
• HHS has failed to consider fluoride as an endocrine disruptor...
• HHS has failed to consider or investigate current rates of skeletal fluorosis in the U.S. ...
• HHS has failed to consider fluoride as a potential carcinogen...
• HHS has failed to confirm the safety of silicofluorides...
Most of the arguments listed above are covered in far more detail in the recently published
book "The Case Against Fluoride" by Connett, Beck and Micklem (Chelsea Green, 2010). We urge
director Sebelius to appoint a group of experts from HHS, who have not been involved in
promoting fluoridation, to provide a fully documented scientific response to the arguments and
evidence presented in this book. Were director Sebelius to do this we strongly believe that
neither she nor these experts will want to see the practice of water fluoridation continue. The
practice is unnecessary, unethical and hitherto the benefits have been wildly exaggerated and
the risks minimized. A scientific response to this book from a HHS team would allow the public
to judge the cases both for and against fluoridation on their scientific and ethical merits.
24. FAN's critique of the EPA's initial steps to determine a new MCLG for fluoride
In the timeline above (see section 5) it has already been explained how inappropriate it was for
the EPA Office of Water (OW) at the HHS/EPA joint press conference on Jan 7, 2011 to indicate
that it was going to take into account the benefits of the water fluoridation program while
determining a new MCLG (safe drinking water standard goal) for fluoride in water (HHS, 2011a).
Here we will address concerns about the way they have gone about determining the MCLG and
indicate a) that it is based upon poor scientific assumptions and b) how it is insensitive to EJ
issues.
In determining a new MCLG for fluoride the EPA announced that they were going to use severe
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dental fluorosis as the most sensitive health effect for fluoride. They argued that if they found a
safe level (safe reference dose or RfD) that protected against severe dental fluorosis it would
protect against impacts on all other tissues including bones in adults. In so doing they
completely ignored all the scientific evidence sent to them by Fluoride Action Network (FAN,
2011a,b; Thiessen 2011, 2015) and others that fluoride is a neurotoxin that has been associated
with lowered IQ in children - a far more serious end point as far as protecting the population is
concerned.
In order to support its hypothesis that severe dental fluorosis was the most sensitive outcome
to fluoride's toxicity the EPA would have to show that in all the studies where IQ has been
lowered (45 studies as of September 2015 at http://fluoridealert.org/studies/brain01/) all
the children with lowered IQ had severe dental fluorosis. If any had moderate, mild or very mild
dental fluorosis their hypothesis collapses. The EPA has not shown this; instead they have simply
ignored all the evidence presented to them on IQ studies. In a delegation to the EPA's OW on
Sept 8 2014 FAN provided evidence that children with moderate, mild and even very mild dental
fluorosis had a lowered IQ. This evidence came from Xiang's important IQ study from 2003.
Xiang was part of the delegation. EPA OW continues to remain silent on this evidence.
UNITED STATES
ENVIRONMENT, i
OTECTION AGE™
Figure 14: A photo taken of the FAN delegation (from left to right: Quanyong Xiang, Paul
Connett, Chris Neurath and Bill Hirzy) outside the EPA's Headquarters after they had met with
two top officials at the EPA Office of Water on Sept 8, 2014
Water Fluoridation and Environmental Justice - a report submitted to the
EJ Interagency Working Group on September 25, 2015, from Fluoride Action Network
A4 p.635
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J Group
No.
Water F
IQ
Urine F
Serum F
*
301
0.50±0.53
99.76±3.50
1.13±0.71
0.044±0.017
1 1
65
1.88±1.07
94.18±13.77
2.70±1.15
0.071±0.023
2
j
59
2.44±0.66
93.27±13.10
3.69±1.61
0.082±0.016
3
63
2.67±0.63
91.51±12.84
3.85±1.79
0.085±0.019
w
24
2.89±0.81
95.33±14.64
3.81±1.80
0.084±0.018
Xiang's presentation at FAN conference , Sept 6, 201
Figure 15: A copy of a slide in Dr. Quanyong Xiang's presentation at the FAN conference in
Crystal City, Sept 6, 2014. The left hand column (0,1,2,3,4) corresponds to Dean's classification
of the different levels of dental fluorosis (0 = none, 1 = very mild, 2 = mild, 3 = moderate and 4
= severe. Note by comparing with column 4 that children had lowered IQ who had very mild,
mild and moderate dental fluorosis. This refutes the claim by the OW that severe dental
fluorosis is the most sensitive health effect of fluoride exposure. Lowered IQ is a more
sensitive end point.
The EPA further indicated in the calculations made available simultaneously in the Federal
Register (HHS, 2011b) that they were going to use Dean's studies from the 1940's to estimate
the threshold level where severe dental fluorosis would occur. Having estimated that level they
then applied an "uncertainty factor of 1" to protect all the members of society - including the
most vulnerable - from this effect.
Normally a factor of 10 is used to extrapolate from the study group to protect a large population
to account for the very wide range of sensitivity expected in any large population (this is
sometimes referred to as the intra-species variation factor). An uncertainty factor of 1 means
100% certainty that Dean's study in the 1940s was so large and so inclusive that it covered the
full range of sensitivity of the total US population of children in the 21st century. This is
extraordinarily cavalier. In his early studies (from the 1930s) Dean did look at age, sex and color
and even mentioned in a 1933 paper, the case of a negro girl with mottled teeth in the bicuspids
who used the fluoride water for just three years. However, in his 21-city study from 1942 he
focused only on white children. Dean states, "The Study embraced 7,257 white urban school
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children, aged 12 to 14 years of 21 cities..." (our emphasis).
Thus the only children who featured in Dean's 21-city study were white - so it wasn't even
inclusive of the US population in 1942, let alone in the twenty-first century.
By using studies that did not include low-income families and communities of color clearly
makes the EPA's calculations inappropriate for estimating a level which would protect every
child from severe dental fluorosis - without a safety factor applied to it - especially in the light
of the discussion above that indicates that both Blacks and Hispanics are more sensitive to
dental fluorosis than Whites. Choosing an uncertainty factor of one is scientifically indefensible
on the one hand, and betrays an insensitivity to EJ issues on the other.
If the EPA is serious about eliminating environmental injustice from its policy decisions this is a
classic case to address. In determining a safe reference dose for fluoride and a new MCLG the
EPA OW has to do two things:
1) They need to provide evidence that severe dental fluorosis is a more sensitive end
point than lowered IQ. The last children in the U.S. who need their IQ lowered are
children from low-income families.
2) Even if they use severe dental fluorosis as the end point they need to use a more
appropriate database and uncertainty factors to produce a safe reference dose to
protect all individuals in society including the most vulnerable.
If they don't do either of these things it will make a mockery of the Presidential Executive Order
of 1994: "Federal agencies must identify and address, as appropriate, "disproportionately high
and adverse human health or environmental effects of their programs, policies, and activities
on minority populations and low-income populations." (Presidential Executive Order 12898 of
February 11, 1994)
The above discussion updates our concerns to those we submitted in two formal responses to
the OW's reports, which appeared in the Federal Register at the same time as their press
conference of Jan 7, 2011.
FAN's two formal responses submitted to the EPA's Office of Water in April 2011 can be
accessed online at:
http://www.fluoridealert.org/wp-content/uploads/epa-2010.dose .pdf
and
http://www.fluoridealert.org/wp-content/uploads/fan.exposure.revised.4-22-ll.pdf
Below we have given a skeletal summary of our responses so that readers will have a quick
access to the many criticisms we had of OW's assumptions and calculations in both documents.
A) A summary of FAN's Responses to EPA OW's report, Fluoride: Dose-Response Analysis For
Non-cancer Effects.
We identified 16 flaws in the methodology and rationale behind OW's proposed RfD (safe
reference dose)
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We argued that
1) Consideration of the adverse effects of fluoride should take precedence over any presumed
benefits in OW's determination of an RfD and MCLG
2) OW has failed to offer convincing evidence that severe dental fluorosis should be considered
the critical effect associated with exposure to fluoride.
3) failed to consider potential variation in responses to the different types of fluoride in drinking
water.
4) failed to apply appropriate safety factors.
5) unnecessarily delayed consideration of the potential carcinogenicity of fluoride.
6) failed to consider fluoride's effects on the brain.
7) failed to consider fluoride as an endocrine disruptor.
failed to consider the disproportionate impact on a number of susceptible
populations in its analysis.
8) disregarded pregnant women and embryos/fetuses in its analysis.
9) completely ignored infants 0-6 months of age in its analysis, and has failed to consider the
disproportionate burden placed on bottle-fed infants.
10) failed to consider the disproportionate impact on above-average water consumers, which
account for at least 10% of the population.
11) failed to consider the disproportionate impact on minority Americans.
12) failed to consider the disproportionate burden placed on low-income families.
13) failed to consider the disproportionate harm to people with inadequate nutrition.
14) failed to consider those with impaired kidney function.
15) failed to consider those co-exposed to lead, arsenic, or aluminum.
16) failed to consider those with an increased sensitivity to fluoride.
B) A summary of FAN's Comments on the EPA OW's Report Fluoride: Exposure and Relative
Source Contribution Analysis
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The policies used to calculate fluoride exposures are flawed, especially when no margin of safety
is applied. FAN identified 12 flaws in their analysis
1) OW's policy of using the 90th percentile for water consumption ignores 10% of the U.S.
population —nearly 31 million people
2) OW's policy of using the mean drinking water fluoride concentration ignores as much
as half of the population whose drinking water has higher fluoride levels.
3) OW's policy of using the average body weight of the population of interest ignores as
much as half of the population in the lower 50th percentile for weight.
4) OW has failed to consider studies of urinary fluoride excretion as an estimate of total
fluoride intake.
5) OW has failed to consider fluoride exposures for several of the most sensitive groups —
pregnant women, embryos/fetuses, and infants 0-6 months
6) failed to adequately consider racial, ethnic, regional, and socioeconomic differences in food
and beverage consumption patterns
OW has ignored several sources of fluoride as contributors to total intake. OW has
8) ignored fluoride exposures from several dental products, including professionally
applied topical fluorides, mouthwashes, and various dental devices.
9) failed to consider fluoride exposure from dietary fluoride supplements in its analysis.
10) failed to consider pharmaceuticals and anesthetics that metabolize to the fluoride
anion in its exposure analysis.
11) failed to consider ambient air as a source of fluoride in its exposure analysis.
12) does not adequately consider exposure from cigarettes in its analysis.
25. The EPA's false characterization of fluoride as a nutrient.
In addition to all the other flaws discussed above there is another major misrepresentation that
the EPA made in both the documents discussed in section 24 above to which we would like to
draw special attention because it is a false claim that is often made by promoters of fluoridation.
This is the claim that fluoride is a nutrient. In the case of OW they should not have made this
claim in 2011 because twice they were informed in 2003 that the source they were using had
rejected the claim. Here are the details.
The EPA states that the source for this claim is the Institute of Medicine (IOM). Here are the
exact quotes.
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In their report, "Fluoride: Exposure and Relative Source Contribution Analysis" on page 39
EPA's Office of Water states:
However, it should be recognized that fluoride is a nutrient and reconstitution of infant
formulas with water containing lower levels of fluoride may result in infants not
consuming the Adequate Intake for fluoride (0.5 mg/day) established by the Institute of
Medicine (1997).
And in their report, Fluoride: Dose-Response Analysis For Non-cancer Effects, on page 95
they state:
The dietary guidelines for fluoride were revised by the Institute of Medicine (IOM) in
1997. The 1997 revisions (see Table 5-1) considered fluoride as a nutrient based on its
presence and function in bones and tooth enamel, (p. 95)
To appreciate the blatancy of this falsehood a little history is needed. In 1997 the Food and
Nutrition Board of the IOM caused considerable consternation among scientists who have taken
an interest in the fluoride debate. The IOM produced a report entitled, Dietary Reference
Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride (IOM, 1997) and held a
public meeting in Washington DC, Sept 23, 1997, to discuss a draft of the report. William Hirzy
PhD (then with the EPA) and Paul Connett PhD attended this day-long meeting and several times
questioned the inclusion of fluoride among a list of well-known nutrients, when there is no
scientific study justifying such a characterization for fluoride.
To demonstrate that a substance is an essential nutrient one has to remove the proposed
nutrient from an animal's diet and demonstrate that some disease occurs as result. This has
never been done for fluoride. Moreover, no one has ever shown that there is any biochemical
process in the body that needs fluoride to function properly or any molecule (fat, amino acid,
protein, nucleic acid or metabolite) that contains fluoride.
Despite the intervention of Hirzy and Connett the IOM went ahead and finalized its draft
retaining fluoride among a list of known nutrients needed for healthy bone growth. About a
dozen scientists wrote to the heads of both the Institute of Medicine (Dr. Kenneth Shine) and
the National Academies (Dr. Bruce Albert) complaining of this false implication. Alberts and
Shine (1998) replied as follows:
First, let us reassure you with regard to one concern. Nowhere in the report is it stated
that fluoride is an essential nutrient. If any speaker or panel member at the September
23rd workshop referred to fluoride as such, they misspoke. As was stated in
Recommended Dietary Allowances 10th Edition, which we published in 1989: "These
contradictory results do not justify a classification of fluoride as an essential element,
according to accepted standards. Nonetheless, because of its valuable effects on dental
health, fluoride is a beneficial element for humans."
Run the clock forward to April 2003 when Paul Connett had a semi-debate at the EPA
headquarters in Washington DC as part of their annual science fair. Ed Ohanian of the EPA's
Office of Water was present. He didn't formally debate Connett but he did summarize some of
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the EPA's activities on fluoride. In these comments he cited the IOM (1997) as characterizing
fluoride as a nutrient. Connett corrected him citing the Shine-Alberts letter (1998).
Then in October 2003 before Connett testified before the NRC panel, which was reviewing
fluoride's toxicity discussed above (section 11), Joyce Donahue (2003), also of EPA's Office of
Water, presented the parameters of the review they wanted from the panel. She also referred
to fluoride as a nutrient and used the IOM report to justify that claim. Connett corrected her
from the floor again citing the Alberts-Shine letter (1998).
it is extraordinary that the EPA's Office of Water should try to get away with this false
characterization yet again.
26. Fluoride has no known role in nutrition or biochemistry (a summary)
Here is what FAN submitted to the EPA in April 2011 on this point.
Fluoride is not considered by knowledgeable experts to be an essential nutrient for
humans, and it has no known, beneficial role in human biochemistry (Nielsen, 1996;
Hunt & Stoecker, 1996; NRC, 1989).
The U.S. authority for recommended dietary intakes concluded in 1989 that
contradictory studies in rats and mice in the 1970s "do not justify a classification of
fluorine [as fluoride] as an essential element, according to accepted standards" (NRC,
1989). (Because animal diets can be more stringently depleted in fluoride than human
diets, studies in short-lived rats and mice are considered the best way to discover the
possible essentiality of minerals in mammals.)
In its most recent publication on recommended dietary intakes, the same U.S. authority
makes no mention of fluoride essentiality in the diets of humans or animals (IOM, 1997).
Human milk is extraordinarily low in fluoride, ranging from 0.007 parts per million (ppm)
to 0.011 ppm (IOM, 1997)—100 times less than in fluoridated water in the U.S. (0.7 to
1.0 ppm).
Human milk also has about 3 times less fluoride than the blood of the mothers
producing it (Sener et al., 2007).
Thus it seems clear that nature has evolved active mechanisms to limit the transfer of
fluoride in humans—both from ingested food and water to blood, and from blood to
breast milk.
Thus either by accident or intent mothers' milk protects the baby from more than
minimal exposure to fluoride. Water fluoridation removes that protection for bottle-fed
babies.
It is well-established that fluoride's toxicity may be exacerbated by poor nutrition. By
not accounting for this fluoridation promoters are contributing to the disproportionate
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harm fluoride exposure and water fluoridation may be causing both low-income and
minority families, who are more likely to suffer from poor nutrition.
However, nutritional factors may enhance fluoride's toxicity. These include deficiencies
in iodine, calcium, magnesium, and vitamin C (ATSDR, 1993, p.112), selenium, and
vitamin D (e.g. ATSDR, 1993, p.112; NRC, 2006).
Poor nutrition has been found to increase the incidence and severity of dental fluorosis
(Pandit et al., 1940; Murray et al., 1948; Littleton et al., 1999) and skeletal fluorosis
(Pandit at al., 1940; Marier et al., 1963; Fisher et al., 1989; Teotia et al., 1984; Littleton
et al., 1999).
The dose of fluoride at which disturbed endocrine function occurs is reduced in
situations of iodine deficiency (NRC, 2006). Lin et al. (1991), in a UNICEF - sponsored
study, found that even modest levels of fluoride in the water (0.88 mg/Lvs. 0.34 mg/L)
resulted in reduced IQ (and increased frequency of hypothyroidism) when combined
with low iodine, even more so than with iodine deficiency alone.
The increasing dietary intake of fats in the U.S. may have negative repercussions in
terms of fluoride metabolism, as "Diets high in fat have been reported to increase
deposition of fluoride in bone and, thus, to enhance toxicity" (HHS, 1991).
As we have not received a response to our April, 2011 submission (as of Sept 2015), we have
yet to hear whether the EPA OW has retracted their claim that fluoride is a nutrient or
whether they are going to try to convince the world that it is.
27. Final HHS ruling in 2015 uses sleight of hand to dismiss FAN's input on fluoride's
neurotoxicity
In April 2015 the HHS released its opinion in support of its recommended level of 0.7 mg/L level
for water fluoridation programs in the US(DHHS, 2015). In this HHS document there is no
mention of the Environmental Justice issue and thus no discussion of the adverse potential this
recommended level bodes for the children of low-income and minority families.
The HHS statement was accompanied by a statement from the director of the CDC's Division of
Oral Health on the "evidence supporting the safety and effectiveness of fluoridation". In this
statement the terms "minority" and "racial" were each used once; the term "poor" was used
twice, and all with the same reference to the Surgeon General's report of 2000 (Weno, 2015;
Surgeon General's reference) discussed above.
The CDC also rejected our concerns about Fluoride's neurotoxicity. Here is the short section that
deals with this:
IQ and other neurological effects
The standard letters and approximately 100 unique responses expressed
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concern about fluoride's impact on the brain, specifically citing lower IQ in children.
Several Chinese studies considered in detail by the NRC review reported lower IQ among
children exposed to fluoride in drinking water at mean concentrations of 2.5-4.1 mg/L—
several times higher than concentrations recommended for community water
fluoridation.
The NRC found that "the significance of these Chinese studies is uncertain" because
important procedural details were omitted, but also stated that findings warranted
additional research on the effects of fluoride on intelligence.
Based on animal studies, the NRC committee speculated about potential mechanisms
for nervous system changes and called for more research "to clarify the effect of
fluoride on brain chemistry and function."
These recommendations should be considered in the context of the NRC review, which
limited its conclusions regarding adverse effects to water fluoride concentrations of 2-4
mg/L and did "not address the lower exposures commonly experienced by most U.S.
citizens."
A recent meta-analysis of studies conducted in rural China, including those considered
by the NRC report, identified an association between high fluoride exposure (i.e.,
drinking water concentrations ranging up to 11.5 mg/L) and lower IQ scores; study
authors noted the low quality of included studies and the inability to rule out other
explanations.
A subsequent review cited this meta-analysis to support its identification of "raised
fluoride concentrations" in drinking water as a developmental neurotoxicant.
A review by SCHER also considered the neurotoxicity of fluoride in water and
determined that there was not enough evidence from well-controlled studies to
conclude if fluoride in drinking water at concentrations used for community fluoridation
might impair the IQ of children. The review also noted that "a biological plausibility for
the link between fluoridated water and IQ has not been established."
Findings of a recent prospective study of a birth cohort in New Zealand did
not support an association between fluoride exposure, including residence in an area
with fluoridated water during early childhood, and IQ measured repeatedly during
childhood and at age 38 years. (CDC, 2015) (our emphasis).
Please note the highlighted section in this excerpt. This statement is referring to the Harvard
meta-analysis by Choi et al., 2012 discussed in section above. We have already noted that
fluoridation promoters have tried to dismiss the relevance of this review with respect to
artificial water fluoridation by referring to the "high concentrations" in the "high-fluoride
villages." However, we saw in table xx that for the 20 studies where the source of fluoride was
water and not coal and for which fluoride concentrations were given, the mean value in the
"high-fluoride" villages was 3.52 ppm, which is lower than the current safe drinking water
standard of 4 ppm. We also noted that a number of studies were lower than 3 ppm, and when
we looked at one study (Xiang et al. 2003 a,b) in more detail some of the children had their IQ
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lowered at 1.5 ppm, and extrapolating from a linear fit of the data, could possibly have occurred
between 0.75 and 1.5 ppm.
To see the "sleight of hand" operating here note the way the CDC authors qualify "high fluoride
exposure" as " drinking water concentrations ranging up to 11.5 mg/L."
When we look at the study in question (Wang, 2007) we find that the 11.5 ppm is one end of a
range "3.5 to 11.5 ppm." Thus this value of 11.5 ppm was not experienced by all the children in
this particular study, nor was it typical for all 20 studies, where the mean value was 3.52 ppm, so
singling it out is highly misleading. (See Table 5, section 15)
Moreover, as any regulatory toxicologist should know when looking at a table of results like this
it is not the highest value, which is of concern but the lowest. It is the lowest value (i.e. the
lowest observable adverse effect level, or LOAEL), which is the starting point for determining the
safe reference dose (RfD) needed to protect all the individuals in a large population that may be
exposed to this toxic. The RfD is the stepping stone in determining the MCLG in water.
So once again we see the CDC Oral Health Division presenting the data in a way to minimize
concerns about the practice they vigorously promote. This is not science but a public relations
exercise in the name of protecting its long-standing policy. Once again we see an example of
where, "When policy is king, science becomes a slave."
28. Summary
Water fluoridation is a very poor and unethical practice, which infringes on the right of every
individual to informed consent to human treatment.
It throws an extra burden on poor families and communities of color. These range from an
increased risk to dental fluorosis (the first telltale sign that the body has been over-exposed to
this toxic substance) to a lowered IQ. The last children in the U.S. who need their IQ lowered are
children from poor families and communities of color because their intellectual development is
more likely to have have compromised by exposure to other neurotoxins like lead and mercury
and because fluoride's toxicity is made worse by poor nutrition.
While the Oral Health Division of the Centers for Disease Control and Prevention lauds the
fluoridation experiment as "One of the top public health achievements of the Twentieth
Century" it is probably our greatest public health mistake and needs to be ended as soon as
possible.
We believe that it is not enough to say "no" to this program but to say "yes" to a viable and
better alternative. We have done this using the challenge of the agenda goals of the EJ IWG for
2016 - 2018 and have a proposed a 5-step plan which addresses these goals (see section 21)
29. Recommendations
The Environmental Justice Interagency Working Group (EJ IWG)
We urge all the agencies involved in the EJ IWG to see how they can become involved in our
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proposed 5-step plan. We believe there is a role for every single agency.
The CDC.
If the CDC's Division of Oral Health resists our 5 step plan, and is going to continue to spend
millions of taxpayers' dollars on fluoridation promotion then it should not be spent on
propaganda. That should be left to private organizations like the ADA and Pew. The CDC's
Division of Oral Health should provide balanced information. As well as providing information on
benefits they need to do a better job of providing information on side effects. Such a task should
be given over to a different section of the CDC, not the Oral Health Division, whose personnel
have little or no training in specialized areas of medicine other than the teeth and no expertise
in toxicology and risk assessment.
Meanwhile, the CDC should be warning, those particularly vulnerable to fluoride's toxic actions
of their vulnerabilities. These citizens include low-income families and Black and Hispanic
Americans.
The EPA
1) As we have made clear above the EPA Office of Water could end fluoridation tomorrow if it
used the best science to determine a safe reference dose (RfD) for fluoride that would protect
all our children from lowered IQ. If they use standard procedures and appropriate safety factors
the RfD would be so low that an MCLG would have to be set at zero, as is the case for both lead
and arsenic. Needless to say, as with arsenic and lead, an MCL (the federally enforceable
standard) would have to be chosen, which took into account the costs of removing naturally-
occurring fluoride down to some compromise that didn't make removal too cost-prohibitive.
The key for the EPA under the Safe Water Drinking Act is to produce a scientifically defensible
MCLG for fluoride.
2) The EPA should live up to its self-proclaimed interest in making sure that their decisions take
into account EJ issues. In 2011 the EPA stated that:
Environmental Justice is the fair treatment and meaningful involvement of all people
regardless of race, color, national origin, or income with respect to the development,
implementation, and enforcement of environmental laws, regulations, and policies. EPA
has this goal for all communities and persons across this Nation. It will be achieved
when everyone enjoys the same degree of protection from environmental and health
hazards and equal access to the decision-making process to have a healthy environment
in which to live, learn, and work.
An excellent place to start making these noble words into a reality would be for the EPA OW to
take them into account in their ongoing determination of a safe MCLG for fluoride in water. As
of Jan 7 2011 the initial steps they have taken in this determination conflicts with these goals in
two fundamental ways:
A) They have ignored all the evidence that fluoride is neurotoxic falsely claiming that severe
dental fluorosis is the most sensitive end point of fluoride's toxicity. If this is uncorrected it
will further hurt the interest of children of low-income and communities of color: they are
the last children that need their IQ lowered or have their mental development impacted in
any way.
B) Even if severe dental fluorosis is erroneously accepted as the most sensitive end point it is
ridiculous for them to use data from the 1930s and 1940s in which the vast majority of the
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children were white. This foolishness was compounded by their applying to this outdated
and incomplete data an uncertainty factor of one, instead of the normal default value of 10,
when extrapolating from a small study that has found harm to produce a reference dose to
protect all the individuals in a large population from that harm. The normal safety factor of
10 is used to protect for the full range of sensitivity to any toxic substance expected in a
large population (i.e. intra-species variation). This variation in sensitivity is caused by many
differences in a large population, including genetics, race, ethnicity, income levels, social
circumstances, diet and health status. The fact that one of the factors which influences the
prevalence of dental fluorosis - especially in its more severe forms - is race underlines the
enormous insensitivity being shown to EJ issues by the EPA in their selection of this
uncertainty factor and needs urgent and immediate correction.
3. The EPA should acknowledge that fluoride is not a nutrient unless they can produce
science to substantiate this claim.
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APPENDICES
APPENDIX A: Article by Daniel Grossman, Fluoride's Revenge: Has this cure, too, become a disease?
Published in the Progressive, December 1990.
APPENDIX B: Hypothyroidism in the USA
APPENDIX C: Certain Thyroid-Related Diseases May Vary by Race: Study looked at Graves', Hashimoto's
thyroiditis among U.S. military personnel.
APPENDIX D: Fluoride chemical species & Lead: No mention by EPA of lead-fluoride-chlorine interactions
APPENDIX E: 119 State Reports on Oral Health
APPENDIX F: Pro-Fluoridation groups have also downplayed or ignored dental fluorosis
APPENDIX G: Civil Rights Leaders have begun to mobilize to end fluoridation's threat to minority
communities
APPENDIX H: On April 19,2011 (check date) FAN sent a letter to the then director of HHS Kathleen
Sebelius. Subsequently approximately 18,000 people sent in emails in support of this letter
APPENDIX I: The Nex0 Method from Dermark
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APPENDIX A
Fluoride's Revenge: Has this cure, too, become a disease?
The Progressive | December 1990 | By Daniel Grossman
(See Photocopy of this article)
Daniel Grossman is a free-lance science writer specializing in environmental and health issues. Research
for this article was supported by a grant from the Fund for Investigative Journalism.
Terry Rich, a Colorado Spring dentist, recently treated Molly, a teenage patient, for an ugly brown stain on
her front teeth. "She was dissatisfied with her teeth," he recalls, noting that dark, brown horizontal lines
marred an otherwise straight smile. Though his acid-etching treatment failed to remove the stain, Rich
hopes to try again with a different formula. Molly is Rich's own child. Like other people across the nation,
she suffers from dental fluorosis, an ailment caused by excessive levels of the chemical fluoride in
naturally mineral-rich water.
Moderate/Severe Dental Fluorosis (Photograph by BMC Oral Health)
An investigation of the health effects of fluoride, including two Freedom of Information Act requests that
pried loose more than 10,000 pages of documentation, shows that a Government regulation intended to
prevent fluorosis was derailed by a decades-old controversy between two agencies over a legally
unrelated Government policy.
Officials at the Public Health Service, the Federal Government's all-purpose health agency, stopped the
Environmental Protection Agency from issuing a standard to prevent dental fluorosis because they feared
the rule would disrupt their own plans to protect dental health. As a result, what might have been an
open public debate became an obscure internecine battle between two bureaucracies, each with its own
idea of what makes good public policy. Though dental fluorosis is hardly a life-threatening ailment, this
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story demonstrates how a powerful agency, intent upon enforcing its own view of the public good, can
suppress anyone who gets in its way.
On October 31, 1985, employees of the EPA were circulating a memo written by Paul Price, a staff
member in the regulatory agency's drinking water program. It was a spoof of an official press release
issued that day to announce a new regulation.
"The Office of Drinking Water," it began, "proudly presents their new improved FLUORIDE REGULATION,
or 'How We Stopped Worrying and Learned to Love Funky Teeth.'" The takeoff reflected the frustration
felt by staff members who had invested years in developing the protective regulation only to see it diluted
because of pressure from another agency.
Though fluoride is best known as the chemical added to drinking water and toothpaste to prevent dental
decay, it can also cause a variety of harmful ailments, including one that puts brown stains on teeth and
may make them brittle and crumbly. The amount of fluoride added to drinking water to prevent tooth
decay is about the same as the amount that can cause moderate staining.
Such staining, known as dental fluorosis, was discovered even before the beneficial effects of fluoride
were recognized. The convoluted history of fluoride — perhaps one of America's most bizarre encounters
with a chemical contaminant — holds the secret to why two agencies, each ostensibly concerned about
the effects of fluoride on teeth, should clash.
Dental fluorosis was first noted in Colorado Springs at the turn of the century by a young dentist who
became obsessed with discovering the cause of the disease, then known as "Colorado Stain." When
minute amounts of fluoride dissolved in drinking water were identified as the culprit in 1931, the Public
Health Service dispatched H. Trendly Dean, a talented epidemiologist, to determine the concentration at
which the disease occurs.
"In moderate cases, all enamel surfaces of the teeth are altered," Dean wrote. "Brown stain is frequently
a disfiguring feature." In severe cases, he added, "brown stains are widespread and teeth often present a
corroded-like appearance." The disease, researchers later discovered, is caused in children up to the age
of eight during the formation of their teeth.
Fluoride would probably be treated today with the same degree of concern as any other contaminant that
affects human health, were it not for the fact that Dean also confirmed an observation that changed the
course of preventative health care. He showed that people with dental fluorosis had fewer cavities—then
considered a public-health scourge. This discovery was greeted with enthusiasm by activists in the dental
community, especially in Wisconsin, a stronghold of the Progressive movement, where a small group of
energetic dentists campaigned vigorously to add fluoride to drinking water.
Dean and his agency were more circumspect, as were the American Dental Association and the American
Medical Association, which preferred to await the results of investigations of the benefits of fluoride. But
by the mid-1940s, a few communities began experimenting with fluoridation - as the process of adding
fluoride came to be known. By 1950, the Public Health Service, under increasing pressure from advocates,
endorsed the process.
As a full-blown campaign to fluoridate the entire country - nourished by the once-skeptical Public Health
Service - began to build, grass-roots opposition appeared as well. Some critics questioned the safety and
efficacy of fluoridation, and others raised ethical, moral, and philosophical objections to the injection of a
potent chemical into a public resource. There were crackpots, too, who countered advocates of
fluoridation with McCarthy-era anticommunist and anti-Semitic rhetoric. One activist who gained
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notoriety in California claimed that fluoridation would produce "moronic atheistic slaves." It would
"weaken the minds of the people," she said, and make them prey to communists. Another called
fluoridation a Jewish attempt to "weaken the Aryan race mentally and spiritually."
When the strategy of challenging fluoridation in local referendums began to threaten the nationwide
endeavor, proponents responded by tarring all opponents - indeed the very idea of opposition - with this
"quack" brush. According to fluoridation advocate G.F. Lull, for example, "We will find in the
antifluoridation camp the antivaccinationists, the antivivisectionists, the cultists and quacks of all
descriptions: In short, everyone who has a grudge against legitimate scientific progress."
The controversy over fluoridation is no longer as visible as it was in the 1950s, but it continues. The Public
Health Service is still trying to make fluoridation universally available, and opponents are still at work with
roadblocks and sandbags. Today, proponents note with alarm that fluoridation was actually rejected in
about 100 of the more than 150 referendums on the measure in the past decade. With only two-thirds of
the public water supplies served by what dentists consider the optimal level of fluoride today, the
longstanding Public Health Service goal of 95 per cent by 1990 was recently lowered to 75 per cent by the
year 2000.
Though many beneficial chemicals are dangerous when consumed at excessive levels, fluoride is unique
because the amount that dentists recommend to prevent cavities is about the same as the amount that
causes dental fluorosis. The Public Health Service recommends that about one part of fluoride be added
for every million parts of water to prevent tooth decay — the amount depends on the climate — while the
Environmental Protection Agency says water with as little as 0.7 parts per million of fluoride can cause
moderate dental fluorosis in a small percentage of the people who drink it.
Today, according to the EPA, there are 1,300 communities -- mostly rural towns — serving nearly two
million people with water naturally enriched with fluoride in concentrations greater than two parts per
million (ppm). And there are 200 communities serving more than a quarter-million people with water
exceeding four ppm. At two ppm, according to agency studies, 10 per cent of all children will contract
either moderate or severe fluorosis. At four ppm, nearly half the children will be afflicted. The Public
Health Service estimates that nearly half a million American schoolchildren suffer from mild or severe
dental fluorosis.
The EPA issued a regulation to protect the public from dental fluorosis in 1977, under authority of the
then newly enacted Safe Drinking Water Act. The rule prohibited public water suppliers from distributing
water with more than two ppm of fluoride, though the deadline for compliance extended until 1984. As
the deadline neared, however, none of the offending suppliers moved to comply, since defluoridation
equipment costs hundreds of thousands of dollars. Instead, EPA came under increasing pressure to
reexamine the rule. The regulation was a temporary standard, promulgated hastily with the expectation
that the agency would later issue a permanent rule based on further deliberations.
EPA staff scientists were convinced of the need to prevent fluorosis. "This was the only contaminant up to
this time that we knew had a human health effect," recalls David Schnare, an EPA drinking water analyst.
Other drinking-water contaminants, he explains, were recognized by the results of animal studies only.
Nevertheless, EPA was besieged by petitions from state governors and dental officials to weaken the
standard or, better yet, replace the legally binding regulation with a less burdensome, voluntary standard.
But voluntary standards are typically ignored.
Dental and other public-health officials opposed the binding rule because they feared EPA would
encourage the antifluoridation camp and hinder the ongoing effort to fluoridate the entire country. EPA's
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plans to regulate fluoride, said John Daniel, a dental official in South Carolina, "served only to stimulate
ardent antifluoridationists in their fanatic quest to associate fluoride with every disease and
unpleasantness known to mankind."
But many members of the medical community are cautiously beginning to question forty years of
doctrinaire advocacy of fluoridation. Even Public Health Service officials are noting today that fluoride
may not be as effective as they once claimed. "Perhaps we have been too much the crusaders," says
Canadian dental official Alan Gray in calling on his colleagues to reconsider the benefits of fluoridation.
State governments opposed the binding regulation for another reason: because defluoridation is
expensive and therefore politically unpalatable. According to EPA estimates, for instance, a typical family
in a community that installed defluoridation equipment could expect an increase in its water bill of
between $20 and $100 annually.
Though the Public Health Service has long been the chief Federal advocate of fluoridation — and therefore
a less-than-neutral judge — EPA in 1981 asked Surgeon General C. Everett Koop, a Public Health Service
leader, to convene a panel to advise the agency on the relationship between fluoride in drinking water
and dental fluorosis. It was an unusual step; according to Joseph Cotruvo, the EPA official directly
responsible for drinking-water standards, EPA had never before asked the Surgeon General to conduct
such a review of a chemical, nor has it since.
Koop's office assembled a committee of dental researchers in various branches of the Service. Completed
in 1982, their report concluded that dental fluorosis, though "cosmetically objectionable," is not a health
hazard. Summarizing the report, Koop wrote to EPA: "No sound evidence exists which shows that drinking
water...in the U.S. has an adverse effect on dental health."
Public Health Service documents verify that the wording of Koop's letter was intended to hinder EPA plans
to set a binding fluoride standard. Unless EPA demonstrates that a contaminant has a "health effect," the
agency cannot legally set a binding standard.
"If we send this letter," Koop explained in a memo to Edward Brandt, his superior in the Public Health
Service, "it means that [EPA] would not be able to publish [binding] drinking-water regulations." Then he
advised, "I think we should go with this letter, in spite of the fact that EPA will not like our response."
Still eager to demonstrate the need to regulate fluoride, the EPA asked the Surgeon General to assemble
another panel in 1983, this time to consider the nondental effects of fluoride. A transcript of the panel's
two-day meeting shows that, despite its nondental mandate, the panel was especially disturbed by what
it learned about dental fluorosis. "You would have to have rocks in your head to allow your child much
more than two parts per million," said Stanley Wallach, then medical-service chief of the Veterans
Administration Medical Center in Albany, New York.
In the final draft of its report, panel chair Jay Shapiro concluded, "There was a consensus that... dental
fluorosis per se constitutes an adverse health effect that should be prevented." Shapiro wrote a memo
warning that "because the report deals with sensitive political issues which may or may not be acceptable
to the PHS, it runs the risk of being modified at a higher level or returned for modification." He attached
the memo to his draft and sent them on to John Small, a Public Health Service official. Small, in turn,
forwarded the draft to Koop.
The final report, which Koop sent the EPA a month later, included none of the Shapiro draft's conclusions
about dental fluorosis. Instead, it concluded that it was "inadvisable" for children to drink water
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containing high levels of fluoride to prevent the "uncosmetic effect" of dental fluorosis. Koop had again
foiled EPA by repeating his conclusion that dental fluorosis is not an "adverse health effect."
When contacted recently, members of the panel assembled by the Public Health Service expressed
surprise at their report's conclusions; they never received copies of the final-altered—version. EPA
scientist Edward Ohanian, who observed the panel's deliberations, recalled being "baffled" when the
agency received its report. But, he added, "it's what they give us in writing that counts."
But William Ruckelshaus, then the administrator of EPA, wanted to set a binding standard to prevent
dental fluorosis, so EPA tried one more time. In 1984, Ruckelshaus asked the National Institute of Mental
Health to assemble a panel to examine the psychological effects of dental fluorosis. This time the request
was submitted directly to NIMH rather than through the office of the Surgeon General.
Although there was no body of research on the psychological effects of dental fluorosis per se, the panel
was guided by numerous studies of facial attractiveness and the behavioral impacts of other dental
impairments, such as cleft lip and palate. Panel members were also impressed by photographs they were
shown of the teeth of people suffering from severe dental fluorosis. They concluded that people with
moderate or severe cases risked "psychological and behavioral problems or difficulties."
EPA staff members were pleased with the results of this study. "The staff response was: Here is our silver
bullet," says Paul Price, then an analyst working on the standard. He recalls that the staff was vacillating
between recommending a standard of one ppm or two ppm, to prevent the psychological effects of
dental fluorosis.
Ruckelshaus was shown a set of pictures of dental fluorosis at a high-level meeting in July 1984, recalls
drinking-water analyst Schnare. Ruckelshaus's comment: "That's an adverse health effect." But he
stepped down as EPA administrator in January 1985 and was replaced by Lee Thomas, a man less
sympathetic to staff concerns about dental fluorosis.
Recent interviews confirm that the staff was preparing at the time to recommend that Thomas issue a
one-ppm standard. "It is legally and scientifically indefensible to set the [standard] at a level other than
optimum (e.g., 1 ppm)," reads the draft of a memo prepared for Thomas's approval.
A handwritten note scribbled on this draft, however, says a higher-level office, controlled not by staff
scientists but by political appointees, preferred a binding standard of four ppm, justified by the threat of
skeletal fluorosis, another effect of fluoride, but a much less common one. The note added, "And they
have the final say!"
The final draft, completed a few weeks later, concluded that dental fluorosis is merely a "cosmetic effect"
and recommends a binding standard of four ppm, and a voluntary one of two ppm When issued six
months later, the standard followed this recommendation.
One drinking water official believes Thomas succumbed to pressure. A native of South Carolina, a state
abundantly endowed with fluoride-rich water, Thomas listened not to his staff but to Republican Senator
Strom Thurmond, a relentless opponent of the fluoride standard. Edward Groth of the Consumers Union,
who wrote a doctoral dissertation on the fluoridation controversy, surmises that Thomas took "the path
of least resistance" in following the lead of the Surgeon General.
The technical staff was "devastated" at the decision to go with a standard of four ppm instead of one,
according to Paul Price, who managed the writing of the standard and its official justification issued by the
EPA. But, he says, once the decision was made, "there were arguments that could be made to justify it."
Water Fluoridation and Environmental Justice - a report submitted to the
EJ Interagency Working Group on September 25, 2015, from Fluoride Action Network
A4 p.665
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Price calls the struggle over fluoride regulation "a clash of two different cultures." The Public Health
Service, he says, was guided by a 1950s-era attitude that health problems are solved with medication and
that doctors know best; anyone questioning this is a crackpot. The Environmental Protection Agency, in
contrast, works on the principle — and is staffed with scientists who believe -- that nothing should be
allowed in drinking water unless its safety can be proven. This conviction dictates stringent regulations
justified by conservative analyses with ample margins of safety. In the case of fluoride, these two
philosophies collide.
In Colorado Springs, where dental fluorosis was first studied almost a century ago, fluoride levels today
reach nearly four ppm Dentist Terry Rich thinks this level is too high, though he concedes the city couldn't
afford a treatment plant even if regulators required it.
And he views the high level of fluoride in his city's water as an opportunity for business. "It could be a
money-making thing in my practice," he says, musing about treatment for people suffering from dental
fluorosis - "if only I could figure out a way to do it."
Water Fluoridation and Environmental Justice - a report submitted to the
EJ Interagency Working Group on September 25, 2015, from Fluoride Action Network
A4 p.666
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APPENDIX B
Hypothyroidism in the USA
The following is from the American Thyroid Association
http://www.thvroid.org/media-main/about-hvpothvroidism/
Prevalence and Impact of Thyroid Disease
More than 12 percent of the U.S. population will develop a thyroid condition during their lifetime.
~ An estimated 20 million Americans have some form of thyroid disease.
~ Up to 60 percent of those with thyroid disease are unaware of their condition.
~ Women are five to eight times more likely than men to have thyroid problems.
~ One woman in eight will develop a thyroid disorder during her lifetime.
~ Most thyroid cancers respond to treatment, although a small percentage can be very aggressive.
~ The causes of thyroid problems are largely unknown.
~ Undiagnosed thyroid disease may put patients at risk for certain serious conditions, such as
cardiovascular diseases, osteoporosis and infertility.
~ Pregnant women with undiagnosed or inadequately treated hypothyroidism have an increased
risk of miscarriage, preterm delivery, and severe developmental problems in their children.
~ Most thyroid diseases are life-long conditions that can be managed with medical attention.
Facts about the Thyroid Gland and Thyroid Disease
The thyroid is a hormone-producing gland that regulates the body's metabolism—the rate at which the
body produces energy from nutrients and oxygen—and affects critical body functions, such as energy
level and heart rate.
~ The thyroid gland is located in the middle of the lower neck.
~ Although the thyroid gland is relatively small, it produces a hormone that influences every cell,
tissue and organ in the body.
~ Hypothyroidism is a condition where the thyroid gland does not produce enough thyroid
hormone. Symptoms include extreme fatigue, depression, forgetfulness, and some weight gain.
~ Hyperthyroidism, another form of thyroid disease, is a condition causing the gland to produce
too much thyroid hormone. Symptoms include irritability, nervousness, muscle weakness,
unexplained weight loss, sleep disturbances, vision problems and eye irritation.
~ Graves' disease is a type of hyperthyroidism; it is an autoimmune disorder that is genetic and
estimated to affect one percent of the population.
Water Fluoridation and Environmental Justice - a report submitted to the
EJ Interagency Working Group on September 25, 2015, from Fluoride Action Network
A4 p.667
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APPENDIX C
Certain Thyroid-Related Diseases May Vary by Race:
Study looked at Graves', Hashimoto's thyroiditis among U.S. military personnel.
http://www.webmd.com/women/news/2014Q415/certain-thvroid-related-diseases-mav-varv-bv-
race
Race appears to be a factor in determining a person's risk of developing autoimmune thyroid conditions
such as Graves' disease or Hashimoto's thyroiditis, a new study in the Journal of the American Medical
Association (JAMA) says. African Americans and Asians are much more likely to develop Graves' disease
than whites are, according to the study published in the April 16, 2014 issue of JAMA. On the other hand,
whites have an increased risk of Hashimoto's thyroiditis when compared to other ethnic groups, the
researchers found.
The findings are based on analysis of medical records from all United States active duty military personnel
aged 20 to 54 from 1997 through 2011. "These stark race differences in the incidence of autoimmune
thyroid disease raise the important question of why?" said lead author Donald McLeod, an
endocrinologist and researcher at the QIMR Berghofer Medical Research Institute in Queensland,
Australia. "If we can work this out, we may unlock the mechanisms of autoimmune thyroid disease, and
potentially yield insights into other autoimmune disorders."
The thyroid gland plays a crucial role in regulating the body's metabolism, influencing how quickly a
person burns calories, how fast their heart beats, and how alert they feel. Graves' disease occurs when
the immune system begins producing an antibody that tricks the thyroid into producing too much
hormone. It's the most common cause of hyperthyroidism, and affects about one in every 200 people,
according to the U.S. National Institutes of Health (NIH).
Hashimoto's thyroiditis happens when the immune system attacks the thyroid gland itself, causing
hormone production to fall and causing hypothyroidism. Hashimoto's affects as many as 5 percent of
adults, according to the NIH.
The analysis found that, compared to whites, black women are about twice as likely and black men are
about two and a half times more likely to have Graves' disease.
Asian/Pacific Islander women had a 78 percent increased risk of Graves' disease compared to whites,
while Asian/Pacific Islander men had a more than threefold increased risk, the study noted. But the risk of
Hashimoto's in both blacks and Asian/Pacific Islanders was much lower than the risk among whites,
ranging from 67 percent to 78 percent less, the findings showed.
"The findings are striking, that there are so many more African Americans and Asian individuals who are
coded as having Graves'," said Dr. James Hennessey, director of clinical endocrinology at Beth Israel
Deaconess Medical Center in Boston. He was not involved with the new research.
Study author McLeod demurred when asked about how a person's race could influence their thyroid
function. "Our current study can't answer whether racial differences in autoimmune thyroid disease
incidence are due to genetics, environmental exposures or a combination of both," McLeod said. "Further
work needs to be performed to find the underlying mechanisms of thyroid autoimmunity."
In the paper, the researchers rule out one potential environmental influence — smoking. Smoking is
associated with an increased risk for Graves' and a decreased risk for Hashimoto's. But whites have the
highest smoking rates in the U.S. military, which runs counter to their increased risk for Hashimoto's and
lower risk for Graves', the study authors added.
Water Fluoridation and Environmental Justice - a report submitted to the
EJ Interagency Working Group on September 25, 2015, from Fluoride Action Network
A4 p.668
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APPENDIX D
Fluoride chemical species & Lead: No mention by EPA of lead-fluoride-chlorine interactions
Lead poses a health concern in two ways with the addition of fluoride chemicals to public drinking water,
and EPA needs to address the lead-fluoride interactions and the lead-fluoride-chlorine interactions.
1. First, lead is a known toxic contaminant in the industrial fluoride waste byproduct added to water at
levels that may exceed the EPA's 15 ppb maximum level and contributes to lead poisoning.
2. Second, fluoride leaches lead salts from any lead-based plumbing systems in older homes common in
poor urban areas heavily populated by low income, minority groups. There is a failure by public health
officials to adequately monitor for toxic lead that is being leached from the water piping system and
plumbing systems in fluoridated cities over decades, since hexafluorosilicic acid (likely the produced intact
silicic acid) causes lead to escape from common materials (brass) used in the water supply system
(reported as elevated blood lead levels in children that have been linked to fluoride in water (NRC 2006,
Coplan et al. 2007).
Research by Masters and Coplan (1999) and Westendorf (1975) provide evidence that fluoride in drinking
water increases blood lead levels and lead is a metal that interferes with acetylcholine esterase activity.
Acetylcholine esterase is a key enzyme playing a vital role in neurotransmission throughout the human
nervous system and one of the most fundamental enzymes in the body. Masters and Coplan (1999) stated
referring to the silicofluorides as "Sifts":
Unfortunately, and as surprising as it may seem, neither of these commercial-grade Sifts have
been properly (or officially) tested for safety in fluoridating drinking water. Indeed, their use in
water fluoridation has even been called an "ideal solution to a longstanding problem"ll as a way
to dispose of a highly toxic by-product that is otherwise an enormous health hazard to the local
environment. Meanwhile, our own research has revealedl2 and recently confirmedl3 a
statistically significant association between silicofluoride-treated water and elevated blood lead
levels, which, in turn, have disturbing implications in relation to their very unwelcome
neurological and sociological consequences.
A recent study in rats found a synergistic effect of significantly higher concentrations of lead in both the
blood and calcified tissues of animals that were exposed to both silicofluorides and lead (Sawan et al.
2010).
Masters and Coplan (2001) raised further concerns about silicofluorides interference effects on vital
biological enzymes such as acetylcholinesterase.
As pointed out in a recent comprehensive review,10 among the many different enzymes that
initiate, control, and terminate various chemical changes in the body, acetylcholinesterase is one
of the most fundamental. Therefore, in view of the extensive use of SiFs for water fluoridation
(estimated to be 200,000 tons per year in the United States), Westendorf s seminal findings take
on added importance in that they reveal that fluorosilicates are more potent in interfering with
acetylcholinesterase activity than uncomplexed fluoride. These SiFs are industrial grade materials
derived from HF and SiF4 emissions that are collected in water as toxic by-products in the
manufacture of phosphate fertilizers from fluoride-bearing rock phosphate. During that step
concentrated aqueous solutions of fluosilicic acid, H2SiF6, are formed containing residual HF and
SiF4, together with variable low concentrations of contaminants like lead, arsenic, cadmium,
beryllium, and heavy-metal radionuclides.
Water Fluoridation and Environmental Justice - a report submitted to the
EJ Interagency Working Group on September 25, 2015, from Fluoride Action Network
A4 p.669
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Recent analysis in Thunder Bay, Ontario, Canada (see below) shows that all 3 fluoride chemicals (H2SiF6 -
hexafluorosilicic acid, NaF - sodium fluoride, and Na2SiF6 - sodium silicofluoride) used in artificial water
fluoridation, increase the lead content in drinking water when lead pipes are used.
Fluoridation Impacts on Water Chemistry P3-4, Report No. 2009.123, (Thunder Bay, Ontario, 2009):
"The drinking water produced from the Bare Point Water Treatment Plant is taken from Lake
Superior and then treated. Water quality testing results of this source water have continually
shown that the Lake Superior water is of high quality, is soft, and of low alkalinity. Testing has
also demonstrated that the water is very low in dissolved major ions and metals. These
characteristics mean that the water is of excellent quality and as a result has little buffering
capacity - the ability to resist changes in the water chemistry.
The effects on the water chemistry of three fluoridating agents, hydrofluorosilicic acid, sodium
silicofluoride and sodium fluoride, were all tested on Bare Point drinking water in a laboratory
controlled setting. The impact the water chemistry with fluoride addition was tested to
determine whether the addition of fluoride would have a potential to increase the number
occurrences of elevated lead levels in the community.
The results of this preliminary study show that all fluoridating agents, when added to the
drinking water at a concentration of 0.7 ppm (the optimal fluoride concentration rate as
recommended by an expert panel convened by Health Canada in 2007), increased lead leaching
from the lead pipe."
Research by Maas et al. 2007 in the journal Neurotoxicology demonstrate that lead in solder and brass
metal in the water pipes, connections and other materials is also leached and released by all fluoride
chemicals used in urban artificial water fluoridation. Their synergistic effects with chlorine and/or
chloramine were demonstrated to increase the lead levels even further and yet the EPA has no discussion
of this lead leaching concern. Maas et al. (2007) found levels of lead leaching from brass when coming in
contact with fluorosilicic acid and chloramine:
CHLORAMINE, FLUOROSILICIC ACID & LEAD LEACHING FROM BRASS MATERIALS
Chemicals
Chlorine
Chloramine *
Chlorine & sodium fluoride
Chloramine* & sodium fluoride
Chlorine and fluorosilicic acid
Chloramine* & fluorosilicic acid
Chloramine** & fluorosilicic acid
Median Lead level
145.9 |ig/DL (1.5mg/L)
23.3 orami (0.23mg/L) or 233 ppb
185.3 |ig/DL (1.85mg/L)
28.1 |ig/DL (0.28mg/L)
362.8 |ig/DL (3.63mg/L) doubled
42.6 |ig/DL (0.43mg/L) doubled
83.1 |ig/DL (0.83mg/L) quadrupled
* with 100% extra ammonia added, to neutralize effect; note difference of one sample of
chloramine without this extra ammonia (at **)
** without extra ammonia.
Water Fluoridation and Environmental Justice - a report submitted to the
EJ Interagency Working Group on September 25, 2015, from Fluoride Action Network
A4 p.670
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Water Fluoridation and Environmental Justice - a report submitted to the
EJ Interagency Working Group on September 25, 2015, from Fluoride Action Network
A4 p.671
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APPENDIX E
119 State Reports on Oral Health
109 of these reports have no mention of dental or enamel fluorosis
10 reports include a mention of dental fluorosis:
2 reports give limited fluorosis statistics: 2009 California and 2014 Idaho
2 reports cite fluorosis only in a reference citation
The Alabama 2010 report presents the most information on fluorosis, albeit very briefly
Out of the 119 reports, five mention "White Spots" which could be dental fluorosis.
• The 2007 Georgia report notes: "20% of 2 to 5 year old Georgia Head Start children
surveyed have white spot lesions."
• The 2011 Washington state report gives the rate for White Spot Lesions in Head
Start/ECEAP Preschoolers at 20.5%, with African American children having the highest
percent.
State
Oral Health Report
Alabama
2007. Dental Screenings by % W/Decay. In order by Dental District and % W/Decay.
2006-2007.
http://fluoridealert.org/wp-content/uploads/al-2007.pdf
Note: 7,643 students were screened at 103 schools.
No mention of dental fluorosis.
Alabama
2012. The Oral Health of Alabama's Children, 2010-2012.
http://fluoridealert.org/wp-content/uploads/al-2012.pdf
No mention of dental fluorosis.
Alabama
2013. The Oral Health of Alabama's Kindergarten and Third Grade Children Compared
to the General U.S. Population and Healthy People 2020 Targets. Alabama Department
of Public Health Data Brief February.
http://fluoridealert.org/wp-content/uploads/al-2013.pdf
No mention of dental fluorosis.
Alaska
Undated. 13. Oral Health. Healthy Alaskans 2010-Volume 1.
http://www.fluoridealert.org/wp-content/uploads/ak.report.pdf
A 2 paragraph description of dental fluorosis is given.
Alaska
2007. Alaska Oral Health Plan: 2008-2012. By BJ Whistler. Women's, Children's and
Family Health, Division of Public Health, Alaska Department of Health and Social
Services. Funding for the State Oral Health Plan was provided by the U.S. Centers for
Disease Control and Prevention through the Chronic Disease Prevention and Health
Promotion Programs Cooperative Agreement (U58/CCU022905).
http://www.fluoridealert.org/wp-content/uploads/ak.2007.pdf
No mention of dental fluorosis.
< "White Spot Lesions" is mentioned on page 12:
"Develop or identify education materials for parental/caregiver recognition of early
enamel caries, 'white spot lesions', in relation to early childhood caries and prevention
efforts."
Alaska
2012. Alaska Oral Health Plan 2012-2016. Alaska Department of Health and Social
Services. July. Funding for the State Oral Health Plan was provided by the U.S. Centers
for Disease Control and Prevention through the Chronic Disease Prevention and Health
Promotion Programs Cooperative Agreement (U58/CCU022905).
http://fluoridealert.org/wp-content/uploads/ak-2012.pdf
No mention of dental fluorosis.
Water Fluoridation and Environmental Justice - a report submitted to the
EJ Interagency Working Group on September 25, 2015, from Fluoride Action Network
A4 p.672
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< "White Spot Lesions" is mentioned on page 35 using the same language as above.
Alaska
2013. Alaska Oral Health Surveillance System. Oral Health Program, Department of
Health and Social Services. November 1. Supported by a cooperative agreement with
the U.S. Centers for Disease Control and Prevention.
http://fluoridealert.org/wp-content/uploads/ak-2013.pdf
* Dental fluorosis mentioned once on page 12: "Rates of dental fluorosis, a cosmetic
condition in tooth enamel, may increase if fluoride levels in the drinking water are
chronically in excess of optimal fluoride levels."
Arizona
2005. The Oral Health of Arizona's Children. Current status, trends, and disparities.
Arizona Department of Health Services - Office of Oral Health. November.
http://fluoridealert.org/wp-content/uploads/az.2005.pdf
* Dental fluorosis mentioned once on page 18: "Consistent with
recommendations developed by the National Institute of Dental and
Craniofacial Research, each tooth surface was scored for decay, restorations,
sealants, fluorosis, trauma, premature loss, and eruption status. Additional
information was gathered to determine treatment urgency and referral
needs."
However, no statistics were given on dental fluorosis even though "More than
13,000 children received dental screenings." and "each tooth surface was
scored for decay, restorations, sealants, fluorosis, trauma, premature loss, and
eruption status..."
Arkansas
2002. Too Few Visits to the Dentist? The Impact on Children's Health. A Special Report
from Arkansas Advocates for Children & Families. February.
http://www.fluoridealert.org/wp-content/uploads/ar-2002.pdf
No mention of dental fluorosis.
Arkansas
Undated. Alaska Oral Health Assessment. Summary Report 2004-2005. By the State of
Alaska, Department of Health and Social Services, Division of Public Health, Oral Health
Program.
http://fluoridealert.org/wp-content/uploads/ak-2004-2005.pdf
No mention of dental fluorosis.
Arkansas
2007. Oral Health in Arkansas. By Mouden LD, Phillips MM, Sledge R, Evans V. Office of
Oral Health. August.
http://fluoridealert.org/wp-content/uploads/ar-2007.pdf
No mention of dental fluorosis.
Arkansas
2012. Arkansas Oral Health Plan 2012-2015. Arkansas Department of Health, Office of
Oral Health.
"Recommendation 2.8. Provide funding for public health clinic start up and
maintenance grants and other safety net programs including community health centers
and not-for-profit volunteer programs. Strategy: 1. On an ongoing basis, pursue funding
for community health center dental expansion and volunteer community programs
through the Tobacco Master Settlement Agreement and other funding mechanisms."
http://fluoridealert.org/wp-content/uploads/ar-2012.pdf
No mention of dental fluorosis.
Arkansas
2013. Office of Oral Health Surveillance Plan. Prepared by Abby Holt and Brian
Whitaker. Arkansas Department of Health.
"Community water fluoridation (CWF) is promoted through a CDC cooperative
agreement. Activities include presentations on the benefits and costs of CWF internally
within the ADH and externally to various governing bodies, community leaders and lay
citizens through the distribution of informational packets and campaigns to include
Water Fluoridation and Environmental Justice - a report submitted to the
EJ Interagency Working Group on September 25, 2015, from Fluoride Action Network
A4 p.673
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print and broadcast media. Internal partners include the ADH Section of Engineering
and the Office of Communications and Marketing among others."
http://fluoridealert.org/wp-content/uploads/ar-2013.pdf
No mention of dental fluorosis.
California
2006. "Mommy, it hurts to chew." The California Smile Survey. An Oral Health
Assessment of California's Kindergarten and 3rd Grade Children. Dental Health
Foundation. February.
http://fluoridealert.org/wp-content/uploads/ca-2006.pdf
"During the 2004-2005 school year we surveyed over 21,000 California children in
kindergarten or third grade, in nearly 200 randomly-selected schools spread across the
State..."
No mention of dental fluorosis.
California
2009. Research and public policy: dental caries and fluoridation. UCSF Dental Public
Health Seminar: Part 1. By Howard Pollick. October 6.
http://www.fluoridealert.org/wp-content/uploads/pollick-2009.pdf
* This is not a report published by the state. However, there is a discussion on dental
fluorosis and rates are given for "High Schools" 1993-94. It's difficult to read the small
chart in the report for the percent of severity of dental fluorosis.
Percent of dental fluorosis given for 10th graders teeth 1993-94:
Fluoridated Urban: 9.0%
Other Urban: 16.1%
Rural 7.9%
All Regions (lifetime residents): 11.5%
California
2009. Dental Health Fact Sheet 2009 [for Santa Clara]. By the Santa Clara Public Health
Department.
http://fluoridealert.org/wp-content/uploads/ca-2009.santa-clara.pdf
No mention of dental fluorosis.
California
2014. Sonoma County Smile Survey. An Oral Health Assessment of Sonoma County's
Kindergarten and Third Grade Children. Prepared by Jenny Mercado MPH,
Epidemiologist, Sonoma County Department of Health Services. November.
http://fluoridealert.org/wp-content/uploads/ca-2014.sonoma-countv.pdf
No mention of dental fluorosis.
Colorado
2000. Addressing the crisis of oral health access for Colorado's children. Colorado
Commission Children's Dental Health. A Report to the Honorable Bill Owens Governor,
State of Colorado. December 2.
"During the Colorado 2000 General Assembly session, through tobacco settlement
legislation, funds were designated for the improvement of the Child Health Plan Plus,
including the addition of a dental benefit to begin January 1, 2001, providing an
'adequate number of dentists are willing to provide services to eligible children.'"
http://www.fluoridealert.org/wp-content/uploads/co-2000.pdf
No mention of dental fluorosis.
Colorado
2005. Smart Mouths, Healthy Bodies: An Action Plan to Improve the Oral Health of
Coloradans. Prepared for Oral Health Awareness Colorado by the Colorado Department
of Public Health and Environment, Oral Health Program. Fall.
http://fluoridealert.org/wp-content/uploads/co-2005.pdf
No mention of dental fluorosis.
Colorado
2011-2015 Colorado Oral Health Surveillance System Plan. The Colorado Department
of Public Health and Environment.
http://fluoridealert.org/wp-content/uploads/co-2011 .pdf
No mention of dental fluorosis.
Colorado
2012. Colorado Oral Health Plan. Developed by Oral Health Colorado.
Water Fluoridation and Environmental Justice - a report submitted to the
EJ Interagency Working Group on September 25, 2015, from Fluoride Action Network
A4 p.674
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http://fluoridealert.org/wp-content/uploads/co-2012.pdf
No mention of dental fluorosis.
Connecticut
2007. Oral Health in Connecticut. Connecticut Department of Public Health.
http://www.fluoridealert.org/wp-content/uploads/ct.report.2007.pdf
* A definition of dental fluorosis is given: "However, excessive fluoride consumption
can cause mottled enamel or fluorosis (i.e. whitish or brownish spots on teeth). Dental
fluorosis results from the ingestion of high levels of fluoride during tooth development
in children less than 8 years old."
Connecticut
2012. The Oral Health of Connecticut's Children. Connecticut Department of Public
Health, Office of Oral Health. October. This publication was supported by the
Cooperative Agreement Number 5U58DP001534-04 from The Centers for Disease
Control and Prevention
http://www.fluoridealert.org/wp-content/uploads/ct-2012.pdf
Key findings:
— Dental decay continues to be a significant public health problem for CT's children
— There are significant oral health disparities in CT with minority and low-income
children having the highest level of dental disease.
No mention of dental fluorosis.
Connecticut
2013. Oral Health Improvement Plan for Connecticut 2013-2018. Connecticut Coalition
for Oral Health. This publication was supported by the Cooperative Agreement Number
5U58DP001534-05 from the Centers for Disease Control and Prevention.
http://www.fluoridealert.org/wp-content/uploads/ct-2013.pdf
No mention of dental fluorosis.
Delaware
2002. Delaware Oral Health Assessment of Third Grade Children. Delaware Health and
Social Services, Division of Public Health. May.
http://www.fluoridealert.org/wp-content/uploads/de-2002.pdf
No mention of dental fluorosis.
Delaware
2013. KIDS COUNT in Delaware Issue Brief. Oral Health. By the Center for Community
Research, University of Delaware (Newark DE). Spring.
This document (oral health issue brief) with funding provided by HRSA # T12HP14660.
http://fluoridealert.org/wp-content/uploads/de-2013.pdf
No mention of dental fluorosis.
Delaware
2013-b. Delaware Smiles. The Oral Health of Delaware's Children. Delaware Health and
Social Services, Bureau of Oral Health and Dental Services. August.
PROJECT FUNDING. Title V Block Grant, Delaware Division of Public Health, Maternal
and Child Health Bureau.
http://fluoridealert.org/wp-content/uploads/de-2013-b.pdf
No mention of dental fluorosis.
Delaware
2014. Delaware Oral Health Plan 2014. Goals and Objectives. Delaware Health and
Social Services, Bureau of Oral Health and Dental Services. June 5.
http://fluoridealert.org/wp-content/uploads/de-2014.pdf
No mention of dental fluorosis.
District of
Columbia
2006. Behavioral Risk Factor Surveillance System (BRFSS) 2006 Annual Report.
Government of the District of Columbia, Department of Health, Center for Policy,
Planning and Epidemiology.
"The BRFSS is conducted for the District of Columbia Department of Health, with
funding and guidance provided by the CDC of the U.S. Public Health Service."
http://www.fluoridealert.org/wp-content/uploads/dc.2006.pdf
No mention of dental fluorosis.
District of
Columbia
2007. Issue Brief: Oral Health is Critical to the School Readiness of Children in
Washington, DC. By Altarum Institute and funded by Maternal and Child Health Bureau,
Health Resources and Services Administration, U.S. Department of Health and Human
Water Fluoridation and Environmental Justice - a report submitted to the
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Services.
http://www.fluoridealert.org/wp-content/uploads/dc-2007.pdf
No mention of dental fluorosis.
Florida
2013. Florida Oral Health Metrics. A Florida Public Health Institute Report.
Report prepared by the Urban Health Solutions Research and Writing Team (Bello L, Dye
M, Garces A, Rovira 1, McCabe B). This report was made possible with generous support
from the DentaQuest Foundation.
http://fluoridealert.org/wp-content/uploads/fl-2013.pdf
No mention of dental fluorosis.
Florida
Undated (after 2012). Statewide Oral Health Surveillance Program: The Third Grade
Basic Screening Survey. By D. Solovan-Gleason, Florida Department of Health.
http://fluoridealert.org/wp-content/uploads/fl-statewide-third-graders.pdf
No mention of dental fluorosis.
Georgia
2006. Oral Health of Georgia's Children. Results from the 2005 Third Grade Oral
Health Survey. By the Georgia Department of Human Resources. April. Funding was
provided through the Health Resources and Services Administration, States Oral Health
Collaborative Systems Grant, Georgia's Access to Dental Services Grant/GADS III
http://fluoridealert.org/wp-content/uploads/ga-2006.pdf
No mention of dental fluorosis.
Georgia
2007. Status of Oral Health in Georgia, 2007. Summary of Oral Health Data Collected
in Georgia. Authors: Levin E, Kanny D, Duval T, Koskela L. Georgia Department of
Human Resources. November. Publication Number: DPH07.155WH.
http://fluoridealert.org/wp-content/uploads/ga-2007.pdf
No mention of dental fluorosis.
< WHITE SPOT LESIONS MENTIONED: "20% of 2 to 5 year old Georgia Head Start
children surveyed have white spot lesions."
"White Spot Lesions (WSL) - Considers only the six maxillary anterior (upper front)
teeth and is defined as white spots found only at the cervical 1/3 of the tooth, with or
without a break in the enamel surface, and with or without brown staining. The
presence of WSL identifies a child as being "at risk for Early Childhood Caries (ECC)"
Georgia
2012. Georgia's Oral Heath Plan. Georgia Oral Health Coalition, Division of Health
Promotion, Maternal and Child Health Section, Oral Health Prevention Program. This
effort was made possible in part by funding from Centers for Disease Control and
Prevention, Division of Oral Health, Oral Health Prevention Infrastructure Cooperative
Agreement.
http://fluoridealert.org/wp-content/uploads/ga-2012.pdf
No mention of dental fluorosis.
Hawaii
2001. Oral Health 2001: A strategic Plan for Oral Health in Hawai'i. Produced by
Hawai'i Primary Care Association. The Frear Eleemosynary Trust, the Mclnerny
Foundation, and the G.N. Wilcox Trust, provided funds to support the planning process
and production of this document.
http://fluoridealert.org/wp-content/uploads/hi-2001.pdf
No mention of dental fluorosis.
Hawaii
Undated. Hawaii Community Focus Groups Determine Priorities for Oral Health
Research. By Harrigan R, DeCambra H, Easa D, Strauss R, Greer M, Beck J.
http://fluoridealert.org/wp-content/uploads/hi-undated.harrigan.et .al .pdf
Acknowledgments: This investigation/manuscript/etc. was supported by a NIDCR R-21
award (DE15020-01) "A Study of Oral Health Disparities in Adult Asian & Pacific
Islanders" and a Research Centers in Minority Institutions (NCRR) award, P20 RR11091,
from the National Institutes of Health.
No mention of dental fluorosis.
Note from Fluoride Action Network: Hawaii is a series of volcanic islands. On the Big
Water Fluoridation and Environmental Justice - a report submitted to the
EJ Interagency Working Group on September 25, 2015, from Fluoride Action Network
A4 p.676
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110
Island volcanic smog (VOG) is a maior issue. Off-gassing chemicals of greatest concern
include hyrdrogen fluoride, a source for exposure for children to dental fluorosis.
Hawaii
2014. Oral Health Surveillance in Hawaii, 2014. Presented by Donald Hayes, MD, MPH,
CDC Assigned Epideniologist, Hawaii Department of Health, Family Services Division.
October 2.
http://fluoridealert.org/wp-content/uploads/hi-2014.pdf
No mention of dental fluorosis.
Idaho
2008. Idaho Oral Health Plan 2008-2013. The Idaho Department of Health and Welfare.
http://fluoridealert.org/wp-content/uploads/id-2008a.pdf
No mention of dental fluorosis.
Idaho
2014. Idaho Smile Survey. 2013 Report. Prepared by Ward Ballard, Research Analyst,
Principal. Idaho Department of Health & Welfare.This report was supported by the
Maternal and Child Health Block Grant and the Cooperative Agreement
1U58DP004914-01 from the Centers for Disease Control and Prevention.
http://fluoridealert.org/wp-content/uploads/id-2014.pdf
• FLUOROSIS is mentioned on pages 2, 12,13, 20
• The rate for severe fluorosis (teeth show brown spots or pitting) was 0.1 percent
for2013 for all third-grade students
• Percent of Idaho Third-Grade Students with Fluorosis, 2001-2013:
2001: 8.7%
2005: 11.4%
2009: 7.8%2013: 5.8%
Illinois
2001 or 2002. Proceedings of the Illinois Oral Health Summit and the Illinois Oral
Health Plan. Illinois' response to the U.S. Surgeon General's report: Oral Health in
America. Partial funding to support the Illinois Oral Health Summit was provided by The
federal Health Resources and Services Administration and The Association of State and
Territorial Dental Directors.
http://fluoridealert.org/wp-content/uploads/il-2001.pdf
No mention of dental fluorosis.
Illinois
2007. CSHCN Oral Health Report. Illinois IFLOSS Coalition.
http://fluoridealert.org/wp-content/uploads/il-2007.pdf
No mention of dental fluorosis.
Illinois
2007. Oral Health Care in Illinois. The Illinois Oral Health Plan II. Spring. A compendium
of information presented to the Illinois public by IFLOSS.
http://fluoridealert.org/wp-content/uploads/il-2007-c.pdf
No mention of dental fluorosis.
Illinois
2007. Illinois Oral Health Surveillance System (IOHSS). By Sangeeta Wadhavan, BDS,
MPH, Oral Health Epidemiologist, Illinois Department of Public Health. NOHC 2007.
http://fluoridealert.org/wp-content/uploads/il-2007-b.pdf
No mention of dental fluorosis.
Indiana
2009. Indiana Strategic Oral Health Initiative (SOHI). Project Report. 2009. Center for
Health Policy (09-C43) School of Public and Environmental Affairs Indiana University-
Purdue University Indianapolis; and the Indiana State Department of Health.
http://fluoridealert.org/wp-content/uploads/in-2009.pdf
No mention of dental fluorosis.
Indiana
2013. The Oral Health of Indiana's Third Grade Children Compared to the General U.S.
Third Grade Population. Indiana State Department of Health Data Brief. December.
http://fluoridealert.org/wp-content/uploads/in-2013.pdf
No mention of dental fluorosis.
Iowa
2006. Oral Health Survey Report: FY06. Report prepared by Tracy Rogers and Xia Chen.
Water Fluoridation and Environmental Justice - a report submitted to the
EJ Interagency Working Group on September 25, 2015, from Fluoride Action Network
A4 p.677
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Ill
Iowa Department of Public Health, Oral Health Bureau.
http://fluoridealert.org/wp-content/uploads/ia-2006.pdf
No mention of dental fluorosis.
Iowa
2009. Third Grade Open Mouth Survey Report. Iowa Department of Public Health, Oral
Health Bureau.
http://fluoridealert.org/wp-content/uploads/ia-2009.pdf
No mention of dental fluorosis.
Kansas
2004. The Oral Health of Kansas Children 2004. By Kimminau KS and Huang CC of the
Kansas Health Institute; and McGlasson D and Kim J. of the Kansas Department of
Health and the Environment.
http://fluoridealert.org/wp-content/uploads/ks-2004.pdf
No mention of dental fluorosis.
Kansas
2011. Kansas Oral Health Plan 2011-2014. Kansas Department of Health and
Environment. January. Funding was provided by the U.S. Centers for Disease Control
and Prevention through the Cooperative Agreement ( 1U5 8/ DP002834 - 01).
http://fluoridealert.org/wp-content/uploads/ks-2004.pdf
No mention of dental fluorosis.
Kentucky
2006. Statewide Oral Health Strategic Plan - 2006. The Commonwealth of Kentucky.
• PAGE 50: Fluoride Varnish is currently funded through federal tobacco settlement
dollars.
• PAGE 4: This program is called KIDS SMILE and is funded from the tobacco settlement
funds for children 0 through 5 years of age.
• Early childhood funding through Kentucky's Federal Tobacco Settlement creates
numerous opportunities.
• CHANGE OPPORTUNITIES: 18. Tobacco tax for oral health.
http://fluoridealert.org/wp-content/uploads/kv-2006.pdf
No mention of dental fluorosis.
Kentucky
2007. Kentucky's Oral Health Poses Challenges. By Michael T. Childress and Michal
Smith-Mello. Foresight, No. 50.
http://fluoridealert.org/wp-content/uploads/kv-2007.pdf
No mention of dental fluorosis.
Kentucky
2008. Using Cartograms to Illustrate Disparities in Oral Health in Kentucky. By Saman
DM, Arevalo 0, Johnson AO. University of Kentucky.
http ://fluoridealert. org/wp-content/uploads/kv -2008. pdf
No mention of dental fluorosis.
Louisiana
2006. Oral Health Survey Report: FY06. Report prepared by Tracy Rogers and
Xia Chen. Iowa Department of Public Health, Oral Health Bureau.
http://fluoridealert.or2/wp-content/uploads/ia-2006.pdf
No mention of dental fluorosis.
Louisiana
Undated. Louisiana Statewide Oral Health Coalition. State Plan for 2010-2013. By the
Louisiana Statewide Oral Health Coalition.
http ://fluoridealert .org/wp-content/uploads/la-state-plan-2010-2013 .pdf
No mention of dental fluorosis.
Louisiana
2010. Oral Health in Louisiana. A document on the oral health status of Louisiana's
population. By Rishu Garg, Oral Health Program Epidemiologist/Evaluator. Department
of Health and Hospitals, Oral Health Program. July.
The creation of this document was made possible with funding from the Centers for
Disease Control and Prevention, Division of Oral Health by Cooperative Agreement
DP08-802.
http://fluoridealert.org/wp-content/uploads/la-2010.pdf
* ENAMEL FLUOROSIS MENTIONED:
Water Fluoridation and Environmental Justice - a report submitted to the
EJ Interagency Working Group on September 25, 2015, from Fluoride Action Network
A4 p.678
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112
Fluoride supplements (page 34): "It is recommended that the risk of tooth decay should
be weighted before issuing a prescription for these supplements in children younger
than 6 years of age because these supplements also increase the risk of enamel
fluorosis."
Fluoride mouth rinse (page 34)"Children under 6 years old are not recommended to
use it without the prescription of a dentist because of the risk of enamel fluorosis as
they tend to swallow it more often than adults."
Fluoride gel and foam (page 34): "These are usually applied in dental offices and pose
less of a threat for fluorosis in children younger than six because of the big intervals in
between the applications... Fluoride varnish has a fluoride concentration of 22,600
ppm..."
Louisiana
2011. Bright Smiles for Bright Futures. Basic Screening Survey. By Rishu Garg, MD,
MPH, A Report of the Oral Health Status of Louisiana's Third Grade Children.
http://fluoridealert.org/wp-content/uploads/la-2011 .pdf
No mention of dental fluorosis.
Maine
2007. Maine Oral Health Improvement Plan. Published by the Maine Dental Access
Coalition. November.
http://fluoridealert.org/wp-content/uploads/me-2007.pdf
No mention of dental fluorosis.
Maine
2013. Oral Health in Maine. Bv Feinstein J, Gradie Ml, Huston S, Mervis C, Ghouri, F,
Nazare S, et al. The Maine Center for Disease Control and Prevention, an office of the
Department of Health and Human Service. January.
No mention of dental fluorosis.
Maryland
2007. Survey of the oral health status of Maryland school children 2005-2006. Authors:
Richard J. Manski RJ, Chen H, Chenette RR, Coller S. University of Maryland Dental
School.
http://fluoridealert.org/wp-content/uploads/md-2007.pdf
No mention of dental fluorosis.
Maryland
2011. Maryland Oral Health Plan 2011-2015. Holt K., ed. Maryland Dental Action
Coalition.
http://fluoridealert.org/wp-content/uploads/md-2011.pdf
This publication was made possible with support from the DentaQuest Foundation and
the Division of Oral Health, Centers for Disease Control and Prevention, U.S.
Department of Health and Human Services.
No mention of dental fluorosis.
Maryland
2012 Annual Oral Health Legislative Report as required by Health-General
Article, Sections 13-2504(b) and 13-2506 and HB 70 (Ch. 656 of the Acts of
2009).
http://fluoridealert.org/wp-content/uploads/md-2012.pdf
No mention of dental fluorosis.
Maryland
2013. Oral Health Survey of Maryland School Children, 2011-2012. By Macek MD,
Coller S, Chen H, Manski RJ, Manz M, Altema-Johnson D, Goodman HS. University of
Maryland School of Dentistry.
http://fluoridealert.org/wp-content/uploads/md-2013.pdf
No mention of dental fluorosis.
Massachusetts
2008. The Oral Health of Massachusetts' Children. By White BA, Monopoli MP, Souza
BS. Catalyst Institute. January.
Assessment and report funded in part by Delta Dental of Massachusetts and the
Association of State and Territorial Dental Directors (see acknowledgments for all
funders).
http://fluoridealert.org/wD-content/uDloads/ma-2008.Ddf
Water Fluoridation and Environmental Justice - a report submitted to the
EJ Interagency Working Group on September 25, 2015, from Fluoride Action Network
A4 p.679
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113
* ONLY MENTION OF DENTAL FLUOROSIS IS ONE REFERENCE CITATION.
Massachusetts
2010. Oral Health Plan for Massachusetts 2010-2015. Better Oral Health for
Massachusetts Coalition.
http://fluoridealert.org/wp-content/uploads/ma-2010.pdf
No mention of dental fluorosis.
Michigan
2006. Michigan Oral Health Plan. Michigan Department of Community Health;
Michigan Oral Health Coalition. September. Funding for the State Oral Health Plan was
provided by the Centers for Disease Control and Prevention through the Chronic
Disease Prevention and Health Promotion Programs Component 4: Chronic Disease
Prevention and Health Promotion Programs (U58/CCU522826).
http://fluoridealert.org/wp-content/uploads/mi-2006.pdf
No mention of dental fluorosis.
Minnesota
2006. Minnesota Oral Health Data Book. Children and Youth. By the Minnesota
Department of Health, Community and Family Health Division. October. Funded by the
U.S. Department of Health and Human Services Health Resources and Services
Administration Grant Number H47MC02019.
http://fluoridealert.org/wp-content/uploads/mn-2006.pdf
* ONLY MENTION OF DENTAL FLUOROSIS IS ONE REFERENCE CITATION.
Minnesota
2013. The Status of Oral Health in Minnesota. By Khan B, Adeniyi A, Thoele MJ.
Minnesota Department of Health, Oral Health Program. September. Funding sources:
CDC Division of Oral Health Cooperative Agreement funding, DP08-802. Health
Resources and Services Administration grants to states to support oral health workforce
activities, T12HP14659.
http://fluoridealert.org/wp-content/uploads/mn-2013.pdf
No mention of dental fluorosis.
Minnesota
2013b. Minnesota Oral Health Plan. 2013-2018. Minnesota Department of Health, Oral
Health Program. January. Funding was made possible by grants to support statewide
oral health related activities from the Health Resources and Services Administration,
Award T12HP1465, and Centers for Disease Control Prevention, Cooperative
Agreement Grant Number 5U58DP0011579.
http://fluoridealert.org/wp-content/uploads/mn-2013b.pdf
No mention of dental fluorosis.
Mississippi
2006. State of Mississippi Oral Health Plan 2006-2010. By the Mississippi Department
of Health.
http://fluoridealert.org/wp-content/uploads/ms-2006.pdf
No mention of dental fluorosis.
Mississippi
Undated. Every Smile Counts. The Oral Health of Mississippi's Third Grade Children
2009-2010 School Year. By the Mississippi State Department of Health, Office of Oral
Health.
http://fluoridealert.org/wp-content/uploads/ms-2009-2010-school-vear.pdf
No mention of dental fluorosis.
Missouri
2005. The Oral Health of Missouri's Children. Executive Summary. Missouri Department
of Health and Senior Services, Oral Health Program.
http ://fluoridealert. org/wp-content/uploads/mo.2005. pdf
No mention of dental fluorosis.
Missouri
2014. Oral Health in Missouri 2014: A Burden Report by the Missouri Department of
Health and Senior Services.
http://fluoridealert.org/wp-content/uploads/mo-2014.pdf
No mention of dental fluorosis.
Montana
2006. Montana Oral Health Plan. Montana's response to "A National Call to Action to
Promote Oral Health, Healthy People 2010, and the Future of Dentistry". Montana
Department of Public Health and Human Services.
Water Fluoridation and Environmental Justice - a report submitted to the
EJ Interagency Working Group on September 25, 2015, from Fluoride Action Network
A4 p.680
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114
http://fluoridealert.org/wp-content/uploads/mt-2006.pdf
No mention of dental fluorosis.
Montana
2007. Montana 2005-2006 Study of Oral Health Needs: 3rd Graders and Head Start
Children. By Rosina Everitte, MPH. June 22.
http://fluoridealert.org/wp-content/uploads/mt-2007.pdf
No mention of dental fluorosis.
Nebraska
2005. Open Mouth Survey of Third Graders Nebraska 2005. Nebraska Department of
Health and Human Services Regulation and Licensure. Funding was provided through
SSDI, a project of the U.S. Department of Health and Human Services, Health Resources
and Services Administration, Maternal and Child Health Bureau, HRSA/MCHB grant
number HI8MC00031C0.
http ://fluoridealert. org/wp-content/uploads/ne-2005 .pdf
No mention of dental fluorosis.
Nevada
2008 Nevada State Oral Health Plan. Department of Health and Human Services,
Nevada State Health Division, Bureau of Family Health Services. April.
Funding for the 2008 State Oral Health Summit was provided by: The Department of
Health and Human Services Health Resources and Services Administration Centers for
Disease Control and Prevention Division of Oral Health
http://fluoridealert.org/wp-content/uploads/nv-2008.pdf
No mention of dental fluorosis.
Nevada
2009. Third Grade Oral Health Survey 2008-2009. Department of Health and Human
Services, Nevada State Health Division, Oral Health Program.
http://fluoridealert.org/wp-content/uploads/nv-2009.pdf
No mention of dental fluorosis.
Nevada
2011. Nevada Oral Health Surveillance Plan. By Pool C, Hansen AC, Cofano L.January.
Department of Health and Human Resources. The report is a draft, there is no final available.
http://fluoridealert.ors/wp-content/uploads/nv-2011 .draft .no-final.pdf
No mention of dental fluorosis.
Nevada
2012-2013 Head Start Oral Health Survey. Nevada. Department of Health and Human
Services, Nevada State Health Division, Oral Health Program. February 2013.
http://fluoridealert.org/wp-content/uploads/nv-2013 .pdf
No mention of dental fluorosis.
New
Hampshire
2003. New Hampshire Oral Health Plan: A Framework for Action. Coalition for New
Hampshire Oral Health Action.
http://fluoridealert.org/wp-content/uploads/nh-2003.pdf
No mention of dental fluorosis.
New
Hampshire
2010. New Hampshire 2008-09 Third Grade Healthy Smiles - Healthy Growth Survey.
Oral Health and Body Mass Index Assessment of New Hampshire 3rd Grade Students.
By the N.H. Department of Health and Human Services. July.
Funded by: HNH foundation, Northeast Delta Dental Foundation, New Hampshire
Department of Health and Human Services.
http://fluoridealert.org/wp-content/uploads/nh-2010-b.pdf
No mention of dental fluorosis.
New
Hampshire
2010. New Hampshire Oral Health Data 2010. By the New Hampshire Department of
Health and Human Services, Oral Health Program. March.
http://fluoridealert.org/wp-content/uploads/nh-2010.pdf
No mention of dental fluorosis.
New Jersey
2009. Pediatric Oral Health Action Plan for New Jersey's Children Aged 0-6. Funded by
New Jersey Head Start-State Collaboration Grant and The Association of State and
Territorial Dental Directors. April.
http://fluoridealert.org/wp-content/uploads/ni-2009.pdf
No mention of dental fluorosis.
Water Fluoridation and Environmental Justice - a report submitted to the
EJ Interagency Working Group on September 25, 2015, from Fluoride Action Network
A4 p.681
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115
New Mexico
2006. New Mexico Oral Health Surveillance System. NMORSS Special Report on
Children 2006. Office of Oral Health, Health Systems Bureau, New Mexico Department
of Health. Funding was provided by State Oral Health Collaborative Systems Grant, #
H47MC01945, Health Resources Services Administration, US Department of Health and
Human Services.
http://fluoridealert.org/wp-content/uploads/nm-2006.pdf
No mention of dental fluorosis.
New Mexico
2006. New Mexico Oral Health Surveillance System. NMOHSS Special Report on the
Border Counties 2006. Office of Oral Health, Health Systems Bureau, New Mexico
Department of Health. Funding was provided by State Oral Health Collaborative
Systems Grant, # H47MC01945, Health Resources Services Administration, US
Department of Health and Human Services.
http://fluoridealert.org/wp-content/uploads/nm-2006-b.pdf
* Dental fluorosis is mentioned on page 5. "The EPA- established Maximum
Contaminant Level Goal (MCLG) for fluoride is currently 4 mg/L; higher levels
increase the risk of severe enamel fluorosis (discoloration, enamel loss, and pitting of
the teeth during tooth development in children).
New York
2005. Oral Health Plan for New York State. By the New York State Department of
Health. August. This effort was made possible in part by funding from Centers for
Disease Control and Prevention, Division of Oral Health, Cooperative Agreement 03022.
http://fluoridealert.org/wp-content/uploads/nv-2005-b.pdf
No mention of dental fluorosis.
New York
2005. Oral Health Status of Third Grade Children. By Kumar JV, Altshul DL, Cooke TL,
Green EL. New York State Oral Health Surveillance System. December 15.
http://fluoridealert.org/wp-content/uploads/nv-2005.pdf
No mention of dental fluorosis.
New York
2005. Children's Oral Health. By the Schuyler Center for Analysis and Advocacy (Albany
NY).
http://fluoridealert.org/wp-content/uploads/nv-2005.schuvler-center.pdf
No mention of dental fluorosis.
New York
2012. Oral Health in New York Citv. A data report from the New York Citv Department
of Health. NYC Vital Signs, Volume 11, No. 5, June 2012.
No mention of dental fluorosis.
New York
2014. Oral Health Plan for New York State. December 2014. By the New York State
Department of Health. December. This effort was made possible in part by funding from
Centers for Disease Control and Prevention, Division of Oral Health, Cooperative
Agreement 03022.
http://fluoridealert.org/wp-content/uploads/nv-2014.pdf
No mention of dental fluorosis.
North Carolina
2013. North Carolina Oral Health Section. Kindergarten and Fifth Grade Oral Health
Status. County Level Summary 2012-2013. North Carolina Division of Public Health,
Dental Health Section.
http://fluoridealert.org/wp-content/uploads/nc-2013.pdf
No mention of dental fluorosis.
North Carolina
2014. Revised Statewide Oral Health Strategic Plan: Collaboration for Integrated and
Comprehensive Oral Health. North Carolina Department of Health and Human Services.
February 1.
http://fluoridealert.org/wp-content/uploads/nc-2014-ocr.pdf
No mention of dental fluorosis.
< "WHITE SPOT LESIONS' is mentioned on page 22.
North Dakota
2005. North Dakota Oral Health Survey 2004-2005 School Year. Prepared by Kathy
Phipps, DrPH, ASTDD Data Coordinator, Morrow Bay, CA.
Water Fluoridation and Environmental Justice - a report submitted to the
EJ Interagency Working Group on September 25, 2015, from Fluoride Action Network
A4 p.682
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116
http://fluoridealert.org/wp-content/uploads/nd-2005.pdf
No mention of dental fluorosis.
North Dakota
2012. Oral Health in North Dakota. Burden of Disease and Plan for the Future 2012-
2017. North Dakota Oral Health Department, North Dakota Department of Health.
Funding for this publication was obtained through cooperative agreement #DP08-802
between the U.S. Centers for Disease Control and Prevention (CDC) and the North
Dakota Department of Health (NDDoH).
http://fluoridealert.org/wp-content/uploads/nd-2012.pdf
No mention of dental fluorosis.
Ohio
2013. Oral Health Section 2013 Plan. Ohio Department of Health.
http://fluoridealert.org/wp-content/uploads/oh-2013 .pdf
No mention of dental fluorosis.
Ohio
2014. Ohio Oral Health Surveillance Plan, 2014-2018. Ohio Department of Health.
February 1.
http://fluoridealert.org/wp-content/uploads/oh-2014.pdf
No mention of dental fluorosis.
Oklahoma
2009. Governors Task Force on Children and Oral Health. August.
http://fluoridealert.org/wp-content/uploads/ok-2009.pdf
No mention of dental fluorosis.
Oklahoma
2013. Oklahoma Oral Health Needs Assessment 2013. Third Grade Children. By the
Oklahoma State Department of Health, Dental Health Service.
http://fluoridealert.org/wp-content/uploads/ok-2013 .pdf
No mention of dental fluorosis.
Oregon
2014. Oregon Oral Health Surveillance System 2002-2014. By the Oregon Health
Authority, Public Health Division, Oral Health Program.
http://fluoridealert.org/wp-content/uploads/or-2014.pdf
No mention of dental fluorosis.
Oregon
2014. Strategic Plan for Oral Health in Oregon: 2014-2020. Oregon Oral Health
Coalition, Oregon Health Authority, Oregon Health Funders Collaborative.
http://fluoridealert.org/wp-content/uploads/or-2014-b.pdf
No mention of dental fluorosis.
Pennsylvania
2002. Oral Health Strategic Plan for Pennsylvania. Commonwealth of Pennsylvania
Department of Health. November 2002.
http://fluoridealert.org/wp-content/uploads/pa-2002.pdf
No mention of dental fluorosis.
Rhode island
2011. Rhode Island Oral Health Plan, 2011-2016. Rhode Island Oral Health Commission,
Rhode Island Department of Health. January. This publication was made possible in part
by funding from the Centers for Disease Control and Prevention, Division of Oral Health,
Cooperative Agreement 08802 and the Health Resources and Services Administration,
Division of Medicine and Dentistry, Grant #T12HP14663.
http://fluoridealert.org/wp-content/uploads/ri-2011 .pdf
No mention of dental fluorosis.
Rhode island
2012. Oral Health of Rhode Island's Children. By the Rhode Island Department of
Health, Oral Health Program. February. Authored byJunhie Oh, BDS, MPH, Oral Health
Epidemiologist/Evaluator; Deborah Fuller, DMD, MS, Dental Sealant Program
Coordinator/Public Health Dentist, Oral Health Program.
http://fluoridealert.org/wp-content/uploads/ri-2012.pdf
No mention of dental fluorosis.
South Carolina
2008. South Carolina State Oral Health Plan. Update May 26, 2008.
http://fluoridealert.org/wp-content/uploads/sc-2008.pdf
No mention of dental fluorosis.
Water Fluoridation and Environmental Justice - a report submitted to the
EJ Interagency Working Group on September 25, 2015, from Fluoride Action Network
A4 p.683
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117
South Dakota
2014. The Oral Health of South Dakota's Third Grade Children Compared to the
General U.S. Third Grade Population. South Dakota Department of Health Data Brief
June 2014.
http://fluoridealert.org/wp-content/uploads/sd-2014.pdf
No mention of dental fluorosis.
South Dakota
2015. Oral Health Plan for South Dakota, 2015-2020. South Dakota Oral Health
Coalition. Spring.
http://fluoridealert.org/wp-content/uploads/sd-2015.pdf
No mention of dental fluorosis.
Tennessee
2010. Tennessee Smiles: The UT Grassroots Oral Health Outreach Initiative. By Lewis
MW, Wasson W, Scarbecz M, Aubertin MA, Woods M, Himel VT. Journal of the
Tennessee Dental Association. 91-4.
• See reference 67
http://fluoridealert.org/wp-content/uploads/tn-2010.pdf
No mention of dental fluorosis.
Texas
2008. Oral Health in Texas 2008. By the Texas Department of State Health Service, the
Centers for Disease Control and Prevention, and the U.S. Department of Health and
Human Services. DSHS OHP acknowledges the funding and technical support received
from the Division of Oral Health at the Centers for Disease Control and Prevention,
Atlanta, Georgia, in making this document available to the citizens of Texas as provided
through Cooperative Agreement No. U58/CCU622789-0.
http://fluoridealert.org/wp-content/uploads/tx-2008.pdf
No mention of dental fluorosis.
Utah
2012. Utah's Plan of Action to Promote Oral Health. A Public-Private Partnership, Utah
Oral Health Coalition. December 20.
http://fluoridealert.org/wp-content/uploads/ut-2012.pdf
No mention of dental fluorosis.
Vermont
2014. Vermont Oral Health Plan 2014. By the Vermont Department of Health.
http://fluoridealert.org/wp-content/uploads/vt-2014.pdf
No mention of dental fluorosis.
Virginia
2011. Oral Health in Northern Virginia. A report commissioned by the Northern Virginia
Health Foundation. September 2011.
http://fluoridealert.org/wp-content/uploads/va-201 l.northern-va.pdf
No mention of dental fluorosis.
Washington
2009. Washington State Collaborative Oral Health Improvement Plan 2009-2014.
Washington State Oral Health Coalition. November. Acknowledgment: Federal funding
from HRSA Grant T12HP10687, CFDA 93.236.
http://fluoridealert.org/wp-content/uploads/wa-20091.pdf
No mention of dental fluorosis.
Washington
2011. Smile Survey 2010. The Oral Health of Washington's Children. By the
Washington State Department of Health; Delta Dental Washington Dental Service
Foundation; Washington State Department of Early Learning. March.
http://fluoridealert.org/wp-content/uploads/wa-2011.pdf
No mention of dental fluorosis.
< WHITE SPOT Lesions mentioned in Tables 7,8,9,10.
WHITE SPOT LESIONS in Head Start/ECEAP Preschoolers is 20.5%
WHITE SPOT: Head Start/ECEAP Preschoolers by race:
25.3%, African-American
20.7%, Minority
20.6%, White, Non-Hispanic
17.5%, Hispanic
Water Fluoridation and Environmental Justice - a report submitted to the
EJ Interagency Working Group on September 25, 2015, from Fluoride Action Network
A4 p.684
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118
West Virginia
2010. West Virginia Oral Health Plan 2010-2015. By the West Virginia Department of
Health & Human Resources. March 2010.
http://fluoridealert.org/wp-content/uploads/wv-2010.pdf
No mention of dental fluorosis.
Wisconsin
2012. The Health of Dane County. The Oral Health Crisis. Produced by the Public Health
Madison & Dane County and the Oral Health Coalition of Dane County. May.
http://fluoridealert.org/wp-content/uploads/wi-2012.dane-countv.pdf
No mention of dental fluorosis.
Wisconsin
2013 - Healthy Smiles / Healthy Growth. Wisconsin's Third Grade Students. By Olson
M, Chaffin J, Chudy N, Yang A.
The publication was made possible in part by funding from two grants from the Centers
for Disease Control and Prevention. The Division of Oral Health, Cooperative Agreement
DP08-802 and the Division of Nutrition, Physical Activity and Obesity Cooperative
Agreement 5U58DP001494-05.
http://fluoridealert.org/wp-content/uploads/wi-2013.pdf
No mention of dental fluorosis.
Wisconsin
2013b. Wisconsin's Roadmap to Improving Oral Health 2013-2018. Wisconsin Oral
Health Coalition. This publication was made possible in part by funding from the Centers
for Disease Control and Prevention, Division of Oral Health, Cooperative Agreement
DP08-802.
http://fluoridealert.org/wp-content/uploads/wi-2013b.pdf
No mention of dental fluorosis.
Wyoming
2010. Oral Health in Wyoming. Final Report. Wyoming Department of Health.
http://fluoridealert.org/wp-content/uploads/wv-2010.pdf
No mention of dental fluorosis.
Water Fluoridation and Environmental Justice - a report submitted to the
EJ Interagency Working Group on September 25, 2015, from Fluoride Action Network
A4 p.685
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119
APPENDIX F
Pro-Fluoridation groups have also ignored dental fluorosis
The Pew foundation has probably been the most active foundation in promoting community
water fluoridation since 2008 by setting up health care coalitions across the country to
vigorously support fluoridation. According to Pew's main fluoridation campaigner, Matt Jacob
(2012), Pew's outreach to states for community water fluoridation (CWF) included the following:
• Arkansas: "Funded a poll and offered other assistance to pass a state mandate in 2011."
• California: "Provided assistance to a successful campaign to secure CWF in San Jose."
• Kansas: "Assisted oral health advocates in Wichita pass a fluoridation policy."
• Mississippi: "Provided message training for oral health field staff."
• Montana: "Assisted successful effort to preserve CWF in the city of Bozeman."
• New Hampshire: "Helped defeat a statewide ban on CWF."
• Oregon: "Offering funds and research for a campaign [referendum] in Portland."
• Wisconsin: "Provided research and technical assistance to preserve CWF in Milwaukee."
• In May 2011, The Pew Center on the States, a major funder of pro-fluoridation groups,
published The State of Children's Health: Making Coverage Matter (Pew, 2011,
http://fluoridealert.org/wp-content/uploads/pew-2011.pdf). There is no discussion of
dental fluorosis in this report.
• In July 2015, a report titled, Fluoridation Advocacy: Pew's Contributions and Lessons that
Emerge (http://fluoridealert.org/wp-content/uploads/pew.iulv-2015.pdf) contained one
citation on fluorosis (page 3) that came from the CDC's "FAQs for Dental Fluorosis." The Pew
Charitable Trusts commissioned the Children's Dental Health Project (CDHP) to prepare this
report. CDHP funders include the CDC, DHHS, Colgate-Palmolive and the W.K. Kellogg
Foundation. An individual from the American Dental Association is on its board. There was one
citation to African-Americans (page 15): "To build this consensus [for working on a referendum
for fluoridation], Upstream formed a diverse coalition of Portland organizations called Healthy
Kids, Healthy Portland (HKHP). The coalition included the African Women's Coalition, the Asian
Pacific American Network of Oregon, Familias en Accion, Kaiser Permanente Northwest,
Lutheran Community Services and the Oregon Business Association. (See below, Portland
Oregon: Money given to minority groups to support fluoridation)
• On the Children's Dental Health Project (CDHP) website ( https://www.cdhp.org/ ) a search
for "fluorosis" had two hits:
¦ April 27, 2015: "... The updated level for fluoride is expected to help reduce
enamel fluorosis. Fluorosis is a change in the appearance of tooth enamel that
does not affect the health or function of the teeth.[In 2006 the NRC-2006 report
stated that severe dental fluorosis was an adverse health effect.] Typically,
fluorosis in the U.S. is a mild, cosmetic condition that leaves faint, white spots or
streaks on the surface of teeth. The effect is subtle, which is why many people
with fluorosis don't even notice it; it often takes a dental professional to
recognize it..." https://www.cdhp.org/blog/316-hhs-updates-fluoride-level
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¦ January 10, 2011: Quote from Burton Edelstein, President of CDHP, "In no way
does this adjustment mean that public health authorities are backing off of their
commitment to fluoridating water" said Edelstein. "In fact, capping water levels
at the newly recommended level (0.7 parts per million) is the best way to meet
children's needs while also reducing the chance that a child will develop
fluorosis. Edelstein added that "Parents can take steps to limit the chance of
fluorosis from toothpaste by supervising tooth brushing."
https://www.cdhp.org/resources/219-public-health-officials-reconfirm-
value-of-water-fluoridation-while-adiusting-recommended-levels
• On Pew's website (http://www.pewtrusts.org/en/proiects/childrens-dental-policv)
Children's Dental Policy, a search for fluorosis gets 2 hits:
- Quote from Bill Maas, Advisor, Pew Children's Dental Campaign (and former
Director of the Division of Oral Health at the CDC): "Opponents have also raised
concerns about community water fluoridation leading to severe cases of dental
fluorosis. Fluorosis is a change in appearance of the tooth's enamel. Nearly all fluorosis
in the U.S. is not harmful and results in white streaks on the teeth that are barely
noticeable. Severe fluorosis can cause enamel damage and brown spots, but that
problem is rare in our country, afflicting only people on private well water." -
http://www.pewtrusts.org/en/research-and-analvsis/q-and-a/2011/12/08/bill-
maas-water-fluoridation
- FAQ's: Q. What is dental fluorosis? Dental fluorosis is a change in the appearance of
tooth enamel that occurs when someone is exposed to too much fluoride. In the U.S.,
fluorosis is typically a minor discoloration of teeth that is usually visible only to a dentist.
It does not cause pain, and it does not affect the health or function of the teeth. The
new HHS recommendation reflects the fact that Americans today receive fluoride from
more sources (toothpaste, mouth rinses, and other products) than they were getting
several decades ago. In 2006, the National Research Council examined water sources
with a range of naturally occurring fluoride levels and found that severe fluorosis
virtually never occurs in levels below 2 parts per million. Public water systems fluoridate
at a concentration that's well below that level. -
http://www.pewtrusts.org/en/research-and-analvsis/q-and-a/2011/ll/ll/water-
fluoridation-frequentlv-asked-questions
• In the Pew sponsored Campaign for Dental Health website http://ilikemvteeth.org/ , there
were two "hits" for African Americans:
¦ A 2012 citation to a $9 million grant to the UCLA School of dentistry to give
access to the city's Latino and African American children (birth to 5 years). -
http://ilikemvteeth.org/million-dollar-grant-aims-increase-dental-care-
access-las-voungest/
¦
-Another 2012 citation noting, "U.S. National Health Interview Surveys from
1964 to 2010 showed that the once blatant racial gap in kid's dental care has
been eliminated... African-American kids still have higher rates of cavities, and
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there are still children of all races who do not have access to dental care." -
http://ilikemvteeth.org/children-race-dentist/
There is no mention on the websites of the Children's Dental Health Project, the Children's
Dental Policy or Pew's Campaign for Dental Health of another neurotoxin that children are
exposed to: mercury in dental amalgams. The FDA defines them as, "is a mixture of metals,
consisting of liquid (elemental) mercury and a powdered alloy composed of silver, tin, and
copper. Approximately 50% of dental amalgam is elemental mercury by weight." -
http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/DentalProducts/Den
tal Am al gam/ ucm 1710 94. htm
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APPENDIX G
Civil Rights Leaders have begun to mobilize to end fluoridation's threat to minority
communities
This section contains the following:
May 21, 2015. Letter from William Owens, Coalition of African American Pastors, to Rep. Barry
Loudermilk, Chairman, House Subcommittee on Oversight / Science, Space, & Technology Committee,
Washington, DC.
http://fluoridealert.org/wp-content/uploads/owens-mav.ll.2015.pdf
November 11, 2014. Resolution of the Santa Rosa-Sonoma County NAACP Opposing Fluoridation of Our
Public Water Supply.
http://fluoridealert.org/wp-content/uploads/sonoma.calif .naacp .nov-2014.pdf
April 17, 2013. Portland NAACP Opposes fluoridation.
http://fluoridealert.org/news/portland-naacp-opposes-fluoridation/
July 1, 2011. Civil Rights Violation Regarding Forced Medication. Resolution of the League of United Latin
American Citizens.
http://lulac.org/advocacv/resolutions/2011/resolution Civil Rights Violation Regarding Forced M
edication/
June 22, 2011. Another King family member speaks out as Fluoridegate scandal builds in Atlanta.
http://fluoridealert.org/news/another-king-familv-member-speaks-out-as-fluoridegate-scandal-
builds-in-atlanta/
April 6, 2011. Letter from Matt Young, DDS, President, International Academy of Oral Medicine and
Toxicology, to Thomas Frieden, MD, MPH, Director, Centers for Disease Control and Prevention, Atlanta,
GA.
http://fluoridealert.Org/wp-content/uploads/iaomt-letter-to-cdc-april.6.2011.pdf
March 29, 2011. Letter from Andrew Young to Chip Rogers, Senate Majority Leader, Georgia State Capitol,
Atlanta, GA.
http://fluoridealert.org/wp-content/uploads/voung-andrew.letter-march.29.2011.pdf
March 9, 2011. Letter from Dr. Gerald L. Durley, Pastor, Providence Baptist Church, to Senator Chip
Rogers, Senate Majority Leader, Georgia State Capital, Atlanta. Re: Repeal of Georgia's Mandatory
Fluoridation Law.
http://fluoridealert.org/wp-content/uploads/durlev 2011.pdf
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APPENDIX H
On January 7, 2011, the U.S. Department of Health and Human Services (HHS) announced its
recommendation to reduce the level of fluoride added to drinking water based on national survey data
showing that 41% of American adolescents (ages 12-15) now have dental fluorosis (a tooth defect
caused by excess fluoride consumption during childhood). On January 13, 2011, the HHS published a
Federal Register notice proposing to reduce the recommended fluoride level from the existing range
of 0.7 to 1.2 parts per million (ppm) to 0.7 ppm. HHS solicited public comments on their
recommendation. The Fluoride Action Network's submission to HHS is reproduced in full below. Over
18,000 emails were sent to HHS in support of FAN's submission.
Fluoride Action Network
February 4, 2011
To HHS and Honorable Secretary Sebelius
In response to your request for comments on the recent change in your recommended level of fluoride
added to community drinking water, I respectfully submit the following points supporting the stance that
a reduction in fluoride levels is not sufficient, and that the United States should follow the approach of
western Europe and end water fluoridation completely:
~ Fluoride is not a nutrient, nor is it essential for healthy teeth. No study has ever revealed a
diseased state resulting from lack of fluoride, including dental caries. (1,2) No American is, or
ever was, "fluoride deficient."
~ Using the water supply to mass medicate the population is unethical. The public water supply
should not be used as a drug-delivery system without regard for an individual's age, weight,
health status, or knowledge of how fluoride will interact with other drugs they are taking. No
informed consent is requested or given, and no medical follow-up is offered.
~ The benefit and safety of ingested fluoride has never been proved by accepted medical
standards. The HHS has failed to inform the public that there is not a single randomized
controlled trial (the gold standard of medical research) that demonstrates the effectiveness of
water fluoridation. (3) HHS has also failed to inform the public that the Food and Drug
Administration has never studied, or approved, the safety of fluoride supplements and continues
to classify all fluoride supplements as "unapproved new drugs." (4, 5) Lastly, HHS has failed to
inform the public that tooth decay rates have declined at the same general rate in all western,
industrialized countries, irrespective of water fluoridation status. (6)
~ Any benefits of fluoride are primarily topical, not systemic. The CDC has acknowledged this for
over a decade (7). The Iowa Fluoride Study, funded by HHS, has reported little, if any,
relationship between individual fluoride intake and caries experience. According to the study (the
largest of its kind): "achieving a caries-free status may have relatively little to do with
fluoride intake, while fluorosis is clearly more dependent on fluoride intake." (8)
~ Americans will still be over-exposed to fluoride at 0.7 ppm. According to EPA's recent
documents "it is likely that most children, even those that live in fluoridated communities, can be
over-exposed to fluoride at least occasionally. (9) At present, nearly 41% of American
adolescents aged 12-15 have some form of dental fluorosis (10), an outwardly visible sign of
fluoride toxicity. Reducing the fluoride levels to 0.7 ppm will not remedy this problem as national
statistics clearly show that dental fluorosis remains significantly elevated at 0.7 ppm. (11)
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Drinking water is just one source of ingested fluoride; others include foods, beverages, dental
products and supplements, pesticides and pharmaceuticals. For communities that practice
artificial water fluoridation, this is the easiest source of fluoride to remove.
~ Infants will not be protected. Infants fed formula made with fluoridated tap water—at the
reduced level of 0.7 ppm—will still receive up to 175 times more fluoride than a breast-fed
infant. In their supporting documents, EPA has not calculated the risks to the bottle-fed infant. In
fact, infants from birth to six months of age were completely excluded from any consideration by
EPA, despite HHS's own admission that "The period of possible risk for fluorosis in the permanent
teeth...extends from about birth through 8 years of age." (12) As the most susceptible
subpopulation, the potential for long-term, irreparable damage to developing infants must be
seriously considered, and should extend beyond just their teeth.
~ African-American children and low-income children will not be protected. HHS's reference (p.
2386) to the study by Sohn et al. (13) failed to mention that African-American and low-income
children were found to consume significantly more total fluids and plain water, and thus receive
more fluoride from drinking water, than white or higher-income children. African-Americans
have been shown to have an increased risk of developing dental fluorosis, and are at higher risk
for suffering from the more severe forms of this condition. (14) Despite receiving high intakes of
fluoride, low-income and minority children living in fluoridated communities continue to suffer
from rampant and severe dental decay (15-18)—undermining the common premise that
fluoridation will prevent these problems. Additionally, low-income children have a greater risk
for suffering from all forms of fluoride toxicity, as poor diet exacerbates the detrimental effects
of fluoride. This is clearly, therefore, an environmental justice issue.
~ HHS has failed to consider fluoride's impact on the brain. Over 100 animal studies have
observed fluoride-induced brain damage (19), 24 human studies have reported lowered IQ in
children exposed to various levels of fluoride (20), and at least 6 other studies have found non-IQ
neurological effects such as impaired visuo-spatial organization. (21-26) One study of 500
children in China observed reduced IQ at a water fluoride level of 1.9 ppm (27, 28) and another
reported a reduction in IQ at even lower (mean=1.3 ppm) water fluoride levels. (29) HHS's new
recommendation of 0.7 ppm offers no adequate margin of safety to protect all of our children,
including those with iodine deficiencies (30-32), from experiencing similar neurological damage.
~ HHS has failed to consider fluoride as an endocrine disruptor. The 2006 NRC report (33) states
that fluoride is an endocrine disruptor, and even at low levels can be detrimental to the thyroid
gland. Pre- and post-natal babies, people with kidney disease, and above-average water drinkers
(including diabetics and lactating women) are especially susceptible to the endocrine disrupting
effects of fluoride in drinking water.
~ HHS has failed to consider or investigate current rates of skeletal fluorosis in the U.S. According
to EPA's supporting document (34), there is a general lack of information on the prevalence of
stage II skeletal fluorosis in the U.S. Yet, many of the symptoms of stage II skeletal fluorosis (e.g.
sporadic pain, stiffness of the joints) are identical to arthritis (35-40), which affects at least 46
million Americans. People with renal insufficiency are known to be at an elevated risk for
developing skeletal fluorosis (33), as crippling stage III skeletal fluorosis with renal deficiency has
been documented in the U.S. at water fluoride levels as low as 1.7 ppm. (41) Since skeletal
fluorosis in kidney patients has been detected in small case studies, it is likely that systematic
studies would detect skeletal fluorosis at even lower fluoride levels.
~ HHS has failed to consider fluoride as a potential carcinogen. Bassin et al. (42) reported a
significantly elevated risk of osteosarcoma in boys living in fluoridated communities, and thus
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fluoride may be a carcinogen. Chester Douglass, who has serious conflicts-of-interest concerning
fluoride research, has stated that a subsequent study will refute these findings (43), but no
publication has appeared in the five years since he made this claim. As EPA has still not
completed carcinogenicity testing for fluoride, HHS should not support the addition of a potential
carcinogen to our drinking water.
~ HHS has failed to consider fluoride as a potential carcinogen. Bassin et al. (42) reported a
significantly elevated risk of osteosarcoma in boys living in fluoridated communities, and thus
fluoride may be a carcinogen. Chester Douglass, who has serious conflicts-of-interest concerning
fluoride research, has stated that a subsequent study will refute these findings (43), but no
publication has appeared in the five years since he made this claim. As EPA has still not
completed carcinogenicity testing for fluoride, HHS should not support the addition of a potential
carcinogen to our drinking water. HHS has failed to consider or investigate current rates of
skeletal fluorosis in the U.S. According to EPA's supporting document (34), there is a general lack
of information on the prevalence of stage II skeletal fluorosis in the U.S. Yet, many of the
symptoms of stage II skeletal fluorosis (e.g. sporadic pain, stiffness of the joints) are identical to
arthritis (35-40), which affects at least 46 million Americans. People with renal insufficiency are
known to be at an elevated risk for developing skeletal fluorosis (33), as crippling stage III skeletal
fluorosis with renal deficiency has been documented in the U.S. at water fluoride levels as low as
1.7 ppm. (41) Since skeletal fluorosis in kidney patients has been detected in small case studies, it
is likely that systematic studies would detect skeletal fluorosis at even lower fluoride levels.
~ HHS has failed to confirm the safety of silicofluorides. Despite being used in more than 90% of
artificial water fluoridation schemes, no chronic toxicity testing of silicofluorides has ever been
completed: "No short-term or subchronic exposure, chronic exposure, cytotoxicity, reproductive
toxicity, teratology, carcinogenicity, or initiation/promotion studies were available" for the
toxicological summary for silicofluorides, as prepared for the National Institute of Environmental
Health Sciences. (44) However, recent epidemiological research has found an association
between the use of silicofluoride-treated community water and increased blood lead
concentrations in children (45) - a link that is consistent with recent laboratory findings. (46) HHS
has failed to inform the American public that the fluoridating agent used in drinking water is a
hazardous waste product from the phosphate fertilizer industry, and can be laced with arsenic
and radionuclides, (47, 48) which are known carcinogens. HHS should not support the addition of
a non-tested substance to our drinking water.
Most of the arguments listed above are covered in far more detail in the recently published book "The
Case Against Fluoride" by Connett, Beck and Micklem (Chelsea Green, 2010). We urge director Sebelius to
appoint a group of experts from HHS, who have not been involved in promoting fluoridation, to provide a
fully documented scientific response to the arguments and evidence presented in this book. Were
director Sebelius to do this we strongly believe that neither she nor these experts will want to see the
practice of water fluoridation continue. The practice is unnecessary, unethical and hitherto the benefits
have been wildly exaggerated and the risks minimized. A scientific response to this book from a HHS team
would allow the public to judge the cases both for and against fluoridation on their scientific and ethical
merits.
References:
1. National Research Council. 1993. Health Effects of Ingested Fluoride. Washington, D.C.: National
Academy Press. Page 30.
2. Letter from the Presidents of the National Academy of Sciences and the Institute of Medicine to
Albert W. Burgstahler, Ph.D. and others. January 12, 1999.
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3. McDonagh M, Whiting PF, Wilson PM, Sutton AJ, Chestnutt I, Cooper J, Misso K, Bradley M,
Treasure E, Kleijnen J. 2000. A systematic review of public water fluoridation. NHS Center for
Reviews and Dissemination. University of York.
4. Kelly JV. 1993. Letter from John V. Kelly, Assemblyman 36th District, New Jersey State
Legislature, to Dr. David Kessler, M.D., Commissioner, United States Food and Drug
Administration, Rockville, Maryland. June 3.
5. Plaisier MK. 2000. Letter from Melinda K. Plaisier, Associate Commissioner for Legislation,
Department of Health and Human Services, Public Health Service, Rockville, MD, to Honorable
Ken Calvert, Chairman, Subcommittee on Energy and Environment Committee on Science, House
of Representatives, Washington DC. December 21.
6. Tooth Decay Trends in Fluoridated vs. Unfluoridated Countries. Fluoride Action Network.
7. Centers for Disease Control and Prevention. 2001. Recommendations for using fluoride to
prevent and control dental caries in the United States. MMWR 50(RR14):l-42. August 17.
8. Warren JJ, Levy SM, Broffitt B, Cavanaugh JE, Kanellis MJ, Weber-Gasparoni K. 2009.
Considerations on optimal fluoride intake using dental fluorosis and dental caries outcomes—a
longitudinal study. J Pub Health Dent 69(2):lll-5.
9. U.S. Environmental Protection Agency. December 2010. Fluoride: Exposure and Relative Source
Contribution Analysis. EPA 820-R-10-015. Page 109.
10. Beltran-Aguilar ED, Barker L, Dye BA. 2010. Prevalence and severity of dental fluorosis in the
United States, 1999-2004. NCHS data brief, no 53. Hyattsville, MD: National Center for Health
Statistics.
11. Heller KE, Eklund SA, Burt BA. 1997 Dental caries and dental fluorosis at varying water fluoride
concentrations. J Public Health Dent. 57(3):136-43. Figure 4.
12. U.S. Department of Health and Human Services. January 2011. Proposed HHS recommendation
for fluoride concentration in drinking water for prevention of dental caries. Federal Register
76(9):2383-8.
13. Sohn W, Heller KE, Burt BA. 2001. Fluid consumption related to climate among children in the
United States. J Pub Health Dent 61(2):99-106.
14. Beltran-Aguilar E, Barker L, Dye BA. 2010. Prevalence and Severity of Dental Fluorosis in the
United States, 1999-2004. NCHS Data Brief.
15. Burt BA, Kolker JL, Sandretto AM, Yuan Y, Sohn W, Ismail Al. 2006. Dietary patterns related to
caries in a low-income adult population. Caries Research 40(6):473-80.
16. Shiboski CH, Gansky SA, Ramos-Gomez F, Ngo L, Isman R, Pollick HF. 2003. The association of
early childhood caries and race/ethnicity among California preschool children. J Pub Health Dent
63(l):38-46.
17. Won Burg MM, Sanders BJ, Weddell JA. 1995. Baby bottle tooth decay: a concern for all
mothers. Pediatric Nursing 21(6):515-9.
18. Barnes GP, Parker WA, Lyon TC Jr, Drum MA, Coleman GC. 1992. Ethnicity, location, age, and
fluoridation factors in baby bottle tooth decay and caries prevalence of head start children.
Public Health Reports 107(2):167-73.
19. Connett P, Beck J, Micklem H S. 2010. The Case Against Fluoride. How Hazardous Waste Ended
Up in Our Drinking Water and the Bad Science and Powerful Politics That Keep It There. Vermont:
Chelsea Green Publishing. Appendix 1.
20. Fluoride and IQ: The Studies. Fluoride Action Network. Updated January 2010.
21. Rocha-Amador D, Navarro M, Trejo-Acevedo A, Carrizales L, Perez-Maldonado I, Diaz-Barriga F,
Calderon J. 2009. Use of the Rey-Osterrieth Complex Figure Test for neurotoxicity evaluation of
mixtures in children. Neurotoxicology 30(6):1149-54.
22. Li J, Yao L, Shao QL, Wu CY. 2004. Effects of high fluoride level on neonatal neurobehavioural
development. Chinese Journal of Endemiology 23:464-465 (republished in Fluoride 41:165-70).
23. Calderon J, Machado B, Navarro M, Carrizales L, Ortiz MD, Diaz-Barriga F. 2000. Influence of
fluoride exposure on reaction time and visuospatial organization in children. Epidemiology
11(4):S153.
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24. Yu Y, Yang W, Dong Z, Wan C, Zhang J, Liu J, Xiao K, Huang Y, Lu B. 1996. Neurotransmitter and
receptor changes in the brains of fetuses from areas of endemic fluorosis. Chinese J Endemiology
15: 257-259 (republished in Fluoride 41(2):134-8).
25. Du L. 1992. The effect of fluorine on the developing human brain. Chinese Journal of Pathology
21(4):218-20 (republished in Fluoride 41:327-30).
26. Han H, Cheng Z, Liu W. 1989. Effects of fluorine on the human fetus. Chinese Journal of Control
of Endemic Diseases 4:136-138 (republished in Fluoride 41:321-6).
27. Xiang Q, Liang Y, Chen L, Wang C, Chen B, Chen X, Zhou M. 2003. Effect of fluoride in drinking
water on children's intelligence. Fluoride 36(2):84-94.
28. Xiang Q, Liang Y, Zhou M, Zang H. 2003. Blood lead of children in Wamiao-Xinhuai intelligence
study. Fluoride 36(3):198-9. Online at
29. Ding Y, Gao Y, Sun H, Han H, Wang W, Ji X, Liu X, Sun D. 2010. The relationships between low
levels of urine fluoride on children's intelligence, dental fluorosis in endemic fluorosis areas in
Hulunbuir, Inner Mongolia, China. J Hazard Materials doi: 10.1016/j.jhazmat.2010.12.097.
30. Ge Y, Niu R, Zhang J, Wang J. 2011. Proteomic analysis of brain proteins of rats exposed to high
fluoride and low iodine. Archives of Toxicology 85(l):27-33.
31. Guan ZZ, Zhuang ZJ, Yang PS, Pan S. 1988. Synergistic action of iodine deficiency and fluorine
intoxication on rat thyroid. Chin Med J 101(9):679-84.
32. Lin FF, Aihaiti, Zhao HX, Jin L, Jiang JY, Maimaiti, and Aiken. 1991. The relationship of a low-iodine
and high-fluoride environment to subclinical cretinism in Xinjiang. Iodine Deficiency Disorder
Newsletter 7(3).
33. National Research Council. 2006. Fluoride in Drinking Water: A Scientific Review of EPA's
Standards. Washington, D.C.: National Academies Press. 507 pp.
34. U.S. Environmental Protection Agency. December 2010. Fluoride: Dose-Response Analysis for
Non-cancer Effects. EPA 820-R-10-019.
35. Gupta R, Kumar AN, Bandhu S, Gupta S. 2007. Skeletal fluorosis mimicking seronegative arthritis.
Scandanavian Journal of Rheumatology 36(2):154-5.
36. Savas S, Cetin M, Akdogan M, Heybell N. 2001. Endemic fluorosis in Turkish patients: relationship
with knee osteoarthritis. Rheumatology International 21:30-5.
37. Hileman B. 1988. Fluoridation of water. Questions about health risks and benefits remain after
more than 40 years. Chemical and Engineering News, 26-42. August 1.
38. Czerwinski E, Nowak J, Dabrowska D, Skolarczyk A, Kita B, Ksiezyk M. 1988. Bone and joint
pathology in fluoride-exposed workers. Archives of Environmental Health 43:340-3.
39. Teotia SPS, Teotia M, Teotia NPS. 1976. Symposium on the Non-Skeletal Phase of Chronic
Fluorosis: The Joints. Fluoride 9:19-24
40. Singh A, Jolly SS. 1970. Chronic toxic effects on the skeletal system. In: Fluorides and Human
Health. World Health Organization, pp. 238-49..
41. Johnson WJ, Taves DR, Jowsey J. 1979. Fluoridation and bone disease. Pp. 275-293 in: Continuing
Evaluation of the Use of Fluorides. E Johansen, DR Taves, and TO Olsen, eds. AAAS Selected
Symposium. Boulder, CO: Westview Press.
42. Bassin EB, Wypij D, Davis RB, Mittleman MA. 2006. Age-specific fluoride exposure in drinking
water and osteosarcoma (United States). Cancer Causes and Control 17(4):421-8.
43. Douglass CW, Joshipura K. 2006. Caution needed in fluoride and osteosarcoma study. Cancer
Causes and Control 17(4):481-2.
44. Haneke KE and Carson BL. 2001. Sodium Hexafluorosilicate [CASRN 16893-85-9] and Fluorosilicic
Acid [CASRN 16961-83-4]: Review of Toxicological Literature. Prepared for Scott Masten, Ph.D.,
National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina.
Contract No. N01-ES-65402.
45. Coplan MN, Patch SC, Masters RD, Bachman MS. 2007. Confirmation of and explanations for
elevated blood lead and other disorders in children exposed to water disinfection and
fluoridation chemicals. Neurotoxicology Sep;28(5):1032-42.
46. Maas RP, Patch SC, Christian AM, Coplan MJ. 2007. Effects of fluoridation and disinfection agent
combinations on lead leaching from leaded-brass parts. Neurotoxicology Sep;28(5):1023-31.
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47. Hanmer R. 1983. Letter to Leslie A. Russell, D.M.D, from Rebecca Hanmer, Deputy Assistant
Administrator for Water, US EPA. Mar 30, 1983.
48. Hazan S. 2000. Letter from Stan Hazan, General Manager, Drinking Water Additives Certification
Program, NSF International; to Mr. Juan (Pepe) Menedez, State of Florida, Department of Public
Health, Tallahassee FL. April 24.
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APPENDIX I
The Nex0 Method
Some information from:
http: //www.nexodentcom
This public health dental program is based on similar principles as the ChildSmile system
in Scotland, but is more comprehensive. It was developed in Denmark, with the initial
trial in a community named Nex0. The results were so dramatic in rapidly lowering
caries rates that the method has been extended to other communities irt Denmark and
other countries. Today, Denmark has the lowest childhood caries rates in the developed
world according to WHO data [WHO 2015], and Denmark has never been fluoridated.
The caries rates over time in Nex0 compared to those in the rest of Denmark which was
not using Nex0 Method, are shown in the graphs below. The first period 1978-1979 was
the baseline period before the Nex0 program began. The first graph is for primary
teeth, dmfs:
Fig 2 def-s 5-yr-olds
, , 1978/79 - 2004: Next and Denmark
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8
6
4
2
0
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oo
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For permanent teeth in 15 year olds, DMFS:
Water Fluoridation and Environmental Justice - a report submitted to the
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A4 p.696
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DMF-S
20
15 -¦
Fig 4: DMF-S, 15-yr-olds
1980/81 - 2004: and Denmark
] Nex0
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When compared to the primary teeth, the permanent teeth took several years before
the reduction in caries caught up to the Denmark level. Nex0 started out as a high
caries area, because it had relatively low SES compared to the rest of Denmark. The
slower rate of improvement is likely because the children were already almost 15 years
old when the program started. However, by 1995, by which time the 15 year olds had
continuous exposure to the method since infancy, the benefit was already very
dramatic. The DMFS rate was only 1.03 in Nex0 compared to 4.01 in Denmark, for a
400% lowering. The largest difference ever claimed by water fluoridation has been
about 70%, and today the claim is typically a 25% lowering of DMFS rates. By 2004 the
rate in Nex0 was just 0.56 compared to 2.85 in the rest of Denmark, a 500% reduction.
These rates are all measures of decay by tooth surface ("S" for surfaces), not "T" for
entire tooth, so they are higher than a tooth score.
The success of the Nex0 Method has been documented in peer-reviewed scientific
papers, both in Denmark and in other countries where it has been tried [Ekstrand 2005].
Here is the brief summary of the Nex0 method itself:
A dental health care program based on individualized non-operative caries
treatment of children and adolescents aged 0-18. The aim of the program is to
maintain sound teeth using the fewest resources possible.
The treatment program is based on 3 principles - dosed at individually assessed
recalls according to diagnosis and risk assessment:
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1. Education of parents, children and adolescents in understanding
Dental caries as a localized disease.
2. Intensive training in home-based plaque control.
3. Early professional non-operative intervention.
All parents and children in a community are given free oral hygiene training starting at 8
months age and continuing frequently through age 18. Parents and children are shown
how to do proper oral hygiene and are checked to see how they are doing at each visit.
If oral hygiene is not adequate or any caries starts developing, the next visit is scheduled
sooner. Topical fluoride is given only if oral hygiene is not adequate or caries starts
developing. Systemic fluorides are never considered. Even sealants are avoided
because they are considered less effective than proper oral hygiene.
If any fillings or dental work is required, they are provided in a timely manner.
The program gets parents and children receiving frequent oral health visits throughout
childhood. Dental auxiliaries perform most of the work rather than dentists to save
expense.
The economics of the Nex0 Method have also been examined using careful scientific
and economic analyses [Ekstrand 2005, Vermaire 2013]. They found that the dramatic
reduction in caries requiring treatment outweighs any additional cost for more frequent
prevention visits. This net economic long-term benefit was found even in the context of
an area like Denmark that has relatively low caries rate. For areas with high caries rates,
due to low socio-economic status for example, the economic benefit would likely be
higher.
REFERENCES:
Ekstrand KR, Christiansen ME. Outcomes of a non-operative caries treatment
programme for children and adolescents. Caries Res. 2005;39(6):455-467.
http://www.karger.com/Article/Abstract/88180
Ekstrand KR, Kuzmina IN, Kuzmina E, Christiansen ME. Two and a half-year outcome of
caries-preventive programs offered to groups of children in the Solntsevsky district
of Moscow. Caries Res. 2000;34(1):8-19.
Vermaire E. Optimizing Oral Health: Towards a tailored, effective and cost-effective
dental care [PhD dissertation]. 2013. Available at:
http://www.ivorenkruis.nl/userfiles/File/Proefschrift_Erik_Vermaire_final.pdf
Water Fluoridation and Environmental Justice - a report submitted to the
EJ Interagency Working Group on September 25, 2015, from Fluoride Action Network
A4 p.698
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132
WHO (World Health Organization). Oral Health Database [website]. Malmo University,
Sweden.
Available at: http://www.mah.se/CAPP/Country-Oral-Health-Profiles/EURO/
Water Fluoridation and Environmental Justice - a report submitted to the
EJ Interagency Working Group on September 25, 2015, from Fluoride Action Network
A4 p.699
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Fluoride in Drinking Water: A Scientific Review of EPA's Standards (Free Executive Summary)
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Free Executive Summary
Fluoride in Drinking Water: A Scientific Review of
EPA's Standards
Committee on Fluoride in Drinking Water, National
Research Council
ISBN: 978-0-309-10128-8, 530 pages, 6x9, paperback (2006)
This free executive summary is provided by the National Academies as
part of our mission to educate the world on issues of science, engineering,
and health. If you are interested in reading the full book, please visit us
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please contact our customer service department toll-free at 888-624-8373.
Most people associate fluoride with the practice of intentionally adding fluoride to public
drinking-water supplies for the prevention of tooth decay. However, fluoride can also enter
public water systems from natural sources, including runoff from weathering of
fluoride-containing rocks and soils and leaching from soil into groundwater. Fluoride
pollution from various industrial emissions can also contaminate water supplies. In a few
areas of the United States, fluoride concentrations in water are much higher than normal,
mostly from natural sources. Because it can occur at toxic levels, fluoride is one of the
drinking water contaminants regulated by the U.S. Environmental Protection Agency
(EPA). In 1986, EPA established a maximum allowable concentration for fluoride in
drinking water of 4 milligrams per liter (mg/L), a guideline designed to prevent the public
from being exposed to harmful levels of fluoride. After reviewing research on various
health effects from exposure to fluoride, including studies conducted in the last 10 years,
this report concludes that EPA's drinking water standard for fluoride does not protect
against adverse health effects. Just over 200,000 Americans live in communities where
fluoride levels in drinking water are 4 mg/L or higher. Children in those communities are at
risk of developing severe tooth enamel fluorosis, a condition that can cause tooth enamel
loss and pitting. A majority of the report's authoring committee also concluded that people
who drink water containing 4 mg/L or more of fluoride over a lifetime are likely at
increased risk for bone fractures.
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Summary
Under the Safe Drinking Water Act, the U.S. Environmental Protection
Agency (EPA) is required to establish exposure standards for contaminants
in public drinking-water systems that might cause any adverse effects on
human health. These standards include the maximum contaminant level
goal (MCLG), the maximum contaminant level (MCL), and the secondary
maximum contaminant level (SMCL). The MCLG is a health goal set at a
concentration at which no adverse health effects are expected to occur and
the margins of safety are judged "adequate." The MCL is the enforceable
standard that is set as close to the MCLG as possible, taking into consider-
ation other factors, such as treatment technology and costs. For some con-
taminants, EPA also establishes an SMCL, which is a guideline for managing
drinking water for aesthetic, cosmetic, or technical effects.
Fluoride is one of the drinking-water contaminants regulated by EPA. In
1986, EPA established an MCLG and MCL for fluoride at a concentration
of 4 milligrams per liter (mg/L) and an SMCL of 2 mg/L. These guidelines
are restrictions on the total amount of fluoride allowed in drinking water.
Because fluoride is well known for its use in the prevention of dental car-
ies, it is important to make the distinction here that EPA's drinking-water
guidelines are not recommendations about adding fluoride to drinking water
to protect the public from dental caries. Guidelines for that purpose (0.7 to
1.2 mg/L) were established by the U.S. Public Health Service more than 40
years ago. Instead, EPA's guidelines are maximum allowable concentrations
in drinking water intended to prevent toxic or other adverse effects that
could result from exposure to fluoride.
In the early 1990s at the request of EPA, the National Research Council
1
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2 FLUORIDE IN DRINKING WATER
(NRC) independently reviewed the health effects of ingested fluoride and
the scientific basis for EPA's MCL. It concluded that the MCL was an ap-
propriate interim standard but that further research was needed to fill data
gaps on total exposure to fluoride and its toxicity. Because new research on
fluoride is now available and because the Safe Drinking Water Act requires
periodic reassessment of regulations for drinking-water contaminants, EPA
requested that the NRC again evaluate the adequacy of its MCLG and
SMCL for fluoride to protect public health.
COMMITTEE'S TASK
In response to EPA's request, the NRC convened the Committee on
Fluoride in Drinking Water, which prepared this report. The committee was
charged to review toxicologic, epidemiologic, and clinical data on fluoride—
particularly data published since the NRC's previous (1993) report—and
exposure data on orally ingested fluoride from drinking water and other
sources. On the basis of its review, the committee was asked to evaluate
independently the scientific basis of EPA's MCLG of 4 mg/L and SMCL of
2 mg/L in drinking water and the adequacy of those guidelines to protect
children and others from adverse health effects. The committee was asked to
consider the relative contribution of various fluoride sources (e.g., drinking
water, food, dental-hygiene products) to total exposure. The committee was
also asked to identify data gaps and to make recommendations for future
research relevant to setting the MCLG and SMCL for fluoride. Addressing
questions of artificial fluoridation, economics, risk-benefit assessment, and
water-treatment technology was not part of the committee's charge.
THE COMMITTEE'S EVALUATION
To accomplish its task, the committee reviewed a large body of research
on fluoride, focusing primarily on studies generated since the early 1990s,
including information on exposure; pharmacokinetics; adverse effects on
various organ systems; and genotoxic and carcinogenic potential. The col-
lective evidence from in vitro assays, animal research, human studies, and
mechanistic information was used to assess whether multiple lines of evi-
dence indicate human health risks. The committee only considered adverse
effects that might result from exposure to fluoride; it did not evaluate health
risk from lack of exposure to fluoride or fluoride's efficacy in preventing
dental caries.
After reviewing the collective evidence, including studies conducted
since the early 1990s, the committee concluded unanimously that the
present MCLG of 4 mg/L for fluoride should be lowered. Exposure at the
MCLG clearly puts children at risk of developing severe enamel fluorosis,
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SUMMARY 3
a condition that is associated with enamel loss and pitting. In addition, the
majority of the committee concluded that the MCLG is not likely to be pro-
tective against bone fractures. The basis for these conclusions is expanded
upon below.
Exposure to Fluoride
The major sources of exposure to fluoride are drinking water, food,
dental products, and pesticides. The biggest contributor to exposure for
most people in the United States is drinking water. Estimates from 1992
indicate that approximately 1.4 million people in the United States had
drinking water with natural fluoride concentrations of 2.0-3.9 mg/L, and
just over 200,000 people had concentrations equal to or exceeding 4 mg/L
(the presented MCL). In 2000, it was estimated that approximately 162 mil-
lion people had artificially fluoridated water (0.7-1.2 mg/L).
Food sources contain various concentrations of fluoride and are the sec-
ond largest contributor to exposure. Beverages contribute most to estimated
fluoride intake, even when excluding contributions from local tap water. The
greatest source of nondietary fluoride is dental products, primarily tooth-
pastes. The public is also exposed to fluoride from background air and from
certain pesticide residues. Other sources include certain pharmaceuticals and
consumer products.
Highly exposed subpopulations include individuals who have high con-
centrations of fluoride in drinking water, who drink unusually large volumes
of water, or who are exposed to other important sources of fluoride. Some
subpopulations consume much greater quantities of water than the 2 L
per day that EPA assumes for adults, including outdoor workers, athletes,
and people with certain medical conditions, such as diabetes insipidus. On
a per-body-weight basis, infants and young children have approximately
three to four times greater exposure than do adults. Dental-care products
are also a special consideration for children, because many tend to use more
toothpaste than is advised, their swallowing control is not as well developed
as that of adults, and many children under the care of a dentist undergo
fluoride treatments.
Overall, the committee found that the contribution to total fluoride
exposure from fluoride in drinking water in the average person, depending
on age, is 57% to 90% at 2 mg/L and 72% to 94% at 4 mg/L. For high-
water-intake individuals, the drinking-water contribution is 86% to 96%
at 2 mg/L and 92% to 98% at 4 mg/L. Among individuals with an average
water-intake rate, infants and children have the greatest total exposure to
fluoride, ranging from 0.079 to 0.258 mg/kg/day at 4 mg/L and 0.046 to
0.144 mg/kg/day at 2 mg/L in drinking water. For high-water-intake indi-
viduals exposed to fluoride at 4 mg/L, total exposure ranges from 0.294
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4 FLUORIDE IN DRINKING WATER
mg/kg/clay for adults to 0.634 rng/kg/day for children. The corresponding
intake range at 2 mg/L is 0.154 to 0.334 rng/kg/day for adults and children,
respectively.
Dental Effects
Enamel fluorosis is a dose-related mottling of enamel that can range
from mild discoloration of the tooth surface to severe staining and pitting.
The condition is permanent after it develops in children during tooth for-
mation, a period ranging from birth until about the age of 8. Whether to
consider enamel fluorosis, particularly the moderate to severe forms, to be
an adverse health effect or a cosmetic effect has been the subject of debate
for decades. In previous assessments, all forms of enamel fluorosis, includ-
ing the severest form, have been judged to be aesthetically displeasing but
not adverse to health. This view has been based largely on the absence of
direct evidence that severe enamel fluorosis results in tooth loss; loss of tooth
function; or psychological, behavioral, or social problems.
Severe enamel fluorosis is characterized by dark yellow to brown stain-
ing and discrete and confluent pitting, which constitutes enamel loss. The
committee finds the rationale for considering severe enamel fluorosis only
a cosmetic effect to be much weaker for discrete and confluent pitting than
for staining. One of the functions of tooth enamel is to protect the dentin
and, ultimately, the pulp from decay and infection. Severe enamel fluorosis
compromises that health-protective function by causing structural damage
to the tooth. The damage to teeth caused by severe enamel fluorosis is a toxic
effect that is consistent with prevailing risk assessment definitions of adverse
health effects. This view is supported by the clinical practice of filling enamel
pits in patients with severe enamel fluorosis and restoring the affected teeth.
Moreover, the plausible hypothesis concerning elevated frequency of caries
in persons with severe enamel fluorosis has been accepted by some authori-
ties, and the available evidence is mixed but generally supportive.
Severe enamel fluorosis occurs at an appreciable frequency, approxi-
mately 10% on average, among children in U.S. communities with water
fluoride concentrations at or near the current MCLG of 4 mg/L. Thus, the
MCLG is not adequately protective against this condition.
Two of the 12 members of the committee did not agree that severe
enamel fluorosis should now be considered an adverse health effect. They
agreed that it is an adverse dental effect but found that no new evidence has
emerged to suggest a link between severe enamel fluorosis, as experienced in
the United States, and a person's ability to function. They judged that dem-
onstration of enamel defects alone from fluorosis is not sufficient to change
the prevailing opinion that severe enamel fluorosis is an adverse cosmetic
effect. Despite their disagreement on characterization of the condition, these
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SUMMARY 5
two members concurred with the committee's conclusion that the MCLG
should prevent the occurrence of this unwanted condition.
Enamel fluorosis is also of concern from an aesthetic standpoint because
it discolors or results in staining of teeth. No data indicate that staining
alone affects tooth function or susceptibility to caries, but a few studies have
shown that tooth mottling affects aesthetic perception of facial attractive-
ness. It is difficult to draw conclusions from these studies, largely because
perception of the condition and facial attractiveness are subjective and cul-
turally influenced. The committee finds that it is reasonable to assume that
some individuals will find moderate enamel fluorosis on front teeth to be
detrimental to their appearance and that it could affect their overall sense
of well-being. However, the available data are not adequate to categorize
moderate enamel fluorosis as an adverse health effect on the basis of struc-
tural or psychological effects.
Since 1993, there have been no new studies of enamel fluorosis in U.S.
communities with fluoride at 2 mg/L in drinking water. Earlier studies indi-
cated that the prevalence of moderate enamel fluorosis at that concentration
could be as high as 15%. Because enamel fluorosis has different distribu-
tion patterns among teeth, depending on when exposure occurred during
tooth development and on enamel thickness, and because current indexes
for categorizing enamel fluorosis do not differentiate between mottling of
anterior and posterior teeth, the committee was not able to determine what
percentage of moderate cases might be of cosmetic concern.
Musculoskeletal Effects
Concerns about fluoride's effects on the musculoskeletal system histori-
cally have been and continue to be focused on skeletal fluorosis and bone
fracture. Fluoride is readily incorporated into the crystalline structure of
bone and will accumulate over time. Since the previous 1993 NRC review
of fluoride, two pharmacokinetic models were developed to predict bone
concentrations from chronic exposure to fluoride. Predictions based on these
models were used in the committee's assessments below.
Skeletal Fluorosis
Skeletal fluorosis is a bone and joint condition associated with prolonged
exposure to high concentrations of fluoride. Fluoride increases bone density
and appears to exacerbate the growth of osteophytes present in the bone and
joints, resulting in joint stiffness and pain. The condition is categorized into
one of four stages: a preclinical stage and three clinical stages that increase
in severity. The most severe stage (clinical stage III) historically has been
referred to as the "crippling" stage. At stage II, mobility is not significantly
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6 FLUORIDE IN DRINKING WATER
affected, but it is characterized by chronic joint pain, arthritic symptoms,
slight calcification of ligaments, and osteosclerosis of the cancellous bones.
Whether EPA's MCLG of 4 mg/L protects against these precursors to more
serious mobility problems is unclear.
Few clinical cases of skeletal fluorosis in healthy U.S. populations
have been reported in recent decades, and the committee did not find any
recent studies to evaluate the prevalence of the condition in populations
exposed to fluoride at the MCLG. Thus, to answer the question of whether
EPA's MCLG protects the general public from stage II and stage III skeletal
fluorosis, the committee compared pharmacokinetic model predictions of
bone fluoride concentrations and historical data on iliac-crest bone fluoride
concentrations associated with the different stages of skeletal fluorosis. The
models estimated that bone fluoride concentrations resulting from lifetime
exposure to fluoride in drinking water at 2 mg/L (4,000 to 5,000 mg/kg ash)
or 4 mg/L (10,000 to 12,000 mg/kg ash) fall within or exceed the ranges
historically associated with stage II and stage III skeletal fluorosis (4,300 to
9,200 mg/kg ash and 4,200 to 12,700 mg/kg ash, respectively). However,
this comparison alone is insufficient for determining whether stage II or III
skeletal fluorosis is a risk for populations exposed to fluoride at 4 mg/L,
because bone fluoride concentrations and the levels at which skeletal fluoro-
sis occurs vary widely. On the basis of the existing epidemiologic literature,
stage III skeletal fluorosis appears to be a rare condition in the United Sates;
furthermore, the committee could not determine whether stage II skeletal
fluorosis is occurring in U.S. residents who drink water with fluoride at 4
mg/L. Thus, more research is needed to clarify the relationship between
fluoride ingestion, fluoride concentrations in bone, and stage of skeletal
fluorosis before any conclusions can be drawn.
Bone Fractures
Several epidemiologic studies of fluoride and bone fractures have been
published since the 1993 NRC review. The committee focused its review on
observational studies of populations exposed to drinking water containing
fluoride at 2 to 4 mg/L or greater and on clinical trials of fluoride (20-34 mg/
day) as a treatment for osteoporosis. Several strong observational studies in-
dicated an increased risk of bone fracture in populations exposed to fluoride
at 4 mg/L, and the results of other studies were qualitatively consistent with
that finding. The one study using serum fluoride concentrations found no
appreciable relationship to fractures. Because serum fluoride concentrations
may not be a good measure of bone fluoride concentrations or long-term
exposure, the ability to show an association might have been diminished in
that study. A meta-analysis of randomized clinical trials reported an elevated
risk of new nonvertebral fractures and a slightly decreased risk of vertebral
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SUMMARY 7
fractures after 4 years of fluoride treatment. An increased risk of bone frac-
ture was found among a subset of the trials that the committee found most
informative for assessing long-term exposure. Although the duration and
concentrations of exposure to fluoride differed between the observational
studies and the clinical trials, bone fluoride content was similar (6,200 to
more than 11,000 mg/kg ash in observational studies and 5,400 to 12,000
mg/kg ash in clinical trials).
Fracture risk and bone strength have been studied in animal models.
The weight of evidence indicates that, although fluoride might increase bone
volume, there is less strength per unit volume. Studies of rats indicate that
bone strength begins to decline when fluoride in bone ash reaches 6,000 to
7,000 mg/kg. However, more research is needed to address uncertainties
associated with extrapolating data on bone strength and fractures from
animals to humans. Important species differences in fluoride uptake, bone
remodeling, and growth must be considered. Biochemical and physiological
data indicate a biologically plausible mechanism by which fluoride could
weaken bone. In this case, the physiological effect of fluoride on bone qual-
ity and risk of fracture observed in animal studies is consistent with the
human evidence.
Overall, there was consensus among the committee that there is scien-
tific evidence that under certain conditions fluoride can weaken bone and
increase the risk of fractures. The majority of the committee concluded that
lifetime exposure to fluoride at drinking-water concentrations of 4 mg/L
or higher is likely to increase fracture rates in the population, compared
with exposure to 1 mg/L, particularly in some demographic subgroups that
are prone to accumulate fluoride into their bones (e.g., people with renal
disease). However, 3 of the 12 members judged that the evidence only sup-
ports a conclusion that the MCLG might not be protective against bone
fracture. Those members judged that more evidence is needed to conclude
that bone fractures occur at an appreciable frequency in human popula-
tions exposed to fluoride at 4 mg/L and that the MCLG is not likely to
be protective.
There were few studies to assess fracture risk in populations exposed to
fluoride at 2 mg/L in drinking water. The best available study, from Finland,
suggested an increased rate of hip fracture in populations exposed to fluo-
ride at concentrations above 1.5 mg/L. However, this study alone is not suf-
ficient to judge fracture risk for people exposed to fluoride at 2 mg/L. Thus,
no conclusions could be drawn about fracture risk or safety at 2 mg/L.
Reproductive and Developmental Effects
A large number of reproductive and developmental studies in animals
have been conducted and published since the 1993 NRC report, and the
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8 FLUORIDE IN DRINKING WATER
overall quality of that database has improved significantly. Those studies
indicated that adverse reproductive and developmental outcomes occur
only at very high concentrations that are unlikely to be encountered by
U.S. populations. A few human studies suggested that high concentrations
of fluoride exposure might be associated with alterations in reproductive
hormones, effects on fertility, and developmental outcomes, but design
limitations make those studies insufficient for risk evaluation.
Neurotoxicity and Ncurobehavioral Effects
Animal and human studies of fluoride have been published reporting
adverse cognitive and behavioral effects. A few epidemiologic studies of Chi-
nese populations have reported IQ deficits in children exposed to fluoride at
2.5 to 4 mg/L in drinking water. Although the studies lacked sufficient detail
for the committee to fully assess their quality and relevance to U.S. popula-
tions, the consistency of the results appears significant enough to warrant
additional research on the effects of fluoride on intelligence.
A few animal studies have reported alterations in the behavior of
rodents after treatment with fluoride, but the committee did not find the
changes to be substantial in magnitude. More compelling were studies on
molecular, cellular, and anatomical changes in the nervous system found
after fluoride exposure, suggesting that functional changes could occur.
These changes might be subtle or seen only under certain physiological or
environmental conditions. More research is needed to clarify the effect of
fluoride on brain chemistry and function.
Endocrine Effects
The chief endocrine effects of fluoride exposures in experimental ani-
mals and in humans include decreased thyroid function, increased calcitonin
activity, increased parathyroid hormone activity, secondary hyperparathy-
roidism, impaired glucose tolerance, and possible effects on timing of sexual
maturity. Some of these effects are associated with fluoride intake that is
achievable at fluoride concentrations in drinking water of 4 mg/L or less,
especially for young children or for individuals with high water intake.
Many of the effects could be considered subclinical effects, meaning that
they are not adverse health effects. However, recent work on borderline
hormonal imbalances and endocrine-disrupting chemicals indicated that ad-
verse health effects, or increased risks for developing adverse effects, might
be associated with seemingly mild imbalances or perturbations in hormone
concentrations. Further research is needed to explore these possibilities.
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SUMMARY 9
Effects on Other Organ Systems
The committee also considered effects on the gastrointestinal system,
kidneys, liver, and immune system. There were no human studies on drink-
ing water containing fluoride at 4 mg/L in which gastrointestinal, renal,
hepatic, or immune effects were carefully documented. Case reports and in
vitro and animal studies indicated that exposure to fluoride at concentra-
tions greater than 4 mg/L can be irritating to the gastrointestinal system,
affect renal tissues and function, and alter hepatic and immunologic param-
eters. Such effects arc unlikely to be a risk for the average individual exposed
to fluoride at 4 mg/L in drinking water. However, a potentially susceptible
subpopulation comprises individuals with renal impairments who retain
more fluoride than healthy people do.
Genotoxicity and Carcinogenicity
Many assays have been performed to assess the genotoxicity of fluoride.
Since the 1993 NRC review, the most significant additions to the database
are in vivo assays in human populations and, to a lesser extent, in vitro
assays with human cell lines and in vivo experiments with rodents. The
results of the in vivo human studies are mixed. The results of in vitro tests
are also conflicting and do not contribute significantly to the interpretation
of the existing database. Evidence on the cytogenetic effects of fluoride at
environmental concentrations is contradictory.
Whether fluoride might be associated with bone cancer has been a
subject of debate. Bone is the most plausible site for cancer associated with
fluoride because of its deposition into bone and its mitogenic effects on bone-
cells in culture. In a 1990 cancer bioassay, the overall incidence of osteo-
sarcoma in male rats exposed to different amounts of fluoride in drinking
water showed a positive dose-response trend. In a 1992 study, no increase in
osteosarcoma was reported in male rats, but most of the committee judged
the study to have insufficient power to counter the evidence for the trend
found in the 1990 bioassay.
Several epidemiologic investigations of the relation between fluoride
and cancer have been performed since the 1993 evaluation, including both
individual-based and ecologic studies. Several studies had significant meth-
odological limitations that made it difficult to draw conclusions. Overall,
the results are mixed, with some studies reporting a positive association and
others no association.
On the basis of the committee's collective consideration of data from
humans, genotoxicity assays, and studies of mechanisms of action in cell
systems (e.g., bone cells in vitro), the evidence on the potential of fluoride
to initiate or promote cancers, particularly of the bone, is tentative and
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10 FLUORIDE IN DRINKING WATER
mixed. Assessing whether fluoride constitutes a risk factor for osteosarcoma
is complicated by the rarity of the disease and the difficulty of characterizing
biologic dose because of the ubiquity of population exposure to fluoride and
the difficulty of acquiring bone samples in nonaffected individuals.
A relatively large hospital-based case-control study of osteosarcoma and
fluoride exposure is under way at the Harvard School of Dental Medicine
and is expected to be published in 2006. That study will be an important
addition to the fluoride database, because it will have exposure information
on residence histories, water consumption, and assays of bone and toenails.
The results of that study should help to identify what future research will
be most useful in elucidating fluoride's carcinogenic potential.
DRINKING-WATER STANDARDS
Maximum-Contaminant-Level Goal
In light of the collective evidence on various health end points and
total exposure to fluoride, the committee concludes that EPA's MCLG of 4
mg/L should be lowered. Lowering the MCLG will prevent children from
developing severe enamel fluorosis and will reduce the lifetime accumulation
of fluoride into bone that the majority of the committee concludes is likely
to put individuals at increased risk of bone fracture and possibly skeletal
fluorosis, which are particular concerns for subpopulations that are prone
to accumulating fluoride in their bones.
To develop an MCLG that is protective against severe enamel fluorosis,
clinical stage II skeletal fluorosis, and bone fractures, EPA should update the
risk assessment of fluoride to include new data on health risks and better es-
timates of total exposure (relative source contribution) for individuals. EPA
should use current approaches for quantifying risk, considering susceptible
subpopulations, and characterizing uncertainties and variability.
Secondary Maximum Contaminant Level
The prevalence of severe enamel fluorosis is very low (near zero) at fluo-
ride concentrations below 2 mg/L. From a cosmetic standpoint, the SMCL
does not completely prevent the occurrence of moderate enamel fluorosis.
EPA has indicated that the SMCL was intended to reduce the severity and
occurrence of the condition to 15% or less of the exposed population. The
available data indicate that fewer than 15% of children will experience
moderate enamel fluorosis of aesthetic concern (discoloration of the front
teeth) at that concentration. However, the degree to which moderate enamel
fluorosis might go beyond a cosmetic effect to create an adverse psychologi-
cal effect or an adverse effect on social functioning is not known.
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SUMMARY 11
OTHER PUBLIC HEALTH ISSUES
The committee's conclusions regarding the potential for adverse effects
from fluoride at 2 to 4 mg/'L in drinking water do not address the lower
exposures commonly experienced by most U.S. citizens. Fluoridation is
widely practiced in the United States to protect against the development
of dental caries; fluoride is added to public water supplies at 0.7 to 1.2
mg/L. The charge to the committee did not include an examination of the
benefits and risks that might occur at these lower concentrations of fluoride
in drinking water.
RESEARCH NEEDS
As noted above, gaps in the information on fluoride prevented the
committee from making some judgments about the safety or the risks of
fluoride at concentrations of 2 to 4 mg/L. The following research will be
useful for filling those gaps and guiding revisions to the MCLG and SMCL
for fluoride.
• Exposure assessment
— Improved assessment of exposure to fluoride from all sources is
needed for a variety of populations (e.g., different socioeconomic condi-
tions). To the extent possible, exposures should be characterized for indi-
viduals rather than communities, and epidemiologic studies should group
individuals by exposure level rather than by source of exposure, location of
residence, or fluoride concentration in drinking water. Intakes or exposures
should be characterized with and without normalization for body weight.
Fluoride should be included in nationwide biomonitoring surveys and nutri-
tional studies; in particular, analysis of fluoride in blood and urine samples
taken in these surveys would be valuable.
• Pharmacokinetic studies
— The concentrations of fluoride in human bone as a function of ex-
posure concentration, exposure duration, age, sex, and health status should
be studied. Such studies would be greatly aided by noninvasive means of
measuring bone fluoride. Information is particularly needed on fluoride
plasma and bone concentrations in people with small-to-moderate changes
in renal function as well as in those with serious renal deficiency.
— Improved and readily available pharmacokinetic models should
be developed. Additional cross-species pharmacokinetic comparisons would
help to validate such models.
• Studies of enamel fluorosis
— Additional studies, including longitudinal studies, should be done
in U.S. communities with water fluoride concentrations greater than 1 mg/L.
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12 FLUORIDE IN DRINKING WATER
These studies should focus on moderate and severe enamel fluorosis in
relation to caries and in relation to psychological, behavioral, and social
effects among affected children, their parents, and affected children after
they become adults.
— Methods should be developed and validated to objectively assess
enamel fluorosis. Consideration should be given to distinguishing between
staining or mottling of the anterior teeth and of the posterior teeth so that
aesthetic consequences can be more easily assessed.
— More research is needed on the relation between fluoride exposure
and dentin fluorosis and delayed tooth eruption patterns.
• Bone studies
— A systematic study of clinical stage II and stage III skeletal fluoro-
sis should be conducted to clarify the relationship between fluoride inges-
tion, fluoride concentration in bone, and clinical symptoms.
— More studies of communities with drinking water containing
fluoride at 2 mg/L or more are needed to assess potential bone fracture risk
at these higher concentrations. Quantitative measures of fracture, such as
radiologic assessment of vertebral body collapse, should be used instead
of self-reported fractures or hospital records. Moreover, if possible, bone
fluoride concentrations should be measured in long-term residents.
• Other health effects
— Carefully conducted studies of exposure to fluoride and emerging
health parameters of interest (e.g., endocrine effects and brain function)
should be performed in populations in the United States exposed to various
concentrations of fluoride. It is important that exposures be appropriately
documented.
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FLUORIDE
IN DRINKING WATER
A SCIENTIFIC REVIEW OF
EPA'S STANDARDS
Committee on Fluoride in Drinking Water
Board on Environmental Studies and Toxicology
Division on Earth and Life Studies
NATIONAL RESEARCH COUNCIL
OF THE NATIONAL ACADEMIES
THE NATIONAL ACADEMIES PRESS
Washington, D.C.
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THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001
NOTICE: The project that is the subject of this report was approved by the Govern-
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and the Institute of Medicine. The members of the committee responsible for the
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This project was supported by Contract No. 68-C-03-013 between the National
Academy of Sciences and the U.S. Environmental Protection Agency. Any opinions,
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THE NATIONAL ACADEMIES
Advisers to the Nation on Science, Engineering, and Medicine
The National Academy of Sciences is a private, nonprofit, self-perpetuating society of
distinguished scholars engaged in scientific and engineering research, dedicated to the
furtherance of science and technology and to their use for the general welfare. Upon
the authority of the charter granted to it by the Congress in 1863, the Academy has a
mandate that requires it to advise the federal government on scientific and technical
matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences.
The National Academy of Engineering was established in 1964, under the charter
of the National Academy of Sciences, as a parallel organization of outstanding en-
gineers. It is autonomous in its administration and in the selection of its members,
sharing with the National Academy of Sciences the responsibility for advising the
federal government. The National Academy of Engineering also sponsors engineer-
ing programs aimed at meeting national needs, encourages education and research,
and recognizes the superior achievements of engineers. Dr. Wm. A. Wulf is president
of the National Academy of Engineering.
The Institute of Medicine was established in 1970 by the National Academy of
Sciences to secure the services of eminent members of appropriate professions in
the examination of policy matters pertaining to the health of the public. The Insti-
tute acts under the responsibility given to the National Academy of Sciences by its
congressional charter to be an adviser to the federal government and, upon its own
initiative, to identify issues of medical care, research, and education. Dr. Harvey V.
Fineberg is president of the Institute of Medicine.
The National Research Council was organized by the National Academy of Sci-
ences in 1916 to associate the broad community of science and technology with the
Academy's purposes of furthering knowledge and advising the federal government.
Functioning in accordance with general policies determined by the Academy, the
Council has become the principal operating agency of both the National Academy
of Sciences and the National Academy of Engineering in providing services to the
government, the public, and the scientific and engineering communities. The Council
is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J.
Cicerone and Dr. Wm. A. Wulf are chair and vice chair, respectively, of the National
Research Council.
www.national-academies.org
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Committee on Fluoride in Drinking Water
Members
John Doijll (Chair), University of Kansas Medical Center, Kansas City
Kim Boekelheide, Brown University, Providence, RI
Barbara G. Farishian, Washington, DC
Robert L. Isaacson, Binghamton University, Binghamton, NY
Judith B. Klotz, University of Medicine and Dentistry of New Jersey,
Piscataway
Java nth V. Kumar, New York State Department of Health, Albany
Hardy Limeback, University of Toronto, Ontario, Canada
Charles Poole, University of North Carolina at Chapel Hill, Chapel Hill
J. Edward Puzas, University of Rochester, Rochester, NY
Nu-May Ruby Reed, California Environmental Protection Agency,
Sacramento
Kathleen M. Thiessen, SENES Oak Ridge, Inc., Oak Ridge, TN
Thomas F. Webster, Boston University School of Public Health,
Boston, MA
Staff
Susan N. J. Martel, Project Director
Cay Butler, Editor
Ta.mara Dawson, Senior Program Assistant
Sponsor
U.S. Environmental Protection Agency
v
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Committee on Toxicology
Members
William E. Halperin {Chair), New Jersey Medical School, Newark
Lawrence S. Bi its, Eastern Virginia Medical School, Norfolk
Edward C. Bishop, Parsons Corporation, Pasadena, CA
James V. Bruckner, University of Georgia, Athens
Gary P. Carlson, Purdue University, West Lafayette, IN
Marion Ehrich, Virginia Tech, Blacksburg
Sidney Green, Howard University, Washington, DC
Meryl Karol, University of Pittsburgh, Pittsburgh, PA
James McDougal, Wright State University School of Medicine,
Dayton, OH
Roger McIntosh, Science Applications International Corporation,
Baltimore, MI)
Gerald Wogan, Massachusetts Institute of Technology, Cambridge
Staff
Kulbir S. Bakshi, Program Director
Eileen N. Aim, Senior Program Officer for Risk Analysis
Ellen K. Mam rs. Senior Program Officer
Susan N. J. Martel, Senior Program Officer
Aida Neel, Program Associate
Ta.mara Dawson, Senior Program Assistant
Radiah Rose, Senior Editorial Assistant
Alexandra Stupple, Senior Editorial Assistant
Sammy Bardley, Librarian
VI
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Board on Environmental Studies and Toxicology1
Members
Jonathan M. Samet (Chair), Johns Hopkins University, Baltimore, MD
Ramon Alvarez, Environmental Defense, Austin, TX
John M. Balbus, Environmental Defense, Washington, DC
Thomas Bijrke, Johns Hopkins University, Baltimore, MD
Dallas Burtraw, Resources for the Future, Washington, DC
James S. Bus, Dow Chemical Company, Midland, MI
Costel D. Denson, University of Delaware, Newark
E. Donald Elliott, Willkie Farr & Gallagher LLP, Washington, DC
J. Paul Gilman, Oak Ridge National Laboratory, Oak Ridge, TN
Sherri W. Goodman, Center for Naval Analyses, Alexandria, VA
Judith A. Graham, American Chemistry Council, Arlington, VA
Daniel S. Greenbaijm, Health Effects Institute, Cambridge, MA
William P. Horn, Birch, Horton, Bittner and Cherot, Washington, DC
Robert Hijggett, Michigan State University (emeritus), East Lansing
James H. Johnson, Jr., Howard University, Washington, DC
Judith L. Meyer, University of Georgia, Athens
Patrick Y. O'Brien, ChevronTexaco Energy Technology Company,
Richmond, CA
Dorothy E. Patton, International Life Sciences Institute, Washington, DC
Steward T.A. Pickett, Institute of Ecosystem Studies, Millbrook, NY
Danny D. Reible, University of Texas, Austin
Joseph V. Rodricks, ENVIRON International Corporation, Arlington, VA
Armistead G. Russell, Georgia Institute of Technology, Atlanta
Lisa Speer, Natural Resources Defense Council, New York, NY
Kimberly M. Thompson, Massachusetts Institute of Technology,
Cambridge
Monica G. Turner, University of Wisconsin, Madison
Mark J. Utell, University of Rochester Medical Center, Rochester, NY
Chris G. Whipple, ENVIRON International Corporation, Emeryville, CA
Lauren Zeise, California Environmental Protection Agency, Oakland
Senior Staff
James J. Reisa, Director
David J. Policansky, Scholar
Raymond A. Wassel, Senior Program Officer for Environmental Sciences
and Engineering
^1 his study was planned, overseen, and supported by the Board on Environmental Studies
and Toxicology.
vii
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Km kir Bakshi, Senior Program Officer for Toxicology
Eileen N. Am , Senior Program Officer for Risk Analysis
K. John Holmes, Senior Program Officer
Ellen K. Mantus, Senior Program Officer
Susan N.J. Marti i, Senior Program Officer
Suzanne van Drunick, Senior Program Officer
Ruth E. Crossgrove, Senior Editor
vttt
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Other Reports of the
Board on Environmental Studies and Toxicology
Assessing the Human Health Risks of Trichloroethylene: Key Scientific
Issues (2006)
New Source Review for Stationary Sources of Air Pollution (2006)
Human Biomonitoring for Environmental Chemicals (2006)
Health Risks from Dioxin and Related Compounds: Evaluation of the EPA
Reassessment (2006)
State and Federal Standards for Mobile-Source Emissions (2006)
Superfund and Mining Megasites—Lessons from the Coeur d'Alene River
Basin (2005)
Health Implications of Perchlorate Ingestion (2005)
Air Quality Management in the United States (2004)
Endangered and Threatened Species of the Platte River (2004)
Atlantic Salmon in Maine (2004)
Endangered and Threatened Fishes in the Klamath River Basin (2004)
Cumulative Environmental Effects of Alaska North Slope Oil and Gas
Development (2003)
Estimating the Public Health Benefits of Proposed Air Pollution
Regulations (2002)
Biosolids Applied to Land: Advancing Standards and Practices (2002)
The Airliner Cabin Environment and Health of Passengers and Crew
(2002)
Arsenic in Drinking Water: 2001 Update (2001)
Evaluating Vehicle Emissions Inspection and Maintenance Programs
(2001)
Compensating for Wetland Losses Under the Clean Water Act (2001)
A Risk-Management Strategy for PCB-Contaminated Sediments (2001)
Acute Exposure Guideline Levels for Selected Airborne Chemicals (4
volumes, 2000-2004)
Toxicological Effects of Methylmercury (2000)
Strengthening Science at the U.S. Environmental Protection Agency (2000)
Scientific Frontiers in Developmental Toxicology and Risk Assessment
(2000)
Ecological Indicators for the Nation (2000)
Waste Incineration and Public Health (1999)
Hormonally Active Agents in the Environment (19.99)
Research Priorities for Airborne Particulate Matter (4 volumes,
19.98-2004)
The National Research Council's Committee on Toxicology: The First 50
Years (1997)
Carcinogens and Anticarcinogens in the Human Diet (1996)
ix
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Upstream: Salmon and Society in the Pacific Northwest (1996)
Science and the Endangered Species Act (1995)
Wetlands: Characteristics and Boundaries (1995)
Biologic Markers (5 volumes, 1989-1995)
Review of EPA's Environmental Monitoring and Assessment Program (3
volumes, 1994-1995)
Science and Judgment in Risk Assessment (1994)
Pesticides in the Diets of Infants and Children (1993)
Dolphins and the Tuna Industry (1992)
Science and the National Parks (1992)
Human Exposure Assessment for Airborne Pollutants (1991)
Rethinking the Ozone Problem in Urban and Regional Air Pollution
(1991)
Decline of the Sea Turtles (1990)
Copies of these reports may be ordered from
the National Academies Press
(800) 624-6242 or (202) 334-3313
www.nap.edu
x
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Other Reports of the Committee on Toxicology
Review of the Department of Defense Research Program on Low-Level
Exposures to Chemical Warfare Agents (2005)
Emergency and Continuous Exposure Guidance Levels for Selected
Submarine Contaminants, Volume 1 (2004)
Spacecraft Water Exposure Guidelines for Selected Contaminants, Volume
1(2004)
Toxicologic Assessment of Jet-Propulsion Fuel 8 (2003)
Review of Submarine Escape Action Levels for Selected Chemicals (2002)
Standing Operating Procedures for Developing Acute Exposure Guideline
Levels for Hazardous Chemicals (2001)
Evaluating Chemical and Other Agent Exposures for Reproductive and
Developmental Toxicity (2001)
Acute Exposure Guideline Levels for Selected Airborne Contaminants,
Volume 1 (2000), Volume 2 (2002), Volume 3 (2003), Volume 4 (2004)
Review of the US Navy's Human Health Risk Assessment of the Naval Air
Facility at Atsugi, japan (2000)
Methods for Developing Spacecraft Water Exposure Guidelines (2000)
Review of the U.S. Navy Environmental Health Center's Health-Hazard
Assessment Process (2000)
Review of the U.S. Navy's Exposure Standard for Manufactured Vitreous
Fibers (2000)
Re-Evaluation of Drinking-Water Guidelines for Diisopropyl
Methylphosphonate (2000)
Submarine Exposure Guidance Levels for Selected Hydrofluorocarbons:
HFC-236fa, HFC-23, and HFC-404a (2000)
Review of the U.S. Army's Health Risk Assessments for Oral Exposure to
Six Chemical-Warfare Agents (1999)
Toxicity of Military Smokes and Obscurants, Volume 1(1997), Volume 2
(1999), Volume 3 (1999)
Assessment of Exposure-Response Functions for Rocket-Emission
Toxicants (1998)
Toxicity of Alternatives to Chlorofluorocarbons: HFC-134a and HCFC-
123 (1996)
Permissible Exposure Levels for Selected Military Fuel Vapors (1996)
Spacecraft Maximum Allowable Concentrations for Selected Airborne
Contaminants, Volume 1 (1994), Volume 2 (1996), Volume 3 (1996),
Volume 4 (2000)
XI
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Preface
In 1986', the U.S. Environmental Protection Agency (EPA) established a
maximum-contaminant-level goal (MCLG) of 4 milligrams per liter (ing/L)
and a secondary maximum contaminant level (SMCL) of 2 mg/L for fluoride
in drinking water. These exposure values are not recommendations for the
artificial fluoridation of drinking water, but are guidelines for areas in the
United States that are contaminated or have high concentrations of natu-
rally occurring fluoride. The goal of the MCLG is to establish an exposure
guideline to prevent adverse health effects in the general population, and
the goal of the SMCL is to reduce the occurrence of adverse cosmetic con-
sequences from exposure to fluoride. Both the MCLG and the SMCL are
nonenforceable guidelines.
The regulatory standard for drinking water is the maximum contami-
nant level (MCL), which is set as close to the MCLG as possible, with the
use of the best technology available. For fluoride, the MCL is the same as the
MCLG of 4 mg/L. In 1993, a previous committee of the National Research
Council (NRC) reviewed the health effects of ingested fluoride and EPA's
MCL. It concluded that the MCL was an appropriate interim standard,
but that further research was needed to fill data gaps on total exposures to
fluoride and its toxicity. Because new research on fluoride is now available
and because the Safe Drinking Water Act requires periodic reassessment of
regulations for drinking water contaminants, EPA requested that the NRC
evaluate the adequacy of its MCLG and SMCL for fluoride to protect public
health. In response to EPA's request, the NRC convened the Committee on
Fluoride in Drinking Water, which prepared this report. The committee was
charged to review toxicologic, epidemiologic, and clinical data on fluoride,
xiii
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XIV PREFACE
particularly data published since 1993, and exposure data on orally ingested
fluoride from drinking water and other sources. Biographical information
on the committee members is provided in Appendix A.
This report presents the committee's review of the scientific basis of
EPAs MCLG and SMCL for fluoride, and their adequacy for protecting
children and others from adverse health effects. The committee consid-
ers the relative contribution of various sources of fluoride (e.g., drinking
water, food, dental hygiene products) to total exposure, and identifies data
gaps and makes recommendations for future research relevant to setting
the MCLG and SMCL for fluoride. Addressing questions of economics,
risk-benefit assessment, or water-treatment technology was not part of the
committee's charge.
This report has been reviewed in draft form by individuals chosen for
their diverse perspectives and technical expertise, in accordance with pro-
cedures approved by the NRC's Report Review Committee. The purpose
of this independent review is to provide candid and critical comments that
will assist the institution in making its published report as sound as possible
and to ensure that the report meets institutional standards for objectivity,
evidence, and responsiveness to the study charge. The review comments and
draft manuscript remain confidential to protect the integrity of the delibera-
tive process. We wish to thank the following individuals for their review of
this report: Kenneth Cantor, National Cancer Institute; Caswell Evans, Jr.,
University of Illinois at Chicago; Michael Gallo, University of Medicine and
Dentistry of New Jersey; Mari Golub, California Environmental Protection
Agency; Philippe Grand jean, University of Southern Denmark; David Hoel,
Medical University of South Carolina; James Lamb, The Weinberg Group
Inc.; Betty Olson, University of California at Irvine; Elizabeth Platz, Johns
Hopkins Bloomberg School of Public Health; George Stookey, Indiana Uni-
versity School of Dentistry; Charles Turner, University of Indiana; Robert
Utiger, Harvard Institute of Medicine; Gary Whitford, Medical College of
Cieorgia; and Gerald Wogan, Massachusetts Institute of Technology.
Although the reviewers listed above have provided many constructive
comments and suggestions, they were not asked to endorse the conclusions
or recommendations, nor did they see the final draft of the report before its
release. The review of this report was overseen by John C. Bailar, University
of Chicago, and Gilbert S. Omenn, University of Michigan Medical School.
Appointed by the NRC, they were responsible for making certain that an
independent examination of this report was carried out in accordance with
institutional procedures and that all review comments were carefully con-
sidered. Responsibility for the final content of this report rests entirely with
the authoring committee and the institution.
The committee gratefully acknowledges the individuals who made pre-
sentations to the committee at its public meetings. They include Paul Con-
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PREFACE XV
nett, St. Lawrence University; Joyce Donohue, EPA; Steve Levy, University of
Iowa; William Maas, Centers for Disease Control and Prevention; Edward
Ohanian, EPA; Charles Turner, Indiana University; and Gary Whitford,
University of Georgia. The committee also wishes to thank Thomas Burke,
Johns Hopkins University; Michael Morris, University of Michigan; Bernard
Wagner, Wagner and Associates; and Lauren Zeise, California Environmen-
tal Protection Agency, who served as consultants to the committee.
The committee is grateful for the assistance of the NRC staff in prepar-
ing the report. It particularly wishes to acknowledge the outstanding staff
support from project director Susan Martel. We are grateful for her persis-
tence and patience in keeping us focused and moving ahead on the task and
her expertise and skill in reconciling the differing viewpoints of committee
members. Other staff members who contributed to this effort are James
Reisa, director of the Board on Environmental Studies and Toxicology; Kul-
bir Bakshi, program director for the Committee on Toxicology; Cay Butler,
editor; Mirsada Karalic-Loncarevic, research associate; Jennifer Saunders,
research associate; and Tamara Dawson, senior project assistant.
Finally, I would like to thank all the members of the committee for their
efforts throughout the development of this report.
John Doull, M.D., Ph.D., Chair
Committee on Fluoride in Drinking Water
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Fluoride in Drinking Water: A Scientific Review of EPA's Standards
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Contents
Summary i
i Introduction 13
Fluoride in Drinking Water, 14
History of EPA's Regulation of Fluoride, 16
Committee's Task, 18
Committee's Approach, 21
Structure of the Report, 22
2 Measures of Exposure to Fluoride in the United States 23
Sources of Fluoride Exposure, 24
Recent Estimates of Total Fluoride Exposure, 54
Total Exposure to Fluoride, 55
Summary of Exposure Assessment, 64
Biomarkers of Exposure, Effect, and Susceptibility, 69
Findings, 81
Recommendations, 87
3 Pharmacokinetics of Fluoride 89
Overview of Fluoride Chemistry, Units, and Measurement, 89
Short Review of Fluoride Pharmacokinetics: Absorption,
Distribution, and Elimination, 90
Pharmacokinetic Models, 92
Fluoride Concentrations in Human Bone Versus Water
Concentration, 93
xvtt
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Fluoride in Drinking Water: A Scientific Review of EPA's Standards
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XV Hi CONTENTS
Fluoride Concentrations in Bones after Clinical Studies, 96
Comparative Pharmacokinetics of Rats and Humans, 98
Organofluorine Compounds, 99
Factors Modifying Pharmacokinetics and Their Implications
for Potentially Susceptible Populations, 99
Findings, 101
Research Recommendations, 101
4 Effects of Fluoride on Teeth 103
Enamel Fluorosis, 103
Other Dental Effects, 126
Findings, 127
Recommendations, 130
5 Musculoskeletal Effects
Chemistry of Fluoride As It Relates to Mineralizing
Effect of Fluoride on Cell Function, 133
Effects of Fluoride on Human Skeletal Metabolism,
Effect of Fluoride on Chondrocyte Metabolism and
Findings, 178
Recommendations, 180
6 Reproductive and Developmental Effects of Fluoride 181
Reproductive Effects, 181
Developmental Effects, 193
Findings, 204
Recommendations, 204
7 Neurotoxicity and Neurobehavioral Effects 205
Human Studies, 205
Animal Studies, 214
Neurochemical Effects and Mechanisms, 218
Findings, 220
Recommendations, 222
8 Effects on the Endocrine System 224
Thyroid Follicular Cells, 224
Thyroid Parafollicular Cells, 236
Parathyroid Glands, 238
Pineal Gland, 252
Other Endocrine Organs, 256
Summary, 260
Recommendations, 266
I3I
Tissues, 131
138
Arthritis, 177
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CONTENTS XIX
9 Effects on the Gastrointestinal, Renal, Hepatic,
and Immune Systems 268
Cil System, 268
The Renal System, 280
Hepatic System, 292
Immune System, 293
Findings, 295
Recommendations, 302
10 Genotoxicity and Carcinogenicity 304
Genotoxicity, 304
Carcinogenicity, 316
EPA Guidelines and Practice in Setting MCLGs Regarding
Carcinogenicity, 334
Findings, 335
Recommendations, 338
11 Drinking Water Standards for Fluoride 340
Current Methods for Setting Standards for Drinking Water, 340
New Risk Assessment Considerations, 342
Fluoride Standards, 345
Findings and Recommendations, 352
References 3 54
Appendixes
A Biographical Information on the Committee on Fluoride in
Drinking Water, 411
B Measures of Exposure to Fluoride in the United States:
Supplementary Information, 416
C Ecologic and Partially Ecologic Studies in Epidemiology, 43 9
D Comparative Pharmacokinetics of Rats and Humans, 442
E Detailed Information on Endocrine Studies of Fluoride, 447
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FLUORIDE
IN DRINKING WATER
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Environmental Health
O Bio Med Central
The Open Access Publisher
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Exposure to fluoridated water and attention deficit hyperactivity disorder
prevalence among children and adolescents in the United States: an ecological
association
Environmental Health (2015) 14:17
doi: 10.1186/s12940-015-0003-1
Ashley J Malin (ashleyjs@yorku.ca)
Christine Till (ctill@yorku.ca)
Published online: 27 February 2015
ISSN 1476-069X
Article type Research
Submission date 7 July 2014
Acceptance date 4 February 2015
Article URL http://dx.doi.org/10.1186/s12940-015-0003-1
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permits unrestricted use, distribution, and reproduction in any medium, prouded the original work is properly credited. The Creative Commons Public Domain
Dedication wai\er Mtp://creati\ecommons.ora/publicdomain/zero/1.0/1 applies to the data made available in this article, unless otherwise stated.
A4 p.735
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Exposure to fluoridated water and attention deficit
hyperactivity disorder prevalence among children
and adolescents in the United States: an ecological
association
Ashley J Malin1*
Corresponding author
Email: ashleyjs@yorku.ca
Christine Till1
Email: ctill@yorku.ca
1 Department of Psychology, York University, Keele St., 4700 Toronto, Canada
Abstract
Background
Epidemiological and animal-based studies have suggested that prenatal and postnatal fluoride
exposure has adverse effects on neurodevelopment. The aim of this study was to examine the
relationship between exposure to fluoridated water and Attention-Deficit Hyperactivity
Disorder (ADHD) prevalence among children and adolescents in the United States.
Methods
Data on ADHD prevalence among 4-17 year olds collected in 2003, 2007 and 2011 as part of
the National Survey of Children's Health, and state water fluoridation prevalence from the
Centers for Disease Control and Prevention (CDC) collected between 1992 and 2008 were
utilized.
Results
State prevalence of artificial water fluoridation in 1992 significantly positively predicted state
prevalence of ADHD in 2003, 2007 and 2011, even after controlling for socioeconomic
status. A multivariate regression analysis showed that after socioeconomic status was
controlled each 1% increase in artificial fluoridation prevalence in 1992 was associated with
approximately 67,000 to 131,000 additional ADHD diagnoses from 2003 to 2011. Overall
state water fluoridation prevalence (not distinguishing between fluoridation types) was also
significantly positively correlated with state prevalence of ADHD for all but one year
examined.
Conclusions
Parents reported higher rates of medically-diagnosed ADHD in their children in states in
which a greater proportion of people receive fluoridated water from public water supplies.
The relationship between fluoride exposure and ADHD warrants future study.
A4 p.736
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Keywords
ADHD, Water fluoridation, Neurotoxicity, Environmental factors
Background
Attention-Deficit Hyperactivity Disorder (ADHD) is the most common neurodevelopmental
disorder of childhood [1], It is characterized by symptoms of inattention,
impulsivity/hyperactivity or both that are present in childhood and can persist into adulthood
[2], As of 2011, 11% of 4-17 year olds in the United States (U.S.) had received a diagnosis at
some point in their lives [3], The high prevalence of ADHD is a growing public health
concern because the behavioural symptoms of the disorder can seriously affect learning and
academic achievement, as well as social functioning.
ADHD is considered to develop from an interaction between genetic and environmental
factors [4-6], with numerous developmental neurotoxicants significantly increasing the risk
for a diagnosis of ADHD. Environmental factors include prenatal and neonatal exposure to
manganese [7], poly-chlorinated biphenyls (PCBs) [8,9], nicotine [10] and mercury [11,12],
as well as childhood exposure to arsenic [13,14], food additives and food colouring [15],
pesticides [16] and lead [17], Fluoride however, despite being a widespread environmental
developmental neurotoxin [18,19], has received virtually no attention in the ADHD literature.
Nevertheless, there is a burgeoning body of human and animal research indirectly suggesting
that it may contribute to the disorder's onset.
Water fluoridation and ADHD
The U.S. is one of the most widely fluoridated countries in the world, with approximately
74.6% of the population receiving fluoridated water for the prevention of dental caries [20],
The vast majority of those on fluoridated public water systems receive fluoride via the
addition of fluoridation chemicals, while a small minority receives naturally occurring
fluoride. Fluoridation chemicals include: hydrofluorosicilic acid, sodium fluorosilicate and
sodium fluoride [21], Until September 2010, the CDC's Department of Health and Human
Services (DHHS) recommended that U.S. public water systems be fluoridated at 0.7 - 1.2
mg/L [22]; however, they have found that children and adults living in communities
fluoridated at this range actually tend to receive 0.9 - 3.6 mg/L and 0.6 - 6.6 mg/L of fluoride
per day respectively from all sources, including: water, food and dental products [23],
Consistently, the 2010 U.S. National Health and Nutrition Survey found that approximately
41% of 12-15 year olds suffer from dental fluorosis, a consequence of fluoride overexposure
[24], The DHHS has since announced a proposal to change the recommended fluoride
concentration to 0.7 mg/L, but this has yet to be widely adopted [22,25],
Rats exposed to fluoridation chemicals have been shown to exhibit ADHD-like symptoms.
Male rats whose mothers were injected with 0.13 mg/L of sodium fluoride two to three times
per day during gestation days 14-18 or 17-19 had symptoms of hyperactivity at nine weeks of
age. Juvenile and adult rats who drank water fluoridated at 100 mg/L for six weeks and 125
mg/L for 11 weeks, respectively, exhibited hypoactivity and impaired attention [26],
Although postnatal fluoride concentrations were high, blood plasma levels ranged from 0.059
- 0.640 mg/L, and these are comparable to plasma levels in humans who ingested 5-10
mg/L of fluoride [26,27], Moreover, impaired learning and memory have also been found
A4 p.737
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among rats that drank 5 mg/L of sodium fluoride treated water for six months or 20 mg/L for
three months [28,29],
Rats with fluorosis also tend to have significant decreases in neural nicotinic acetylcholine
receptors (nACHRs) and inhibited cholinesterase expression [30-33], both of which could
interfere with attentional processes [34], Moreover, they have significant decreases in protein
expression of a4 and a7 nAChR subunit genes [28,31,35], and abnormalities at the a4
nAChR subunit in particular have been implicated in all ADHD subtypes [36,37],
Furthermore, nicotinic receptor agonists that ameliorate ADHD symptoms do so in rats by
acting on the a4/?2 and, in some cases, 0.7 subunits [38-41],
Fluoride can readily cross the placenta, accumulate in the infant brain and easily exert
neurotoxic effects, such as decreasing norepinephrine in the parietal and occipital lobes,
decreasing serotonin in the parietal lobe and increasing serotonin in the frontal and occipital
lobes [42-45], Such changes can adversely affect arousal and attention, pain tolerance, and
learning and memory respectively [42,43], Expectedly, prenatal fluoride exposure has been
associated with impaired infant neurobehavioural development. For example, infants whose
mothers lived in areas with water fluoridated at 1.7 to 6 mg/L while pregnant had delayed
orientation reactions when compared to those whose mothers were exposed to 0.5 to 1.0
mg/L [46],
Exposure to fluoridated water during childhood has also been associated with impaired
attention and cognitive and intellectual functioning. Importantly, among children who were
exposed environmentally to water fluoridated at 1.2 - 3 mg/L (slightly above the U.S.
recommended level), increased urinary fluoride concentrations were associated with slower
reaction time and poorer visuospatial organization that could interfere with attention, and
reading and writing respectively [47], Additionally, urinary fluoride of 5.6 ± 1.7 mg/L was
inversely related to performance on a measure of visual memory and visuospatial
organization, as well as attention (the Rey-Osterrieth Complex Figure Test) [48], A recent
meta-analysis, which included a number of epidemiological studies, also found that children
living in 'high fluoride' areas had IQs that averaged 7 points lower than those living in 'low
fluoride' areas [49], Seven of the 'high fluoride' areas had fluoride concentrations slightly
above the U.S recommended range (1.8 - 3 mg/L) [50-56], while one had a concentration
within the recommended range (0.88 mg/L) [57], Moreover, a dose-response relationship
between exposure to water fluoridated at relatively low concentrations (0.24 - 2.84 mg/L) and
reduced IQ among children has also been established [58], The association between fluoride
exposure and lowered IQ in children provides support for a neurotoxic developmental effect.
While ADHD was not measured in these epidemiological studies, it is plausible that fluoride
is also contributing to attention-related symptoms given its association with lower IQ.
Using an ecological design, the current study examined whether higher water fluoridation
prevalence is associated with higher rates of ADHD diagnoses in the U.S.. Given the research
linking exposure to fluoridated water to adverse neurodevelopmental and cognitive effects, it
was hypothesized that states with more widespread water fluoridation would tend to have
higher ADHD prevalence.
A4 p.738
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Methods
ADHD sample
State-based ADHD prevalence data was obtained from the Centers for Disease Control and
Prevention (CDC) website. The CDC collected this information via the National Survey of
Children's Health (NSCH). TheNSCH is a cross-sectional random-digit survey, conducted in
2003, 2007 and 2011, in which parents were contacted via telephone and asked about the
emotional and physical well-being of a randomly selected child from their household. To
determine ADHD prevalence, each responding parent or guardian was asked whether "a
doctor or other health care provider ever told you that [child] had attention deficit disorder or
attention-deficit/hyperactivity disorder, that is, ADD or ADHD". In the 2007 and 2011
NSCH, if the parent answered yes, he or she was asked whether the child was currently
diagnosed with ADHD and, if so, how severe it is. In 2011, the responding parent was also
asked the age of diagnosis [59], Lifetime parent-reported health care provider-diagnosed
ADHD (whether a parent or guardian had ever been told by a health care provider that his or
her child had ADD or ADHD) was the measure of ADHD prevalence used in this study.
Extracted from the original sample of children aged 0-17, three subsamples of children aged
4-17 living in the U.S. were used to assess ADHD prevalence per state in 2003 (n = 79,264),
2007 (n = 73,123), and 2011 (n = 76,015). The lifetime prevalence of ADHD increased over
time and was 7.8% in 2003, 9.5% in 2007, and 11% in 2011. ADHD prevalence was also
higher for males, children of lower socioeconomic status (SES), older children, and for
children whose parents had a high school education as compared to those whose parents
either did not graduate high school or attained postsecondary education [3],
Water fluoridation prevalence data
Data on the number of people receiving fluoridated water from public water supplies in each
of the 51 United States in 1992 (n = 144,217,476), 2000 (n = 161,924,080), 2002 (n = 172,
209,735), 2004 (n = 180,632,481), 2006 (n = 184,028,038), and 2008 (n = 195,545,109) was
also obtained from the CDC website [20], To determine state-based fluoridation prevalence,
the CDC obtained and analyzed data from the Water Fluoridation Reporting System (WFRS),
an online tool monitoring the percentage of the U.S. population on public water systems that
receives optimally fluoridated drinking water [20], For the years 1992, 2006 and 2008 the
CDC distinguished between the number of people in the U.S. receiving fluoridation
chemicals versus naturally occurring fluoride. Additionally, for 1992 only, the CDC
distinguished between the prevalence of artificially versus naturally fluoridated water per
state. In 1992, approximately 93.4% of people on public water systems received optimally
fluoridated water via the addition of fluoridation chemicals, while 6.6% exclusively received
naturally occurring fluoride. In both 2006 and 2008, approximately 95.5% received
fluoridation chemicals and 4.5% received natural fluoride.
To calculate the percentage of each state receiving optimally fluoridated (i.e. according to the
DHHS recommendations) water from public water systems (i.e. encompassing either
naturally or artificially fluoridated water) state population estimates were obtained from the
United States Census website [60,61], The number of people receiving optimally fluoridated
water in each state was divided by the number of people in each state for a given year and
multiplied by 100. For 1992, the number of people receiving artificially fluoridated water and
A4 p.739
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the number receiving naturally fluoridated water in each state were also divided by the state
population estimate and multiplied by 100 to determine the respective state based prevalence.
Statistical analysis
Descriptive statistics were calculated for U.S. water fluoridation prevalence for all years
examined. Statistical comparisons of ADHD prevalence and water fluoridation prevalence
between geographic regions were determined using one-way ANOVA followed by
Bonferroni post hoc test in all cases except for regional fluoridation prevalence comparisons
in 2000 and 2002. In those cases Games-HoweH's test was used due to heterogeneous
variances. Pearson correlations were used to examine relationships between state water
fluoridation prevalence and state ADHD prevalence. These were not corrected for family
wise error given the exploratory nature of this study. Hierarchical and multivariate regression
analyses were conducted to examine the relationship between artificial water fluoridation
prevalence and ADHD prevalence after controlling for natural water fluoridation prevalence
and SES, and SES respectively. A one-tailed alpha level of 0.05 was the criterion for
statistical significance for all analyses. A Bonferroni correction was applied to the univariate
analysis of the multivariate regression however, making the criterion for significance for that
analysis an alpha of 0.017.
Results
State water fluoridation
Median percentages and interquartile ranges of the U.S. population receiving optimally
fluoridated water from public water systems in 1992, 2000, 2002, 2004, 2006 and 2008 are
presented in Table 1. Median water fluoridation prevalence ranged from 58.16 - 66.33% from
1992-2008, increasing over time. Interquartile ranges ranged from 26.99 - 31.83%, indicating
that fluoridation prevalence between states was highly variable.
Table 1 Percentage of each state receiving fluoridated water per year
Year
Median
Interquartile Range
1992
58.16
30.33
2000
58.62
31.83
2002
63.93
29.61
2004
66.24
26.99
2006
65.75
30.52
2008
66.33
30.39
ADHD and water fluoridation prevalence according to geographic region
ADHD and water fluoridation prevalence were organized in Tables 2 and 3 respectively
according to the United States Census Bureau's classification of geographic regions [62] (See
Additional file 1). Differences in ADHD prevalence between geographic regions were
statistically significant in 2003 (F (3, 47) = 21.84, p = .000), 2007 (F (3, 47) = 12.07, p =
.000), and 2011(F (3, 47) = 13.35, p = .000). In 2003, ADHD prevalence was significantly
lower in the West (M = 6.41, SD = 0.8) than in all other regions, and in both 2003 and 2007
significantly higher in the South (M = 9.41, SD = 1.05 and M = 11.74, SD = 2.28,
respectively), than in all other regions. In 2007 and 2011, ADHD prevalence was lower in the
A4 p.740
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West (M = 7.73, SD = 1.3 and M = 8.75, SD = 1.67, respectively) than in all other regions,
but not significantly lower than the North East (M = 9.46, SD = 0.97 and M = 10.96, SD =
1.72, respectively). In 2011, ADHD prevalence was highest in the South (M = 13.51, SD =
2.49), but not significantly higher than the Midwest (M = 11.93, SD = 2.03).
Table 2 Prevalence of ADHD as a function of geographic region
Region
2003
Mean % SD
2007
Mean % SD
2011
Mean % SD
Northeast
7.92 1.13
9.46
0.97
10.96
1.72
Midwest
7.87 1.05
9.82
2.03
11.93
2.03
South
9.41 1.05
11.74
2.28
13.51
2.49
West
6.41 0.80
7.73
1.28
8.75
1.67
Note. Mean percentage of children or adolescents ages 4-17 ever diagnosed with ADHD as of that year; SD,
standard deviation. Northeast, n = 9, Midwest, n = 12,
South, n = 17, West, n = 13.
Table 3 Prevalence of water fluoridation as a function of geographic region
1992 2000 2002 2004 2006 2008
Region
M
SD
M
SD
M
SD
M
SD
M
SD
M
SD
Northeast
39.6
22.36
49.39
22.60
50.79
22.0
49.78
19.25
50.30
19.43
50.13
21.39
Midwest
69.1
11.84
69.62
9.32
72.51
10.77
73.25
10.69
72.87
10.78
70.17
13.11
South
69.0
15.11
67.80
16.17
71.68
14.74
74.82
15.11
74.37
15.85
73.37
17.51
West
31.7
22.78
34.13
20.70
37.26
20.86
39.90
19.5
41.16
19.35
43.65
19.78
Note. M, mean percentage of population receiving fluoridated water from public water systems in that year. SD,
standard deviation. Northeast, n = 9, Midwest, n = 12, South, n = 17, West, n = 13.
Differences in water fluoridation prevalence between regions were also statistically
significant in 1992 (F (3, 47) = 15.05, p = .000), 2000 (F (3, 47) = 12.21, p = .000), 2002 (F
(3, 47) = 13.20, p = .000), 2004 (F (3, 47) =15.07, p = .000), 2006 (F (3, 47) = 13.28, p =
.000), and 2008 ( F (3, 47) = 8.88, p = .000). Similar to ADHD prevalence, water fluoridation
prevalence in all years examined was lower in the West than in all other regions, but not
significantly lower than the North East. In 2004, 2006 and 2008 water fluoridation prevalence
was also higher in the South than in all regions, but not significantly higher than the Mid-
West.
The relationship between ADHD prevalence and water fluoridation
prevalence
Since artificial and natural water fluoridation prevalence per state was only distinguished in
1992, the relationship between each and ADHD prevalence was of primary focus and
examined separately. States with higher artificial fluoridation prevalence had significantly
higher ADHD prevalence in 2003 (r (49) = .46, p = .000), 2007 (r (49) = .42, p = .001), and
2011 (r (49) = .48, p = .000). Natural fluoridation prevalence in 1992 however, was not
significantly related to ADHD prevalence in 2007 or 2011, r (49) = - 19, p = .09, and r (49) =
-.22, p = .06 respectively, but was significantly negatively associated with ADHD prevalence
in 2003, r (49) = -.29, p = 0.02.
The relationship between overall state water fluoridation prevalence (not differentiating
between artificial and natural fluoridation) and state ADHD prevalence in later years was also
examined. Positive associations were found between the two for all years examined, except
between water fluoridation prevalence in 2008 and ADHD prevalence in 2007 (p = .07).
A4 p.741
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These correlations were numerically smaller however, than between artificial water
fluoridation prevalence and ADHD prevalence (see Table 4).
Table 4 Pearson correlations among water fluoridation prevalence and ADHD prevalence
Variables
2
3
4
5
6
7
8
9
1.) ADHD2003
.67
.65
.32*
37**
.38**
39**
39* *
.32*
2) ADHD2007
—
.71
.35**
.30*
.30*
.31*
.28*
.21
3.) ADHD2011
—
—
39**
.34**
.32*
.34**
.33**
.25*
4.) FPrev_1992
—
—
—
.82
.80
.81
.80
.75
5.) FPrev_2000
—
—
—
—
.96
.91
.91
.89
6.) FPrev_2002
—
—
—
—
—
.96
.97
.93
7.) FPrev_2004
—
—
—
—
—
—
.99
.95
8.) FPrev_2006
—
—
—
—
—
—
—
.96
9.) FPrev_2008
—
—
—
—
—
—
—
—
Note. ADHD, parent-reported health care provider-diagnosed lifetime prevalence of ADHD in that year.
FPrev_, percentage of the population receiving fluoridated water from public water systems in that year. *p <
.05, **p < .01. When not corrected for family-wise error, simple Pearson r > .25 is significant at p = .05, r > .33
is significant at p = .01.
ADHD prevalence, SES and artificial water fluoridation prevalence
Those of lower SES are often targets of public artificial water fluoridation programs [63,64]
and also tend to have higher ADHD prevalence [3], Therefore, data on median household
income per state in 1992 was obtained from the U.S. Census website [65] to examine whether
SES could be mediating the relationship between artificial water fluoridation prevalence and
ADHD prevalence. States with lower median household income in 1992 had significantly
higher artificial water fluoridation prevalence in 1992 (r (49) = -.27, p = 0.03) and consistent
with the NSCH findings, significantly higher ADHD prevalence in 2003 (r (49) = -.35, p =
.006), 2007 (r (49) = -.37, p =. 007) and 2011 (r (49) = - .44, p = 0.001). Therefore, a
hierarchical regression analysis was conducted to examine whether higher artificial water
fluoridation prevalence in 1992 predicted higher prevalence of ADHD in 2003 after
controlling for natural water fluoridation prevalence and median household income in 1992.
These results are presented in Table 5.
Table 5 Hierarchical regression predicting 2003 ADHD prevalence with 1992 artificial and natural
fluoridation prevalence
Variables
Total R2
AR2
F change
df
B
Step 1
.21
.21
13.11**
1,49
ArtF_l 992
.027**
Step 2
.24
.03
1.75
1,48
ArtF_l 992
.024**
NatF_1992
-.043
Step 3
ArtF_l 992
.34
.10
6.87*
1,47
.017*
NatF_1992
-.071*
SES_1992
-.010**
Note. ArtF, prevalence of artificial water fluoridation. NatF, Prevalence of natural water fluoridation.
SES, median household income. B, unstandardized coefficient.
* p < .05, ** p < .01.
The final model was significant, F (3, 47) = 7.91, p = 0.000, and accounted for 33.5% of the
variance in 2003 parent-reported health care provider-diagnosed ADHD. In the final model,
A4 p.742
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artificial water fluoridation prevalence significantly and independently positively predicted
2003 ADHD prevalence, B = 0.017, t (47) = 2.16, p = 0.036, while natural water fluoridation
prevalence and median household income in 1992 (measured in hundreds of dollars)
significantly negatively predicted it, B = -0.071, t (47) = -2.21, p = 0.032 and B = - 0.010, t
(47) = 2.62, p = 0.012 respectively. Therefore, while higher artificial fluoridation prevalence
in 1992 was associated with higher parent-reported health care provider-diagnosed ADHD
prevalence in 2003, higher natural fluoridation prevalence and median household income in
1992 were each associated with lower 2003 ADHD prevalence.
A multivariate hierarchical regression analysis was also conducted to examine the unique
relationships between artificial fluoridation prevalence and ADHD in all three years of
interest after median household income in 1992 was controlled (see Table 6). Natural water
fluoridation prevalence in 1992 was not included in this model because it was not
significantly correlated with ADHD prevalence in 2007 or 2011, and was already controlled
for in the previous regression predicting 2003 ADHD prevalence.
Table 6 Multivariate regression predicting ADHD prevalence with 1992 artificial fluoridation prevalence
and 1992 median household income
Variables
B
SE
t
p value
[95% CI]
ADHD 2003
ArtF_l 992
.023
.008
3.05
.004
.008, .038
SES_1992
-.007
.004
-1.92
.061
-.015, .000
ADHD 2007
ArtF_l 992
.031
.012
2.64
.011
.007, .055
SES_1992
-.013
.006
-2.17
.035
-.025, -.001
ADHD 2011
ArtF_l 992
.042
.013
3.20
.002
.015, .068
SES_1992
-.018
.007
-2.77
.008
-.031,-.005
Note. ArtF, prevalence of artificial water fluoridation. SES, median household income. ADHD. Parent-reported
health care provider-diagnosed lifetime prevalence of ADHD, in the given year. B, unstandardized coefficient.
Bonferroni corrected criterion for statistical significance, p < 0.017.
The overall model was significant when predicting ADHD prevalence in 2003 (F (2, 48) =
8.71, p = 0.001), 2007 (F (2, 48) = 7.94, p = 0.001) and 2011 (F (2, 48) = 12.21, p = 0.000),
accounting for 24%, 22% and 31% of the variance in ADHD prevalence respectively. In the
final model, artificial fluoridation prevalence in 1992 significantly and independently
predicted parent-reported health care provider-diagnosed ADHD in all three years examined,
Wilks X = .81, F (3, 46) = 3.64, p = 0.02, while the predictive relationship between median
household income in 1992 and ADHD prevalence in all three years was reduced to that of a
trend, Wilks X = .86, F (3, 46) = 2.48, p = 0.07. After applying a Bonferroni correction,
artificial fluoridation prevalence in 1992 significantly predicted ADHD prevalence in 2003,
(B = 0.023, t (48) = 3.05, p = 0.004), 2007 (B = 0.031, t (48) = 2.64, p = 0.011), and 2011 (B
= 0.042, t (48) = 3.20, p = 0.002). Thus, after adjusting for socioeconomic status, a 1%
increase in artificial water fluoridation prevalence in 1992 was associated with a 0.023%
increase in ADHD prevalence in 2003 (corresponding to approximately 67,000 additional
diagnoses), a 0.031% increase in ADHD prevalence in 2007 (corresponding to approximately
93,000 additional diagnoses) and a 0.043% increase in ADHD prevalence in 2011
(corresponding to approximately 131,000 additional diagnoses). Median household income in
1992 (measured in hundreds of dollars) did not meet the threshold for significance in
predicting ADHD prevalence in 2003 (p = 0.061) or 2007 (p = 0.035), but did so in 2011 (B
= -.018, t = - 2.77, p = 0.008) (see Figure 1).
A4 p.743
-------
Figure 1 Artificial fluoridation prevalence predicting ADHD prevalence after adjusting
for 1992 median household income. The line with large dashes and triangles represent
predicted values of ADHD prevalence in 2003. The line with small dashes and diamonds
represent predicted values of ADHD prevalence in 2007. The solid line and circles represent
predicted values of ADHD prevalence in 2011.
Discussion
Fluoride is a developmental neurotoxin [18,19] associated with impaired cognitive
functioning in infants and children. This is the first study to examine the relationship between
exposure to fluoridated water and ADHD prevalence, and did so using population-based data
collected by the CDC. It is also unique in that it examined ADHD prevalence within the U.S.,
decreasing the likelihood that differences in ADHD prevalence between states reflect
differing diagnostic criteria (DSM criteria is most commonly applied in the U.S. to diagnose
ADHD). Furthermore, ADHD state prevalence was determined using identical methodology,
eliminating the common problem of differing methodologies when comparing ADHD
prevalence between countries [1],
As hypothesized, water fluoridation prevalence was positively associated with parent-
reported health care provider-diagnosed ADHD prevalence. Geographic regions and states in
which a greater proportion of people received fluoridated water from public water systems
tended to have a greater proportion of children and adolescents diagnosed with ADHD. This
suggests that living in an "optimally" fluoridated community increases a child or adolescent's
risk of developing the disorder. Moreover, results did not appear to be confounded by
socioeconomic status because they remained consistent after controlling for this variable. Our
findings are consistent with prior epidemiological studies that have associated high and low
fluoride concentration exposure [49,58] with neurodevelopmental effects in children.
Artificial water fluoridation prevalence was significantly positively associated with ADHD
prevalence, while natural water fluoridation prevalence was either negatively or not
significantly associated with it. Although this could imply that the relationship between
exposure to fluoridated water and increased ADHD prevalence is specific to fluoridation
chemicals, the high variability in naturally occurring fluoride concentrations (0.1 mg/L - 15.9
mg/L) [21] within states prevents this conclusion from being made. Specifically, natural
fluoride concentration could potentially be confounding the relationship between natural
fluoridation prevalence and ADHD prevalence leading to a misleading result. For example,
counties with low natural fluoridation prevalence could have high concentrations of naturally
occurring fluoride that pose a greater neurodevelopmental risk than high prevalence of low
concentrations of naturally occurring fluoride. This could contribute to increased ADHD
prevalence within states that have low natural fluoridation prevalence. Thus, future research
controlling for the high variability in natural fluoride concentration is necessary to more
validly examine this relationship. Additionally, unlike artificially fluoridated water, U.S.
citizens can be exposed to naturally fluoridated water from sources other than public water
systems (e.g. wells and springs). Therefore, the state prevalence of natural fluoridation from
public water systems may not reflect the true state-based proportion of people exposed to
naturally fluoridated water.
Since states of lower SES tended to have higher artificial water fluoridation prevalence and
ADHD prevalence, another important area of investigation was whether artificial water
A4 p.744
-------
fluoridation prevalence in 1992 still predicted ADHD prevalence after SES was considered.
That is, did children and adolescents in states with higher artificial water fluoridation
prevalence merely have higher rates of ADHD because they tended to be of lower
socioeconomic status and therefore more likely to have additional ADHD risk factors?
Results showed that this was not the case and prevalence of artificial water fluoridation in
1992 did indeed predict ADHD prevalence independent of SES. Moreover, artificial water
fluoridation prevalence even appeared to be the more robust predictor.
Although more research is needed to investigate the relationship between exposure to
fluoridated water and increased ADHD prevalence, there are two main pathways by which
exposure to fluoridated water could theoretically contribute to the disorder. First,
silicofluoride-treated water has been shown to corrode lead-bearing plumbing, increasing the
leaching of lead in the water [66], Silicofluorides appear to react synergistically with lead,
which in turn, increases its uptake into the body [27], Consequently, children living in
communities with silicofluoride-treated water tend to have increased lead venus blood levels
(VBLs) (above 5 (ig/dL), and those with additional risk factors for lead exposure (e.g. living
in a house built before 1939 or living in poverty during the ages of 0-5) appear most
vulnerable [67-70], Lead VBLs equal to and lower than those more commonly found among
children living in silicofluoride-treated communities have repeatedly been associated with a
significantly increased risk of developing ADHD [15,71], In fact, it has been suggested that
25.4% (598 000) of ADHD cases among 8-15 year olds in the U.S. could be attributed to lead
exposure greater than 1.3 (ig/dL [72],
Second, exposure to fluoridated water may contribute to ADHD via suppression of the
thyroid gland. Fluoride reduces thyroid gland activity [73-75] and thyroid hormones are
particularly important for cholinergic activity in the basal forebrain and hippocampus [76],
Moreover, hypothyroxemia has been associated with ADHD and is considered a potential
cause of the disorder [77], In fact, thyroid gland suppression is the mechanism by which PCB
exposure contributes to it [78], Additional studies are necessary to investigate the interaction
among fluoride exposure, thyroid function and ADHD symptoms and to clarify whether
exposure to fluoridated water contributes to ADHD via suppression of the thyroid gland.
Even though current findings indicate a relationship between ADHD prevalence and fluoride
exposure that occurs through the optimal fluoridation of public water systems, there are
several study design limitations that should be considered. First, this study is an ecological
design that broadly categorized fluoride exposure as exposed versus non-exposed rather than
collecting information related to concentration of fluoride and patterns and frequency of
exposure or outcome at the individual level. Future research could explore the relationship
between exposure to fluoridated water and the occurrence of ADHD at the individual level.
Further clarification of a potential dose-response relationship between fluoride exposure and
ADHD symptoms would also be important for determining causality. Second, given that
fluoridation prevalence in neighboring years was highly correlated from 2000 onward and
unavailable for the mid to late 90s, it could not be determined whether exposure to
fluoridated water at a particular period of development was most associated with increased
ADHD prevalence. Nevertheless, given that other research has demonstrated the developing
brain's particular sensitivity to the neurotoxic effects of fluoride, it is likely that prenatal and
early postnatal development presents a window of vulnerability. Third, fluoridation
prevalence data was analyzed with ADHD prevalence data from different years, and
therefore, it cannot be confirmed that those surveyed in a given year were living in the same
region as when the fluoridation data were derived. Fourth, we were unable to obtain reliable
A4 p.745
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population-based data on blood lead levels among 4-17 year old children and adolescents,
and therefore could not determine whether lead was mediating the relationship between
exposure to fluoridated water and ADHD. Lastly, parent-reported health-care provider-
diagnosed ADHD prevalence was used in this study which is not as precise a measure as
others (e.g. conducting formal ADHD assessments) or may be subject to potential parent
biases regarding seeking or accepting an ADHD diagnosis for their child. Therefore, the
survey method used in the current study may not completely capture 'true' ADHD
prevalence. Despite these limitations, an association between exposure to fluoridated water
and ADHD prevalence was still found, even after considering the increased tendency for
children in low SES states to receive an ADHD diagnosis.
Conclusions
In summary, this study has empirically demonstrated an association between more
widespread exposure to fluoridated water and increased ADHD prevalence in U.S. children
and adolescents, even after controlling for SES. The findings suggest that fluoridated water
may be an environmental risk factor for ADHD. Population studies designed to examine
possible mechanisms, patterns and levels of exposure, covariates and moderators of this
relationship are warranted.
Competing interests
The authors declare they have no competing interests.
Authors' contributions
AM conceived of the study and hypothesis, acquired the data and contributed to the study
design, data analysis, interpretation of results and manuscript preparation. CT contributed to
the study design, supervision of data analysis, interpretation of results and manuscript
preparation. Both authors read and approved the final manuscript.
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Additional files provided with this submission:
Additional file 1. US Census Regions and Divisions. Census regions and divisions of the United States. This file includes a
map of the U.S. census regions and divisions as well as a list of the states in each region and division (1094k)
http://www.ehjournal.net/content/supplementary/sl2940-015-0003-l-sl.pdf
A4 p.754
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Research
Comparison of Indoor Mercury Vapor in Common Areas of Residential
Buildings with Outdoor Levels in a Community Where Mercury Is Used
for Cultural Purposes
Gary Garetano,1-2 Michael Gochfeld,3-4 and Alan H. Stern2 5
1Hudson Regional Health Commission, Secaucus, New Jersey, USA; department of Environmental and Occupational Health, University
of Medicine and Dentistry of New Jersey-School of Public Health, Piscataway, New Jersey, USA; 3Department of Environmental and
Occupational Medicine, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, Piscataway, New
Jersey, USA; 4Environmental and Occupational Health Sciences Institute, Piscataway, New Jersey, USA; 5New Jersey Department of
Environmental Protection, Division of Science, Research, and Technology, Trenton, New Jersey, USA
hlemental mercury has been imbued with magical properties for millennia, and various cultures use
elemental mercury in a variety of superstitious and cultural practices, raising health concerns for
users and residents in buildings where it is used. As a first step in assessing this phenomenon, we
compared mercury vapor concentration in common areas of residential buildings versus outdoor
air, in two New Jersey cities where mercury is available and is used in cultural practices. We meas-
ured mercury using a portable atomic absorption spectrometer capable of quantitative measurement
from 2 ng/111* mercury vapor. We evaluated the interior hallways in 34 multifamily buildings and
the vestibule in an additional 33 buildings. Outdoor mercury vapor averaged 5 ng/ni indoor
mercury was significantly higher (mean 25 ng/nip < 0.001); 21% of buildings had mean mer-
cury vapor concentration in hallways that exceeded the 95th percentile of outdoor mercury vapor
concentration (17 ng/m*), whereas 35% of buildings had a maximum mercury vapor concentra-
tion that exceeded the 95th percentile of outdoor mercury concentration. The highest indoor aver-
age mercury vapor concentration was 299 ng/nr\ and the maximum point concentration was
2,022 ng/m\ In some instances, we were able to locate the source, but we could not specifically
attribute the elevated levels of mercury vapor to cultural use or other specific mercury releases.
However, these findings provide sufficient evidence of indoor mercury source(s) to warrant further
investigation. Key utorcls: cultural use of mercury, elemental mercury, indoor air quality, mercury,
mercury exposure, mercury vapor, Santeria, voodoo, h.nuiron Health Perspect 1 14:59—62 (2006).
doi:10.1289/ehp.8410 available via http:llclx.cloi.orgl |Onlinc 20 September 20051
Mercury is one of two elements that are liq-
uid at ambient temperature. It is 13 times
heavier than water, and its unique proper-
ties have led to a wide variety of uses in
industry and elsewhere. Elemental mercury
is still widely used in dentistry and a variety
of hospital applications (Haas et al. 2003).
It is also found in a number of technologic
applications such as thermometers, barome-
ters, thermostats, switches, gas meters, and
especially fluorescent lights that may be
found in residential buildings. In the past,
organic mercury compounds were widely
used as preservatives in household paints,
and mercury antiseptics are still in use.
The unique properties of elemental
mercury or quicksilver have led people to
attribute magical and spiritual powers to it
through the ages. Mercury was viewed as an
essential component of the alchemical triad
of mercury, sulfur, and air and has been
associated with the Hindu god Shiva (Little
1997). Mercury amalgam religious icons
remain available today (Garetano G, unpub-
lished data). Elemental mercury is also used in
the spiritual practices associated with Santeria,
voodoo, Espiritismo, Palo Mayumbo, and
other Afro-Caribbean syncretic religions
[Riley et al. 2001; U.S. Environmental
Protection Agency (EPA) 2002]. Additional
uses of elemental mercury in a superstitious
manner have been reported (Wendroff 1990).
These practices include sprinkling elemental
mercury in the home, in cars, or around
babies and carrying capsules of mercury as
amulets to bring good luck or love (Johnson
1999; U.S. EPA 2002). These activities do
not appear to be components of ceremonial
use associated with spiritual traditions, nor are
they condoned or recommended by serious
practitioners of those traditions (Stern et al.
2003). We label these uses of mercury, sepa-
rate from the ceremonial use in spiritual tradi-
tions, as cultural uses. In communities where
cultural uses of mercury are believed to be
prevalent, the availability of mercury in spe-
cialty shops called botanicas has been well
documented (Riley et al. 2001; Wendroff
1990; Zayas and Ozuah 1996).
Both the technologic applications and cul-
tural uses of mercury provide the opportunity
for it to be an indoor air pollutant in residen-
tial settings. Elemental mercury evaporates at
a rate of 7 |ag/cm2/hr at 20°C (Andren and
Nriagu 1979). Up to 80% of inhaled mercury
is absorbed and readily crosses the blood-
brain barrier (Cherian et al. 1978; Clarkson
2002). The primary health concern associated
with inhaled mercury vapor is its neurotoxic-
ity, and infants are considered particularly
vulnerable. The Agency for Toxic Substances
and Disease Registry (ATSDR) and the U.S.
EPA, respectively, have established a minimal
risk level (MRL) of 300 ng/m3 and a refer-
ence concentration (RfC) of 200 ng/m3 for
elemental mercury vapor in residential quar-
ters (ATSDR 1999; U.S. EPA 1995). The
release of elemental mercury in a household
may pose some health risk for those who are
exposed. For example, broken clinical ther-
mometers typically contain only 600—675 mg
elemental mercury but can generate mercury
vapor concentrations an order of magnitude
above both the U.S. EPA RfC and the
ATSDR MRL (Carpi and Chen 2001;
Muhlendahl 1990; Riley et al. 2001; Smart
1986). Health effects in children have been
documented from such exposures (Moreno-
Ramfrez et al. 2004).
By comparison, elemental mercury for
cultural use is commonly distributed in
gelatin capsules containing approximately
9 g elemental mercury (Riley et al. 2001;
Wendroff 1990), which, when released, can
result in high concentrations of vapor (Riley
et al. 2001; U.S. EPA 1993). At least one
case of significant human exposure to ele-
mental mercury requiring medical interven-
tion as a result of cultural practices has been
reported (Forman et al. 2000).
Once spilled, sprinkled, or left in an open
container, elemental mercury may release
vapor for prolonged periods. Significant levels
of mercury vapor have been found in build-
ings decades after spillage, resulting in the
significant exposure of subsequent building
Address correspondence to G. Garetano, Hudson
Regional Health Commission, 595 County Ave.,
Secaucus, NJ 07094 USA. Telephone: (201) 223-
1133. Fax: (201) 223-0122. E-mail: ggaretano@
hudsonregionalhealth.org
We thank D. Riley, C.A. Newby, and T.O. Leal
for their assistance with related portions of this pro-
ject; and J. Burger (Rutgers University) for use of the
Lumex analyzer. J. Klotz, J. Zhang, and M. Robson
provided valuable input during the preparation of
the manuscript.
The New Jersey Department of Environmental
Protection provided grant support for the project.
The authors declare they have no competing
financial interests.
Received 18 June 2005; accepted 20 September
2005.
Environmental Health Perspectives • volume 1141 number 1 I January 2006
A4 p.755 59
-------
Garetano et al.
occupants without their knowledge (Centers
for Disease Control and Prevention 1996;
Orloff et al. 1997).
Other than those investigations con-
ducted in response to known spills, data
regarding mercury vapor concentration in
residential buildings are scant. Carpi and
Chen (2001) surveyed 12 residential and
commercial sites in the New York metropoli-
tan area without prior knowledge of mercury
contamination. Eleven of these locations
were found to have mercury vapor concen-
trations significantly elevated over outdoor
concentrations. Prior breakage of clinical
fever thermometers was subsequently identi-
fied as the probable mercury source in two of
the locations.
Given the lack of documentation of mer-
cury vapor in residential buildings in general
or of a disproportionate elevation of mercury
vapor in buildings in communities where it
is used culturally, we chose to conduct a sur-
vey of residential dwellings in a community
in which elemental mercury is readily avail-
able to assess the prevalence of mercury use
or spillage.
We hypothesized that elevated levels of
mercury vapor would be found in residential
buildings in communities that engage in cul-
tural uses of mercury. We further hypothe-
sized that these elevated levels can serve as a
signal of significant cultural use in addition
to unintentional breakage and spillage from
other sources. In this article we address the
first hypothesis. We address the second
hypothesis in a subsequent study to be pub-
lished separately.
Materials and Methods
Rationale for this study design, Riley et al.
(2001) described a high level of apprehension
and distrust of authorities or any outsider
from a different culture. As a result of these
cultural barriers, direct investigation of the
residences of persons possibly using mercury
for cultural purposes without first establishing
a cause for concern was deemed inappropri-
ate. Therefore, as a first step in characterizing
the extent of this phenomenon, we chose to
monitor mercury vapor within interior hall-
ways of residential buildings, rather than
directly measuring mercury vapor in resi-
dences, under the assumption that intentional
and unintentional releases of mercury within
the building would be reflected in elevated
concentrations in common areas compared
with the respective outdoor concentrations.
Measurement of mercury vapor in common
areas does not provide a direct estimate of
exposure, but by comparing these measure-
ments with respective outdoor levels and by
comparing measurements across buildings, we
can assess the prevalence of elevated indoor
mercury concentrations. This information can
inform decisions about appropriate public
health strategies and can guide future surveys.
Site selection. The information on cul-
tural uses of mercury suggests that such uses
are most common among certain Latino-
Caribbean populations. The geographic area
selected for inquiry was based on our prior
knowledge of both the predominant Latino
population and the presence of botanicas
that typically sell mercury (Riley et al. 2001;
Stern et al. 2003). The study was conducted
in the New Jersey municipalities of Union
City and West New York, comprising a total
area of approximately 2.4 mi2 (6.2 km2),
with 82.3 and 78.7% Latino population,
respectively. Multifamily buildings were cho-
sen for accessibility of common areas as well
as for the potential for efficient screening.
A primary criterion was that the buildings
surveyed be within 0.5 miles (0.8 km) of a
botanica. On the initial sampling date, a
building meeting this criterion was selected
on referral from a local health official, and all
accessible buildings for approximately a two-
block radius were evaluated. On subsequent
sampling dates the same procedure was fol-
lowed in other areas of the community meet-
ing the same criteria. Additionally, three
botanicas and one former botanica encoun-
tered during the residential building surveys
were also visited.
Mercury vapor monitoring. We meas-
ured real-time mercury vapor concentration
in air using an atomic absorption spectrome-
ter (model 915 + ; Ohio Lumex Co. Inc.,
Twinsburg, OH). The instrument has a sen-
sitivity of 2 ng/m3 of mercury in air and has
been successfully used for measuring mercury
in ambient air (Ohio Lumex 2000; Zdravko
and Mashyanov 2000). In previous studies,
residential structures identified as having ele-
vated mercury concentration with such direct
reading instruments were also found to have
elevated mercury vapor concentration with
8-hr sampling and subsequent laboratory
analysis (Singhvi et al. 2001).
The instrument was factory calibrated
according to the manufacturer's specification
and was within its factory calibration sched-
ule. The spectrometer warmup, operation,
and calibration followed the manufacturer's
instructions. Internal calibration uses a built-
in mercury cell and was performed in the
field before and on completion of sampling
in typical field conditions. During internal
calibration, measured mercury concentration
varied from the predicted concentration by
< 10% on each date. We validated precision
by evaluating the relative deviation of tripli-
cate measurements at each sampling location.
The overall relative deviation for the 286
triplicate sample sets that were equal to or
exceeding the manufacturers' stated detection
limit of 2 ng/m3 mercury vapor was 7.9%.
Once the instrument was warmed up and
calibrated, it was operated continuously. All
measurements were recorded at a height of
approximately 1 m above the floor unless
otherwise indicated. Each data point is the
average of three discrete 10-sec measurements
at a given sampling location. The instrument
also displayed mercury concentration continu-
ously in a real-time sampling mode. This
allowed evaluation of spatial variation and
trends in mercury vapor concentration.
Potential sources were localized where possible.
Site visits were conducted on 6 days in
June and August 2002. Although only one
visit was planned for each site, repeat visits
were made to two buildings because of the
high mercury vapor concentration encoun-
tered. Mercury vapor was monitored in the
vestibule and the interior hallways on each
floor of the buildings. These interior hallways
contain the entrances to residential apart-
ments. About half the buildings surveyed had
open access to both locations. A total of
227 locations in 67 buildings were surveyed.
On average, five hallway locations were
assessed in those buildings that were fully
accessible. All buildings were visited once
except the two buildings with the highest
readings. Mercury vapor measurements were
recorded in 37 outdoor locations in proxim-
ity to the buildings evaluated. Outdoor read-
ings near neighboring buildings showed low
variation. Within the three botanicas and one
former botanica, mercury vapor was moni-
tored in the retail portion of the store.
Additional data. In addition to mercury
vapor measurements, the following data were
also collected for each building: number of
residential units, number of floors, presence
of a central heating ventilation and air condi-
tioning system (HVAC), and the presence of
open windows.
Data analysis. We calculated the mean
mercury vapor concentration for each floor
of a building by averaging all data points for
that floor. We computed the average mer-
cury concentration for a building by averag-
ing the mean concentration for each floor.
The maximum mercury vapor concentration
reported for a building is the maximum data
point from any hallway location within the
building. Statistical analysis was conducted
using SPSS software (SPSS Inc., Chicago,
IL). Specific tests are indicated in the results
section as applicable.
Results
Site access and characteristics. Sixty-seven
buildings were visited, of which approxi-
mately half were fully accessible. Only
vestibules were accessible in the remainder.
All buildings in which the interior halls were
was accessed (n = 34) were multistory (mean,
4 floors) with a total of 497 residential units
60
volume 1141 number 1 I January 2006 • Environmental Heaftft PeiSpectives
-------
Indoor mercury vapor in residential buildings
(mean, 14 units). Buildings in which only the
vestibule was accessible tended to be slightly
smaller (mean, 12 units), although this differ-
ence was not significant (p = 0.18). Based on
familiarity with the area, including commu-
nity history, overall appearance, and census
characteristics, all buildings are believed to be
> 50 years old, although records were not
uniformly available. None of the buildings
had HVAC systems that influenced the areas
evaluated. Ventilation within the hallways
was primarily influenced by windows and
doors to residential apartments; 12 of 34
(35%) buildings had open hallway windows
during the time of the visit.
Mercury vapor concentration. The data
were log-normally distributed; thus, arithmetic
and geometric mean values, as well as per-
centiles, are reported. Because of relatively lim-
ited sample size and non-normal distributions,
we compared mercury values using the Mann-
Whitney U-test as well as by £-test on log-
transformed data, unless otherwise indicated.
Outdoor mercury vapor concentrations
had a mean value of 5 ng/m3 with an 80th
percentile of 12 ng/m3 and a 95th percentile
of 17 ng/m3. Our findings are consistent with
outdoor levels measured elsewhere ranging
from several nanograms per cubic meter to
20 ng/m3, with higher concentrations associ-
ated with urban/industrial areas and ambient
mercury outside a mercury storage facility in
Hillsborough, New Jersey, ranging from 2 to
8 ng/m3 (ATSDR 1999; Gochfeld M,
unpublished data; New Jersey Department of
Environmental Protection 2001).
The geometric and arithmetic mean mer-
cury concentrations in building hallways were
10 ng/m3 and 25 ng/m3, respectively. In
building vestibules, the geometric and arith-
metic means were 7 ng/m3 and 11 ng/m3,
respectively. The mercury vapor concentra-
tion in interior hallways was significantly
greater than that found outdoors (p < 0.001)
and in building vestibules (p < 0.05). Mercury
vapor in vestibules was also greater than that
found outdoors (p < 0.001). All three loca-
tions were found to differ significantly (p <
0.001) when compared simultaneously using
the Kruskal-Wallis nonparametric one-way
analysis of variance test. Indoor and outdoor
mercury vapor concentrations are summarized
in Tables 1 and 2.
We found that 7 of 34 (21%) buildings
had a mean mercury vapor concentration in
hallways that exceeded the upper 95th per-
centile of outdoor mercury vapor concentra-
tion (17 ng/m3), and that 35% of buildings
(12 of 34) had maximum mercury vapor
concentration in hallways that exceeded the
upper 95th percentile of outdoor mercury
vapor concentration.
No significant difference was noted in
the mean and maximum mercury vapor
concentration in buildings that had open
windows compared with those that had
either no windows or closed windows (p <
0.8 and p < 0.4, respectively). No difference
was noted between mercury vapor concen-
tration by measurement date using Kruskal-
Wallis Test (p > 0.6) nor among the floors of
the building on which the maximum con-
centration of mercury was detected (p > 0.7).
Within the three botanicas surveyed,
average mercury concentration ranged from
40 ng/m3 to 482 ng/m3 (mean, 220 ng/m3),
whereas a former botanica averaged 72 ng/m3.
Mercury concentration within the botanicas
was significantly greater than that within the
residential buildings (p < 0.01).
Spatial variability. We were able to local-
ize potential sources of mercury contamination
in seven buildings as evidenced by increasing
mercury concentration as the "source area"
was approached. At two sites, the probable
source of mercury vapor emission was tracked
to areas on the floor surface, one near a build-
ing entrance, the second on a stairway to a roof
exit. In the remaining five buildings, mercury
vapor concentration increased as certain indi-
vidual or groups of apartment entrances were
approached. No visible contamination was
noted in any of the cases, and the actual source
of vapor remained unknown.
We noted order of magnitude differences
in mercury concentration between locations
in buildings with high mercury concentra-
tion. For example, mercury vapor concentra-
tion ranged from 35 ng/m3 to 2,022 ng/m3
in the building with the highest concentra-
tion. Similar findings were noted elsewhere.
The difference between mercury concentra-
tion on the building level (floor) on which
the maximal value was noted and the remain-
der of the building was significandy higher in
four of the buildings (p < 0.04).
Temporal variability. Although our intent
was to survey buildings once, two buildings
had maximum hallway mercury vapor con-
centrations of 2,022 ng/m3 and 774 ng/m3,
which exceeded both the ATSDR MRL
(300 ng/m3) and U.S. EPA RfC (200 ng/m3).
Local public health officials were notified, and
repeat visits were made to each building. The
building with the highest concentration was
visited on five dates. Both the average and
maximum mercury vapor concentrations of
the building were significantly different on
repeat visits (Kruskal-Wallis test, p < 0.04).
Outdoor temperature ranged from 17 to
31°C, and hallway windows were open, pro-
viding passive ventilation, on all dates. The
building hallways were not cooled, and indoor
temperature was similar to that outdoors.
Unexpectedly, mercury vapor concentration
did not vary as a result of temperature changes
(p > 0.7), and contrary to expectation, higher
mercury vapor concentrations were noted
on cooler days. By the final visit, maximum
mercury vapor concentrations in each build-
ing (109 and 19 ng/m3, respectively) were sig-
nificantly reduced (p < 0.01) compared with
the initial visit. In both buildings, mean and
maximum mercury concentrations fell below
MRL and RfC. Despite the reduction in
vapor concentration, the area of maximum
concentration remained consistent.
Discussion
Our findings provide a valuable first look at
the differences between indoor mercury con-
centrations and those outdoors in an area with
known cultural use of mercury. Although our
data are not intended as estimates of residen-
tial exposure to mercury vapor, they do indi-
cate that, compared with outdoor levels, such
exposures are likely in a significant proportion
of multifamily residential buildings in an area
with known cultural uses of mercury. This
study did not include comparison with indoor
mercury concentrations in a comparable area
that can serve as a control for cultural use of
mercury. Therefore, these data cannot distin-
guish between those elevations in mercury
concentration resulting from cultural uses and
those resulting from unintentional releases of
mercury (e.g., broken thermometers or fluo-
rescent lightbulbs, spilled gas meter seals). We
are currently engaged in a follow-up study to
investigate these questions.
Table 1. Comparison of mercury vapor concentration (ng/m3) within building hallways and outdoors.
Location
No. Arithmetic mean ±SD
Geometric mean (SD)
Outdoors
37 5± 5
4(2)
Building vestibule
57 11 ±12
7(2)
Mean in building hallways
34 25 ±53
10(4)
Maximum in building hallways
34 102 ±364
17(4)
Mann-Whitney [/-test, p< 0.001.
Table 2. Distribution of mercury vapor concentration (ng/m3) within building hallways and outdoors.
Percentile
Location
25th
50th 75th
90th 95th
Outdoors
3
4 6
12 17
Building vestibules
4
7 13
22 36
Mean of building hallways
6
11 16
66 155
Maximum within hallways
9
14 25
CO
CO
CD
CO
CD
Environmental Health Perspectives • volume 1141 number 1 I January 2006
A4 p.757 61
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Garetano et al.
There are relatively few reports of "back-
ground" mercury concentration in indoor air
in residential buildings or "noncontami-
nated" environments to which our results can
be compared. Our finding of mercury vapor
in greater concentrations indoors compared
with outdoors is consistent with the findings
of Carpi and Chen (2001), who investigated
mercury in residences without prior knowl-
edge of mercury use or release.
Carpi and Chen (2001), using a direct
reading instrument, were able to identify
specific points inside several of the apart-
ments they investigated that appeared to be
the source of mercury emissions. Likewise,
we were able to localize potential mercury
sources in several buildings with elevated
mercury concentrations. We clearly
observed an increasing gradient in mercury
vapor concentration as a potential source
was approached. Although the exact source
was not identified, the potential source of
mercury vapor seemed to be residential
apartments in five of the buildings with ele-
vated mercury vapor concentration. Our
finding that > 20% of buildings we studied
had average and 35% had maximum mer-
cury vapor concentrations that exceed the
95th percentile of outdoor concentrations is
significant and leads to the conclusion that
sources of contamination are present and
prevalent indoors in this community. These
findings are consistent with the hypothesis
of cultural use of mercury, but not defini-
tive. The elevated mercury vapor concentra-
tion found in botanicas is also consistent
with its availability for cultural use.
These measurements were not made in
areas that directly reflect exposure, nor, for
the most part, do they measure concentration
at the emission source. Therefore, these meas-
urements could underestimate mercury con-
centration at the point of long-term exposure.
Our surveys were subject to the variability in
environmental conditions that occurs in
occupied residential buildings and possibly
the variability in patterns and methods of cul-
tural mercury use. In most buildings sur-
veyed, including those with the highest
mercury vapor concentration, windows were
open. This may partially explain the variabil-
ity in mercury concentration and the lack of
association with temperature we found in the
sites with repeated visits. Although spot meas-
urements of mercury vapor concentration in
buildings may not reflect long-term average
mercury concentration, we believe that the
signals of elevated mercury concentration pro-
vided by spot measurements are relevant as
a screening tool in identifying the presence
of mercury release regardless of its source.
For this approach to be more effective as a
tool for screening for exposures of concern,
models need to be developed that can reason-
ably predict the transit of mercury vapor
from a source "behind closed doors" to other
rooms or areas of a building under conditions
that simulate occupancy.
Whether exposure to elevated mercury
vapor arises from intentional cultural uses or
from unintentional breakage and spillage of
mercury-containing equipment, these expo-
sures pose the potential for adverse health
effects and should be addressed. However,
the nature and scope of the public health
problem will be significantly different for
each of these cases. Each will require a differ-
ent public health outreach and intervention
strategy. It is therefore essential that future
investigations clarify the relative contribution
of each cause. We are currently continuing
research to this end.
Given the findings of Carpi and Chen
(2001) and this investigation, we feel some
broader evaluations to establish reference
ranges of mercury concentrations in the
indoor residential environment are warranted.
Such a reference range would include mercury
contamination resulting from historical
accidental breakage of mercury-containing
equipment. Such contamination may be
widespread and would likely be independent
of cultural factors. Based on reports on the
manner in which mercury may be used for
cultural purposes, and our present findings,
we also recommend expanded screenings in
areas where mercury may be used for cultural
purposes with the inclusion of suitable control
locations. Although cultural obstacles may be
present that may impede a direct approach to
assessing human exposure to mercury vapor as
a result of cultural practices and its relevance
to public health, we believe further evalua-
tions in the field will ultimately shed light on
this elusive issue.
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62
volume 1141 number 1 I January 2006 • Environmental Heaftft Pei§|3ectives
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AN EVALUATION OF POTENTIAL EXPOSURE TO MERCURY IN A COMMUNITY [Union
City & West New York, NJ] WHERE MERCURY IS USED FOR CULTURAL PURPOSES
Doctoral Dissertation, School of Public Health, University of Medicine and Dentistry of New Jersey
January, 2006
Gary Steven Garetano, R.N., M.P.H., D.P.H.
Dissertation Director
Michael Gochfeld, M.D., Ph.D.
ii
ABSTRACT OF THE DISSERTATION
Elemental mercury is used in a variety of superstitious and cultural practices. These practices involve
intentional dispersal of mercury within residential buildings by individuals who believe this will
provide some benefit or ward off harm but may represent an insidious source of mercury exposure.
iii
We determined that cultural mercury use is a likely source of exposure for a small but noteworthy
percentage of individuals in communities where there is such use.
6
Chapter 1
Comparison of Outdoor Mercury Vapor Levels to Levels in Common Areas of Residential
Buildings in a Community where Mercury is used for Cultural Purposes
10
We hypothesize that elevated levels of mercury vapor are present in residential buildings in communities
that engage in cultural use of mercury compared with outdoors. We further hypothesize that elevated
levels can serve as a signal of significant cultural use in addition to unintentional breakage and spillage
from other sources.
14
Windows and doors to residential apartments primarily influenced ventilation within the hallways. 12 of
34 (35%) buildings had open hallway windows during the time of the visit.
16
Mercury concentration within the botanicas was significantly higher than that within the
residential buildings (P<0.01).
In the remaining five buildings, mercury vapor concentration increased as certain individual or groups of
apartment entrances were approached. No visible contamination was noted in any of the cases and the
actual source of vapor remained unknown.
18
A4 p.759
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Although our data are not intended as estimates of residential exposure to mercury vapor they do indicate
that, compared with outdoor levels, such exposures are likely in a significant proportion of multifamily
residential buildings in an area with known cultural uses of mercury.
19
Though the exact source was not identified, the potential source of mercury vapor seemed to be
residential apartments in five of the buildings with elevated mercury vapor concentration. ... Our...
findings are consistent with the hypothesis of cultural uses of mercury, but not definitive. The elevated
mercury vapor concentration found in botanicas is also consistent with its availability for cultural
use.
These measurements were not made in areas that directly reflect exposure, nor, for the most part, do they
measure concentration at the emission source. Therefore, these measurements could underestimate
mercury concentration at the point of long-term exposure. ... In most buildings surveyed, including
those with the highest mercury vapor concentration, windows were open.
20
Whether exposure to elevated mercury vapor arises from intentional cultural uses or from unintentional
breakage and spillage of mercury-containing equipment, these exposures pose the potential for adverse
health effects and should be addressed.
Based on reports on the manner in which mercury may be used for cultural purposes, and our present
findings, we also recommend expanded screenings in areas where mercury may be used for cultural
purposes with the inclusion of suitable control locations.
26-27
Chapter 2
Comparison of Mercury Vapor in Residential Communities that use Mercury for Cultural
Purposes with a Reference Community
After controlling for a number of factors that might influence Hg° vapor levels, the most plausible
explanation for greater Hg° vapor levels in the study area is cultural use of mercury.
31
Extensive detail exists elsewhere on the prevalence, manner of use and availability of Hg° for cultural
purposes (Johnson 1999; Johnson 2004; Ozuah et al. 2003; Riley et al. 2001; Stern et al. 2003; Wendroff
1990; Zayas and Ozuah 1996). Though mercury is available in communities where it is culturally, due to
apprehension, a distrust of authorities and those outside the culture, it's sale or distribution to these
"outsiders" is limited (Riley et al. 2001; Stern et al. 2003). This is not the case outside the U.S. where we
readily purchased several grams of Hg° and other select liquids and received verbal instructions on the
most auspicious days to spread them on the floor in the home with the recommendation to do so twice-
weekly (see figure 1).
32
Although the magnitude of exposure to Hg° vapor from cultural use is unknown, the hazard of Hg°
vapor is well established and it is detectable years after small spills from objects such as a fever
thermometer (Carpi and Chen 2001; von Muhlendahl 1990). With larger spills, significant concentrations
of Hg° vapor may persist for decades (Sasso et al. 1996). This presents the specter of exposure to Hg°
in residences from either unintentional or intentional Hg° releases without knowledge of such
A4 p.760
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exposure. Wendroff (2005) contends cultural mercury use has created such a problem. Based on
the described manner and frequency of mercury use by some individuals this contention is not
without basis.
49
We cannot attribute the greater prevalence of elevated mercury vapor levels in this area or in the primary
study community to cultural use with absolute certainty, but we have no alternate explanation.
49-50
Our method relies upon sensitive instrumentation to detect a signal of mercury release though the source
may be distant. Thus, Hg° vapor exposure near the source in apartments is likely to be significantly
greater than we detected in common areas, unless as we noted on occasion, the source was in the common
area.
50
When we examine these data in context with the prior literature, previous and ongoing biomonitoring
programs, there is no choice other than to acknowledge some percentage of individuals are
needlessly and possibly unknowingly exposed to Hg° vapor because of the cultural or folk use of
mercury. This includes residents of apartments where mercury was used culturally by prior
residents.
59
Chapter 3
Evaluation of Urinary Mercury as a Biomarker of Exposure for Individuals Exposed to Mercury
Vapor in a Non-occupational Setting
62-63
While noting sub-clinical neurological findings from low-level Hg° vapor exposure, Heyer et al. (2004)
put forth the supposition, "It is possible that elemental mercury may follow the history of lead,
eventually being considered a neurotoxin at extremely low levels."
83
We have demonstrated that the utilization of the value, 20|j,g/L, as the upper limit of normal urine
mercury fails to identify significant exposure. All individuals in the lowest Hg° vapor exposure category
were exposed to Hg° vapor at a level of magnitude above the U.S. EPA RfC (U.S. EPA 1995) and the
ATSDR MRL (ATSDR 1999), yet two-thirds had urine Hg less than 20|j,g/L. If individuals in this group
were the first to seek urine mercury screening, significant exposure might have been undetected. Thus,
for this reason and those stated in the text, we feel strongly that the value, 20|ig/L, and the word
"normal" should only appear together in a historical context.
96
Chapter 4
Conclusions and Recommendations
97
The detection of elevated Hg° vapor levels in residential buildings and botanicas supports the
contention that mercury is available and released in residential buildings by cultural use.
A4 p.761
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98
However, the selection of reference buildings controlled factors likely to contribute to elevated Hg° vapor
levels leaving cultural mercury use as the plausible explanation for the difference in Hg° vapor levels
between the control and reference communities.
99-100
In summary we conclude:
1. Hg° vapor levels in the common areas of residential buildings in communities that use
mercury for cultural purposes are significantly greater than those outdoors.
2. Hg° vapor levels are significantly greater in the common areas of residential buildings in
communities that use mercury for cultural purposes compared to those in communities
where the use of Hg° is unlikely.
3. Hg° vapor exposure from cultural mercury use is likely in a small but noteworthy
percentage of households in the study area.
4. Biomonitoring of urine mercury is [a] reasonable tool to assess intermediate and chronic duration
non-occupational exposure to Hg° vapor, including that from cultural use, though at present, its
sensitivity to detect exposure at less than 3|j,g/m3 Hg° is unclear.
100
Recommendations for Public Health Action
The prevalence of cultural mercury use and the likelihood of exposure to Hg° vapor at levels of public
health concern warrant specific actions to address this use in communities where this practice exists.
Though the extent of public health action might vary based on the prevalence of cultural use and
associated Hg° exposure, the following recommendations are relevant to the study communities surveyed
in this research.
1. Culturally appropriate educational outreach activities, using written materials or other media that
addresses sources of mercury, its health hazards, and resources for individuals who may be
exposed are required. Educational materials must be accessible to individuals without deliberate
action to seek information regarding mercury.
2. Health care providers should be provided with educational materials and guidance regarding
biomonitoring.
3. Public health clinics and appropriate community-based clinics should provide urine
mercury screening to those individuals that reasonably believe they are exposed, regardless
of their ability to pay for this analysis.
4. Local public health officials should have the capability, individually or regionally, to conduct
mercury vapor monitoring with sensitive instruments. Monitoring in residences should be
offered to all individuals with urine mercury above population norms. Public health officials
should consider monitoring in all residences that request it.
101
5. Recommendations 1 through 4 should be designed and implemented in a manner that allows
A4 p.762
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evaluation of their efficacy and relevance to other communities.
6. A strategy should be developed by state and local public health and environmental officials,
in consultation with federal officials, to guide response actions if residences with mercury
vapor at levels of concern are identified.
Recommendations for Additional Research
Research needs in addition to those that might accompany the recommended public health actions are also
present.
1. In other communities where there is cultural mercury use, air-monitoring surveys similar to
that in Chapter 2 may be useful where deliberate public health action is deferred due to a
lack of information regarding the prevalence of these practices.
2. Studies to establish baseline levels of mercury vapor in residential buildings are warranted both to
evaluate the contribution of indoor mercury vapor to total mercury exposure and to provide a basis
of comparison for public health investigations involving indoor mercury vapor exposure.
3. The existing literature should be evaluated with consideration of the contribution of dental
amalgam to urine mercury, to better describe the "normal" ranges of urine mercury in non-
occupationally exposed populations.
102
4. The effect of adjustment on urine mercury should be further evaluated in an attempt to aid
interpretation of results and to foster consistency in reporting so that inter-study and inter-
individual comparisons may be more relevant.
103
Appendix A
Determination of the Number of Households in the Study Area that Might Contain Elemental
Mercury in Sufficient Quantity to Generate a Signal of Mercury in Common Areas of the Residence
105
By extrapolation, 1.74% of households (95% CI: 1.05%, 2.43%) or 689 (CI: 416, 962) of the 39,591
within the study area may contain mercury at a level sufficient to result in a Hg° vapor signal of
greater than 25 ng/m3 in building common areas. On average, there are 2.8 persons per household in
this community.
Conclusion
The majority of households in the study area are not likely to contain Hg° in sufficient quantity to
generate Hg° vapor signals of greater than 25 ng/m3 in common areas. Despite this, the number of
individuals in households where Hg° is present at this level is of concern.
106
A4 p.763
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Curriculum Vita
[The author is currently Assistant Director of the Environmental Health and Public Health Emergency
Preparedness Programs of the Hudson Regional Health Commission, 595 County Avenue, Building 1,
Secaucus, NJ 07094. Telephone (201) 223-1133 ggaretano@hudsonregionalhealth.org]
Verbatim excerpts and selective boldface by:
Arnold P. Wendroff, Ph.D.
Mercury Poisoning Project
544 Eighth Street,
Brooklyn, NY 11215-4201
(718) 499-8336
mercurywendroff@mindspring.com
www.mercurypoisoningproject.org
A4 p.764
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TO: White House Environmental Justice Advisory Committee
FR: Grand Canyon Trust
RE: WHEJAC's Assessment on Annual Performance Scorecard/Docket ID No.
EPA-HQ-OA-2022-0050
DATE: March 10, 2022
Dear White House Environmental Justice Advisory Committee,
This letter in response to the annual performance scorecard Docket ID No.
EPA-HQ-OA-2022-0050. It is understood that the scorecards provide a method for
evaluation and accountability to assess the agencies' progress for addressing historic
environmental justice. WHEJAC's efforts to addressing these issues consist of
strategic, scientific, technological, regulatory, community engagement and economic
issues related to environmental justice1. This letter provides a brief background with
prioritized actions and recommendations to address both current and historic
environmental injustices within the Black Mesa region of Northern Arizona.
Background
The Colorado Plateau is a region with enriched cultural and natural resources, home to
generations of Native American communities expanding across the plateau. These
communities are at the frontlines of the climate crisis and the transition away from a
fossil-fueled dependent based economy.
Extensive coal mining operations on Black Mesa occurred within the Navajo and Hopi
reservation for several decades from the 1950's to 2019 consisting of the Black Mesa
Mine and the Kayenta Mine. The mining and combustion of Black Mesa coal created
jobs and revenue for the Navajo Nation and the Hopi Tribe. The shuttered-closure of
the Navajo Generating Station (NGS) and its primary coal supplier Kayenta Mine
(2019), left behind lingering environmental, social and cultural impacts.
The Navajo Nation government and Hopi Tribe did not have an appropriate time-frame
nor the capacity to prepare an ample response. The unplanned closure of NGS
bolstered significant economic impacts, reinforced by Navajo Nation losing 20% of its
annual revenue and 80% of the Hopi Tribe's annual revenue. Approximately 85% of the
employees of NGS and Kayenta Mine were Navajo citizens. The closure projected to
sever 1,500 direct and indirect jobs and benefits for the Navajo Nation2.
1 https://www.epa.gov/environmentaljusticeAwhite-house-environmental-justice-advisory-council
2 Yulin Hong et al, April 2020, Just and Equitable Transition for Navajo Nation.
1
A4 p.765
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It is important for the advisory committee to take into consideration the impacts that
communities have faced for several generations in the Black Mesa region. The social
and environmental impacts are interconnected with historical federal actions such as the
1974 Navajo Hopi Land Settlement Act. This event displaced many Hopi and Navajo
families across the region and was enacted in support of developing the coal reserves
in the area3. To enforce artificial boundaries, additional federal action resulted in a 40
year moratorium on building and infrastructure development in the region as well as a
livestock reduction program. Taken together, the region of Black Mesa has endured
economic degradation and systemic exploitation of land, resources, and people
including destruction of water resources, lack of basic infrastructure, inadequate
reclamation, culturally sensitive impacts, and proven health disparities.
The ancestral lands of the Indigenous communities in the region have tremendous
cultural and natural value that are intertwined with economic value through the spiritual
and traditional practices and knowledge of the people. A just and equitable transition
requires creative and ambitious thought that respects this dynamic relationship.
Environmental reclamation is required for the people who are the ancestral stewards of
this land to develop long term economic solutions that honor traditional lifeways and
provide the stability that is needed for long-term restoration.
The people of the Navajo Nation and the Hopi Tribe continue to face social and
economic impacts from the lack of accountability from operators, stakeholders and
federal government agencies. Outlining components of a transition on the Black Mesa
include first reclamation and remediation followed by sustainable economic
development.
Implementation of Black Mesa Region Hydrological Study
We recommend the Administration consider immediate action to fund a hydrological
study that will provide technical-scientific expertise within the Black Mesa region. A
study to conduct hydrological subsurface and groundwater study is a paramount to
achieve a just and equitable transition. The Navajo Aquifer (N-Aquifer) is one of the
largest aquifers located in the region. The N-Aquifer is the main water resource
available to the Tribe's local communities members and other non-tribal members.
Peabody Western Coal Company, primary operator of Kayenta Mine, extracted more
than coal resources. The coal-mine used millions of gallons a day for it's mining
operations drawing water from the N-Aquifer. There is a need to conduct an extensive
3 https://hardrock.navajochapters.org/navajo-hopi-partition-land-information/
2
A4 p.766
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hydrological study for the region for the planning of sustainable economic development.
There are many benefits that a hydrological study could provide:
• Future planning of regional economic developmentr
• Development of regional climate adaptation and mitigation plans within Northern
Arizona or the Four Corners region.
• Environmental sustainability plans and water conservation guidelines for
underserved communities in Navajo County.
• Ecological vulnerability assessment for agricultural and food production projects.
• Guidelines to enhance and protect culturally sensitive plant and animal species
that are dependent on water resources within the region.
• Comprehensive understanding of the interface between large-scale industrial
development and water resource availability.
• Aid in the development of supporting guidelines, toolkits, roadmaps, etc. for a just
and equitable transition.
The initiation of a hydrological study is highly recommended, it is a key action that could
preserve and sustain the Black Mesa region-economically, environmentally, and socially.
Oversight of Coal Mine Reclamation on Black Mesa
The reclamation of coal mines is required by the Surface Mining, Reclamation and
Control Act (SMCRA) to be conducted during and following mine operations4. The
Office of Surface Mining, Reclamation and Enforcement (OSMRE) is responsible for
overseeing the reclamation of Black Mesa. For nearly two decades, community
members of Black Mesa have been witness to poor oversight and little progress
regarding reclamation at the Black Mesa mine and as a result have very little confidence
in the OSMRE to act according to the standards laid out by the Administration's
environmental justice policy with regards to the Kayenta Mine.
A just and equitable transition starts with adequate oversight and prioritization of
reclamation by the Department of the Interior. Reclamation of the land and resources
committed to developing access to quality water are critical elements to existing efforts
by community led organizations seeking to provide solutions that will create
generational economic stability, food security and restoration of the social and physical
health of the people of the Black Mesa region. The initial action required for adequate
reclamation is for the OSMRE to initiate a "significant mine permit review" for the
Kayenta Mine which will allow for the Navajo Nation and Hopi Tribe to participate in the
oversight process.
4 https://www.osmre.gov/laws-and-regulations
3
A4 p.767
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Providing Just Transition Assistance
A just and equitable transition in the Southwestern region of the United States requires
immediate funding aimed at assisting coal impacted communities to achieve economic
diversification, job creation, and economic justice. While in operation the Black Mesa
coal mine, the Kayenta coal mine, and the NGS electric generating facility provided the
region short-lived economic opportunities. In the Southwestern United States, the
legacy of these investments is substantial growth and a comfortable and affordable
living for urban populations. The other side of this legacy is the economic and
environmental degradation of a rural area of the country that in this time of transition
requires direct and specific investments but also lacks the capacity to attract significant
funding. We recommend the committee to provide funding specific to rural underserved
communities in this specific region that have experienced on-going environmental and
social impacts.
Conclusion
An all-of-government approach to a just transition should be carried forth with the
inclusion of reclaiming lands, restoring tribal and local economies. There are many
uncertainties with regards to the extent of the environmental and ecological damages
that have occured pending the closure. It is important to recognize the injustices that
still exist and that governmental intervention is urged. A unified action of the federal
government would set a precedent for the future Four Corners region that includes the
states of New Mexico, Arizona, Utah and Colorado.
For several decades the community members organized and created local non-profit
organizations to ensure that justice is fulfilled for the people and land . A few of the
organizations that were created in the region include Black Mesa United, To Nizhoni
Ani, Black Mesa Trust, and Black Mesa Water Coalition. These organizations are
community-led established by members of the Black Mesa region that have devoted
their work to assist, support and elevate voices of the multi-generational members of the
community of Black Mesa.
The Grand Canyon Trust acknowledges the social, economic, and environmental
injustices that communities of the Black Mesa region have and continue to experience.
Therefore, we are providing support and assistance to these communities through
various programs and initiatives.
4
A4 p.768
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We thank you for taking into account our recommendations.
Jessica Stago
Program Director
Native America Economic Initiatives, Grand Canyon Trust
Wilda Anagal
Legislative Community Coordinator
Native America Economic Initiatives, Grand Canyon Trust
5
A4 p.769
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February 10, 2022
White House Environmental Justice Advisory Council
c/o Karen L. Martin, WHEJAC Designated Federal Officer
Washington, DC
Dear Councilmembers:
Thank you for the opportunity to comment on the WHEJAC January 26 and 27, 2022 public
meetings. We are a group of students at the University of Kansas1 enrolled in an Environmental
Injustice course this term. With encouragement from our instructor (not as an assignment), the
undersigned students were able to attend parts of the public meeting. It was an interesting
"behind the scenes" experience to watch and learn about all the initiatives across the federal
agencies in the area of environmental justice. After viewing the very informative presentations
from government officials, commentary from the WHEJAC membership and the public, we are
submitting this comment letter because we noticed some projects discussed during the
meeting to be similar to ones found in the Kansas City metropolitan area in Kansas and
Missouri.
ABOUT CAN
CleanAirNow (CAN) is a nonprofit, grassroots environmental organization located in Kansas City
that helps promote clean air for communities of color and low income and spreads awareness
of the disproportionate burdens from air pollution in these neighborhoods that may constitute
environmental racism. CAN has helped to establish air monitors in the Armourdale2 and
Rosedale3 communities in the Kansas City metropolitan area. Historically, these communities
have been disproportionately impacted by air pollution. The people in these neighborhoods are
suffering negative health consequences.
These low-income communities of color are suffering the effects of chemical pollutants in their
air at a much higher rate than their white high-income counterparts. These communities are
exposed to a plethora of chemicals and air pollutants that cause cardiovascular and respiratory
damage. The generational disadvantages caused by improper redlining and zoning have caused
additional financial and physical damages to these communities by devaluing their homes and
1 Disclaimer. This comment was not funded or guided by the University of Kansas or its departments and agencies,
nor funded or guided by any local, county, state or the federal government.
2 In 2010, Armourdale had a population of 5,488. The overwhelming majority of the region's inhabitants (76%)
identify as people of color. With respect to the type of residence, there are 1,623 homes in the region. On the
contrary, there are 1,915 housing units in the region. Further, the median household income for this neighborhood
is $31,600. See Environmental Justice Recommendations: Comments on the Armourdale General Plan, May 2021
3 In the 19th century, Mexican workers established communities in neighborhoods such as Rosedale and
Armourdale. These communities' nearness to the Kansas City railyard and interior port has exposed their residents
to dangerous levels of fine particulate matter (PM2.5) for generations. See B. Lugo-Martinez, Environmental
Racism in the Heartland, Fighting for Equity and Health in Kansas City, November 2021, Union of Concerned
Scientists and CleanAirNow, httpsi//doi,org/10,47923/2021,14322
A4 p.770
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creating lifelong health problems that last for generations. The Kansas City area has air
pollution monitors currently, but not enough and not in the right places. These communities
would best benefit from having fence line monitors and community chosen monitors closer to
schools, senior housing, parks, and residential areas. CAN is already working on this but needs
the help of the EPA, federal, local, and state governments to help create new regulations on
these chemical producing companies, railways, and diesel truck routes to reduce the
environmental risk to these communities and ensure that new residences or community spaces
are not built within close proximity to these plants and air-polluting industrial groups.
In addition, CAN has worked with "las promotoras de salud" (health promotors in English) and
"El Centro" in the Argentine community,4 which is predominantly Latino, located in Wyandotte
County, Kansas City, Kansas. CAN and the health promotors provide information on how the air
they breathe correlates to the negative health impacts they suffer. They provided air monitors
which allowed community members to access real-time quality index at the fence line of
polluting industries in this community. These monitors and real-time communications are
important to people who generally, lack access to such information.
CAN is concerned about the negative and cumulative effects of environmental racism in these
neighborhoods. By establishing their own air quality monitoring, they have shown that the
Clean Air Act (CAA) alone is insufficient to mitigate the compounding impact of air pollution in
these areas from multiple industries, some of which have been in violation of the CAA. To begin
addressing these injustices, CAN has proposed several recommendations including developing
ways to measure the cumulative impact of air pollution to at risk communities and making sure
the buildings serving the most vulnerable populations (schools, senior centers, daycares,
community centers) are fitted with filters designed to take out the most harmful chemicals
being emitted by the nearby industries.
Many of the undersigned students do not reside in the Argentine, Armourdale, or Rosedale
neighborhoods. However, from our initial studies this term we have become aware of the
environmental injustices around the greater Kansas City metropolitan area. We are aware of
the damages to local communities from air pollution. For example, a path one of us used to
walk regularly is now desolate as the once luscious path struggles to grow anything anymore,
which seems to be related to nearby stationary sources of air pollution in Douglas County,
Kansas, where Kansas University is located. With Kansas and Missouri being the quintessential
"flyover states" (less attention from Washington DC), having significant open land, and often
ambient air quality is in attainment, many companies have sited factories in "areas of least
4 The Argentine neighborhood was named after the silver smelter that operated for more than a century on 20
acres next to the Kansas River beginning in 1880. It released lead and other heavy metals into the surrounding soil
and water and was later designated an EPASuperfund site. See B. Lugo-Martinez, Environmental Racism in the
Heartland, Fighting for Equity and Health in Kansas City, November 2021, Union of Concerned Scientists and
CleanAirNow, https://doi.org/10.47923/2021.14322
A4 p.771
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resistance" that over the years have caused air pollution problems at the fence-line for adjacent
communities.
As students, we recognize the challenge is how best the United States can move forward
knowing that aspects of prevention under the CAA and other environmental laws and
regulations have failed to protect the most vulnerable. We recognize that addressing
environmental racism has never been a component of the mission of the Environmental
Protection Agency. We are now left with the challenge of reversing the harm caused and
redefining this serious call to action, and with that we provide the following recommendations
to the WHEJAC:
RECOMMENDATIONS
~~~ It is critical going forward to promulgate a national environmental justice policy and law
that requires more transparency by polluters including direct communications with
local, affected communities as well as other fundamental principles of environmental
justice including fair treatment.
~~~ Organizations like CAN immediately need more funding and resources to better
understand the damage from legacy pollution and ongoing sources, particularly,
regarding air emissions. With resources, CAN and other grassroots organizations can
help identify damages and recommend relief and restoration for their disadvantaged
communities and better represent these communities. We ask the WHEJAC to
recommend the federal government establish specific "set asides" in the federal budget
for financial resources to be earmarked for grassroots, non-profit organizations, such as
CAN, that are utilizing citizen science to help hold companies accountable for their
impacts on disadvantaged neighborhoods. For example, see the Indian set aside under
the Clean Water Act. Such a set aside could be used as a template in various
components of the federal budget to specifically fund grassroots EJ grant programs.
~~~ The working class and those without an income need access to environmental
information. They need information to come from sources they can trust. As a group of
diverse students, it is our hope that more people whom look like the people in these
disadvantaged communities will join the EJ movement to help those who do not
understand the urgency of environmental crisis that is ahead of us all. We request the
WHJAC encourage the whole federal government to hire and retain more minorities and
ethnically diverse employees.
~~~ We are well aware of the unfair treatment of minorities and those of lower
socioeconomic status in terms of the environment, but who's helping? We ask the
WHEJAC to recommend the federal government provide more concrete ways and
initiatives for local communities to receive the help they deserve, the information they
A4 p.772
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need, the consideration of their way of life in decision making that affects these
communities. And, we ask the WHEJAC to make recommendations for concrete ways to
support people volunteering to assist disadvantaged communities.
~~~ The federal and state governments need to strictly enforce existing federal
environmental and civil rights laws.
~~~ The federal government needs a government-wide policy to address the cumulative
effects of climate change on the most sensitive people in the United States, especially in
overburdened, underserved, or disadvantaged communities.
SUMMARY
Communities in the Kansas City metropolitan area are in desperate need of assistance. One
example is the Argentine neighborhood, a largely Hispanic neighborhood located near a
massive railyard that is known to heavily pollute the area known to cause respiratory problems,
cancer, and a decreased lifespan. An organization called CleanAirNow is working to collect more
data and share what it finds to help protect this neighborhood and others like it in the Kansas
City area. To provide environmental justice for overburdened, underserved and disadvantaged
communities, the federal government needs to support grassroots organizations like CAN and
others. We, the undersigned students request the WHEJAC consider and take action on the
comments and recommendations above.
Thank you for the opportunity to comment.
Sincerely,
Hailey N. Williams, Emporia, Kansas
Sydney Drinkwater, Lawrence, Kansas
Marcela Paiva Veliz, Lawrence, Kansas
Magali Rojas, Kansas City, Missouri
Devin Grace Araujo, Shawnee, Kansas
Holly Marie Howe, St. Joseph, Michigan
A4 p.773
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o.«"V
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•V Pftoi*
UNITED STATES ENVIRONMENTAL PROTECTION AGENCY
WASHINGTON, D.C. 20460
MAR 3 0 1983
O F F ! C I: O F
WAT P R
Leslie A. Russell, D. M . D. f"
363 Walnut Street
Newtonvilie, Mass.' 02160
Dear Dr. Russell:
Thank you for your letter of March 9, 1983, in regard to
the fluoridation of drinking water.
The information available to the Environmental Protection
Agency is that fluoridation is a safe and effective means for
reducing the occurrence of dental caries. The fluoridation
process has been endorsed by several Presidents of the United
States and by several Surgeons General, including the current
Surgeon General, Dr. C. Everett Koop. A copy of Dr. Koop's
statement on fluoridat ion is enclosed.
Water treatment chemicals, including fluosilicic acid,
have been evaluated for their potential for contributing to
the contamination of drinking water. The Water Treatment
Chemicals Codex, published by the National Academy of Sciences
prescribes the purity requirements for fluosilicic acid and
other fluoridat ion chemicals.
In regard to the use of fluosilicic acid as a source of
fluoride for fluoridation, this Agency regards such use as an
idea1 envi ronmental solu t ion to a long—standi ng problem. By
recovering_ by-product fluosilicic acid from fertilizer
manufacturing, water and air pollution are minimized, and
water utilities have a low-cost source of fluoride available
to them. I hope this information adequately responds to your
concern.
Sincerely yours,
/ w)
1 \ 5L-'Vt-C'C/ f A,-
Rebecca Ha nine r
Deputy Assistant Administrator
for Water
Enclosure
-------
Mosaic
NSE
SAFETY DATA SHEET
CERTIFIED TO NSF / ANSI 60
SECTION 1
Trade Name:
Chemical Name:
CAS Number:
Chemical Family:
Synonyms:
Primary Use:
Company Information:
Emergency Phone:
PRODUCT AND COMPANY IDENTIFICATION
Hydrofluosilicic Acid
Silicate(2-). hexafluoro-,dihydrogen
16961-83-4
Inorganic Fluorides
Fluorosilicic Acid, Fluosilicic Acid, Hexafluosilicic Acid, HFS, FSA
Industrial Chemical, Water treatment
THE MOSAIC COMPANY
3033 Campus Drive
Plymouth, MN 55441
www.mosaicco.com
(800) 918-8270 or (763) 577-2700 8 AM to 5 PM Central Time US
24 Hour Emergency Telephone Number:
For Chemical Emergencies: Spill, Leak, Fire or Accident
Call CHEMTREC North America: (800) 424-9300 CCN 201871
Others: (703) 527-3887 (collect)
Distributed by:
SAL Chemical
3036 Birch Drive,
Weirton, WV 26062
304.748.8200-Phone
304.797.8751-Fax
SECTION 2
GHS Classification
Label Elements:
Prevention:
Hazard Statement H302
Hazard Statement H314
Hazard Statement H318
HAZARD IDENTIFICATION
Acute Tox Category 4 (Oral)
Skin Corrosion/Irritation: Category 1B
Serious Eye Damage/Eye Irritation: Category 1
Signal Word: DANGER
Hazard Statement(s)
H302 Harmful if swallowed
H314 Causes severe skin burns and eye damage
H318 Causes serious eye damage
Precautionary Statements
P260 Do not breath fumes/gas/mist/vapors/spray
P264 Wash skin thoroughly after handling
P270 Do not eat, drink or smoke when using this product.
P280 Wear protective gloves/protective clothing / Wear eye protection/face protection
P284 In case of inadequate ventilation/ wear respiratory protection
Status: Revised
Section(s) Revised: All
Revision Date: 07/13/2015
Page 1 of 7
Issue Date: 07/13/2015
MSDS #: MOS 200011.01
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Mosaic
NSR
CERTIFIED TO NSF / ANSI 60
Response:
Storage:
Disposal:
P301+ P312
P301+P330+P331
P305+P351+P338
P303+P361+P353
P304+P340
P310
P363
P390
P405
P501
IF SWALLOWED: Call a Poison Center/Doctor if you feel unwell.
IF SWALLOWED: Rinse mouth, Do NOT induce vomiting.
IF IN EYES: Rinse cautiously with water for several minutes; Remove
contact lenses, if present and easy to do. Continue rinsing.
IF ON SKIN: Take off immediately all contaminated clothing. Rinse skin
with water.
IFINHALED: Remove person to fresh air and keep comfortable for
breathing
Immediately call a doctor
Wash contaminated clothing before reuse.
Absorb Spillage to prevent material damage.
Store locked up
Disposal of content/containers to be in accordance with
local/regional/national regulations.
SECTION 3
Formula:
Composition:
COMPOSITION INFORMATION ON INGREDIENTS
H2SiF6
Hazardous Component CAS Number Percentage
Hydrofluosilicic Acid 16961-83-4 23-25%
SECTION 4
First Aid Procedures:
Most important
symptoms and effects,
both acute and delayed
Note to Physician:
FIRST AID MEASURES
Eyes: Immediately flush with plenty of water for at least 15 minutes. Get medical attention
immediately.
Skin: If on skin, promptly wash the contaminated area with soap and plenty of water.
Immediately flush with plenty of water. Discard clothes if contaminated. Get medical
attention if irritation occurs
Inhalation: Move to fresh air. Administer oxygen. Treat symptomatically. Get medical
attention promptly. Observe for possible delayed reaction.
Ingestion: Do Not induce vomiting. Give large quantities of milk or water to patient if
conscious. Seek medical attention promptly.
Refer to Section 11 - Toxicological Information
None
SECTION 5
Extinguishing Media:
FIRE FIGHTING MEASURES
Suitable extinguishing media:
Small fires: Use water spray, dry chemical or carbon dioxide (CO2).
Large fires: Use water spray, foam, dry chemical or carbon dioxide (CO2).
Move containers from fire area if you can do it without risk. Do not get water inside
containers. Cool containers with flooding quantities of water until well after fire is out.
Unsuitable extinguishing media: None known
Status: Revised
Section(s) Revised: All
Revision Date: 07/13/2015
Page 2 of 7
Issue Date: 07/13/2015
MSDS #: MOS 200011.01
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Mosaic
NSR
Unusual Fire and
Explosion Hazards
Protection of Fire-fighters
CERTIFIED TO NSF / ANSI 60
Flash Point: Not Applicable
Flammable OSHA Flammability Class: Not applicable
Properties LEL/UEL: Not Applicable
Auto-Ignition Temperature: Not Applicable.
Wear self-contained breathing apparatus with full protective clothing.
Fluorosilicic Acid is a non-combustible; substance itself does not burn but may decompose
upon heating to produce corrosive and/or toxic fumes.
SECTION 6
Advice for non-
emergency personnel:
Advice for emergency
responders:
Environmental
Precautions:
Response Techniques:
ACCIDENTAL RELEASE MEASURES
Prevent further leakage or spillage if safe to do so. Keep away from incompatible materials.
Wear suitable protective clothing, gloves and eye/face protection. Use recommended
respiratory protection. Stop leak if you can do it without risk. Absorb or cover with dry earth,
sand or other non-combustible material and transfer to containers. Ventilate area.
Prevent further leakage or spillage if safe to do so. Do not let product get into drains; do not
flush into surface water or sanitary sewer system.
Pick up mechanically. Use neutralizing agent. Absorb with liquid-binding material (dry earth,
sand, vermiculite, acid binders). Ensure adequate ventilation. Dispose spilled/contaminated
material as described in Section 13 "Disposal Considerations".
SECTION 7
Handling:
Storage:
HANDLING AND STORAGE
Use only in well-ventilated areas. Use only equipment and materials which are compatible
with the product. Preferably transfer by pump or gravity. Keep away from incompatible
products. For precautions see Section 2.
Do not use packing made of metal. Store only in the original container. Do not store together
with strong bases or very alkaline substances. Do not store together with substances which
can be oxidized. Do not store together with flammable substances/solutions. Do not store
near sources of heat or ignition, or reactive materials. Must be stored in a room with spill
collection facilities. Keep containers tightly closed in a cool, well-ventilated place and away
from heat. Keep in a contained area. Keep away from Incompatible products.
SECTION 8
Engineering Controls:
EXPOSURE CONTROLS / PERSONAL PROTECTION
Assure that ventilation is adequate to control airborne levels.
Personal Protective
Equipment (PPE):
General Hygiene
Considerations:
Eye/Face:
Skin:
Respiratory:
Other:
Splash proof goggles and full-face shield should be worn at all times.
Acid proof gloves, headgear, protective shoes and clothing should be
worn to prevent contact.
Wear NIOSH approved respiratory protective equipment when vapor or
mists may exceed applicable concentration limits.
Facilities utilizing or storing this material should be equipped with an
eyewash station and a safety shower.
Avoid breathing fumes. Avoid ingestion. Wash thoroughly after handling. Avoid contact with
eyes or skin Use with adequate ventilation
Status: Revised
Section(s) Revised: All
Revision Date: 07/13/2015
Page 3 of 7
Issue Date: 07/13/2015
MSDS #: MOS 200011.01
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Mosaic
NSR
CERTIFIED TO NSF / ANSI 60
Exposure Guidelines: OSHA Permissible Exposure Limits (PEL): 2.5 mg/m3 as Fluoride
ACGIH Threshold Limit Value (TLV):
2.5 mg/m as Fluoride
SECTION 9
PHYSICAL AND CHEMICAL PROPERTIES
Note: Unless otherwise stated, values in this section are determined at 20°C (68°F) and 760 mm Hg (1 atm).
Material Description
Appearance/Description:
Color:
Physical State:
Odor:
Odor Threshold:
General Properties
Boiling Point:
Freezing/Melting Point:
Thermal Decomposition:
pH (1 % Solution):
Specific Gravity:
Bulk Density:
Solubility in water:
Viscosity:
Molecular Weight of Pure Material:
Volatility
Volatility:
Vapor Pressure (mm Hg):
Vapor Density (air = 1):
Evaporation Rate:
Flammability
Flash Point:
Flammability/Explosive Limits (%):
Auto-ignition Temperature:
Environmental
Octanol/Water Partition Coefficient
Colorless to amber liquid with a pungent odor
Colorless to amber
Liquid
Pungent
Not data available.
105°C (221°F) @ 23%-25%
-18° to -20°C (-1° to -4°F)
>105°C (>221°F) @ 23%-25%
1.2
1.2. Water = 1
10.2 Ib./gallon
100% soluble in water
6.5 cps
144.11 g/mol
No data available.
22.5 @ 25°C (77°F)
No data available.
No data available.
Not applicable.
Not applicable.
Not applicable.
No data available.
Status: Revised
Section(s) Revised: All
Revision Date: 07/13/2015
Page 4 of 7
Issue Date: 07/13/2015
MSDS #: MOS 200011.01
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Mosaic
NSR
CERTIFIED TO NSF / ANSI 60
SECTION 10
Reactivity
Chemical Stability:
Possibility of Hazardous
Reactions
Conditions to Avoid:
Incompatible Materials:
Hazardous
Decomposition Products:
Hazardous
Polymerization:
Corrosiveness:
STABILITY AND REACTIVITY
No data available
Stable under recommended conditions of storage, handling and proper use.
Corrosive in contact with metals, It may give off hydrogen gas by reaction with metals.
Avoid thermal decomposition, do not overheat.
Bases, acids, strong oxidizing agents, metals, stoneware and glass.
Extreme temperatures such as a fire cause formation of highly toxic and corrosive fumes of
fluorides such as SiF4and HF.
Will not occur.
Attacks silica bearing materials, metals, and stoneware
SECTION 11
GHS Properties
Acute Toxicity:
Aspiration Hazard
Carcinogenicity:
Germ Cell Mutagenesis
Skin Corrosion Irritation
Serious eye
damage/irritation
Skin sensitization
Specific Target Organ
Toxicity - Single
Exposure:
Specific Target Organ
Toxicity - Repeated
Exposure
Reproductive Toxicity
Respiratory Sensitization
Additional information:
Oral : LD50 (oral, rat) 430 mg/kg
TOXICOLOGICAL INFORMATION
Classification
Oral 4: ATEmx (oral) = 1,720 mg/Kg
Inhalation: No data available.
Dermal: No data available
No data available.
No data available.
No data available.
Causes severe skin burns and eye irritation. Acid with extreme pH < 2.
Causes serious eye damage. Acid with extreme pH < 2.
No data available.
No data available.
No data available.
No data available.
No data available.
The Registry of Toxic Effects of Chemical Substances (RTECS) VV8225000
Status: Revised Page 5 of 7 Issue Date: 07/13/2015
Section(s) Revised: All MSDS #: MOS 200011.01
Revision Date: 07/13/2015
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Potential Health Effects
Eye
Skin
Inhalation
Ingestion
Mosaic
NSR
CERTIFIED TO NSF / ANSI 60
Acute (immediate): Causes serious eye damage.
Chronic (Delayed): Repeated or prolonged exposure to corrosive materials may cause
conjunctivitis.
Acute (immediate): Causes severe skin burns and eye damage.
Chronic (Delayed): Repeated or prolonged exposure to corrosive materials will cause
dermatitis.
Acute (immediate): May cause corrosive burns
Chronic (Delayed): Repeated or prolonged exposure to corrosive fume may cause bronchial
irritation with chronic cough.
Acute (immediate): Harmful if swallowed.
Chronic (Delayed): Repeated or prolonged exposure to corrosive materials or fumes may
cause gastrointestinal disturbances.
SECTION 12
Toxicity
Persistence and
degradability
Bio accumulative
potential
Mobility in soil
Results of PBT and vPvB
assessment
Other adverse effects
ECOLOGICAL INFORMATION
No data available.
Not relevant. (Inorganic substance).
Log Pow: Not applicable Log Kow: Not applicable
No data available.
Bio accumulative potential
low
PBT /vPvB assessment not available as chemical safety assessment not required/not
conducted.
No data available.
SECTION 13
DISPOSAL CONSIDERATIONS
Recover or recycle if possible. Keep material in a closed DOT- approved container pending
disposal in accordance with all applicable regulations.
Disposal should be in accordance with applicable, regional, national, and local laws and
regulations.
It is the responsibility of the waste generator to determine the toxicity and physical
properties of the material generated to determine the proper waste disposal and disposal
methods in accordance with applicable regulations.
SECTION 14
Regulatory Status:
Proper Shipping Name:
Hazard Class:
Packing Group
Identification Number:
Emergency Guide No.
US DOT
TRANSPORT INFO
USDOT Canada TDG
Fluorosilicic Acid Fluorosilicic Acid
Class 8 (Corrosive) 8
UN 1778 UN 1778
154 154
Poison Inhalation Hazard: No
IATA
Fluorosilicic Acid
UN 1778
8L
Marine Pollutant: No
IMO/IMDG
Fluorosilicic Acid
UN 1778
EMS-No: F-A, S-B
Reportable Quantity: No
Status: Revised Page 6 of 7 Issue Date: 07/13/2015
Section(s) Revised: All MSDS #: MOS 200011.01
Revision Date: 07/13/2015
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Mosaic
NSR
CERTIFIED TO NSF / ANSI 60
SECTION 15
CERCLA:
RCRA 261.33:
SARA TITLE III:
TSCA:
Canada
WHMIS 1988:
CA Proposition 65:
REGULATORY INFORMATION
Not Regulated. Product is not listed with an RQ (Reportable Quantity)
Not Regulated
Section 302/304: Not Regulated Reportable Quantity: No TPQ: No
Section
311/312: Acute: Yes
Section 313: Not Regulated
Listed on TSCA Inventory
DSL: Yes
Chronic: Yes Fire: No
Pressure: No Reactivity: No
NDSL: No
Fluorosilicic Acid is listed as Class E (Corrosive) and D1B (Toxic material). This SDS has
been prepared according to the hazard criteria of the Controlled Product Regulations (CPR)
and the SDS contains all of the information required by the CPR.
(Health & Safety Code Section 25249.5)
Not listed
SECTION 16
NFPA
HMIS
Disclaimer:
OTHER INFORMATION
Preparation:
Revision Date:
Sections Revised:
SDS Number:
References:
Health: 3
Health: 3
Flammability: 0
Flammability: 0
Instability: 1
Physical Hazard: 0
Special Hazard: None
PPE: Determined by user.
See Section 8
The information in this document is believed to be correct as of the date issued.
HOWEVER, NO WARRANTY OF MERCHANTABILITY, FITNESS FOR ANY PARTICULAR
PURPOSE, OR ANY OTHER WARRANTY IS EXPRESSED OR IS TO BE IMPLIED
REGARDING THE ACCURACY OR COMPLETENESS OF THIS INFORMATION, THE
RESULTS TO BE OBTAINED FROM THE USE OF THIS INFORMATION OR THE
PRODUCT, THE SAFETY OF THIS PRODUCT, OR THE HAZARDS RELATED TO ITS
USE. This information and product are furnished on the condition that the person receiving
them shall make their own determination as to suitability of the product for their particular
purpose and on the condition that they assume the risk of their use thereof. The conditions
and use of this product are beyond the control of Mosaic, and Mosaic disclaims any liability
for loss or damage incurred in connection with the use or misuse of this substance.
The preparation of this SDS was in accordance with ANSI Z400.1 -2010.
July 13, 2015
All
MOS 200011.01
Globally Harmonized System of Classification and Labelling of Chemicals (GHS) -4m
Edition 2011
OSHA Hazard Communication Standard, 2012
Status: Revised
Section(s) Revised: All
Revision Date: 07/13/2015
Page 7 of 7
Issue Date: 07/13/2015
MSDS #: MOS 200011.01
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Good afternoon and thank you for this opportunity. I'm John Mueller, in
Tulsa, Oklahoma. My college degree is in Geophysical Engineering, and I
am now retired from 25 years as a licensed civil engineer working mainly
for public water and wastewater utilities. I have been studying the history
and science of water fluoridation for almost 13 years. My community
voice today, speaks in behalf of a very large Environmental Justice
community; that is the community of citizens who are disproportionately
harmed by exposure to fluoride, especially Blacks and other vulnerable
subgroups, and particularly all pregnant women and their prenatal and
infant offspring, all being at risk of harm according to currently available
science. The additional supporting materials I will be submitting includes
an annotated listing of over 90 relevant studies and documents produced
just within the last five to six years alone. And I must point out that the
fluorine atom in the harmful "forever chemicals", PFAS, is the same highly
reactive fluorine atom that is in its ionic form in fluoridated tap water,
even though their chemical behaviors and harmful properties can differ
widely due to different chemical bonding.
Fluoride has been the most protected environmental pollutant ever since
the Public Health Service approved it in 1950 and recommended its
addition to tap water to help prevent childhood tooth decay. Lead, for
comparison, was protected for decades before EPA finally acted
responsibly in its regulation. But fluoride's protected status, for more than
70 years, has created a very hard and dense wall. On one side of that wall
is world class science showing fluoride is a developmental neurotoxicant;
and on the other side is the powers-that-be who are bent on maintaining
fluoride's protected status. That wall must now come down as required
by implementation of President Biden's Executive Orders. I am hopeful
and reasonably optimistic that I, and others, are giving you the knowledge
and understanding to issue the strongest recommendation to remove
that wall for the greater good. The most available tool for its removal is,
conveniently, the current lawsuit in which EPA is being sued under
A4 p.782
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provisions of Section 21 of the Toxic Substances Control Act (TSCA), to
ban the addition of fluoridation chemicals to public drinking water. A
new, amended petition is anticipated for EPA's consideration in this
lawsuit, to accommodate more recent studies conducted since the
original petition was first filed in November 2016. Today, my request is
for WHEJAC to do all in its power to have EPA and Administrator Regan
approve the upcoming amended petition that will be filed with the
Federal court later this year in that TSCA lawsuit.
Thank you so much for this unique opportunity.
John F. Mueller, Jr., PE (Ret)
5255 S. Irvington PI
Tulsa, OK 74135
918-237-5296
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Prepared Comments for WHEJAC public meeting on February 24, 2022
Good afternoon. I'm John Mueller, in Tulsa, Oklahoma, and I represent,
albeit ostensibly, the community of citizens who depend on artificially
fluoridated water for their daily needs. Unfortunately, water fluoridation
has, for far too long, been falsely claimed by the CDC and other
proponents to be "safe and effective." But with highest integrity, the
current science has revealed that fluoridation is not safe; it has far-
reaching harmful effects, similar to those from arsenic, lead and mercury,
and physically painful effects on those with chemical sensitivities and
their caregivers. Its efficacy for preventing childhood tooth decay
becomes irrelevant when mental health risks of permanent brain damage
are at stake. Furthermore, the CDC has the data confirming fluoridation
disproportionately affects Blacks and other vulnerable subgroups. But
CDC appears to want to ignore the current science which has been
revealed in studies funded by the National Institutes of Health. Based on
that science and relevant Executive Orders, including EOs 14008 and
13985, a regulatory ban on fluoridation is obligatory. Accordingly, a
scorecard for assessing progress in addressing this injustice must
necessarily include water utilities' compliance with such a regulatory ban.
The CDC has the identities of those fluoridating utilities, and a scorecard
dataset could be as simple as having a column for either a Yes or No to
document if the utility has in fact discontinued adding fluoridating
chemicals.
Fortunately, President Biden's Environmental Justice agenda has paved
the way to ensure that a nationwide ban on water fluoridation is in fact
imminent. I am confident that President Biden and Vice President Harris
have the political will to "walk the talk" about scientific integrity and
environmental justice, and that the White House Council on
Environmental Quality and the Interagency Council will do their part to
ensure all affected agencies follow suit under a "whole of government"
and "whole of EPA" approach.
I want to briefly point out how the American Dental Association (ADA) is
attempting to influence the National Toxicology Program's (NTP)
A4 p.784
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forthcoming report on fluoride's neurotoxicity, a draft of which I have
noted in previous WHEJAC meetings, and attached to my Feb 10 email to
this group. The ADA, in a letter dated February 7, 2022, has pleaded with
the NTP director, Dr. Rick Woychik, to exclude from that report "any
neurotoxin claims" relating fluoridation to potential developmental
neurotoxic effects. This unethical approach by the ADA, in concert with
any support from the CDC, clearly flies in the face of scientific integrity
and transparency, as will be shown in the additional materials I will be
emailing to the WHEJAC.
Thank you for your commitment to properly address urgent and
compelling matters such as this.
A4 p.785
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WHEJAC February 2022 Meeting
Oral Public Comments - Kathy Yuknavage, Our Common Wealth 670, Treasurer:
Our Common Wealth 670 is a grassroots non-profit organization based on the island of Saipan in
the Commonwealth of the Northern Mariana Islands (CNMI).
Our primary concern is the substandard EIS review process conducted by the Department of
Defense (DoD) that allows increasing US military expansion and environmental harm in the
region, and DoD's often flippant responses to Commonwealth concerns.
U.S. Military Environmental Planning in
the Mariana Islands
A timeline of the U.S. Military's Final Environmental Impact Statement (EIS)
release dates in the Mariana Islands.
I
1999
June
Military Training
in the Marianas
Final EIS
2010
May
Mariana Islands
Range Complex
(M1RC) Final EIS
July
Guam & CNMI
Military Relocation
Final EIS
2015
April
CNMI Joint Mtlimn
Training (CJMT)
Draft EIS*
May
\lariana Islands
Training and Testing
(MITT) Final EIS
• August
2016
September
Tinian Divert
Infrastructure
Improvements
Final EIS
Guam A CNMI Military
Relocation Final
Supplemental EIS
2020
June
Mariana Islands
Training and
Testing (MITT)
Supplemental EIS
July
Tinian Divert Infrastructure
Improvements Final
Supplemental
EIS
* Revised CJMT Draft EIS is pending as of January 2020.
Five reviews have been conducted from late 1990 to present. DoD's stated purpose is meeting
military training requirements in the Western Pacific. Their need was using the CNMI as the
sole location for this purpose. This purported need precludes consideration of other alternative
sites with existing installations on larger land masses elsewhere in the Pacific that can share this
training responsibility and are less susceptible to impacts as our small island archipelago of less
than 184 sq land miles.
WWII and current exercises have left military debris, unexploded ordnance (UXO), and
contamination on our land and surrounding waters. DoD is now proposing new leases on our
islands despite the acknowledgement within the CNMI Covenant with the US that no additional
lands would be leased for such purposes. This disregards Indigenous sovereignty.
A4 p.786
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Allowing Live-fire training on leased lands that will be returned even more polluted than after
WWII, is problematic from both a socio-economic and environmental justice perspective. DoD
has made clear that removing UXO and contaminants on leased lands is not a requirement or a
priority.
Suggested EJ scorecard metrics:
• DoD should be required to complete baseline studies of water, sediment and biota
contamination to demonstrate past and current levels to ensure accountability for
remediation and restoration of leased lands.
• Activities should support cultural norms, incorporate best practices to meet local
environmental requirements, and abide by local laws and regulations. DoD has forgone
obtaining Coastal Management Permits. Although allowed legally, it does not offset socio-
economic impacts to our underserved and indigenous population when DoD's proposed
actions are inconsistent with marine and terrestrial resource protection.
• All pertinent research must be considered not just those studies that Federal Agencies
have funded or that support their preferred activities, and not allow other peer reviewed
research cited by local agencies that does not support their activities be disregarded.
• Public hearings should have knowledgeable panels capable of answering substantive
questions posed by participants. Should a panel not be able to answer most questions,
then this should not be considered a Public Hearing or engaged public discourse for
comment.
• DoD continues to offer higher salaries to entice experienced local professionals that used
to review EISs on behalf of the CNMI, to now make assessments for them. Federal
agencies should provide proportionate funding to local governments to hire experienced
experts and make necessary purchases to enable thorough reviews for a just assessment
of environmental concerns.
• Federal resources should be provided to garner broad participation in Public Hearings
including social media, radio, TV, and not just a newspaper ad. Provide pertinent
information of plans in an accessible and timely manner, and in Agency responses to
comments. There should be translation services, and indigenous people should be given
time to express themselves, consistent with and respectful of local culture. Consent should
always be a primary goal before consultation.
A4 p.787
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LEAGUE 0/ UNITED LATIN
AMERICAN CITIZENS
Civil Rights Violation Regarding Forced Medication
WHEREAS, the League of United Latin American Citizens is this nation's oldest and largest
Latino organization, founded in Corpus Christi, Texas on February 17, 1929; and
WHEREAS, LULAC throughout its history has committed itself to the principles that Latinos
have equal access to opportunities in employment, education, housing and healthcare; and
WHEREAS, LULAC advocates for the well-being of, but not exclusively of, Hispanics
throughout our country; and
WHEREAS, safe drinking water is a necessity for life; and
WHEREAS, the purpose of a public water supply is to supply water to the entire community
which is composed of people with varying health conditions, in varying stages of life, and of
varying economic status; not to forcibly mass medicate the population which is a civil rights
violation; and
WHEREAS, fluoridation is mass medication of the public through the public water supply; and
WHEREAS, current science shows that fluoridation chemicals pose increased risk to sensitive
subpopulations, including infants, the elderly, diabetics, kidney patients, and people with poor
nutritional status; and
WHEREAS, minority communities are more highly impacted by fluorides as they historically
experience more diabetes and kidney disease; and
WHEREAS, minorities are disproportionately harmed by fluorides as documented by increased
rates of dental fluorosis (disfiguration and discoloration of the teeth); and
WHEREAS, the National Research Council in 2006 established that there are large gaps in the
research on fluoride's effects on the whole body; a fact that contradicts previous assurances
made by public health officials and by elected officials, that fluorides and fluoridation have been
exhaustively researched; and
WHEREAS, a growing number of cities and health professionals have rejected fluoridation
based on current science and the recognition of a person's right to choose what goes into his/her
body; and
A4 p.788
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WHEREAS, the CDC now recommends that non-fluoridated water be used for infant formula (if
parents want to avoid dental fluorosis - a permanent mottling and staining of teeth), which
creates an economic hardship for large numbers of families, minority and otherwise; and
WHEREAS, the League of United Latin American Citizens (LULAC), founded in 1929, has
historically been a champion of the disenfranchised and a leader in the fight for social and
environmental justice; and
WHEREAS, City Council Districts 1-6 of San Antonio (predominantly minority districts) voted
overwhelmingly that the public water supply should not be contaminated with fluoridation
chemicals; and
WHEREAS, the election to fluoridate the water, essentially disenfranchised the right of these
minority Districts to safe drinking water for all; and
WHEREAS, the U.S. Health and Human Services and the EPA (January 2011) have recently
affirmed the NRC Study results that citizens may be ingesting too much fluoride and that the
exposure is primarily from drinking water; and
WHEREAS, the proponents of fluoridation promised a safe and effective dental health additive,
but the San Antonio Water System's (SAWS) contract for fluoridation chemicals proves a "bait
and switch"; as SAWS is adding the toxic waste by-product of the phosphate fertilizer industry,
that has no warranty for its safety and effectiveness for any purpose from the supplier (PENCCO,
Inc.) or the source (Mosaic Chemical); and
THEREFORE, BE IT RESOLVED, that LULAC commends efforts by organizations that oppose
forced mass medication of the public drinking supplies using fluorides that are industrial grade,
toxic waste by-products which contain contaminants (arsenic, lead, mercury) which further
endanger life; and
BE TT FURTHER RESOLVED, that LULAC supports efforts by all citizens working to stop
forced medication through the public water system because it violates civil rights; and
BE IT FURTHER RESOLVED, that LULAC opposes the public policy of fluoridation because
it fails to meet legislative intent; and
BE IT FURTHER RESOLVED, that LULAC demands to know why government agencies
entrusted with protecting the public health are more protective of the policy of fluoridation than
they are of public health.
Approved this 1 st day of July 2011.
Margaret Moran
LULAC National President
A4 p.789
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Lynne Bonnett
675 Townsend Avenue, unit 169
New Haven CT 06512
Public Comment for WHEJAC. February 27, 2022.
Tweed New Haven Authority seeks to expand in a small residential community.
They are in the midst of performing an Environmental Assessment using the Federal Aviation
Agency's guidelines for evaluating how this expansion will affect our community.
The airport is in a flood plain, surrounded by residential homes and very close to Long Island Sound. In
order to expand they need to extend the runway. I am a resident representative for the Project
Advisory Committee that has met only one time since January 13, 2022. Residents report difficulty
getting information from Tweed leadership and routinely file FOIA requests. I, myself, have tried to get
information about stormwater drainage from their property but have not been able to get that
information from them or from the local wastewater treatment plant. I have heard that the runoff from
deicing is sent to the wastewater treatment plant but have not been able to confirm that.
The consultants hired by Tweed New Haven Authority to conduct the EA fall back on antiquated rules
and regulations used by the FAA that limits air pollution measures to computer modeling and 24 hr
averages, (no real time measurements using monitors) as well as noise complaints from jets flying over
sensitive residential areas such as schools and homes. These episodic noise and vibrations are 85
decibels in neighbor's yards.
People report tasting jet fuel, being unable to carry on conversations, having sleep interrupted by the
loud noise, homes vibrating from the jets, cracks in the walls, plaster falling off of walls and a myriad of
other complaints.
We think that true environmental assessment takes acute exposures in to account, not just 24 hr
averages that dilute the true effect of these episodic exposures. Ozone, for example, is measured in 8-
hour segments in the State of CT (I believe also in the EPA). It is toxic, burns airways, stunts lung growth
in children and causes heart disease, respiratory disease and cancer. It is highest during daytimes when
children and residents are outside. 24 hr averages will not describe the true toxicity of these exposures.
Please ask/require that the EPA upgrade the rules and regulations for the FAA's Environmental
Assessment to be more in line with current scientific information about how to measure the impact of
air pollutants and noise on the populations affected.
Thank you.
Sincerely,
/Lynne Bonnett/
A4 p.790
-------
Pediatric Dermatology Vol 29 No. 2 199-201, 2012
Acrodynia and Hypertension in a Young Girl
Secondary to Elemental Mercury Toxicity
Acquired in the Home
Jessica J. Mercer, M.D., Lionel Bercovitch. M.D., and Jennie J. Muglia, M.D.
Department of Dermatology, Warren A/pert Medical School, Brown University, Providence, Rhode Island
Abstract: Acrodynia, also known as pink disease, erythredema poly-
neuropathy, Feer syndrome, and raw-beef hands and feet, is thought to be a
toxic reaction to elemental mercury and less commonly to organic and
inorganic forms. Occurring commonly in the early 20th century, acrodynia is
now a seemingly extinct disease in the modern world because of regulations
to eliminate mercury from personal care products, household items, medi-
cations, and vaccinations. We present a case of a 3-year-old girl with acro-
dynia secondary to toxic exposure to elemental mercury in the home envi-
ronment
CASE PRESENTATION
A 3-year-old girl was admitted with a 3-day history of
redness, pain and swelling of both hands, profuse sweats,
irritability, chills, poor oral intake, and severe perium-
bilical pain. Within the 2 weeks before admission, she
had been evaluated in the emergency department on two
separate occasions for abdominal pain, which was
diagnosed as constipation and viral gastroenteritis.
Examination at admission revealed redness and edema of
the hands and feet, desquamation of the fingertips and
toes, and mild webspace maceration (Figs. 1 and 2).
Lymphadenopathy, conjunctival injection, and mucous
membrane involvement were absent. Blood pressure was
158/100. Differential diagnoses of her hypertension and
systemic symptoms included pheochromocytoma, neu-
roblastoma, coarctation of the aorta, and vasculitis.
Cutaneous differential diagnoses initially included atyp-
ical Kawasaki syndrome, postviral acral desquamation,
Address correspondence to 'Lionel Bercovitch, M.D.. Depart-
ment of Dermatology, Warren Alpert Medical School, Brown
University, 593 Eddy Street, APC 10, Providence, RI 02903, or
e-mail: lionel__bercovitch@brown.edu.
DOI: 10.111 l/j.1525-1470.2012.01737.x
erythromelalgia, and juvenile plantar dermatosis in the
setting of preexisting atopy. Total metanephrine level
was high at 475 pg/mL (normal <205 pg/mL), but was
nondiagnostic of a catecholamine-secreting tumor,
which typically is greater than four times the reference
range. Magnetic resonance imaging, angiography, and
echocardiogram excluded internal masses, aortic coarc-
tation, and other cardiovascular abnormalities. There-
after, mercury toxicity was suspected, and later
confirmed by a 24-hour urine mercury level of
178 ^g/24 hours (normal 0-20 ^g/24 hours). Hyper-
tension was managed with amlodipine and labetalol.
Chelation therapy with succimer was initiated. A com-
pounded topical preparation containing mexiletine 2%,
a lidocaine analog, and kctamine 2% applied to her
hands and feet provided transient pain control. There
was no history of excess fish intake or exposure to mer-
cury, broken thermometers, batteries, or fluorescent
bulbs. Environmental survey of the home, where the
© 2012 Wiley Periodicals, Inc.
A4 pi$l9
-------
200 Pediatric Dermatology Vol. 29 No. 2 March/April 2012
Figure 1. Desquamation of the fingers.
Figure 2. Desquamation of the toes.
family had lived for 2 months, revealed mercury levels in
the carpet of 40,000 Hg/m3 (normal < 100 wg/m?). After
5 weeks of chelation therapy, all signs and symptoms had
resolved.
DISCUSSION
Acrodynia, also known as pink disease, erythredema
polyneuropathy, Feer syndrome, and raw-beef hands
and feet, is a syndrome related to elemental mercury and,
less commonly, inorganic mercury salt intoxication pri-
marily in children (1,2). Chardon first described it in the
French literature in 1830, and Crawford later recognized
it in the American literature in 1932 (3,4), but it was not
until 1948 that Warkany and Hubbard (5) established a
connection between acrodynia and mercury toxicity. It
presents with the triad of edematous, painful, pink to red,
desquamating fingers and toes; neurologic symptoms
(irritability, photophobia, weakness, paresthesias); and
hypertension (6). Elemental mercury exists as a liquid
that can evaporate at room temperature. It is thought
that elemental mercury toxicity affects children more
often than adults because their nostrils are nearer the
floor and because mercury vapor, which is heavier than
air, settles near the floor because of the effect of gravity
(6,7). In addition, children have higher minute volume
respiration per unit of weight and therefore inhale more
air per unit of body weight than do adults (7).
The diagnosis of acrodynia may be easily overlooked
because of its current rarity in North America and Eur-
ope. As noted in the literature, there is substantial clinical
overlap between acrodynia and Kawasaki disease (7).
One author previously suggested mercury as the causa-
tive agent of Kawasaki disease (8). This led to a study
evaluating mercury levels in six patients with a clinical
diagnosis of Kawasaki disease; all were found to have
high urinary mercury excretion, although later reports
failed to confirm this association (9). Acrodynia should
also be considered in the differential diagnosis for pa-
tients with presumed Kawasaki disease who are afebrile
or have atypical presentations.
Another cardinal feature of acrodynia is hyperten-
sion. Mercury causes high blood pressure by inhibiting
catecholamine-O-methyltransferase, the critical enzyme
involved in catabolism of catecholamines, through direct
inactivation of its coenzyme S-adenosylmethionine.
Inhibition of catecholamine-O-methyltransferase by
mercury results in accumulation of dopamine, epineph-
rine, and norepinephrine (10), which probably explains
the high catecholamine levels seen in our patient. In
addition to following mercury levels in response to
treatment, catecholamine levels may also be tracked as a
surrogate marker of therapeutic response (2).
Although it was determined that the patient in our
case was exposed to elemental mercury in the carpeting of
her new home, its source could only be speculated.
Common residential sources include spillage from mer-
cury-containing devices such as thermometers and con-
tact with latex paint containing mercury added to
prolong shelf life. In addition, some religions in Afro-
Caribbean cultures, including Santeria, voodoo, and
Palo, ritually sprinkle elemental mercury about the home
to ensure health, wealth, and happiness (11,12). The
concern with elemental mercury in flooring and uphol-
stery is that it can persist for weeks to months, resulting in
chronic exposure to mercury vapor (13). This may in-
crease the risk of toxicity , because it has been shown that
urine mercury levels correlate positively with duration of
A4 p.792
-------
Mercer et al: Mercury Toxicity as Acrodynia in a Young Girl 201
residency in a contaminated building and total amount
of time spent in the building (14), Vacuuming worsens
mercury exposure by further dispersing the vapor, and
clearance should not be attempted without guidance
from the local health department (13).
One must have a high index of suspicion to recognize
mercury toxicity, if suspected, laboratory testing of
blood, urine, or hair samples can be performed for con-
firmation. Whole blood should be examined as opposed
to serum, because mercury concentrates in erythrocytes,
urine should be collected over a 24-hour period rather
than spot checking, and the longest of hair strands
should be evaluated (7). Because mercury has a short
half-life in the blood but a long half-life in other tissues,
blood samples are more useful for diagnosing acute
poisoning, whereas urine and hair samples are better for
diagnosis of chronic intoxication (7). Although reference
levels are not well established for children, the threshold
for toxicity is probably lower than in adults, and clinical
correlation is recommended.
Treatment entails removal of the source of mercury
exposure in the patient's environment with the aid of
trained personnel and elimination from the body largely-
through chelation therapy. The Food and Drug
Administration has not approved any therapy for
mercury toxicity in children, but DMSA succimer is
approved for the treatment of lead poisoning in children
and has been adopted as the most commonly used che-
lating agent for mercury in the pediatric population (15).
Other agents less commonly used are D-penicillamine,
2,3-dimercaptopropanol (British anti-lewisite, dimer-
caprol), and 2,3-dimercapto-l-propane sulfonic acid.
Transient elevation in plasma mercury levels may occur
with use of these agents because of oxidation within red
blood cells (7). Repeat blood or urine mercury levels
should be performed after chelation therapy to ensure
that the level has decreased appropriately.
Although acrodynia is now relatively rare, cases such
as ours may still be encountered. Awareness and recog-
nition of the characteristic cutaneous findings of red,
desquamating, and edematous hands and feet coupled
with high blood pressure and neurologic symptoms will
prevent the diagnosis from being overlooked. Prompt
diagnosis and treatment of this disorder may help pre-
vent long-term neurological sequelae.
REFERENCES
1. Curtis HA, Ferguson SD, Kell RL et al. Mercurv as a
health hazard. Arch Dis Child 1987;62:293 295.
2. Michacli-Yossef Y, Berkovitch M, Goldman M. Mercury
intoxication in a 2-year-okl girl: a diagnostic challenge for
the physician. Pediatr Nephrol 2009;22:903-906.
3. Chardon E. De Pacrodynie, Rev Med Fr 1830:3:51 74.
4. Crawford S. Juvenile acrodynia. Arch Derm Syphilol
1932:26:215-237.
5. Warkany J, Hubbard DM. Mercury in the urine of
children with acrodynia. Lancet 1948;29:829-830.
6. Clarkson TW, Magos L. Mayers GJ. The toxicology of
mercury—current exposures and clinical manifestations. N
Engl J Med 2003;349:1731-1737.
7. Ozuah PO. Mercury poisoning. Curr Probl Pediatr
2000;30:91-99.
8. Cheek DB. Comment on mucocutaneous lymph node
syndrome: could it be a heavy metal poisoning? Pediatrics
1975;56:335 336.
9. Orlowski JP, Mercer RD. Urine mercury levels in Kawa-
saki's disease. Pediatrics 1980;66:633-636.
10. Torres AD, Rai AN, Hardiek ML. Mercury intoxication
and arterial hypertension: report of two patients and review
of the literature. Pediatrics 2000;105:E34.
11. Zayas LH, Ozuah PO. Mercury use in espiritismo: a survey
of botanicas. Am J Public Health 1996;86:111-112.
12. LaPeter L, De La Garza P. Mercury in rituals raises
alarms. St. Petersburg Times. January 26. 2004 (on-line).
http://www.sptimes.com/2004/01/26/Hillsborough/Mer-
cury_in_rituals_ra.shtml. Accessed on July 31, 2011.
13. Schwartz J G. Snider T E, Montiel MM. Toxicity of a family
from vacuumed mercury. Am J Emerg Med 1992; 10:258
261.
14. OrlofTKG, Ulirsch G, Wilder L et al. Human exposure to
elemental mercury in a contaminated residential building.
Arch Environ Health 1997;52:169 172.
15. Ellenhorn MJ. Metals and related compounds. In: Schon-
wold S, Ordag G, Wasserberger J, eds. Ellen horn's medical
toxicology, 2nd ed. Baltimore: William and Wilkins,
1997:1588 1599.
A4 p.793
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Emergency Medicine News
Volume XXI Number 8 pages 24-25 Special Report
August 1999
Mercury Hazard
Widespread in
Mag ico-Rel ig ions
Practices m U.S.
People of Hispanic and Caribbean ethnicity use metallic
mercury to ward off evil spirits by ingesting it, applying
it to the shin, and wearing it in an amulet
'£V.
BY MICHAEL I. GREENBERG, MD, MPH
I recently attended an extremely inter-
esting scientific conference organized
by the Southern States Mercury T^sk
Force. .Hiis-group of environmentalists,
, tcxieologists, 'and scientists meet annual-
ly primarily to discuss the mercury haz-
^ •ard ln many bodi^of fresh water in the
off evil spirits. This simple
answer thrust Dr. Wendroff
into the strange and unusual
world of magico-reUgious
practices and ceremonies and
their associated potentially
hazardous exposures.
Because the student's
answer baffled Dr. Wendroff, ,
he asked the child to bring him
some of the mercury, and the
\ 1:
^ -^TKe conference was absolutely tasci-
;,.natingoritl^s^ject, and covered many child complied. Dr. Wendroff.
hazards for began alocal investigation that
• ,iiiq«uin8pQ^ marine ani- led to a most fascinating and "
niab.and marine food sources. While the
> /conference cOncentrated^on this aspect
: of environmental science, I became side-
. • tracked by ..an engrossing lecture deliv-
\ered byiArnold P,:Wendroff, PhD, a
research associate at Brooklyn College in
'¦:Bi^kiyn,-^;.v-;: .
Magico-Religious
Use of
important public health/taxi- ^
cology discovery that ! will
describe in this special report
For Sale in 'Yerberms'
Elemental mercuiy — "azogue" as it is
, Dr. Wendroff is a social scien-
. tist who was a career elementary
school teacher in the New York
City school system, working in a
K IC' U K > f I (I llK'I'CUl'V is
coiiViiionly found for
o\ er-t lio-coumor in
siot'Os k'lirtwii as
'hot an i cits'"or 'yerborias*
facility primarily attended by
Hispanic students. Dr. Wendroff
said one day during a lesson
about the periodic table, one
young Hispanic student indicat-
ed that he was familiar with the
symbol for mercury.
Dr. Wendroff asked the student
it" he knew mercury was used for,
folly expecting him to say that
mercuiy was used in thermome-
ters. 'Hie student responded that
his mother used mercury to ward
Metallic Mercury
- Used as a floor wash or cast directly
onto floors to provide protection against
evil spirits
- Sprinkled into automobile interiors for
protection
- Ingested directly
- Applied to the skin or used in spiritual
cleansing baths
-Placed in oil lamps or candles illuminated ;
for protection
-Kept inside vials and worn as charms
or amulets
-Used to provide love spells
Source: Michael I. Greenberg, MD, MPH
known in the Hispanic community or *vi
dajan" in the Haitian community — is
commonly found for sale over-the-
, counter in stores known as
"botanicas" or "yerberias." These
• botanicas and yerberias are small,
, privately owned specialty shops,
•located primarily in Latino and
U.S.-Carribbean . communities,
. that stock and sell popular reli-
gious items as well as many items
that are thought to provide heal-
ing/medicinal benefits. Within the
Latino and Caribbean communi-
ties, some people practice ethno-
religious rituals that are pari of
what is known as Santera,
Espuitismo, or Voodoo. Azogue,
or mercuiy, often piays a very
important role in these religious
and ethno-medical rituals.
In the practice of Santeria.
azogue is believed to give "res-
guardo" or protection or even pro-
vide "cantazo" or a "strike against
the person." Espiritismo, also
known as the "work of the dead,"
is part of a traditional healing ritu-
al in which people maintain rela-
tionships with the "angel
guardian" (guardian angel) and
"gufas" (spirit guides). Mercury is
integral in the ceremonial practice
of these belief systems, and is
apparently widely used in this
-------
August > 1999
regard. The metallic mercury uaed by
practitioners of these healing faiths is
used in many different ways as listed in
the table.
The uses of mercuiy in these
magico-religious rituals are Legion
and appear lo be widespread. !n
fact, a recent survey revealed that
most U.S. cites with large Hispan-
ic populations had functioning
botanicas, and that the vast
majority of these stores sold mer-
cury over-the-counter. These
sales are unregulated by local or
state governments, and the prod-
uct is unaccompanied by any sig-
nificant cautionary information
regarding the health hazards of
mercury. In fact, many of the
botanicas actually advocate the
use of mercury in the most dan-
gerous ways, usually resulting in
aerosolization and creation of an
inhalation hazard.
grossly elevated levels of mercury were
reportedly found in her breast, milk, thus
posing a compound hazard to mother
and child.
Elemental mercury — "uogue" as H is known in
the Hispanic community or *vl dajan" in the Hait-
ian community — is commonly found lor sab
over-the-counter in stores known as "botanicaa"
or "yerborias," such as the one shown here.
Total Mercury Sales
A 1996 report discovered that 35 botani-
cas in the Bronx, NY, had collectively sold
more titan 150 nine-gram units of mercury
per day. This would represent total mer-
One Internet Site
aclvex*tises the
unrestricted sale of
mercury via mai 1
for only $18 per
pound
cury sales of more Chan 420 kilograms for
these stores alone. Extrapolating this to
the potential for environmental catastro*
phe and human health hazard, these num-
bers suggest that it is possible that more
than 13,000 Bronx dwellings will have a
mean weight of nine grams of mercury
dispersed in them per year. Of course, the
possibility does exist that fewer dwelling
are contaminated but with even higher
mercury burdens than reported.
In 1997, a report by the Chicago
Department of Health revealed that 15 of
79 Hisparuc adults interviewed in Chica-
go admitted to using mercury regularly
for magico-religious purposes, In a non-
publbhed study, Dr. Clyde Johnson of the
City University of New York discovered
that 44 percent of adults of Caribbean
descent and 27 percent of Hispanic eth-
nicity (n=2Q3) indicated that they used
mercury in their homes or carried it in
their cars or on their person.
Shockingly, more than half of those
interviewed indicated that they routinely
disposed of mercury in their household
garbage. One case of special interest
involved a woman of Dominican descent
who had been adding mercury to her
cologne and applying the cologne to her
skin daily. As a result of this practice,
The magico-religious uses of mercuiy
really tell a story of toxic potential rather
tlian a story of specific and predictable tox-
icity. The fact is that the total potential that
these sources of mercury pose is
impossible to calculate or even esti-
mate accurately. There are many
important variables, and each
locale where these practices occur
may have specific U treats germane
to them.
It is clear, however, thai the
uncontrolled use of ceremonial
mercury is widespread, not cur-
rently being evaluated effectively,
and is certainly not well appreciat-
ed. In fact, a recent search of the
Internet revealed numerous
"cyber-botanicas," all of which were
advertising the sale of mercuiy. One Inter-
net site advertised the unrestricted sale of
azogue via mail for only $18 per pound.
Medical Hazards
The medical hazards of aerosolized and
inhaled mercury are well recognized and
have been well described in the sci-
entific literature. In fact, accidental
mercury intoxication by entire fami-
lies following inadvertent, vacuuming
of small amounts of spilled mercury
Is well known. What is not- well
known is the potential biological
impart that large amounts of mercury
dispersed witliin homes, cars, and
directly onto individuals will pose.
If individuals live in a particular
apartment and engage in such prac-
tices, the apartment or dwelling cer-
tainly will become contaminated
with mercury. Subsequent inhabitants of
these dwellings will never know they are
facing the potential of continuing, poten-
tially serious exposure to mercury.
Knowledge of the fact that mercury is
being widely used by specific populations
is critical information for emergency
physicians. Specifically, chronic elemen-
tal mercury intoxication often presents
clinically with rather vague and non-spe-
cific findings such as fatigue and lethargy,
fn addition, tremor, visual difficulties,
tachycardia, dermographism, and gingivi-
tis may also be seen.
A typical triad of symptoms
of chronic elemental mercury
intoxication includes excitabili-
ty, tremor, and gingivitis. As in
many environmental toxic expo-
sures, the key to successful treat-
ment, and, in fact, the first step
in that treatment, involves identi-
fication of the source of expo
sure and its prompt removal.
The sorts of mercuiy expo-
sures discussed in this report
comi>ei emergency physicians to
be diligent and vigilant Hie spe-
cific populations identified often
If individuals engnue in
using mercury to ward
off evi 1. t lioir dwel I i ng
certainly will become
contain i tinted
with mercurv
present to inner city emergency depart-
ments. Practitioners in these areas are
urged to explore the possibility that occult
or overt mercury exposure may have
occurred. Taking a careful history will
require careful querfioning, and in many
cases will require careful language transla-
tion and interpretation.
Sensitivity to the fact that the expo-
sures may be part and parcel of religious
ceremonies will be essential. That these
ceremonies are of special importance to
the patient yet foreign to the physician
may challenge the physician's history-tak-
ing skills. In any case, emergency physi-
cians in any practice setting should be
prepared to recognize the possible mani-
A 1097 report by
the Chicago DOM
--revealed that 15 of 70
Hispanic adults
interviewed in Chicago
admitted to using
mercury regularly
Testations of chronic elemental mercury
exposure in ethno-religious ceremonies.
Iri addition, emergency physicians may
find themselves taking the lead in report-
ing environmental contaminations and
exposures to local and state public health
officials, and providing necessary educa-
tional information to patients who may
be using mercury in this way. ¦
A4 p.795
-------
COMMITTflf ON APPROPRIATIONS, iowey.iim.ao.gav
RANKING MFMBlrR St Jflaa ;/ Washington
OK/
KI-KCOM
oi'i ri ¦¦ i
im'..
¦ i t; i {.!. s i ah mm- u iM
AND ftt i A-TFI1 PROGRAMS. ''** *•«•
MKiNOMF MBEfi vn trcntsitK
Jiita ffl. Hotorp
Congress of tfjc (Huitcb States
17th District, jlrlxi Horfc
December 17, 2014
Colonel Paul Owen
Commander, New York District
U.S. Army Corps of Engineers
26 Federal Plaza, Room 2113
New York, New York 10278
Dear Colonel Owen:
I am writing on behalf of many North Rockland County (New York) constituents,
including the elected officials of the Towns of Haverstraw and Stony Point, who have contacted
me regarding the proposal by Transmission Developers, Inc. (TDI) to construct the Champlain
Hudson Power Express transmission line (CHPE). I understand the Section 404 Clean Water
Act permit (404 permit) application for this project is still pending approval by the Army Corps
of Engineers (ACOE), I request that the 404 permit not be issued until ACOE has done a hard-
look review of the proposed dredging.
There are still significant concerns regarding this proposed project, ranging from
maritime requirements to dredging of the Hudson River. Several agencies, including the I J.S.
Coast Guard, the Maritime Association of the Port of New York/New Jersey Tug & Barge
Committee, and the American Waterways Operators, submitted letters and comments to ACOE,
expressing their concerns regarding CHPE's disregard of the industry standard of 15-foot burial
depth. These letters convey the strong recommendations that CHPE be buried to a depth of at
least 15 feet, not 7 feet as proposed by CHPE, in order avoid fouling an anchor on the cable or
the articulated mattresses, which are used to cover the powerline in places it cannot be buried
deep enough. The Hudson River has a long history as a vita] component of our nation's Marine
Transportation System, and has a strong current. Vessels need to be able to anchor during the
sudden onset of fog or other inclement weather, and a cable buried less than 15 feet deep would
present a significant risk that the anchor could be damaged or become entangled in the cable or
articulated mattresses.
Additionally, the Final Environmental Impact Statement (FEIS) does not adequately
evaluate the health, safety, and environmental impacts of the various levels of dr^lgi^g required
to construct CHPE. The FEIS incorporates a sediment analysis with data from 2009, but does
not explore the effects of dredging this sediment for 102.5 miles through the Hudson River.
-------
Furthermore, the Iona Marsh, a nationally registered habitat for the bald eagle, has not
been evaluated for environmental impacts, as the DEIS states that the proposed CHPE Project
route would not cross them. However, one of the four trajectories provided by TDI shows CHPE
passing through the northern section of Iona Island. Neither the impacts to the bald eagle's
habitat nor the potential consequences of constructing CHPE through Iona Island, which was
used by the U.S. Navy as a naval ammunition depot from J 900 through 1947, have been
evaluated.
Therefore, I ask that you give full consideration to the concerns raised by my
constituents regarding this project, and withhold the 404 permit until these concerns have been
adequately addressed.
Sincerely,
Nita M. Lowey
Member of Congress
NML:sl
cc: Brian Mills, NEPA Document Manager, Department of Energy A4 p-797
Jodi McDonald, Chief, Regulatory Branch, Army Corps of Engineers
-------
HIDDEN DANGER: Environmental Health Threats in the Latino Community
Principal Authors
Adrianna Quintero-Somaini, Mayra Quindongo
Contributing Authors
Evelyn Arevalo, Daniel Lashof, Erik Olson, Gina Solomon, M.D, M.P.H.
Natural Resources Defense Council
October [20] 2004
[Available on the NRDC web site at www.nrdc/orq/health/effects/latino/enqlish/contents.asp ]
EXECUTIVE SUMMARY
p. x
MERCURY EXPOSURE
The harmful effects of mercury pose another health threat to Latinos. The major ways in which Latinos are
exposed to mercury are by eating mercury-contaminated fish and by using mercury in religious ceremonies,
cosmetics, and folk remedies.
p. xi
Certain religious and cultural practices provide another route of exposure to mercury, which is sprinkled
indoors by practitioners of Espiritismo and Santeria (religious traditions found most commonly among
people of Puerto Rican and Cuban origin, respectively), and in the Voodoo and Palo traditions. Surveys in
Massachusetts, New York, and Chicago found that between 19 and 44 percent of Hispanic respondents
reported using mercury for magic or religious purposes. Researchers estimate that 47,000 capsules of
mercury are sold per year in botanicas (stores that sell remedies and religious items) in [the borough of the
Bronx] New York City, and these capsules are likely to cause long-term contamination of more than 13,000
homes or apartment buildings each year. Use of mercury in an apartment building has been shown to cause
elevated levels of mercury vapor in the hallways and entryway, and probably also in other apartments where
mercury is not used. Toxic vapors can linger for months or even years, leading to neurological and
respiratory symptoms in apartment residents.
p. 54
Chapter 6
MERCURY
Another substance posing a significant health threat to Latinos is mercury. Once known best as the silvery
liquid in thermometers, mercury is better known today as a poison that damages the brain and kidneys.
Despite the health risks associated with the chemical, the public largely does not appreciate the seriousness
of the threat and the presence of its sources. This is especially true in the Latino community, where public
education efforts in Spanish have so far been limited. The most serious ways in which Latinos may be
exposed to dangerous amounts of mercury are eating mercury-contaminated fish and using mercury in
religious ceremonies, cosmetics, and folk remedies.
p. 55
A4 p.798
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MERCURY LEVELS IN THE BLOOD AND HAIR OF LATINOS
Nationwide, more than one in 12 women of reproductive age has mercury in her blood that exceeds the level
set as safe by the Environmental Protection Agency (EPA).4 A large study done by the Centers for Disease
Control and Prevention (CDC) tested for mercury in the blood and hair of more than 2,500 women and
children around the United States. On average, Mexican-American children had higher levels of mercury in
their bodies compared with non-Hispanic white children.5 In addition, three people tested in that study had
mercury levels that were 100 to 1,000 times as high as the average for the other people tested. All of these
people were Mexican-Americans, including a 37-year-old woman and two children ages 1 and 3. These
people had both methyl mercury and inorganic mercury in their bodies, suggesting that they may have been
exposed to this toxic chemical both from eating fish and from direct exposure such as from folk remedies or
religious uses.
p. 57
FOLK REMEDIES AND COSMETICS
Mercury, known as azogue in some Latino communities, is sometimes used as a folk remedy for empacho
(indigestion or gastroenteritis). This practice is most common among Mexican-Americans, and surveys have
found that one out of 12 Latinos in New Mexico mention azogue as a cure for empacho.15 Doctors have [p.
58] documented individual cases of children becoming ill, even requiring hospitalization, from the use of
mercury for empacho16 Not surprisingly, children are more likely than adults to be harmed by ingesting
azogue11 Diagnosis is complicated by the similarity between the symptoms from consuming azogue and the
symptoms of the illness it is used to treat. People who use azogue for the treatment of illness do not realize
that it is harmful, just as most Americans did not realize until recently the potential hazards of mercury-
containing disinfectants (such as Merthiolate or Mercurochrome) for treating cuts and scrapes in children.
p. 58
RELIGIOUS CEREMONIES
Another source of mercury exposure that goes largely unnoticed is its use in the religious practices of some
Latin American and Afro-Caribbean communities. Practitioners of Espiritismo and Santeria (religious
traditions most commonly found among people of Puerto Rican and Cuban origin, respectively), Voodoo,
and Palo use mercury. It is sometimes carried in capsules, burned in candles or oil lamps, sprinkled around
the home, or added to perfumes. In these religious traditions, azogue helps summon spirits for magical spells
and serves as an amulet that keeps evil spirits at bay and brings good luck.20
Initial studies indicate that the use of azogue is relatively common in the Latino and Caribbean
community. A 2003 study of 898 Latino respondents in [Lawrence] Massachusetts found that 38 percent
have used or know someone who has used azogue for religious, spiritual, or health purposes.21 Similarly, a
study of 203 adults in New York City revealed that 44 percent of Caribbean respondents and 27 percent of
those from Latin America reported using mercury as a part of their cultural practices.22 In a Chicago survey,
19 percent of Hispanics reported using mercury for magic or religious purposes.23 And in another survey, 12
percent of practitioners reported sprinkling mercury around a child's crib or bed.24
p. 59
Mercury is sold in most botanicas, stores that sell remedies and religious items. Studies show that
more than 85 percent of botanicas around the country sell azogue and that in some areas the percentage is
even higher.25 A canvass of 35 botanicas in the Bronx found that they collectively sold more than 420
kilograms (924 pounds) of mercury yearly.26 Based on this survey, researchers estimated that 47,000
capsules of mercury are sold per year in [the Bronx,] New York City, and these capsules would be likely to
cause long-term contamination of more than 13,000 homes or apartment buildings each year.27
Even if a family does not use mercury themselves, there can be a danger of exposure because
mercury lingers in cracks in the floor or in carpets for months or years, slowly giving off mercury vapor that
A4 p.799
-------
can be inhaled by people living in the building. For example, use of mercury in an apartment building has
been shown to cause elevated levels of mercury vapor in the hallways and entryway, and probably in other
apartments where mercury was not used. Moving into a house or apartment where mercury was used in the
past can expose new occupants to mercury hazards. Children have been reported to become seriously ill
from living in a room where a mercury thermometer was broken eight months previously, and the amounts
of mercury used in these rituals can be significantly more than the amount in a thermometer.28 In certain
areas of New Jersey with large populations of Caribbean-Americans, indoor mercury levels have often been
found to be five times the outdoor level.29 When mercury is in vapor form it can cause neurological
problems and is also associated with respiratory symptoms such as shortness of breath, pneumonia, and lung
disaease.30
In 2001, the New York State Senate adopted a resolution calling on state and federal agencies to
investigate the residential use of mercury in New York. The Senate was especially concerned about the risks
to women and children and about the risks to people who move into apartments unaware that the previous
tenant scattered mercury that could make them sick.31 In 1994, the U.S. Environmental Agency warned state
and local health officials of a mercury threat to Hispanics related to the use of mercury in many Hispanic
communities.32
Studies have shown elevated levels of mercury in people's bodies related to inadvertent exposure to
mercury used in rituals. A survey of 100 Hispanic and Caribbean children from a Bronx, New York,
community with known access to mercury for religious rituals revealed that 5 percent had elevated levels of
the toxic metal in their urine.33 The mercury levels were as high as those shown to cause subtle cognitive
defects, abnormalities in motor function, and mood changes in adults. Recently, health officials
investigating a mercury spill in a school found that Latinos who used mercury in their homes had higher
mercury levels than individuals exposed at the school.34
Mercury disposal is also cause for concern. A 1999 study showed that 64 percent of users of azogue
reported throwing mercury into the garbage, and 27 percent reported flushing it down the toilet.35 New
York's Bureau of Wastewater Treatment has been unable to identify the source of about 68 pounds per year
of mercury entering one of its plants from a region that contains the city's largest Latino population.36 When
mercury is disposed of in garbage or wastewater, it eventually is transformed into methyl mercury and
contaminates the fish we eat.
p. 60
Conversations with azogue users indicate that some realize that touching or eating mercury may be
harmful, but they are generally unaware that mercury is highly volatile and that inhalation is a very
dangerous route of mercury exposure.37 A culturally sensitive education campaign that involves Santeros
(Santeria priests), local groups, and local government officials could address this problem. Significantly,
various studies show that botanica owners are already wary of outsiders and are trying to conduct sales in an
inconspicuous manner. Any action that drives this business further underground will only hinder efforts at
education. Therefore, an approach that allows practitioners to make well-informed decisions will help to
protect children in these communities.
RECOMMENDATIONS
• Local departments of health in cities with significant Latino populations should provide bilingual
materials at public health clinics and in schools to inform Latinos about the risks of mercury use in folk
remedies, cosmetics, and religious ceremonies.
A4 p.800
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ENDNOTES
15 R.T. Trotter, "Greta and Azarcon: A survey of episodic lead poisoning from a folk remedy," Human
Organization 44( 1)(1985): 64-72. A Guide for Health-Care Providers." Available online at
http://www.ci.nvc.nv.us/html/doh/pdf/eode/mercurvl.pdf.
16 P.E. McKinney, "Elemental mercury in the appendix: An unusual complication of a Mexican-American
folk remedy," Journal of Clinical Toxicology37(l)(l999): 103-107; M.E. Geffner and A. Sandler, "Oral
metallic mercury: A folk remedy for gastroenteritis," Clinical Pediatrics 19(6)( 1980): 435-437.
17 New York City Department of Health, "Metallic Mercury Exposure: A Guide for Health-Care
Providers." Available online at http://www.ci.nyc.ny.us/html/doh/pdf/eode/mercury 1 pdf.
18 J. Villanacci, R. Beauchamp, D M. Perrotta, M. Rodriguez, A. Abel, R.J. Dutton, D M. Simpson, et al.,
"Update: Mercury poisoning associated with beauty cream—Arizona, California, New Mexico, and Texas,
1996," MMWR 45(29)(1996): 633-635.
19 M M. Weldon, M.S. Smolinski, A. Maroufi, B.W. Hasty, D.L. Gilliss, L.L. Boulanger, et al., "Mercury
poisoning associated with a Mexican beauty cream," Western Journal of Medicine 173(2000): 15-18.
20 D M. Riley, C.A. Newby, T O. Leal-Altneraz, and V.M. Thomas, "Assessing elemental mercury vapor
exposure from cultural and religious practices," Environmental Health Perspectives 109(8)(2001 ):779-784.
21 J SI Center for Environmental Health Studies, commissioned by Massachusetts Executive Office of
Environmental Affairs, Environmental Justice Office, "Ritual Use of Mercury (Azogue) Assessment and
Education Project," August 7, 2003, p. 6.
22 C. Johnson, "Elemental Mercury Use in Religious and Ethnic Practices in Latin American and
Caribbean Communities in New York City," Population and Environment: A Journal of Interdisciplinary
Studies 20(5)( 1999) 443-453.
23 A.P. Wendroff and D A. Jetter, "Mercury exposure from magicoreligious use in Hispanic and Caribbean
homes "Environmental Times December 1999: 1-16.
24 J SI Center for Environmental Health Studies, commissioned by Massachusetts Executive Office of
Environmental Justice Office, "Ritual Use of Mercury (Azogue) Assessment and Education Project," August
7, 2003, p. 6.
25 L.H. Zayas and P.O. Ozuah, "Mercury use in Espiritismo: A survey of botanicas," American Journal of
Public Health 86( 1)(1996): 11 1-1 12.
26 Ibid.
27 A. Wendroff, "Reports by Botanica personnel of mercury sale and use for spiritual practices, Bronx,
New York City," 1995. Available online at http://www.mercurypoisoningproiect.org.; M.J. Greenberg,
"Mercury hazard widespread in magico-religious practices in U.S.," Emergency Medicine News 21 (8)(1999):
24-25.
28 K.E. Muhlendahl, "Intoxication from mercury spilled on carpets," The Lancet, December 22/29,
1990:1578.
A4 p.801
-------
29 A H. Stem, M. Gochfeld, D.Riley, A. Nevvby, T. Leal, amd G. Garetano, "Cultural Uses of Mercury in
New Jersey," New Jersey Department of Environmental Protection, May 2003.
30 Agency for Toxic Substances and Disease Registry, "Toxicological Profile for Mercury," 1999.
Available online at http://www.atsdr.cdc.gov/toxprofiles/tp46.pdf.
31 M. Smith, "Urging the New York State Congressional Delegation to call upon the Department of Health,
the United States Consumer Product Safety Commission, the Federal Occupational Safety and Health
Administration and/or any other appropriate agency to investigate the unlawful retail sale of elemental
mercury to consumers within the City of New York." Senate No. 1468, April 24, 2001.
32 "EPA Warns health officials of mercury threat to Hispanics," The Nation's Health, May/June 1994, p. 5.
33 P.O. Ozuah, M.S. Lesser, J.S. Woods, H. Choi, and M. Markowitz, "Mercury exposure in an urban
pediatric population " Ambulatory Pediatrics 3(l)(2003):24-26.
34 A. Goldstein, "Tests find 10 with higher mercury," Washington Post, October 15, 2003, p. BO 1.
35 C. Johnson, "Elemental Mercury Use in Religious and Ethnic Practices in Latin American and Caribbean
Communities in New York City," Population and Environment: A Journal of Interdisciplinary Studies
20(5)(1999):443-453.
36 Personal communication, June 10, 2003, with Jorge Villacis and Lily Lee of NYC DEP and Dr. Arnold
Wendroff.
37 D. Riley, C.A. Nevvby, T O. Leal-Almeraz, and V.M. Thomas, "Assessing Elemental Mercury Vapor
Exposure from Cultural and Religious Practices," Environmental Health Perspectives
[Available on the NRDC web site at www.nrdc/orq/health/effects/latino/enqlish/contents.asp ]
A4 p.802
-------
Metallic
Mercury
Exposure
A Guide for
Health-Care
Providers
-------
TABLE OF CONTENTS
What is Azogue/Vidajan 2
Reasons and Means of Use 4
Routes of Exposure 6
Health Effects 7
Testing for Exposure and Absorption 10
Removal and Disposal of
Metalic Mercury 12
Legal Issues 14
Addressing Patient Concerns 14
Additional Resources 15
A4 p.804
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METALLIC MERCURY EXPOSURE
A Guide for Health-Care Providers
Some people in Latin American and Caribbean
communities, especially those who practice Santeria,
Espiritismo, or Voodoo, may use metallic mercury
(known as azogue or vidajan) in religious and
ethnomedical rituals that could adversely affect their
health. Some people may use metallic mercury in folk
treatments as a substitute for, or as a supplement to,
conventional medical treatment.
This brochure has been developed to inform health-
care professionals and providers that their patients who
use metallic mercury may be at risk for mercury
poisoning. It addresses the most common questions
and concerns about metallic mercury:
O What is Azogue / Vidajan? © Reasons and Means
of Use © Routes of Exposure O Health Effects ©
Testing for Exposure and Absorption © Removal and
Disposal of Metallic Mercury 0 Legal Issues ©
Addressing Patient Concerns © Additional Resources
-------
O WHAT IS AZOGUE / VIDAJAN?
Azogue / Vidajan is metallic mercury.
In the English and Spanish languages, quicksilver and
azogue are popular names for metallic mercury. In
Haitian Creole, metallic mercury is called vidajan.
Azogue / vidajan may be commonly found in
botdnicas and religious stores that sell popular
religious and non-conventional medicinal products
located in Latino and Caribbean communities.
Metallic mercury can be easily identified by its shiny,
silver-gray appearance. This heavy and slippery liquid
metal easily breaks up into many small beads, which
can join again with equal ease. When dispersed in a
room, it may not be easily seen and can remain for
months or years.
Metallic mercury:
~ does not dissolve in water or alcohol
~ is odorless but has a metallic taste
~ is a liquid and a vapor at room temperature
~ evaporates slowly into indoor air (and evaporates
more quickly as the temperature increases)
~ is invisible in vapor form
There are other types of mercury besides the metallic
form. Some people confuse the silvery metallic
mercury with the red mercury called mercuric sulfide
(Spanish mercurio). Mercuric sulfide (also called
cinnabar) is used as pigments in paints and tattoos.
Metallic mercury is refined to its elemental form from
mercuric sulfide.
-------
Metallic mercury is sold in botanicas in capsules or
glass vials in amounts ranging from a few grams to 3
to 5 ounces for spiritual "works" (trabajos). It can also
be found in thermometers, electrical switches, and
thermostats in the home.
Azogue / Vidajan capsules can have up to 10 times (3 to
5 ounces) more metallic mercury than one
thermometer.
Mercury Vapors
Metallic mercury begins evaporating as soon as it
contacts air. Higher temperatures increase the rate and
amount of evaporation. Since azogue / vidajan
capsules are not sealed, there is always a risk of
evaporation from the container. The vapor particles
will stick to almost anything: jewelry, carpets,
draperies, clothing, furniture and cracks in floors.
Metallic mercury vapors are invisible and may persist
throughout the room for many months or years.
Because mercury vapors can remain within indoor
environments for extended periods of time, people
who live in or regularly visit these households may be
at risk for exposure to harmful levels of mercury
vapor. The risk of exposure may be greater during cold
seasons, when people heat their homes and close their
windows, trapping heat (and mercury vapors) inside.
Changes in temperature can cause fluctuations in the
concentration of indoor mercury levels.
-------
f.ltlf IN|,VII lifin>if Bivltllh
Mercury vapor is denser than air and settles near the
floor. Children are at a greater risk of exposure
because they spend more time on the floor. Younger
children in particular can be exposed to more of the
invisible vapors because they often crawl or play on
the floor, and generally have higher respiration rates.
© REASONS AND MEANS OF USE
Industrial Uses
In the past, metallic mercury was a common ingredient
in pharmaceutical products, was used in industry to
coat mirrors, and could be found in some paints (prior
to 1991). Today, this liquid metal is found in electrical
equipment (e.g., batteries), weather instruments (e.g.,
thermometers, barometers, manometers, switches), and
dental amalgams. It is also used in factories to produce
chlorine gas and in "informal" gold extraction as well
as the industrial gold mining process.
Spiritual Uses
The use of azogue can vary widely among individuals.
Azogue has particular significance in Santeria or
Lucumi religion. The metal "works" for Eleggua, an
African Yoruba god and one of the Siete Potencias
Africanas (The Seven African Powers), called upon by
believers to open paths and remove obstacles. Azogue
is also one of the seven basic metals of Santeria. It is
believed that the metal azogue can give either
resguardo (protection) or cantazo (a strike against a
person, bringing harm and illness).
A4 p.808
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Espiritismo, also called "the work of the spirits," is a
traditional healing practice in which people maintain
relationships with the "protecciones"—the angel
guardian (guardian angel) and guias (spirit guides).
Adherents believe that azogue has spiritual powers
similar to its characteristics as a metal. Just as azogue
moves quickly, likewise it "speeds" the "works" of
Santeros and Espiritistas.
Practitioners of Santeria, Espiritismo, or Voodoo may
periodically use azogue or vidajan in practices to seek
spiritual aid from the gods or spirits. It is used in a
variety of ways for various reasons.
It may be:
~ placed in floor washes or sprinkled directly onto
the floor to cleanse or protect the home
~ ingested to cure stomach ailments
~ applied to the skin or used in baths for spiritual
cleansing
~ placed in oil lamps or candles for protection and to
increase good fortune
~ kept inside a vial or charm bag for protections or
as amulets
~ offered as petitions to the Yoruba gods
~ used for love spells
A4 p.809
-------
^ N»mi V'i>iit, f.ilf IN|,VI lipirl^ifl >if K>vllh
® ROUTES OF EXPOSURE
It Is hazardous to use metallic mercury and breathe
its vapors. There is always a risk of mercury intake
whenever it is used.
Inhaling Mercury Vapors
Metallic mercury is harmful when ingested, but even
more dangerous when inhaled. The vapors rapidly
diffuse through the lungs and enter the bloodstream.
The mercury is converted to different physical and
chemical states, and distributed to tissues throughout
the body. Almost 80% of inhaled metallic mercury
vapor is absorbed by the body. The mercury
accumulates in the kidneys and brain. Some of the
inhaled mercury is exhaled, or released through urine
or excrement.
Ingesting Mercury
Ingested metallic mercury is usually converted to a
non-diffusible form that prevents it from easily
entering the bloodstream. Most of it goes through the
gastrointestinal tract and is expelled from the body
through excrement. Less than 1% of ingested metallic
mercury is absorbed by the body. About half of the
mercury ingested will be excreted after 35 to 90 days.
While in adults, ingesting small quantities of metallic
mercury may not immediately result in noticeable
health effects, the same amount of mercury can make a
child sick due to their smaller body size and because
the developing organs are very sensitive.
A4 p.810
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Applying Mercury to the Skin
Metallic mercury that is rubbed on the skin or used in
spiritual baths may evaporate and be inhaled. Smaller
amounts may also enter the bloodstream directly
through abraded skin and accumulate in the kidneys
and the central nervous system.
© HEALTH EFFECTS
Metallic mercury may cause permanent damage to
the brain and kidneys, and may even cause death.
The type of damage to the body caused by this form of
mercury is determined by how much and for how long
the person is exposed to it. Vapors may be fatal if inhaled
in large amounts for even a brief period of time.
Metallic mercury can persist in the body for months;
mostly in the kidneys and brain. The most affected part
of the body is the nervous system.
The half-life of metallic mercury in humans is
approximately 30-40 days in blood and about 60 days
in urine. Mercury vapor is lipid-soluble and readily
crosses the blood-brain barrier and the placenta.
Mercury can be detected in the brain for many years
after an exposure.
Depending on the level of exposure, the appearance of
signs and symptoms may vary. Health effects can
occur within hours (acute) or over weeks, months or
even years (chronic). Acute poisoning symptoms
would be expected to occur only after exposure to very
high concentrations.
-------
Signs and Symptoms of Short-Term
(Acute) Exposure:
~ cough
~ difficulty breathing
~ chest pain
~ nausea, vomiting
~ diarrhea
~ fever
~ metallic taste in the mouth
~ renal failure (shock and acute renal dysfunction)
Signs and Symptoms of Long-Term
(Chronic) Exposure:
~ stomatitis, gingivitis
~ tremors
~ erethism (strange irritability and marked shyness)
~ memory loss
~ headache
~ fatigue, insomnia
~ depression
~ loss of appetite and weight loss
~ behavioral and cognitive difficulties
~ decreased lung vital capacity
~ renal failure
~ burning eyes and conjunctivitis
~ rashes and peeling skin on palms of hands and
soles of feet
A4 p.812
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The use of mercury in ethnomedical or religious
practices typically involves small quantities
administered over time. Thus, affected individuals
would likely exhibit chronic symptoms.
Symptoms associated with metallic mercury exposure
may be general in nature (fatigue, nausea, headaches),
and often can be mistaken for symptoms of other
conditions or illnesses. For this reason, mercury
poisoning may be difficult to diagnose.
Mercury and Children
Metallic mercury has the greatest effect on the fetus
and small children, and their developing central
nervous systems.
Metallic mercury will reach the fetus of a
pregnant woman.
It is important to protect pregnant women and small
children from metallic mercury. It will enter the fetal
bloodstream through the placenta and may produce
permanent damage to the child's developing organs,
especially the brain, kidneys, lungs and liver. Nursing
mothers who inhale the vapors can also affect infants
through breast milk.
Toddlers who crawl on floors contaminated with
mercury can inhale or ingest it. The amount and
frequency of mercury exposure determines the impact
on a child's development. However, the younger the
child, the greater the risk of long-term neurological
and developmental effects.
-------
u N-mi Vftiit,
Children are more susceptible to mercury toxicity
because their organs exhibit higher absorption and
retention rates of mercury, and their nervous systems
are highly sensitive to the metal.
Some children exposed to metallic mercury can
develop a condition called acrodynia or "pink
disease."
Signs and Symptoms of Acrodynia in
Children:
~ severe leg cramps
~ irritability
~ numbness, prickling or tingling
~ painful pink fingers
~ peeling hands, feet and nose
~ rash
~ heavy sweating
~ sensitivity to light
© TESTING FOR EXPOSURE AND
ABSORPTION
Since users of metallic mercury may not be aware of
its harmful effects, they may not mention it to their
health-care providers. It is important to ask patients if
they use non-conventional or folk / traditional
treatments for ailments and if any of those remedies
contain mercury fazogue or vidajan).
Environmental Testing
Metallic mercury vapors are invisible and odorless. A
mercury vapor analyzer, a small machine that measures
the level of mercury in the air, can be used to detect
mercury within indoor environments. This measurement
takes only a few minutes and the results are immediate.
A4 p.814
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¦eta 11
Medical Testing
Several laboratory tests measure the levels of all forms
of mercury in the body. Blood or urine samples can be
tested for metallic mercury levels. Hair samples can be
tested for long-term exposure to methylmercury (the
form of mercury found in some fish), if careful testing
methods are used. But a urine test is the recommended
way to measure metallic mercury levels in the body.
The New York State Heavy Metals Registry has established
reportable levels for elevated mercury. The reportable
levels are concentrations at or above 5 ng/ml in blood, and
at or above 20 ng/ml in urine. The mercury level in blood
reflects exposure to all forms of mercury, and may
therefore be influenced by dietary intake (i.e. fish).
Ideally, in order to determine elevated mercury levels,
urine samples should be collected over 24 hours, but
spot urine samples can be used instead, if corrected for
creatinine levels. If patients report using metallic
mercury, or a spot urine sample has elevated results,
then a 24-hour urine collection, corrected for
creatinine, should be analyzed.
For blood or urine sample analysis call the New York
State Clinical Laboratory Evaluation Program at
(518) 485-5378 to find the nearest laboratory certified
to conduct mercury analyses.
Treatment
Determining and eliminating exposure is the most
important step in the treatment process.
There are several ways to enhance elimination of
mercury from the body. Duration of use, symptoms of
exposure, and mercury levels determine when and how
to treat a patient exposed to mercury.
A4 p.815
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Chelators, specific agents that bind to mercury to form
a nonpoisonous compound that can be excreted from
the body, can reduce the body burden of mercury.
Chelation should be reserved for individuals who have
evidence of very high mercury absorption and
significant symptoms. The appropriate chelator to use
depends on the form of mercury to which a person has
been exposed and the health status of the individual.
Some types of chelators are contraindicated for
elemental and organic mercury compounds because of
the possibility of increased neurotoxicity, so expert
consultation should be sought prior to treatment.
To receive more information about testing or treatment
procedures, call the Mount Sinai Occupational Health
Clinic at (212) 987-6043 or Bellevue Occupational
Health Clinic at (212) 562-4572. Both clinics are part
of the New York State Network of Occupational Health
Clinics and have experience in evaluating mercury
exposure.
© REMOVAL AND DISPOSAL OF
METALLIC MERCURY
Common household appliances should not be used to
collect spilled metallic mercury. Brooms and mops will
only spread the contamination. Vacuum cleaners will
disperse the mercury into droplets, and the heat they
generate can increase vaporization. Mercury should
never be discarded into sinks, bathtubs or toilets, as it
may become trapped, evaporate and re-enter the home.
When cleaning up a mercury spill, care needs to be
taken to avoid contaminating clothing, shoes, and
A4 p.816
-------
¦eta 11
jewelry. Metallic mercury readily binds to gold and
can permanently damage jewelry.
Small amounts of metallic mercury (like the amount found
in fever thermometers) can be cleaned up from hard
surfaces such as tile, wood, or linoleum floors. But, if
it has been spilled or placed on carpets, upholstery or
porous surfaces they should be discarded or specially
cleaned with mercury spill kits and detergents.
Mercury spill kits are sold by safety equipment distributors,
industrial safety supply outlets and laboratory safety
services. Check under environmental and ecological
products and services or laboratory safety services in
phone books.
If patients need information on how to clean
up small mercury spills they can call:
NYC DEPARTMENT OF HEALTH
Bureau of Environmental andOccupational Disease Prevention
(212) 788-4290 (Business Hours)
Poison Control Center
(212) 764-7667 (24 hours a day)
If a large amount of mercury has been spilled
in a home or business, people should call:
NYC DEPARTMENT OF HEALTH
Poison Control Center
(212) 764-7667 (24 hours a day)
NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION
(718) DEP-HELP (24 hours a day)
If a person has a large amount of mercury in their home
or business and wants to dispose of it, the NYC Department
of Environmental Protection can recycle the mercury.
A4 p.817
-------
For more information about recycling mercury, call the
NYC Department of Environmental Protection during
business hours at (718) 595-4784.
0 LEGAL ISSUES
It is not illegal to use or sell mercury. However,
Federal and New York City law requires that mercury
containers be properly labeled alerting people to the
hazards associated with mercury.
© ADDRESSING PATIENT CONCERNS
In order to improve the well-being of your patients and
their families, they should be aware of the potential
dangers of mercury use. Children are at particular risk
for harmful effects. As a physician, you can respect your
patients' religious beliefs and still provide effective
health care. Patients should be asked about their use of
traditional/folk treatments and educated about the dangers
of metallic mercury (azogue /vidajan). They should be
aware of how to find out about alternatives that will allow
them to continue practicing their religious or cultural
beliefs, using safer substances.
Information about these alternatives can be found in
the books sold in botanicas. Patients can also be
encouraged to ask their espiritista, santero, or dokte fey
to suggest other things that may be used in place of
azogue or vidajan.
A patient education brochure is available from the
New York City Department of Health. The brochure
discusses the health effects associated with using
azogue / vidajan (metallic mercury) and includes steps
for cleaning up small amounts of azogue / vidajan in
homes. For copies, call (212) 788-4290.
A4 p.818
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¦eta 11
© ADDITIONAL RESOURCES
NEW YORK CITY DEPARTMENT OF HEALTH
Bureau of Environmental and Occupational Disease Prevention
125 Worth St., CN-34C
New York, NY 10013
(212) 788-4290 (Business Hours)
{For information on indoor air testing, medical and environmental
levels of concern, potential assessments, patient brochures and
metyhods for clean up of small amounts of mercury.}
NEW YORK CITY DEPARTMENT OF HEALTH
New York City Poison Control Center
455 First Ave. CN-81
New York, NY 10016
(212) 764-7667 (24 hours)
{For help in acute poisoning situations and for clinical and
treatment information}
NEW YORK STATE CLINICAL LABORATORY
EVALUATION PROGRAM
(518) 485-5378
NEW YORK STATE NETWORK OF OCCUPATIONAL
HEALTH CLINICS
New York City:
Bellevue Occupational Health Clinic
First Ave. at 27th St. Rm CD349
New York, NY 10016
(212) 562-4572
Mt. Sinai- Irving J. Selikoff Center for Occupational and
Environmental Medicine
One Gustave L. Levy Place, Box 1058
New York, NY 10029
(212) 987-6043
A4 p.819
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iJ N-hi Vfti it,
NEW YORK STATE DEPARTMENT OF HEALTH
Bureau of Toxic Substances Assessment
1-800-458-1158 (toll free within NY State)
{Information on indoor air testing and the Environmental
Laboratory Approval Program}
NEW YORK CITY DEPARTMENT OF ENVIRONMENTAL
PROTECTION
(718) DEP-HELP(24 hours a day. To report a large mercury spill.)
(718) 595-4784 (Business hours. For information on mercury
We would like to acknowledge the excellent brochures on this
topic developed by the Hispanic Health Council of Hartford,
Connecticut and the Environmental Epidemiology and
Occupational Health section of the State of Connecticut
Department of Public Health and Addiction Services. Their
brochures served as the basis for our educational materials. We
would also like to thank the many reviewers who so generously
provided comments on this brochure.
This brochure was developed and edited by Natasha Dwamena,
Nancy Jeffery and Lori Stevenson of the New York City
Department of Health's Bureau of Environmental and
Occupational Disease Prevention.
The City of New York
DEPARTMENT OF HEALTH
recycling).
ACKNOWLEDGMENTS
Thomas R. Frieden, md, mph
Commissioner
nyc.gov/health
Michael R. Bloomberg
Mayor
A4 p.820
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> >
o
i
The City of New York
DEPARTMENT OF HEALTH
Rudolph W. Giuliani Neal L. Cohen, m.d.
Mayor Commissioner
Web Site: www.ci.nyc.ny.us/health
Azoaue
Vidajan
Metallic
Mercury
Poisoning
I i
-------
Htw ¥ork City Department of Health
Acknowledgments
We would like to acknowledge the excellent brochures
on this topic developed by the Hispanic Health Council of
Hartford, Connecticut and the Environmental
Epidemiology and Occupational Health section of the
State of Connecticut Department of Public Health and
Addiction Services. Their brochures served as the basis for
our educational materials. We would also like to thank the
many reviewers who so generously provided comments
on this brochure.
This brochure was developed and edited by Natasha
Dwamena, Nancy Jeffery, and Lori Stevenson of the New
York City Department of Health's Bureau of Environmental
and Occupational Disease Prevention.Special thanks to
the NYC DOH Office of Cultural Affairs and Alexandra
Ternier for their translation services.
Metallic Mtrear* and Year Heslfli t
What is Azogue/Midajan?
Azogue is Spanish and
Vidajon is Haitian Creole
for metallic mercury
also known as quicksilver in English.
Metallic mercury is a very toxic, silver-gray
liquid metal.
~ It does not dissolve in water or alcohol.
~ It has no smell but has a metallic taste.
~ It can be a liquid or a vapor
at room temperature.
~ It can remain where spilled for
several months.
~ It evaporates in air.
~ Its vapors cannot be seen.
ALL TYPES OF MERCURY ARE TOXIC.
Azogue/Vidajan is found in thermometers
used to measure body temperature, some
paints (made before 1991), electrical switches,
thermostats and batteries. It is also sold in
botanicas in capsules in amounts ranging
from a few grams to 3-5 ounces for spiritual
"works" (trabajos),
A4 p.822
-------
An ozogue/vidajon
capsule can contain up
to!0 times more mercury
than one thermometer.
The mercury vapor from these capsules is
heavier than air, so the vapor tends to settle
near the floor. Children may be at a greater
risk of breathing in the vapor because they
may crawl and play on floors.
WHAT IS AZOGUE/VIDAJAN USED FOR?
Some people use azogue/vidajan in
traditional medicine or for spiritual/religious
purposes, such as:
~ to cleanse or protect the home
~ to cure stomach ailments
~ for spiritual cleansing
~ for protection and to increase good
fortune
~ to offer petitions to the Yoruba gods
~ for love spells
Metallic Mercury and Yaur Health 3
When used for spiritual/religious purposes,
azogue/vidajan has been:
~ placed in floor washes or sprinkled onto
the floor
~ applied to the skin or used in baths
~ swallowed
~ placed in oil lamps or candles
~ kept inside vials or charm
bags as amulets
IS THERE A SAFE WAY TO USE
AZOGUE/VIDAJAN?
NO! There is always a risk of breathing azogue
vapors when it is used in any way.
Azogue/Vidajan is dangerous when
inhaled. It can also be harmful when
swallowed or applied to the skin.
Azogue/Vidajan gets into carpets, draperies,
furniture, and cracks in the floors when spilled. It
can stay in a room for months or years.
You won't know how often you are
breathing azogue/vidajan vapor because
you cannot see or smell it.
A4 p.823
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HOW CAN
AZOGUE/VIDAJAN
AFFECT YOUR HEALTH?
-» Azogue/Vidajan can stay in your kidneys
and brain for months. The most affected part
of the body is the nervous system.
-» Azogue/Vidajan can cause permanent
damage to the brain and kidneys. It can
harm the developing baby, and may even
cause death.
The health effects depend on how much
and for how long a person has had contact
with azogue/vidajan.
Signs and Symptoms of Azogue/Vidajan
(Metallic Mercury) Poisoning:
~
tremors
~
irritability and shyness
~
redness and swelling of the mouth and
gums
~
memory loss
~
headache
~
tiredness and difficulty sleeping
~
depression
~
loss of appetite and weight loss
~
eye and skin irritation
~
respiratory failure and death (after very
high exposures)
It may take a long time for signs and
symptoms to develop. For this reason,
poisoning may be difficult to diagnose.
-> Tell your doctor if you experience any of
these signs and symptoms. Also let your
doctor know if you use azogue/vidajan
(metallic mercury).
Health Effects on Children
Azogue/Vidajan is most dangerous to the
unborn child and small children.
Vapors breathed in by
pregnant women can enter
the developing baby.
Azogue/vidajan can also be
passed to an infant through
the mother's breast milk.
A4 p.824
-------
Toddlers who crawl on floors
where azogue/vidojan has
been spread may breathe it
in or may swallow it. This
exposure can cause brain
damage that may lead to
behavioral and learning
problems,
The younger the child, the greater the risk of
long-term effects.
Children are more affected by mercury than
adults. Some children exposed to
ozogue/vidajon can develop a condition
called acrodynia or pink disease.
Signs and Symptoms of Acrodynia in Children:
~ severe leg cramps
~ irritability
~ numbness, prickling or tingling
~ painful pink fingers
~ peeling hands, feet and nose
~ rash
~ heavy sweating
~ sensitivity to light
Mefaliie Mtreany and Yoiif Health ?
WHAT CAN BE USED INSTEAD OF
AZOGUE/VIDAJAN?
Botanicas have substitutes for azogue/vidajan.
Alternatives to azogue/vidojan can be found
in books sold in botanicas. You can also ask
an espiritista, santero or dokte fey to suggest
other things that may be used in place of
azogue/vidajan.
HOW TO MEASURE THE AMOUNT OF
AZOGUE/VIDAJAN IN THE BODY OR
HOME
The only way to know if there are
azogue/vidajan vapors in the home is to test
for it with special equipment, such as a
mercury detector (mercury vapor analyzer)
that measures the level of azogue/vidajan in
the air in the home. For more information
about mercury air testing, call the New York
City Department of Health.
There are laboratory tests that
measure the level of azogue/
vidajan in urine and blood, A
urine test is the best way to
measure for exposure to
A4 p.825
-------
6 New Yerk City Department of Health
azogue/vidajan (metallic mercury). If you
think you have been exposed and need
testing, call your doctor or the New York City
Department of Health.
HOW TO CLEAN UP AZOGUE/VIDAJAN
When azogue/vidajan is spilled, it breaks
apart into tiny silver beads that roll around
and stick to surfaces and get in cracks.
Do not use a vacuum cleaner,
broom, or mop to collect
spilled azogue/vidajan.
Brooms and mops will spread
the azogue/vidajan beads
and a vacuum will heat the
azogue/vidajan, causing it to
give off DANGEROUS vapors.
Do not throw azogue/vidajan down sinks,
toilets or bathtub drains.The azogue/vidajan
may become trapped, then evaporate and
re-enter the home.
Metallic Mercury and imt Health 9
Small amounts of azogue/vidajan (like the
amount found in thermometers—about 4.5 grams)
r~ mm in huh iiii|iiiiiiiiijiiiiiii|i.
can be cleaned up from surfaces like tile,
wood, or linoleum floors. If azogue/vidajan
has been spilled or placed on carpets,
upholstery or other porous surfaces, throw
them away if possible, or clean them using
mercury spill kits and detergents.
Do not attempt to clean-up large amounts of
mercury (more than the amount found in a
fever thermometor) yourself.
Method for Clean-up of SMALL (less than 5
grams) amounts of spilled azogue/vidajan
(metallic mercury).
Keep children and pets away from the
area before and during clean-up.
Remove gold jewelry.Mercury can
damage gold items.
1. Have ready 4-5 sealable plastic bags
(preferably ziplock), a trash bag, rubber or
latex gloves, paper towels, cardboard or
squeegee, an eyedropper, wide tape and
a flashlight.
A4 p.826
-------
2. Put on rubber or latex gloves.
3. Carefully pick up any pieces of broken
glass (from a thermometer or vial). Place
them on a paper towel and put the towel
in a zip lock bag to be thrown away.
4. Use stiff cardboard or a rubber squeegee
to collect the silver beads in one place.
(Use a flashlight to help you look for
azogue/vidojon beads). Remember to
look all around the area because the
beads can stick to surfaces and get into
cracks in the floor!
5. Use an eye dropper to carefully draw up
the azogue/vidajan beads. Slowly squeeze
the beads onto a damp paper towel. Put
the towel in a zip lock bag to be sealed
and thrown away.
6. Use the sticky side of wide tape to pick up
any remaining glass and azogue/vidajan
beads. When done, place the tape
containing glass and azogue/vidajan into
a zip lock bag.
7. When all visible pieces have been picked
up and clean-up is done, place the
cardboard or squeegee into a zip lock
bag for disposal.
Mtfallie Mtrtury m4 Your Health It
8. Carefully remove rubber gloves and place
them in a zip lock bag.
9. Put the sealed zip locked bags in a sealed
garbage bag amd dispose with regular
household trash.
If possible, open a window for 24 to 48
hours in the room where the azogue/vidajan
was spilled to ventilate the area after the
clean-up has been completed.
Do not vacuum area until 2-3 days after
the clean-up.Make sure there are no beads
of azogue/vidajan left before vacuuming!
After this you may vacuum the area as
needed.
It can be very difficult to completely remove
azogue/vidajan beads that have made their
way into cracked surfaces, such as wood,
linoleum, ceramic or parquet floor tiles.
Mercury spill kits can be used to clean up
spills. These kits are sold by safety equipment
distributors, industrial safety supplies outlets, or
laboratory safety services (check under
environmental and ecological products and
services or laboratory safety services in phone
books).
A4 p.827
-------
If there is a large amount of mercury (more
than the amount found in a fever thermometer)
in your home or business and you want to
dispose of it, the New York City Department of
Environmental Protection (DEP) can recycle
the mercury. Please call the Department of
Environmental Protection during normal
business hours (Monday through Friday, 9 am
to 5 pm) at 718-595-4784 to find out more
about recycling mercury.
If a large amount of mercury has been spilled
in your home or business, please call the New
York City Department of Health Poison Control
Center or the New York City Department of
Environmental Protection.
NYC Department of Health
Poison Control Center:
212-764-7667 (24 hours a day)
NYC Department Environmental Protection
718-DEP-HELP (24 hours a day)
FOR MORE INFORMATION
If you have any questions about possible
health effects from azogue/vidajon or how to
clean up azogue/vidajan from your home,
please call the New York City Department of
Health.
If you have questions about the disposal of
large amounts of mercury (more than the
amount found in a fever thermometer),
please call the New York City Department of
Environmental Protection.
You can also talk to your doctor about
azogue/vidajan and ask your santero or
espiritista or dokte fey to suggest substitutes
for azogue/vidajan.
NEW YORK CITY DEPARTMENT OF HEALTH
Bureau of Environmental and Occupational
Disease Prevention
Information on Health Effects and Clean-up of Mercury
125 Worth St., CN-34Cs
New York, NY 10013
(212) 788-4290 (Monday-Friday, 9 am -5 pm)
NEW YORK CITY DEPARTMENT OF HEALTH
Poison Control Center
Information on Health Effects and Clean-up of Mercury
455 First Ave. CN-81
New York, NY 10016
(212) 764-7667 (24 hours a day)
NEW YORK CITY DEPARTMENT OF ENVIRONMENTAL
PROTECTION
Department of Emergency Response and
Technical Assessment
Information on Mercury Recycling
(718) 595-4784 (Monday-Friday, 9 am -5 pm)
To report a large mercury spill
(718) DEP-HELP (24 hours a day)
A4 p.828
-------
EXECUTIVE OFFICE OF THE PRESIDENT
OFFICE OF MANAGEMENT AND BUDGET
WASHINGTON, D.C. 20503
July 20, 2021
M-21-28
MEMORANDUM FOR THE HEADS OF DEPARTMENTS AND AGENCIES
SUBJECT: Interim Implementation Guidance for the Justice40 Initiative
President Biden is committed to securing environmental justice and spurring economic
opportunity for disadvantaged communities that have been historically marginalized and
overburdened by pollution and underinvestment in housing, transportation, water and
wastewater infrastructure, and health care. In Executive Order 14008,1 the President
directed the Director of the Office of Management and Budget (OMB), the Chair of the
Council on Environmental Quality (CEQ), and the National Climate Advisor, in
consultation with the White House Environmental Justice Advisory Council (WHEJAC),
to jointly publish guidance on how certain Federal investments might be made toward a
goal that 40 percent of the overall benefits of such investments flow to disadvantaged
communities - the Justice40 Initiative. The Justice40 Initiative is a critical part of the
Administration's whole-of-government approach to advancing environmental justice.
The following Interim Implementation Guidance for the Justice40 Initiative ("guidance"
or "interim guidance") provides the initial recommendations pursuant to section 223 of
Executive Order 14008,2 and supports the Administration's comprehensive approach to
advancing equity for all in line with Executive Order 13985.3 The Executive branch
should implement this guidance in accordance with existing authorities in order achieve
the 40-percent goal.
Summary of Interim Implementation Guidance for the Justice40 Initiative
This interim guidance includes a set of actions required of agencies that manage covered
Justice40 programs. These actions include identifying the benefits of covered programs,
determining how covered programs distribute benefits, and calculating and reporting on
reaching the 40-percent goal of the Justice40 Initiative. This interim guidance provides
implementation direction to an initial set of covered programs under the Justice40
Initiative. Additional guidance is forthcoming. The interim guidance applies to all entities
with covered programs, including those agencies with potential covered programs listed
in Appendix B.
1 Tackling the Climate Crisis at Home and Abroad, 86 Fed. Reg., 7619 (Feb. 1, 2021).
2 Supra note 1, at 7632.
3 Advancing Racial Equity and Support for lJnderser\>ed Communities Through the Federal Government,
86 Fed. Reg., 7009 (Jan. 25, 2021).
FROM: Shalanda D. Young, Acting Director, Office of Management and Budget
Brenda Mallory, Chair of the Council on Em ' ' 1 ^uality
Gina McCarthy, National Climate Advisor
A4 p.829
-------
Interim Agency Justice40 Implementation
I. Interim Definition of Disadvantaged Communities
II. Covered Programs
III. Examples of Benefits of Covered Programs
IV. Calculating Benefits
V. Reporting
VI. Pilot to Maximize Benefits to Disadvantaged Communities
I. Interim Definition of Disadvantaged Communities
Further guidance to agencies on how to define disadvantaged communities for the
purposes of the Justice40 Initiative4 will be released later this year, concurrent with the
establishment of a geospatial Climate and Economic Justice Screening Tool being
developed by CEQ, in partnership with the United States Digital Service (USDS). This
new tool will include interactive maps with indicators to assist agencies in defining and
identifying disadvantaged communities.
Until such time when further guidance is provided, agencies should consider using, as
appropriate, the following indicators of disadvantaged communities to implement the
goals of the Justice40 Initiative utilizing existing data sources and indices that are
currently used by programs serving low income, vulnerable, and underserved
communities:
• Community - Agencies should define community as "either a group of
individuals living in geographic proximity to one another, or a geographically
dispersed set of individuals (such as migrant workers or Native Americans),
where either type of group experiences common conditions."5
• Disadvantaged - Agencies should consider appropriate data, indices, and
screening tools to determine whether a specific community is disadvantaged
based on a combination of variables that may include, but are not limited to, the
following:
o Low income, high and/or persistent poverty
o High unemployment and underemployment
o Racial and ethnic residential segregation, particularly where the
segregation stems from discrimination by government entities
o Linguistic isolation
o High housing cost burden and substandard housing
4 Executive Order 14008 uses the phrase "disadvantaged communities," and this term has been used in
existing Federal and state programs to prioritize funding for environmental justice. Some community
members and advocates prefer alternative terminology, and specifically the use of "overburdened and
underserved communities." Until subsequent guidance can address the question of the most appropriate
terminology, this memorandum relies on the language used in Executive Order 14008.
5 CEQ, Environmental Justice: Guidance under the National Environmental Policy Act (Dec. 10, 1997),
available at https://ceq.doe.gov/docs/ceq-regulations-and-guidance/regs/ej/justice.pdf.
2
A4 p.830
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o Distressed neighborhoods
o High transportation cost burden and/or low transportation access
o Disproportionate environmental stressor burden and high cumulative
impacts
o Limited water and sanitation access and affordability
o Disproportionate impacts from climate change
o High energy cost burden and low energy access
o Jobs lost through the energy transition
o Access to healthcare
In determining which variables to consider, agencies should consider the statutory
authority for covered programs. In addition to the above definition of disadvantaged
communities, geographic areas within Tribal jurisdictions should be included.
II. Covered Programs
Agencies should work with OMB, as outlined in section IV, to review and determine
whether Federal programs fall within the scope of the Justice40 Initiative. Agencies
should contact their OMB Resource Management Office or email EJ@omb.eop.gov to
consult on the determination of covered programs.
A. Covered Program. A "covered program" is a Federal Government program
that makes covered investment benefits in one or more of the following seven
areas:
i. Climate change
ii. Clean energy and energy efficiency
iii. Clean transportation
iv. Affordable and sustainable housing
v. Training and workforce development (related to climate, natural
disasters, environment, clean energy, clean transportation, housing,
water and wastewater infrastructure, and legacy pollution reduction,
including in energy communities6)
vi. Remediation and reduction of legacy pollution
vii. Critical clean water and waste infrastructure
B. Covered Investments. A "covered investment" is a Federal investment in one
or more of the following categories:
i. Federal financial assistance as defined at 2 CFR 200,7 including both
Federal grants as well as other types of financial assistance (including
loans, credit, guarantees, or direct spending/benefits);
ii. Direct payments or benefits to individuals;
iii. Federal procurement benefits (acquisition of goods and services for the
Federal government's own use);
6 Energy communities, as discussed in Executive Order 14008, include coal, oil, and gas and power plant
communities.
7 2 CFR 200 Subpart A §200.1 (Uniform Administrative Requirements, Cost Principles, and Audit
Requirements for Federal Awards) defines Federal financial assistance.
3
A4 p.831
-------
iv. Programmatic Federal staffing costs (e.g. federal pay for staff that provide
technical assistance); and
v. Additional federal investments under covered programs as determined by
OMB.
When appropriate and within existing statutory authorities, eligible investments of
covered programs include: FY 2021 enacted appropriations, supplemental appropriations,
prior year carryover from unobligated balances, and (when they become available) future
fiscal year appropriations.
III. Examples of Benefits of Covered Programs
Benefits include direct and indirect investments (and program outcomes) that positively
impact disadvantaged communities.
Table 1 provides a summary of additional examples of benefits of covered investments
identified by the WHEJAC and the White House Environmental Justice Interagency
Council (IAC) to be considered by agencies when determining the benefits of covered
program.
Table 1
Category
r.xample Benefits W hen Applied lor (or within)
Disadvantaged Communities
Climate Change
• Reduction of greenhouse gas (GHG)
emissions and local air pollutants8
• Creation of community resilience plans that
specifically include addressing needs of
disadvantaged communities
• Increased technical assistance and
community engagement of disadvantaged
communities
• Increased flood mitigation Benefits
• Hectares of floodplain restored
• Hectares of wetlands restored
• Green stormwater infrastructure
• Urban flood risk mapping addressing
the distribution of socially vulnerable
communities and risks
8 For example, program expenditures to reduce air pollution generated by one state or locality that benefit
"down wind" disadvantaged communities or in, such as, installing a control device on an incinerator that
reduces exposure to harmful pollutants in a disadvantaged community in a neighboring state.
4
A4 p.832
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• Increased urban heat island effect mitigation
benefits
• Increased acres of greenspace
restored
• Increased tree and vegetation cover
and sustainable shade coverage
• Increased access to and advancement of
public health warnings (weather and
preparedness messages) translated into
multiple languages
Clean Energy and Energy
Efficiency
• Increased energy efficiency programs and
resources
• Deployment of clean energy, including
renewable community energy projects
• Establishment of community microgrids
• Reduction of energy burden (e.g. the share of
household income spent on home energy
costs)
Clean Transportation
• Improvement in public transportation
accessibility, reliability, and options
• Reduction of exposure to harmful
transportation-related emissions
• Access to clean, high-frequency
transportation
• Access to affordable electric vehicles,
charging stations, and purchase programs
• Increased bicycle and walking paths
Affordable and Sustainable
Housing
• Availability and access to affordable green
housing
• Reduction in displacement
• Improved indoor air quality
• Improved housing quality and safety and
enhanced public health
• Reduction in abandoned or vacant homes
• Reduced housing cost burden
5
A4 p.833
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Training and Workforce
Development
• Increased participation in clean energy good
job training and subsequent good job
placement/hiring, including providing the
free and fair chance to join a union and
collectively bargain.
• Increased participation in good j ob training
programs that target participation from
disadvantaged communities, including
formerly incarcerated individuals and youth
transitioning out of foster care
• Increased climate-smart training, including
training to identify waste, efficiencies, and
GHG inventories.
• Increased percentage of good job training
programs within energy communities, such
as those that include paid employment and
that measure and report participant
outcomes.
Remediation and Reduction of
Legacy Pollution
• Reduction of criteria air pollutant and toxic
air pollutant exposure
• Reduction in farmworker exposure to
pesticides
• Brownfield redevelopment
• Remediation of Superfund sites
• Community engagement training; capacity
support for reduction strategies
• Reclamation of abandoned mine lands and
capping of orphan oil and gas wells
Development of Critical Clean
Water Infrastructure
• Replacement of lead service lines
• Increased access to safe drinking water and
sanitary sewer services
• Reduction in waterborne and respiratory
illnesses
• Reduction in the quantity of raw sewage
discharged
• Increase in the number of community water
systems that meet applicable health-based
standards
6
A4 p.834
-------
Building on program metrics and engagement with state and community partners, the
WHEJAC, and the IAC, and other groups including the Interagency Working Group on
Coal and Power Plant Communities and Economic Revitalization, OMB will work with
CEQ and USDS to develop and publish a common set of metrics to measure select
benefits across agencies, e.g., improvements in air quality.
IV. Calculating Benefits
Executive Order 14008 states that "40 percent of the overall benefits" of federal
investments from covered programs should flow to disadvantaged communities. To
respond to that directive, each agency should establish a methodology for calculating the
benefits that a) flow from each applicable covered program and b) accrue in
disadvantaged communities from each covered program.
A. Benefits Methodology. The determination of what constitutes a "benefit" will
vary by covered program. Accordingly, each agency is directed to:
i. Within 60 days of the issuance of this guidance, to deliver to OMB:
a. An assessment of agency programs (referencing the list of programs in
Appendix B) that are covered programs in accordance with section
II. A and II.B of this guidance; and
b. A description of the types of benefits that result from the identified
covered programs.
ii. Within 150 days of the issuance of this guidance deliver to OMB a
methodology for calculating the covered program benefits accruing to
disadvantaged communities. This methodology should also include a
description of the metrics that the agency is developing to measure
covered program benefits.9
B. Stakeholder Consultation. When determining the benefits of a covered
program, as specified in section IV(A), agencies should consult with
stakeholders, including state, local, and Tribal governments, as well as Native
communities, to ensure public participation and that community stakeholders
are meaningfully involved in what constitutes the "benefits" of a program. In
addition, if the calculation of a benefit to a disadvantaged community includes
investments outside of that community, the disadvantaged community should
be consulted. In engaging with stakeholders, agencies should consider their
obligation under Title VI of the Civil Rights Act of 1964 to ensure meaningful
access for individuals with limited English proficiency (LEP), as well as their
9 It may not be possible to accurately measure the allocation of covered program benefits based solely on
the geography where the program expenditures occur. Accordingly, agencies should actively consider the
purpose of the covered program when determining whether covered program benefits have accrued to
disadvantaged communities. For example, an energy efficiency program that provides weatherization
assistance to individual households may need to analyze the allocation of program benefits by tracking the
characteristics of recipient households, rather than relying on geographic indicators. Programs that
distribute grants to states and territories that then distribute funds to households may need to work with
such states and territories to obtain additional information about the ultimate distribution of federal funding
and benefits.
7
A4 p.835
-------
obligation pursuant to Section 504 of the Rehabilitation Act to take
appropriate steps to ensure effective communication for individuals with
disabilities. Where applicable, agencies should also comply with, the
Paperwork Reduction Act, Federal Advisory Committee Act, or other relevant
law, regulation, or guidance. Agencies should also review and incorporate,
where appropriate, recommendations from the WHEJAC and the IAC when
developing metrics. (Examples of Stakeholder Engagement Plans will be
available to agencies on the MAX Justice40 page.)
V. Reporting
Agency heads are responsible for calculating the accrual of covered program benefits to
disadvantaged communities. Agencies should consult with OMB when determining
whether their program is a covered program. Consistent with section IV, agencies shall
report the following information to OMB for each covered program within 60 days and
150 days of the issuance of this guidance, as specified, and annually thereafter.
A. Within 60 days of the issuance of this guidance agencies shall report:
i. Agency
ii. Program
iii. Program ID (for financial assistance programs, this should be the
assistance listing as defined in 2 C.F.R. § 200.20310)
iv. Amount Appropriated
v. Amount Obligated11
vi. Developed Stakeholder Engagement Plan (y/n)
B. Within 150 days of the issuance of this guidance agencies shall report:
vii. Benefit Methodology Submitted (y/n)
viii. Benefit Methodology Submitted (date)
ix. Target Benefits of Program (qualitative list of types of targeted benefits)
x. Percent of Benefits Directed to Disadvantaged Communities (e.g., percent
new waste water systems installed in disadvantaged communities of total
waste systems installed)
xi. Percent of Benefits Not Directed to Disadvantaged Communities (e.g.,
percent new waste water systems not installed in disadvantaged
communities)
xii. Percent of Benefits with Unknown Direction (e.g., a percentage of waste
water systems with unknown installation location), including a brief
explanation of why the percent of benefits to disadvantaged communities
cannot be determined
xiii. Line Item Data for the Geographic Distribution of Benefits and Program
Funding (e.g., a table of data with rows for the census block groups served
10 Assistance listings refers to the publicly available listing of Federal assistance programs managed and
administered by the General Services Administration. Assistance listings are detailed public descriptions of
federal programs that provide grants, loans, scholarships, insurance, and other types of assistance awards.
11 As obligation amounts change over time, agencies should update this reported amount semi-annually.
8
A4 p.836
-------
by each waste water system installation and the locations that received
funding for that installation)12
a. For programs that do not target benefits geographically, the data
provided should reflect the common characteristics of communities
receiving benefits at the narrowest level that does not raise privacy
concerns
xiv. Amount of Program Funding Received in Disadvantaged Communities
(e.g. the dollars of funding received by a grant or loan recipient in a
disadvantaged community)
Forthcoming guidance will provide additional information on the tool agencies should
use to report the above information discussed in sections IV and V, and specific
instructions for submitting the data into that tool.
The Administration's overall progress towards the Justice40 Initiative's goal will be
tracked by the categories of covered project (climate change, clean energy and energy
efficiency, clean transportation, affordable and sustainable housing, training and
workforce development, the remediation and reduction of legacy pollution, and the
development of critical clean water infrastructure).
VI. Pilot to Maximize Benefits to Disadvantaged Communities
In addition to the previously mentioned covered programs, Appendix A lists 21 programs
that will undertake an initial implementation of the Justice40 Interim Implementation
Guidance to maximize the benefits that are directed to disadvantaged communities. These
programs were selected by reviewing WHEJAC recommendations, consulting with the
IAC, and reviewing agency responses to information requests about current federal
investments in disadvantaged communities.
The agencies with covered programs listed in Appendix A should identify applicable
program funding mechanisms, policies, and procedures based on this guidance and
consider program-specific guidance that provides recommendations for maximizing the
benefits of the program that accrue in disadvantaged communities, as appropriate and
consistent with applicable law. Specifically, the agencies with covered programs listed in
Appendix A are directed to:
A. Develop a Stakeholder Engagement Plan. Within 30 days of issuance of this
guidance, develop a plan to engage stakeholders relevant to the covered agency
program. Plans should include a timeline for engaging relevant stakeholders, to
include grantees and recipients, and a list of key issues relating to implementation
of the Justice40 Initiative with respect to the covered program for stakeholder
input. Plans should account for other stakeholder engagement efforts, including,
but not limited to public involvement activities conducted pursuant to the
National Environmental Policy Act and nation-to-nation consultations with
12 Although this request includes the submission of detailed data, the calculation of several items listed
already requires such data to exist, and this requirement asks the agency to also report the raw data used to
make those calculations. Since disadvantaged communities in the CEJST will be defined at a very narrow
geographic level, agencies need to prepare benefits and place of performance data at a narrow geographic
level to perform these calculations. Agencies should report at the narrowest geographic unit possible.
9
A4 p.837
-------
Tribes. In addition, if the calculation of a benefit to a disadvantaged community
includes investments outside of that community, the disadvantaged community
should be consulted.
B. Justice40 Implementation Plan to Maximize Benefits. Within 60 days of
issuance of this guidance, develop a draft implementation plan describing a) the
agency's plan to maximize benefits of the covered program in disadvantaged
communities; b) any significant barriers or constraints to maximizing benefits to
disadvantaged communities; c) opportunities and/or resource needs that may
address the identified barriers or constraints; and, d) timelines for achieving the
milestones identified in the agency's plan.
C. Consider the Following Program Modifications to Maximize Benefits. When
developing a Justice40 implementation plan to maximize benefits, that agency
should consider the following guidelines, to the extent consistent with statutory
and constitutional requirements, for modifying programs:
i. Foster well-paying job creation and job training, including a free and fair
chance to join a union and collectively bargain.
ii. Coordinate investments and leverage funds where possible to provide
multiple benefits and to maximize benefits.
iii. Avoid potential burdens to disadvantaged communities.
iv. Ensure transparency and accountability through full compliance with
OMB requirements at 2 C.F.R. part 200 for financial assistance programs
and provide public access to program information including through high
quality data in compliance with Federal Funding Accountability and
Transparency Act reporting (2 C.F.R. § 200.212).
v. Conduct outreach, and support technical assistance and capacity building
to help potential applicants' access, manage, and report on results of
funding.
vi. Hold competitive solicitations that prioritize or award extra points to
projects that meet the criteria for benefiting disadvantaged communities
and includes community engagement, planning, and feedback.
vii. When developing eligibility requirements in program guidelines and
solicitation materials, establish targets or minimum thresholds for a
specific benefit. For example, an agency could identify a certain
percentage of total jobs for a project to be held by residents of a
disadvantaged community in order to receive a higher priority for funding.
viii. Require applicants to apply cost savings from project implementation to
benefit disadvantaged communities (e.g., energy cost savings reinvested in
the local community to promote workforce development and community
health).
ix. To the extent modifications are restricted by statute or regulation, describe
what, if any, legislative changes would be required to advance the goals of
Justice40 Initiative with respect to such covered program.
D. Calculating Benefits and Reporting. Within 60 days of issuance of this
guidance, in line with section IV. A and V (but on the timeline specified in
section VI.), provide a methodology for calculating, the covered program benefits
10
A4 p.838
-------
accruing generally and to disadvantaged communities. This methodology should
also include a description of any additional metrics that the agency is developing
to measure covered program benefits.
E. Other Reporting. The pilot programs listed in Appendix A should also plan to
report the information outlined in section V.
Pilot programs should submit the requested information to EJ@omb.eop.eov by the
stated deadlines. Agencies may also use tomb.eop.eov to pose any questions
regarding this guidance.
11
A4 p.839
-------
Appendix A. Justice40 Covered Program Pilot to Maximize Benefits to
Disadvantaged Communities
Agency Program
ARC Partnerships for Opportunity and Workforce and Economic Revitalization (POWER)
DHS Flood Mitigation Assistance Program
DHS Building Resilient Infrastructure and Communities Program (BR1C)
DOE Weatherization Assistance Program
DOE Solar Energy Technologies Office (National Community Solar Partnership)
DOE Vehicles Technologies Office (Clean Cities)
DOE Environmental Management, Los Alamos
DOE Advance Manufacturing Office (Industrial Assessment Centers)
DOl Abandoned Mine Land Economic Revitalization (AMLER) Program
DOT Bus and Bus Facilities Infrastructure Investment Program
DOT Low or No Emissions Vehicle Program
EPA Drinking Water State Revolving Fund
EPA Clean Water State Revolving Fund
EPA Brownfields Program
EPA Superfund Remedial Program
EPA Diesel Emissions Reductions Act Program (DERA)
EPA Reducing Lead in Drinking Water
HHS National Institute of Environmental Health Science (N1EHS) Environmental Career
Worker Training Program
HHS Low Income Home Energy Assistance Program (L1HEAP)
HUD Lead Hazard Reduction and Healthy Homes Grants
USDA Rural Energy for America Program
12
A4 p.840
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Appendix B. Internal Guidance for Agencies
A. Covered Program List
OMB has begun compiling a list of potential "covered programs" at
https://eo.max.eov/iustice40. The programs listed have potential existing authorities that
could be used to benefit disadvantaged communities. Agencies with covered programs
are directed to begin examining (and consider modifications to) policies, practices, and
procedures to implement the Administration's Justice40 goals. If an agency would like to
request to add or remove a program from this list, please contact EJ@omb.eop.eov.
B. Agencies with Potential Covered Programs
Appalachian Regional Commission
Corporation for National and Community Service
Corps of Engineers—Civil Works
Delta Regional Authority
Denali Commission
Department of Agriculture
Department of Commerce
Department of Energy
Department of Health and Human Services
Department of Homeland Security
Department of Housing and Urban Development
Department of Justice
Department of Labor
Department of State
Department of the Interior
Department of Transportation
Department of Veterans Affairs
Environmental Protection Agency
National Aeronautics and Space Administration
National Science Foundation
13
A4 p.841
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Mercury Exposure in an Urban Pediatric Population
Philip O. Ozuah, MD, MSEd; Michael S. Lesser, MD; James S. Woods, PhD; Hyunok Choi, MPH;
Morri Markowitz, MD
Objective.—To determine the prevalence of elevated urinary mercury (Hg), as a marker of exposure, in a population
of children drawn from an inner-city community with documented access to elemental mercury.
Methods.—A prospective consecutive patient series was conducted from November 1998 to January 1999 at an inner-
city clinic in New York. Anonymous urine specimens from subjects (aged 1-18 years) were collected in mercury-free
containers, split, acidified with 1:100 hydrochloric acid, and frozen. Cold-vapor atomic absorption spectrofluorometric
assays were conducted simultaneously at laboratories at the University of Washington and the New York City Department
of health.
Results.—We enrolled 100 children (mean age 9.4 years; 62% male; 55% Hispanic; and 43% African American).
Assay results from both laboratories were strongly correlated (r = 0.8, P < .0001). Mean urinary Hg was 1.08 ± 1.82
Hg/L. The 95th percentile for urinary Hg was 2.8 |xg/L (range 0.2 to 11.7 |a.g/L). Five subjects had Hg levels above 5
p,g/L.
Conclusion.—We found that 5% of subjects had unsuspected elevated urinary Hg levels. This finding, in a group of
inner-city minority children, strongly supports the need for further investigation of the sources of mercury exposure in
this population.
KEY WORDS: mercury; toxin exposure; urban health
Ambulatory Pediatrics 2003;3:24-26
Childhood exposure to mercury is a growing con-
cern among health care providers and public
health officials. Some published reports suggest
that a substantial proportion of inner-city minority popu-
lations may be engaged in ritualistic uses of elemental
mercury.16 These practices include sprinkling and burn-
ing elemental mercury in the home. The volatilization of
elemental mercury may present a serious danger to home
occupants, particularly children, because absorption of
mercury vapor through the lung is nearly complete. Mer-
cury, a potent neurotoxicant, has disproportionate effects
on the developing organisms' central nervous system, and
for the same dose of elemental mercury exposure, children
are affected much more severely than adults.7 9
In a previous report, we found that elemental mercury
was readily available at folk pharmacies in a community
located in an inner-city section of New York.1 However,
the full extent of elemental mercury exposure in children
from this community has not been investigated. Thus, the
From the Albert Einstein College of Medicine/Children's Hos-
pital at Montefiore (Dr Ozuah and Dr Markowitz), Bronx, NY; the
New York City Department of Mental Health (Dr Lesser), New
York, NY; the Department of Environmental Health (Dr Woods),
University of Washington, Seattle, Wash; and the Albert Einstein
College of Medicine/Department of Family Medicine (Mr Choi),
Bronx, NY.
This paper was presented in part at the Annual Meetings of the
Pediatric Academic Societies, Boston, Mass, May 2000.
Address correspondence to Philip O. Ozuah, MD, MSEd, Chil-
dren's Hospital at Montefiore, 3544 Jerome Ave, Bronx, NY 10467
(e-mail: pozuah@pol.net).
Received for publication January 11, 2002; accepted May 1,
2002.
AMBULATORY PEDIATRICS
Copyright © 2003 by Ambulatory Pediatric Association 24
aim of this study was to determine the prevalence of el-
evated urinary mercury (Hg), as a marker of exposure, in
a population of children drawn from an inner-city com-
munity with documented easy access to elemental mer-
cury.
METHODS
Subjects and Setting
We conducted a prospective consecutive patient series
from November 1998 to January 1999 at an ambulatory
clinic in the South Bronx of New York City. The study
site was located in the same community where we had
earlier demonstrated widespread sales of elemental mer-
cury.1 Nearly all the children treated at this site reside in
the same community. Of all children treated at this site,
69% are Hispanic, 30% are African American, and 99%
are Medicaid eligible, below the federal poverty level, or
working poor.
Inclusion criteria were as follows: 1) clinic visits for
routine health maintenance or follow up, 2) routine uri-
nalysis ordered by the physician, 3) no suspicion of uri-
nary tract infection, and 4) age between 1 and 18 years.
All children meeting the inclusion criteria were enrolled.
All specimens were collected anonymously.
This study was approved by the Institutional Review
Board at Montefiore Medical Center, Bronx, New York.
Informed consent was waived because of the anonymous
use of urine specimens originally collected for non-re-
search purposes.
Laboratory Methods
Urine from each subject was placed in a polyethylene
screw-cap container, acidified with 1:100 hydrochloric
*3 , Number 1
January-February 2003
-------
AMBULATORY PEDIATRICS
Mercury Exposure in an Urban Setting
25
acid, split into pairs, and immediately refrigerated at 4° or
lower. Samples from each pair were packed in a Coleman
cooler with frozen cold packs and shipped by overnight
express delivery service to Dr Woods' laboratory at the
University of Washington in Seattle and to the New York
City Department of Health Bureau of Laboratories for
analyses.
Analysis of mercury in urine samples was performed
using a state-of-the-art PSA Merlin Mercury Analysis
System. This system employs continuous-flow, cold-vapor
spectrofluoromefry for mercury detection, has rapid and
random-access automatic sampling capabilities (40 sam-
ples in less than 1 hour), and affords the highest possible
resolution of Hg concentrations in biological media (20
ppt [ng/Ll practical detection limit). Data were stored and
analyzed using a computerized Touchstone software pro-
gram. Each urine sample was analyzed in duplicate, and
the mean of the 2 analyses was computed as the Hg con-
centration of that sample. A complete series of quality-
control test samples derived from standard reference ma-
terials inorganic Hg solutions, including both water and
spiked urine samples containing total Hg concentrations
in the range of 0 to 100 jxg/L, was run with each set of
analyses.
To determine the prevalence of elevated urinary Hg, we
considered urinary Hg levels above 5 (xg/L to be elevated.
Although there are no firmly established background lev-
els for urinary Hg in children, published data indicate that
the vast majority of unexposed children should have uri-
nary Hg levels below 5 |xg/L.'; 11
Data Analysis
The degree of correlation between urinary Hg mea-
surements from both laboratories was examined by Pear-
son Correlation. Descriptive statistics were used to deter-
mine the distribution of mercury measurements.
RESULTS
A total of 100 children participated. There were no re-
fusals. The mean age was 9.4 years. Sixty-two percent of
subjects were boys, 55% were Hispanic, and 43% were
African American.
Urinary Hg measurements from both laboratories were
strongly correlated (r = 0.8, P < .0001). For all partici-
pants, the mean value of urinary Hg measurements was
1.08 (xg/L (standard deviation ± 1.82). The 5th, 10th,
25th, 50th, 75th, and 95th percentiles for urinary Hg lev-
els were 0.25, 0.25, 0.38, 0.64, 1.12, and 4.7 fxg/L, re-
spectively. The range was 0.2 to 11.7 |xg/L.
Five subjects had urinary Hg levels greater than 5 |xg/
L, and 3 subjects had levels above 10 jxg/L.
DISCUSSION
We found that 5% of children in this study had un-
suspected elevated urinary Hg levels. These findings, in
a group of inner-city minority children, have some ram-
ifications. Published reports12 indicate that dental person-
nel with urinary Hg measurements below 4 |xg/L have
subtle preclinical deficits in cognition, motor function,
and mood. A substantial number of children in our study
had urinary Hg levels above 4 |xg/L. This is potentially
significant because neurodevelopmental deficits have
been shown to be more prevalent among inner-city mi-
nority children.13 Thus, if present in the local environ-
ment, elemental mercury may be a contributing factor to
the deficits observed in inner-city, low-income minority
children.
We note several limitations of our study. As a result
of the anonymous approach that was employed, we did
not evaluate the children for recent dental work, number
of dental amalgam surfaces, or dietary intake of fish.
All of these factors have been associated with increased
mercury burden.1415 Therefore, we were unable to di-
rectly link the measured urinary Hg levels with ritual-
istic practices. In addition, we were unable to link the
urinary Hg measurements to individual demographic
data. However, regardless of the source of exposure,
elevated urinary Hg is deserving of concern, especially
in children. Also, we were unable to assess any rela-
tionship between urinary Hg levels and neurobehavioral
function in these children, although other studies have
documented preclinical toxicity in adults with low lev-
els of exposure.12
The findings of this pilot study indicate that mercury
exposure is ongoing in this population of children.
Comparable populations are extant in cities throughout
the United States. Prior work identified ritualistic use
of elemental mercury as a possible source of environ-
mental mercury exposure in this community. However,
the full scope of sources and ramifications of mercury
exposure among these children require more extensive
study.
REFERENCES
1. Zayas LH, Ozuah PO. Mercury use in espiritismo: a survey of
botanicas. Am J Public Health. 1996;86:111-112.
2. Wendroff AP. Domestic mercury pollution. Nature. 1990;347:
623.
3. McKinney PE. Elemental mercury in the appendix: an unusual
complication of a Mexican-American folk remedy. J Toxicol
Clin Toxicol. 1999;37:103-107.
4. US Environmental Protection Agency. RM2 Assessment Docu-
ment for Cultural Uses of Mercury. Washington, DC: Office of
Pollution Prevention and Toxics, US Environmental Protection
Agency; 1993.
5. Forman J, Moline J, Cernichiari E, et al. A cluster of pediatric
metallic mercury exposure cases treated with meso-2,3-dimer-
captosuccinic acid. Environ Health Perspect. 2000;108:575-
577.
6. Johnson C. Elemental mercury use in religious and ethnic prac-
tices in Latin America and Caribbean communities in New York
City. Popul Environ. 1999;20:443-453.
7. Moutinho ME, Tompkins AL, Rowland TW, et al. Acute mer-
cury vapor poisoning. Am J Dis Child. 1981;135:42-44.
8. Curtis HA, Ferguson SD, Kell RL, Samuel AH. Mercury as a
health hazard. Arch Dis Child. 1987;62:293-294.
9. Agocs MM, Etzel RA, Parrish RG, et al. Mercury exposure
from interior latex paint. N Engl J Med. 1990;323:1096—
1101.
10. Minoia C, Sabbioni E, Apostoli P, et al. Trace element reference
values in tissues from inhabitants of th^ Eigggean Community.
I. A study of 46 elements in urine, blood and serum of Italian
subjects. Sci Total Environ. 1990;95:89-105.
-------
26
Ozuah et al
11. Lauwerys RR, Hoet P, eds. Industrial Chemical Exposure:
Guidelines for Biological Monitoring. Boca Raton, Fla: CRC
Press; 1993:75.
12. Echeverria D, Aposhian HV, Woods JS, et al. Neurobehavioral
effects from exposure to dental amalgam Hg(o): new distinc-
tions between recent exposure and Hg body burden. FASEB J.
1998;12:971-980.
13. Kramer RA, Allen L, Gergen PJ. Health and social character-
AMBULATORY PEDIATRICS
istics and children's cognitive functioning: results from a na-
tional cohort. Am J Public Health. 1995;85:312-318.
14. Grandjean P, Weihe P, White RF, et al. Cognitive deficit in 7-
year-old children with prenatal exposure to methylmercury.
Neurotoxicol Teratol. 1997;19:417-428.
15. Kingman A, Albertini T, Brown LJ. Mercury concentrations in
urine and whole blood associated wj^Jj atg^am exposure in a
US military population. J Dent Res. 1998;77:461-471.
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Hazardous rituals: mercury
pollution in the Bronx
By Ozzie Ramos, The Bronx Journal, 10 June 2005. English
Language.
For years, elemental mercury or azogue, has been used in the Afro-
Caribbean communities for ritualistic purposes. Families practicing Vodun,
Santeria, Espiritismo, and other underground religions often use the
substance to cleanse their homes of spirits, to put spells on loved ones,
even to improve the skin or cure intestinal disorders. "As a girl, I used to
watch my aunt cleanse her home with mercury," said Evelyn Cordero of the
Bronx, as she left La Division Botanica on Fordham Road. "I remember
wondering what made the water glitter as she mopped."
In March, the Rockland County Department of Health added an article to its
health code that prohibited keeping mercury in an uncovered container in
homes. It also required that all mercury sold in stores must be correctly
labeled in English, French and Spanish, and must contain warnings about its
danger. In addition, vendors are required to inform buyers of the dire
consequences of mercury spills and exposure.
"This was specifically done because of the knowledge that people in the
Afro-Caribbean neighborhoods of Rockland were using mercury for ritualistic
purposes," said Dr. Arnold Wendroff, the environmentalist and director of
the Mercury Poisoning Project, who has been monitoring mercury use in
these communities for more than ten years.
Is this a wake-up call for the Bronx?
Given the Bronx's much larger Haitian and Latino community, why has New
York City's Department of Health not enacted similar laws banning the use
of uncontained elemental mercury? "There is published hard data on
mercury sales in the Bronx, and on the influx of mercury into the sewage
treatment plants like Ward's Island," said Wendroff. "But no one wants to
rock the boat because they know there's a major mercury problem in the
Bronx."
Even Rockland County is careful about rocking the boat. Which is why, said
Wendroff, the Rockland County Health Code sets its own level for the
evacuation of buildings, using a measurement of mercury levels that is 100
times higher than those currently used in the rest of the country, (the
national standard for evacuation in mercury spills is 1 microgram per cubic
meter of air. For Rockland, it is 100 micrograms.). "And the reason why it's
so high," he adds, "is apparently because the Rockland County Department
of Health believes there is a problem, but they have no place to put people
who would be displaced from their homes during an evacuation."
Carmen Santiago sells religious items at the Guadeloupe Botanica on the
Grand Concourse and 183rd Street. "Mercury wards off evil spirits in the
home, and has been used for that purpose for quite a while," she said. "I
know mercury is bad for you and that the cops will close you down if you
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sell it. I also know that you can still buy in some botanicas if you know
someone. But I don't see it."
Neither does the owner of La Division Botanica, a man who calls himself
"Professor" Eliseo, but refuses to reveal his given name. Eliseo, 52, who has
owned his botanica for nine years and also teaches Espiritismo for $150 a
session, said, "I have been men pour mercury from the jar into gelatin
capsules to sell it for a couple of dollars. And I used mercury a couple of
times myself by placing it in candles." Eliseo said he stopped after hearing
about someone who drank mercury to cure his intestinal problems, but
damaged his kidneys in the process. "I can tell you that mercury is being
sold and used today. But I do not either sell it or use it," he adds. Instead,
he employs herbal preparations in the rituals he practices.
Eliseo points out that since 9/11, paranoia has spread throughout the
botanica circuit. "I've heard rumors that if you sell mercury, you can be
arrested because the government would think you might be making
bombs," he said.
There is no truth to the notion that mercury is an ingredient for bombs. It is
also not illegal, as long as it is properly contained and labeled. What is true,
however, is that mercury is a menace. Sprinkled on floorboards, it
evaporates and seeps into the floors and walls for up to 15 years.
Inhabitants of an apartment inhale the invisible and undetectable vapors,
which can damage the brain, heart, lungs, and liver. Children and fetuses
are especially vulnerable to mercury's effects, which can include insomnia,
bronchitis, emotional instability, neurological problems, gingivitis and
developmental problems.
"What users don't know is how toxic mercury is long after they've used it,"
said Wendroff, "and how compromised developmentally they may become if
they have been contaminated." Unlike lead or asbestos, he points out,
mercury breaks up. "It's a liquid and a gas at the same time. The little
droplets on the floor are continuously evaporating. And the vapor is what's
toxic. It is inhaled and absorbed into the blood. The exposure is continuous
and lasts for years." Which means that families who move into apartments
where practitioners once sprinkled mercury are also at risk, although they
may not suspect it.
To measure the extent of mercury use in the Bronx, doctors at Montefiore
Medical Center conducted a study in 1995 in which an Espiritismo
practitioner went to Bronx botanicas to see if she could buy mercury at
each. She was able to buy unlabeled mercury at 38 of the 41 botanicas she
visited. Thirty-five shops reported sales averaging 930 pounds a year. In
addition, more than 29 percent of botanica workers and customers indicated
that the primary way they used mercury was to sprinkle it on floors.
Since 1995, said Wendroff, "Somewhere between 8,000 and 50,000 homes
per year are being contaminated with enough mercury to warrant
evacuation."
Local environmentalists like Marian Feinberg, the environmental health
coordinator of the organization "For a Better Bronx," believe that these
statistics are alarmist and that putting the blame solely on the Hispanic
community is racist. "If mercury is so dangerous, why are dentists still
putting it in our mouths?" she said, "most of the mercury in the
environment that we're exposed to comes from power plants. The tuna fish
that you eat today is more dangerous. It's full of mercury."
Wendroff, who has a Ph.D in medical sociology with a specialty in the
traditional medicine and witchcraft of the southeast African country of
Malawi, where he served in the Peace Corps, first became aware of the
mercury problem in 1991 while teaching science at a Brooklyn junior high
school. Pointing to the symbol for mercury, he asked if anyone knew what it
was used for, thinking that kids would reply, "Thermometers." However,
one boy volunteered that his mother sprinkled mercury on the floor to ward
off what is known in Santeria as brujo, or evil spirits. "It suddenly rang a
bell," said Wendroff, who also noticed that the child was exhibiting signs of
mercury exposure such as anorexia, irritability and forgetfulness.
A4 p.846
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Wendroff claims that not only are individual homes tainted by mercury use,
so is the city's water supply. It becomes compromised when excess
mercury is either flushed down toilets or poured down drains after Santeria
rituals are completed.
However, mercury in the community has become a taboo subject. Few want
to talk about it, and even fewer want to own up to the fact that it is a
problem. The New York City Department of Environmental Protection tested
New York City's waste water in late 2003 and early 2004 and discovered
that there was an enormous excess of levels of mercury in the Ward's
Island plant, which serves Washington Heights and the South Bronx.
Most politicians, like Congresswoman Nydia Velasquez, Senator Bill Bradley,
former Mayor David Dinkins, and former Bronx Borough President,
Fernando Ferrer, have paid lip service to the problem, but little more.
Wendroff claims to have written to almost every local politician and said
that they have either ignored him or voiced their concern with no follow-up.
When The Bronx Journal contacted Bronx Borough President Alfonso Carrion
and Ferrer for this article, they both refused to comment.
Mercury is a political hot potato, said Wendroff, in part because politicians
fear alienating the Hispanic community by placing the blame on ritualistic
mercury use, and in part because any real solution is expensive. "Cleaning
up mercury spills can cost up to $50,000 per apartment," he explains. "It
can be cleaned up. But first you have to find it, which is also expensive. And
embarrassing. Because all these political people know. And so does the
media. They're treating it as a "potential health threat' and not doing the
research themselves." In the end, he believes, the government, because of
its past negligence, will be directly responsible for the cleanup.
What both Wendroff and Feinberg agree on is that public health education is
crucial. "I don't think it's about politicians," said Feinberg. "It's about health
education. The most affecting change will come when people will start to be
more educated in general about the problem."
Still, Wendroff remains skeptical. He points out that in 2000 the New York
City Department of Health created two pamphlets, one for laypersons in
English, Spanish, and Creole, and another for health care workers. "But
they never adequately distributed them to the public," he said. "They did a
cover-your-ass operation. And that was it. The city is at a fabulous,
fabulous legal liability. After all, our officials failed to seriously assess the
problem. And they never communicated their concern to the people."
For now, the Bronx—and the New York City Department of Health—needs to
take inspiration from Rockland. As Dr. Joan Facelle, Rockland's health
commissioner, said bluntly, "We don't know the extent of the problem."
Included by permission of The Bronx Journal. Voices © 2005, IPA,
all rights reserved.
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A4 p.847
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SATC0N2 Community Engagement
Working Group
Authors
Aparna
Venkatesan
University of San Francisco; Co-chair
USA
James
Lowenthal
Smith College; Co-chair
USA
Doug
Arion
Carthage College/Mountains of Stars
USA
Fernando
Avila Castro
National Astronomical Observatory, Astronomy Institute, UNAM
MX
Michele
Bannister
University of Canterbury
NZ
John
Barentine
Dark Sky Consulting, LLC
USA
David
Begay
Indigenous Education Institute and U. of New Mexico
USA
Juan-Carlos
Chavez
Blue Marble Space Institute of Science
USA
Sally
Carttar
National Park Service
USA
Rick
Gering
Naperville (IL) Astronomical Association
USA
Ruskin
Hartley
International Dark-Sky Association
USA
Jeffrey
Hall
Lowell Observatory; SATCON2 Co-Chair; Ex-officio WG Member
USA
Alvin
Harvey
MIT
USA
Jessica
Heim
Univ. of Wales Trinity St. David + Consortium for Dark Sky Studies
USA
Stella
Kafka
American Association of Variable Star Observers
USA
Ka'iu
Kimura
'Imiloa Astronomy Center of Hawai'i, Big Island
USA
Kris
Larsen
Central Connecticut State University
USA
Annette
Lee
St. Cloud State University
USA
Nancy
Mary boy
Indigenous Education Institute & University of Washington
USA
Hilding
Neilson
University of Toronto
CA
Erika
Nesvold
Just Space Alliance
USA
Doug
Simons
Canada France Hawai'i Telescope and Univ. Hawai'i
USA
James
Sweitzer
Science Communication Consultants
USA
Diana
Umpierre
Florida Sierra Club
USA
Connie
Walker
NSF's NOIRLab; SATCON2 Co-Chair; Ex-officio WG Member
USA
SATC0N2 Community Engagement Working Group
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Table of Contents
1. Summary and Overview 4
1.1. Charge 4
1.2. Constituencies 4
1.3. Background and Context 5
1.4. Common Themes and Principles 6
1.5. Recommendations 6
1.6. Subgroup reports 9
2. Astrophotography, Astrotourism and Broader Implications of a Global Rise in
Night Sky Brightness 10
2.1. Astrophotographers 11
2.2. Astrotourism professionals 14
2.3. Rising diffuse night sky brightness from satellites and space debris 17
2.4. Other skywatchers and broad implications 20
3. Survey of the Amateur Astronomy Community Regarding Impacts of
Satellite Constellations 22
3.1. Overview 22
3.2. Data Collection 23
3.3. Summary of Results 25
3.4. Open Ended Comments 26
3.5. Analysis and Discussion 27
3.6. Input and follow-up from Town Hall discussion 27
3.7. Survey Form 28
4. Perspectives from Indigenous Communities 32
4.1. Key Themes 33
5. Planetariums and the Satellite Constellation Challenge 37
5.1. Introduction 37
5.2. Assessing satellite constellation impacts in planetariums 38
5.3. Recommendations 39
6. Environmental and Ecological Impacts of Satellite Constellations 41
6.1. Historical, political, and environmental context 41
6.2. Environmental harm from satellite constellations 42
References and Further Reading 47
Acronyms & Abbreviations 52
SATCON2 Community Engagement Working Group A4 p 85°
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1. Summary and Overview
This report is part of a collection of Working Group Reports from the SATCON2 Conference.
1.1. Charge
The SATCON2 Community Engagement Working Group aimed to engage a broad and diverse swath
of stakeholders in dark skies and near-Earth space who are impacted by large mega-constellations
of tens of thousands of low-Earth orbit (LEO) satellites, beyond professional astronomy alone. The
working group consisted of 22 members across 23 time zones including professional and amateur
astronomers, members of sovereign Indigenous/First Nations communities, dark-sky advocates,
planetarium professionals, and environmental/ecological non-governmental organizations. We set out
to work together towards a new and effective conceptual, ethical, legal, and regulatory framework for
the protection and sustainability of space and the night sky as a global cultural, natural and scientific
commons. Community Engagement Working Group members invested thousands of volunteer hours
in working group meetings, listening sessions with impacted constituencies, numerous conversations,
developing, conducting and analyzing surveys, and finalizing our results and recommendations.
1.2. Constituencies
For SATCON2, the Community Engagement Working Group focused on five specific constituencies
that had not previously been explicitly included in SATCON1 or other policy discussions about satellite
constellations, including some groups traditionally excluded from political and economic power:
1 Astrophotography and Astro-Tourism
2 Amateur Astronomy
3 Indigenous Communities and Perspectives
4 Planetariums
5 Environmental and Ecological Concerns
They shared their feedback, needs and recommendations during listening sessions and conversations
before the workshop and during dedicated sessions at the workshop.
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We acknowledge that there remain many constituencies and perspectives not included in the
Community Engagement Working Group that may prove important players in future negotiation and
policy-making, such as telecommunication companies, space contractors, economic development
groups, ground-based internet equipment suppliers, and Internet service providers.
The largest group not included explicitly in the Community Engagement Working Group is the population
of humans world-wide who admire, cherish, view, connect with, seek solace from, practice traditional
religion and culture with, navigate by, are inspired by, and need the stars, the Milky Way, and unpolluted
night skies. Our principles and recommendations include them implicitly, and we call for explicit
consideration of the rights of humanity to see the stars in all future space activities including satellite
constellations.
We emphasize that these reports represent the needs and perspectives of individuals, specific
communities, and those who were able to offer feedback and participate. Our compiled report does not
speak for all members of any constituency, or all examples of a group, e.g., all Native American tribal
communities or all environmental groups.
Last, we honor all the voices and communities who offered their time and feedback for the months
leading up to the SATCON2 workshop and this report. This included many who have been historically
marginalized and are overloaded by disproportionate fallout from climate change and the pandemic. We
are grateful for their uncompensated labor in a time of loss, crisis fatigue, and global pain, in which we
are quickly approaching our and our planet's ability to cope — much like overcrowded low-Earth orbits.
1.3. Background and Context
In early 2020 much of work and life as we knew it ground to a halt with the arrival of the COVID-19
pandemic on the global stage. But one activity continued unceasingly at pre-pandemic levels: the
relentless launch of satellite constellations by private operators, while the world was roiled by climate
change, economic collapse, racial injustice and of course, the still ongoing pandemic.
The 18 months leading up to SATCON2 revealed widening inequalities among all these factors, including
the dire need for affordable accessible broadband for all as education, work and much of daily life went
online. Globally available cheap broadband is the main promise and potential from companies such as
Starlink, OneWeb and others. It remains to be seen whether this promise is fulfilled, but in the process
we stand to clutter LEO orbits with hazardous space debris, blind our ground-based telescopes to the
cosmos, imperil life and well-being with falling rocket bodies and increasing greenhouse gas emissions
— and lose dark skies for all of humanity and all flora and fauna over the next few years. The impacts will
likely affect a broad swath of constituencies across humanity, beyond professional astronomy alone. By
invoking the democratization of space, the commons of space itself — as enshrined in the Outer Space
Treaty of 1967 (OST) — continues to be claimed piecemeal by corporations in a longstanding pattern of
unchallenged, unregulated "progress" on our collective behalf. We are reminded of this through regular
headlines on space billboards and space tourism; the SATCON2 workshop week in mid-July was itself
bracketed by the brief space adventures of Richard Branson, Jeff Bezos and their crews. Some working
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group members contrasted that billionaire space race with the two-week Red Road to DC1, which began
during the SATCON2 workshop week, and involved the journey of a 25-foot Native American totem pole
through sacred Indigenous lands from Washington state to Washington DC, highlighting historical and
continuing exclusion and erasure of marginalized communities and culture.
We view this report as the beginning, rather than the end, of a conversation that is long overdue. We
urge active ongoing engagement among federal agencies, private and state actors in space, professional
societies and especially organizations and communities representing the diversity of stakeholders in our
shared skies, so we can co-create a new, ethical, sustainable approach to space exploration rather than
the current regulatory maze of siloed concerns enabling business as usual.
1 A. Common Themes and Principles
We identified common themes that recurred and resonated across the Community Engagement Working
Group's five subgroups. Collectively, the Community Engagement Working Group offers the following
observations and principles:
1 The skies and space belong to everyone. Space is a global commons.
2 All people are impacted by changes in the sky. Nearly all consulted for SATCON2 had already
noticed a dramatic rise in satellite constellation sightings in the past two years, and were worried.
3 Many communities see the unchecked actions of space actors as colonization expanded to a
cosmic scale during a time of global crisis.
4 The sky must be considered part of the environment and the current National Environmental
Policy Act (NEPA) exemption for the satellite constellation industry must end.
5 Ecosystems depend on the night sky and on each other.
1.5. Recommendations
The Community Engagement Working Group offers the following nine recommendations to decision-
makers, regulators, the satellite industry, researchers, and all communities affected by satellite
constellations.
1. Duty to consult
Satellite operators must first consult all impacted groups, including the sovereign American Indian /
Alaska Native nations and global Indigenous communities, before launching satellites. Industry must fully
consider the concerns of Indigenous nations, including sovereignty, transparency, written agreements,
and jurisdiction of treaties in space. Space belongs to us all and we need to listen to all constituencies
impacted by satellite constellations. The OST establishes space as a global commons, and the American
Astronomical Society (AAS) mission statement emphasizes inclusivity, sustainability, and the importance
of humanity's understanding of the Universe.
1 https://redroadtodc.org/
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2. Need for more information and communication
Communities want more information and dialogue. Astronomers and other parties concerned about the
impacts of LEO satellite constellations need to engage, listen, share, and act with affected constituencies,
government agencies, and cultural, grassroots, and political leaders. Decision-makers and private
satellite operators must intentionally invite the voices and groups that have historically been excluded
from the power structure and decision-making regarding space activity. Involving youth is a key aspect
to co-creating solutions together to protect the Earth and skies that they will inherit.
3. Engage with industry
Astronomers and other interested and affected groups need to continue to engage with the satellite
industry to build relationships and find common ground. The Centre for the Protection of the Dark and
Quiet Sky from Satellite Constellation Interference proposed by the International Astronomical Union
(IAU) is one possible venue for such engagement.
4. Recognize and rebalance power structures
Decision-makers and advocates for the regulation of LEO satellites should recognize the economic, legal,
and political structures that continually affect technology choices. The regulatory process must take
those power structures into account to optimize societal and environmental benefit with equity — power
over a global commons comes with responsibilities to the global good. The social systems of economic
and technological opportunities that enable satellite constellations focus on technological solutions;
but there is only so much back-correcting that software can do to remove satellite streaks in images, or
that engaging affected communities in dialogue, reports, and conferences can do to make amends once
irreparable damage is done to the sky and to communities — just as removing plastics from the ocean
is proving an impossible task. We urge the broad inclusion of all affected communities in meaningful
dialogue from the start.
At the same time, there has been an enormous amount of volunteer labor from mainstream astronomy,
communities and institutions devoted to addressing the challenges posed by satellite constellations.
Funding for training and FTEs from agencies and industry is needed for continued efforts in the future.
5. Learn from the past
History offers valuable lessons on many issues of concern with satellite constellations, including
environmental concerns, loss of millenia-old practices, and the painful legacies of colonization. The past
century in particular offers ample examples of disruptive technologies that have been developed first
and regulated only later, with varying degrees of cost, benefit, risk, and impact, e.g., telephones, trains/
planes/cars, fossil fuels, and the Internet itself. Examples of global challenges requiring international
collaboration include damage to the ozone layer, for which corrective action has been largely successful,
and climate change, for which a global course of corrective action has remained elusive. We must learn
from those examples as we grapple with the satellite constellation challenge.
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6. "Science vs. Internet" is a false choice
Affordable broadband is crucial to almost all aspects of 21st century work and life, and some
communities welcome satellite broadband. However, we must not assume that LEO satellite
constellations are the only option, or that sacrificing the night sky is an acceptable trade-off. Industry
and government agencies must develop a meaningful assessment of viable alternatives to satellite
broadband, including ground-based fiber, from the aspects of cost, infrastructure and environmental
impact. Satellite operator business models may not accurately assess the profitability of satellite
constellation broadband Internet and its affordability for low-income users; in Mexico, Starlink currently
charges roughly four times more than ground-based broadband, and one recent study found only a small
overlap between global populations that need broadband and those that can afford to pay market rates
for it. Costs of satellite constellations that are put on society — such as coping with space debris after
satellite collisions or bankruptcies and environmental costs from launches, operations, and deorbiting —
should be fully considered in the true cost of satellite constellations, rather than left as externalities.
7. Better international regulation and globally coordinated
oversight/enforcement
We need coordinated international regulation of the satellite constellation industry with oversight and
enforcement, in contrast to the current regulatory maze of siloed issues enabling business as usual. Most
of the constituencies polled by the Community Engagement Working Group want industry to slow down
until meaningful solutions can be developed in consensus, involving youth and communities. The fallout
from unregulated unchecked satellite constellation launches includes dramatic predicted increases in all
of the following: space debris, radio frequency interference, orbital traffic and collisions, environmental
fallout in the upper atmosphere or oceans after satellite decommissioning, and global sky brightness (not
just individual satellite streaks) washing out fainter stars or meteors, and undermining dedicated dark
sky parks and preserves.
8. Slow or stop satellite constellation launches until problems
are resolved
We strongly urge that the pace of launches be slowed or stopped until the issues can be much more fully
understood and meaningful solutions to proven and likely problems can be developed in consensus.
All the constituencies we polled and consulted are already noticing a dramatic rise in the number of
satellites seen, when the number of satellites in orbit is currently only 5-10% of what is planned to be
launched in the next decade. We need to plan for and mitigate both the known impacts of satellite
constellations and a broad array of unintended consequences from them for many human endeavors.
9. Continued active engagement and conversation
The Community Engagement Working Group views the SATCON2 workshop as the beginning, rather than
the end, of a long overdue conversation that was prompted by satellite constellations, but that extends
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to far broader issues of preserving space and the night sky as a scientific, environmental and cultural
commons for humanity. The Community Engagement Working Group urges active engagement and long-
term relationship-building among industry, leadership, all space actors and communities representing
the diversity of stakeholders in our shared skies so we can co-create an inclusive, ethical, and sustainable
approach to space.
1.6. Subgroup reports
The reports from our five constituencies follow this overview. We emphasize that these reports represent
the needs and perspectives of individuals, specific communities, and those who were able to offer
feedback and participate. Our compiled report does not speak for all members of any constituency, or
all examples of a group, e.g., all Native American tribal communities or all environmental groups. We
acknowledge that we ran out of time and resources to include many perspectives at the workshop and in
this report and that they still need to be honored, including the role of aesthetics, culture, heritage, art,
storytelling, and humanity in our connection to the skies. There are other issues that we could do only
peripheral justice to, including rural economic development, an assessment of alternatives to satellite
broadband, the digital divide etc. Rather than being a comprehensive or conclusive document, this
report shares early findings as we begin a long-term process of building relationships and listening to
communities' needs and perspectives on the impact of LEO satellite mega-constellations, co-creating
new ways for how we collectively approach space in the coming years.
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4. Perspectives from Indigenous
Communities
The primary authors of this section and subgroup members are, in alphabetical order of last name:
Fernando Avila Castro (Mestizo / Universidad Nacional Autonoma de Mexico)
David Begay (Dine, Indigenous Education Institute and U. of New Mexico)
Juan-Carlos Chavez (Yaqui/Sonora, affiliate at the Blue Marble Space Institute of Science)
Alvin Harvey (Dine, MIT)
Ka'iu Kimura (Native Hawaiian, 'Imiloa Astronomy Center of Hawai'i)
Annette Lee (Ojibwe and D(L)akota, St. Cloud State University)
James Lowenthal (Smith College)
Nancy Maryboy (Dine/Cherokee, Indigenous Education Institute and U. of Washington)
Hilding Neilson (Mi'kmaw, University of Toronto)
Doug Simons (Canada France Hawai'i Telescope and U. of Hawai'i)
Aparna Venkatesan (U. of San Francisco)
International perspectives on this report's topics were offered by Hilding Neilson, Fernando Avila Castro
and Michele Bannister (non-Indigenous (Pakeha), University of Canterbury, New Zealand).
This report shares a summary of perspectives and needs as directly stated by our Indigenous colleagues
and conference participants at SATCON2, primarily through the Community Engagement Working Group.
We emphasize that these speakers and participants speak for themselves and their own experiences only,
not their whole community or all Indigenous peoples or tribal nations.
We also respectfully draw the reader's attention to the References and Further Reading section at the
end, which includes a brief (incomplete) compilation of articles co-authored by this subgroup's members
and others on Indigenous perspectives in space and related report topics, as well as recent articles
featuring subgroup members that draw attention to the ongoing role of satellite constellations in "astro-
colonialism" and space as an environmental commons.
Opening the workshop, Dr. Chavez began by drawing attention to our relationship with Mother Earth
and Father Sky, asking that we honor their gifts and take responsibility for our actions and choices as we
A4 p 857
SATCON2 Community Engagement Working Group 32
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began this conversation. He invited all those working on these issues to bring our best intentions to this
journey, and to seek ways to heal and learn from the past so we can do better and be better as beloved
communities. He ended by seeking permission to continue in a good way so that our desire to progress
does not come at the cost of elders or with ideals of empire, but so we can proceed in ways that honor
our interconnectedness.
%„1. Key Themes
Some key themes that emerged from the morning talks and the afternoon Town Hall and breakout room
on Indigeous and international perspectives are described below.
Indigenous peoples are part of sovereign nations — they are not special interest groups. Satellite
constellations that are visible by the unaided eye on Earth will impact Indigenous peoples. The SATCON1
report noted in passing that the satellites might affect wayfinding practiced by different Indigenous
peoples. It is commendable that the SATCON2 working groups included greater discussion about
how Indigenous peoples might be harmed by or benefit from these satellites, including the voices of
some Indigenous peoples. However, Indigenous peoples were included in the discussion as a special
interest group along with amateur astronomers, astrophotographers, and others. This is inappropriate
because Indigenous peoples in Canada and the United States are groups of sovereign nations with
rights highlighted by treaties and the United Nations Declaration of the Rights of Indigenous Peoples.
Consulting and including Indigenous peoples in a working group is a positive step from the SATCON1
report, but more work is needed for that discussion to be nation-to-nation and not colonizer-to-
Indigenous peoples.
Altered relationship with the cosmos. Indigenous workshop speakers shared that "satellites literally
interrupt our relationship with the stars and ceremonial ways of connecting with them", "Stars are our
ancestors and erasing them is erasing our tellings and scientific-cultural traditions", and "Land, sky and
oceans are relationships, a verb". Speakers emphasized the need for a relational ethical approach to
space built on consensus and consultation. There is also a profound shift in our view of the stars as a
fixed sphere, as we introduce more human-made moving objects into this realm.
A new form of colonization. The perspectives of Indigenous peoples with respect to outer space and
the expected rapid growth of satellite constellations are important and necessary. Indigenous peoples
from around the globe have observed the night sky since time immemorial and have a sophisticated
and complex relationship with the visible night sky. As sovereign peoples and cultures, the rapid growth
of these satellite constellations can have a significant and negative impact on this relationship. Many
Indigenous stories are written in the stars. Light pollution has acted to erase Indigenous stories and
identities — again — disconnecting these peoples from the night sky, mirroring the painful history of
colonization in which Indigenous peoples lost their land and water. Speakers viewed light pollution as
erasing their stories and satellites as rewriting them. They shared successful collectives to honor and
preserve ancestral knowledge about Indigenous star stories and sky traditions, including Pai Pai star
stories29 from the bilingual 68 Voices project30 based in Mexico, and the highly successful nonprofit Native
29 https://68voces.mx/Dai-pai-el~origen-de-los-celos
30 https://68voces.mx/
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Skywatchers31 founded by astronomer-artist Dr. Annette Lee. Speakers also raised the disproportionate
impact of colonization, climate change and COVID19 on Indigenous communities.
Duty to consult. Indigenous peoples and nations must be consulted and their decisions should be
respected. Many nations might view these satellites as inappropriate and as another form of pollution
or colonization, but many nations might view the benefits of the satellites, such as access to broadband
internet, as being valuable to their communities. However, it is not the purview of the workshop report
authors, or academia and industry, to dictate the impact of these LEO satellites on Indigenous peoples.
As such, the discussion would be better served as a nation-to-nation dialogue that includes consultation
and consent.
Urgent need for cultural competency in space agencies and space actors. The accelerating situation
with satellite constellations and the use of near-Earth space reveals an urgent need for space policy and
scientific programs rooted in cultural competency and sensitivity to cultural traditions. NASA could lead
the way by having an Office of Tribal Affairs or an Office of Cultural Protocol. Such an office could address
ongoing practices around sensitive issues (e.g., what is heritage and who gets to define it; the thriving
export business of human remains and ashes to near-Earth space). Several participants also suggested
that NASA is missing an opportunity for due diligence on a major international issue: engaging sovereign
nations in space exploration. NASA has much to learn from Indigenous ways of knowing and integrative
scientific-cultural practices such as wayfinding, which have reflected for millennia the relatively new
NASA values of Inclusion and Mission Success. Participants shared that a talking circle with NASA
leadership is needed — something that has been very rich when allowed to happen — rather than the
current approach of being sent in circles when Indigenous scientists and communities wish to be heard.
We can also learn from inclusive or creative approaches in other countries, e.g., in New Zealand, a small
yet highly active spacefaring nation. Recent major national shifts in cultural competency include the
official declaration32 of the heliacal rising of Matariki (The Pleiades) as a national holiday honoring Maori
calendrical and cultural traditions. In addition, national initiatives in New Zealand are required to protect
and enact Maori principles and incorporate Maori in economic and cultural development, as per Te Tiriti
o Waitangi | the Treaty of Waitangi. The New Zealand government has to consider how any policy affects
Maori empowerment and communities, including for instance in science implementation and funding.33
New Zealand has five dark-sky reserves at present, for culture, astrotourism, and science; iwi-owned
astrotourism in the largest reserve contributes to rural economic development, and the increased
visibility of satellites there has been noted.
Legal and policy issues in space in the context of treaties with Sovereign Indigenous Nations. A
growing number of issues need legal clarification and explicit addressing34. These include: how do
we define the environment of the Earth, where does Earth end and space begin, and what is the legal
jurisdiction of Earth's laws? What are the legal obligations for state and private actors in space given
existing treaties with sovereign Indigenous nations? We need written agreements between industry,
31 https://www.nativeskywatchers.com/
3 2 https://www.mbie.govt.nz/business-and-emDloyment/employment-and-skills/emDloyment-legislation-reviews/matariki/matariki
public-holiday/
3 3 http://www.maramatanga.co.nz/sites/default/files/Rauika%20Ma%CC%84ngai A%20Guide%20to%20Vision%20
Ma%CC%84t.auranea FINAL.pdf
34 E.g., https://www.nature.com/articles/d41586-021-Q1954-4
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spacefaring countries and Indigenous nations that respect these treaties and these communities'
sovereignty. Such agreements must be transparent and include cost analysis so that agreements are not
dependent on a new generation of leaders and people. Looking at New Zealand's approach once more,
Aotearoa (the Maori name for New Zealand) is a new Artemis Accords signatory with public statements35
emphasizing Maori principles of sustainability and stewardship of natural resources, as applied to outer
space, which is termed an environment. Legal scholars are yet to answer the broader legal question of
whether night skies are implicit in the multiple existing agreements and treaties between state actors
and Indigenous peoples.
Systematic studies are needed on the viability of satellite broadband and outcomes for economic
development. Two of our subgroup members drew attention to the unfolding situation as regards
satellite broadband in their countries.
In Mexico, as an example, Dr. Avila Castro shared that as of July 2021, according to official data36 31% of
the working population earns 3700 pesos a month or less, or approximately a third of the population
earns $185 USD or less a month at current exchange rates of $1 USD = 20 pesos. Only 2% of the working
force earns 18,700 pesos ($925 USD) a month. The announced price of Starlink in Mexico is the same
as in the USA: An initial $500 USD (10,000 pesos) and a monthly fee of $99 USD (2,000 pesos). With
this information we can easily see that Starlink is completely out of reach of the vast majority of the
population. On the other hand, Mexico has 84 million internet users which is around 70% of the overall
population. In urban areas, internet coverage is acceptable and affordable through cellular (3G, 4G),
and ground-based internet (DSL, cable, optic fiber). As with other services, rural areas are the ones left
behind so it could be argued that Starlink could fill those gaps in coverage. However, rural areas have
the lowest incomes meaning that satellite internet is completely unaffordable for them. Even if resources
are pooled to share a satellite link for the whole community, infrastructure has to be acquired, installed,
and maintained (routers, cables, WiFi antennas, etc) and at that point it makes more sense to solve
the last mile problem through conventional internet access. But let's expand the scenario even further,
e.g., that Starlink is installed and operating through a community effort. What is going to happen if the
Starlink project doesn't pan out and has to shut down the service? Now the community has invested
a lot of money, only to be left with some proprietary antennas that are no longer useful. This is what
technological colonization means in a developing country. You no longer own the infrastructure or
services — they are owned instead by a private company in a foreign country37. So for the developing
world, satellite internet in this form does not have a real market to expand, nor does it have a long term
benefit for the people. However, people in these countries will suffer the increase in light pollution,
and the loss of their traditional tales and stories in the skies. Any short-term benefits from satellite
broadband may therefore be eclipsed by long-term economic and other impacts, with no clear path
of recovery.
35 https://www.beehive.govt.nz/release/space-exploration-soars-artemis-accords
36 Data come from the National Institute of Statistics, Geographical Information (IN EG I), and the Federal Institute of
Telecommunications (IFT).
37 More broadly, fiberoptic cables can serve multiple data-carrying functions in multiple formats for multiple providers and users from
individuals to corporations to governments for multiple decades. In contrast, satellite dishes to access satellite broadband internet are fixed to
one household account with one private provider corporation using one format of data transmission, and are prone to rapid obsolescence.
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In the case of the nation of Canada, Dr. Neilson shared that access to broadband internet has been
promised by governments for years38. To that end the Canadian government has committed support to
the satellite company Telesat39 which currently has a constellation of about 300 LEO satellites in space to
provide broadband internet access to almost two million Canadians who lack affordable access. Most of
this access will impact large areas of Canada with small population densities who are disproportionately
Indigenous. At the time of writing, it is unclear whether and how many communities have been consulted
about this.
Nuanced approaches without appropriation are required. Indigenous peoples have their own
governance, rights and needs. Both academia and industry should avoid statements emphasizing
preferred narratives around satellite constellations. We must avoid such appropriations of Indigenous
perspectives and needs, or misinterpreting them for pre-determined uses — this is a real issue now that
astronomers are at the receiving end of colonization. Nuanced approaches that engage in long-term
relationships and listening with communities are needed, recognising that consensus building happens
differently in each community and culture. This is not a single issue across all Indigenous peoples
(e.g., cultural sky traditions); rather, this is a complex tradeoff between broadband access, economic
development, cultural heritage, and survival (many Indigenous peoples do not have access to clean water
or other basic necessities).
We end by sharing that the co-Chairs of the Community Engagement Working Group were invited into
extended dialogue with a circle of Oceania wayfinders ranging from Hawai'i to Aotearoa and many Pacific
communities, starting in the week of the SATCON2 workshop. It would be inappropriate to attempt
to summarize these conversations this early in the process, but we honor the wayfinders' gracious
invitation into dialogue as we collectively move forward to preserve the health and integrity of the ocean
above us as well as the ocean between our lands.
We express gratitude and support for these Indigenous perspectives offered at SATCON2. We hope that
we can listen, consult, learn from the past and co-create an ethical sustainable future in space that
honors our interconnection and does not come at the expense of things that belong to us all.
38 https://crtc.gc.ca/eng/internet/internet.htm
39 https://www.telesat.com/about-us/
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6. Environmental and Ecological Impacts of
Satellite Constellations
The primary authors of this section and subgroup members are:
James Lowenthal (Smith College)
Diana Umpierre (Sierra Club)
Erika Nesvold (JustSpace Alliance)
Sally Carttar (National Park Service)
The Environmental Impacts subgroup of the SATCON2 Community Engagement Working Group
researched and discussed numerous aspects of environmental and ecological impacts of satellite
mega-constellations, held a virtual listening session with the Sierra Club, held dedicated presentation
and discussion sessions during the SATCON2 workshop, and reached out to numerous individuals with
expertise in environmental conservation and related concerns. Here we report the main issues and
themes that surfaced from those inquiries and discussions.
We offer three main recommendations, summarized here and expanded below:
1 Earth-orbiting space should be considered part of Earth's environment, legally and otherwise.
2 Satellite constellations should not be exempt from NEPA review.
3 Sovereignty should be respected with regard to space and the night sky.
6.1. Historical, political, and environmental context
Just as the SATCON2 conference got underway to grapple with the challenges posed by Elon Musk's
SpaceX Starlink and other mega-constellations of LEO satellites, news headlines around the world
highlighted the race to space by two other billionaires, Jeff Bezos of Blue Origin and Richard Branson of
Virgin Galactic. At the same time, much of the American and Canadian west was suffering from record-
breaking heat waves and wildfires, as was Greece, while other areas, including parts of Germany and
Belgium, saw massive and fatal flooding following unprecedented torrential rainfall, all exacerbated
by anthropogenic climate change. Several members of the Community Engagement Working Group
and people interviewed pointed out the ironic contrast between the dire material needs of the vast
SATCON2 Community Engagement Working Group
A4 p.862
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majority of the Earth's population and the indulgences of some of the richest men in the world, as if
the wealthy were literally escaping a planet on fire by means unavailable to most people. Others drew
parallels between the current space race, including the development of satellite constellations, and the
long history of colonial imperialism over the last millennium: the new natural resource up for grabs is
space itself, to be exploited and capitalized by the highest bidders and the quickest and largest private
corporations.
International legal and philosophical conception of the need to protect space for all humanity was
enshrined, soon after the advent of the Space Age, in the OST. The OST lays the foundation for peaceful
international cooperation and universal access to space, but it contains no explicit reference to the
need for environmental protection against harm from human activities in space. More than 50 years
later, facing the prospect of a rapid and manifold expansion and commercialization of activity in space,
the United Nations Office of Outer Space Affairs (UNOOSA) issued the first Guidelines for the Long-Term
Sustainability of Outer Space Activities of the Committee on the Peaceful Uses of Outer Space (UN
COPUOS 2021). Guideline A.2 reads in part:
In developing; revising or amending; as necessary, national regulatory frame- works, States
and international intergovernmental organizations should...:
b: Implement space debris mitigation measures, such as the Space Debris
Mitigation Guidelines of the Committee on the Peaceful Uses of Outer Space,
through applicable mechanisms;
c: Address, to the extent practicable, risks to people, property, public health and
the environment associated with the launch, in-orbit operation and re-entry of
space objects;
Gilbert & Vidaurri (2021) study existing national and international case law and conclude that
consideration of the NEPA should be applied to space activities — contrary to the practice of the
US Federal Communications Commission (FCC), which is to disregard environmental impacts when
considering applications by satellite operators for licenses to launch and operate satellite constellations.
Sutherland (2021) describes the process by which NASA applies NEPA, in contrast to the FCC. Cirkovic
(2021a,b) argues for a new "cosmolegal" conception of space and space law that recognizes the
limitations of traditional terrestrial legal frameworks and the potential risks from overcrowding of orbits,
space debris, and possible contamination of other planets by human activity in space. Comparisons
between the problems of space debris, satellite constellations, and climate change become even more
concrete given the prediction that increasing levels of atmospheric C02 will reduce drag on LEO satellites,
making them stay in orbit longer (O'Callaghan, 2021).
Thus there is growing concern about the environmental impacts of satellite constellations, and precedent
for implementing regulation and national and international law to control, mitigate, minimize, or
eliminate those impacts.
6.2. Environmental harm from satellite constellations
Environmental harm from satellite constellations occurs during all three phases of satellite constellation
lifetimes. Below we summarize the major impacts we found in the literature and from our discussions.
SATCON2 Community Engagement Working Group
A4 p.863
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I. Impacts to the natural and human environment identified or predicted from launching satellite
constellations include:
a. Large quantities of C02, NOx, water vapor, and other greenhouse gases and toxic substances
are produced by combustion of liquid and/or solid fuel during rocket launches (see Dallas et
al., 2020 for a comprehensive review). Depending on the type of fuel used and the size of the
launching rocket, up to 300 tons of C02 can be produced per launch. The breakdown of water
vapor released in the stratosphere leads to depletion of the ozone layer (Marais, 2021).
b. Combustion of kerosene fuel produces black carbon, and combustion of solid rocket fuel
produces soot and alumina, both of which can affect the albedo (reflectivity) of Earth's
atmosphere to sunlight (Lawler & Boley, 2021).
c. Pollution associated with rocket launches, including over sensitive habitats such as the Gulf
Coast in Texas and Cape Canaveral in Florida, negatively impacts humans and wildlife alike.
Rocket launching facilities that are placed in environmentally delicate areas and/or near low-
income or marginalized people raise questions about environmental justice and equity, e.g.,
the SpaceX spaceport near Boca Chica, TX (Sandoval & Webner, 2021).
d. Falling debris and explosions associated with failed rocket launches have raised concerns and
protest among neighbors of proposed launching sites, e.g., Little Cumberland Island, Georgia,
where Camden County plans a new spaceport (Marvar, 2021).
II. Impacts on the natural and human environment identified or predicted from operating LEO
satellites at orbit-raising and final station altitude include:
a. Possible disruption of various species' ability to navigate using the stars. A wide range of
species are suspected or known to use the stars and even the Milky Way to navigate (e.g.,
Foster et al., 2018; Sokol, 2021; Fritts 2021), from dung beetles (Foster et al., 2021) to bats
(Stone, Harris & Jones, 2015), harbor seals (Mauck et al., 2008), and migratory songbirds
(Emlen, 1967; Wiltschko et al., 1987; Pakhomov, Anashina & Chernetsov, 2017). The possibility
that the proliferation of bright artificial LEO satellites could lead to the disruption of migration
by many millions or billions of individual animals (Lintott & Lintott, 2020) is still new enough
just two years after the first launch of Starlink satellites that no peer-reviewed studies have
been published yet reporting confirmed impacts of satellite constellations on animals;
however, numerous members of the working group felt that there was sufficient reason to be
concerned about such possible effects on animals that the precautionary principle should
apply, and that launches should be halted unless and until the effects are demonstrated to be
negligible.
b. Interference with the timeless and profound human experience of regarding the starry
sky. The night sky is a fundamental part of nature, and one that provides us with solace,
inspiration, and connection with countless generations before us and, one hopes, yet to
come. The human right to see the naturally dark, unpolluted, starry night sky has been
articulated in the Declaration in Defense of the Night Sky and the Right to Starlight (Starlight
Foundation, 2007), and Resolution B5 in Defence of the Night Sky and the Right to Starlight
(International Astronomical Union, 2009), and by the US National Park Service, which
operates an extraordinarily popular Night Skies program whose motto is "Half the Park is
After Dark" and whose philosophy is that naturally dark skies are, like clean air and clean
SATCON2 Community Engagement Working Group
A4 p.864
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water, a natural resource to which every human has a right (National Park Service, 2021).
Satellite constellations have the potential to dramatically and irrevocably alter the naked-
eye appearance of the night sky (e.g., Lawler, Boley & Rein, 2021; Lawler and Boley, 2021;
Skibba, 2021).
Earth-orbiting satellites know no national boundaries, and several Community Engagement
Working Group members pointed out the need to respect the sovereignty of other nations,
including Native American and other Indigenous peoples, who may regard outer space and
the night sky as part of the environment, even if the FCC does not.
The rise in overall night-sky brightness due to the combined light from many thousands
of satellites, even if individually invisible to the naked eye, may already be a significant
new form of light pollution; Kocifaj et al. (2021) calculate that the night sky may already be
as much as 10% brighter than natural as a result of the integrated reflected light from all
artificial objects currently in orbit, including fewer than 2000 Starlink satellites out of more
than 10,000 planned; that contribution to overall sky brightness will inevitably grow as more
satellite constellations are put in orbit. Reasonable estimates based on planned satellite
constellations just in the 2020's imply that the night sky could be artificially brightened by as
much as 250%, erasing the view of the Milky Way and more than half of naked-eye visible stars
(see the Astrophotography subgroup report of the Community Engagement Working Group).
The circadian rhythms of humans and animals are generally thought to be controlled by the
perception of integrated and diffuse light such as from the sky (Brown, 2016), rather than from
individual light sources, and many species are sensitive to extremely low levels of light, well
below 1 lux (e.g., Walbeek et al., 2021). Therefore an overall elevation of night sky brightness
by satellite constellations may have profound and negative effects on many or most species of
flora and fauna on Earth. Again, the field is too new for there to be published empirical studies
yet, but Community Engagement Working Group members argued that the precautionary
principle should apply.
Some interviewees indicated that any potential impacts on the integrity and continuance
of Earth Observation (EO) satellites from orbital debris collisions and especially a potential
debris cascade (the Kessler syndrome) due to overcrowding of orbits would be points of major
concern to the environmental and ecological justice community, from scientists and activists
to policy makers. Many of those EO satellites operate in LEO. For decades, EO satellites have
provided data that have helped humanity understand, appreciate and protect the planet's
atmosphere and ecosystems. They have exposed the vulnerability of our planet and the
limits of our natural resources. They provided evidence and now the means to monitor our
progress, or lack thereof, in tackling the climate and biodiversity crises. Whether directly or
indirectly, whether knowingly or not, these constituents have benefited from EO observations
in their work on ecosystems, natural resources, wildlife biodiversity, agriculture, food security,
transportation, weather, water and air quality, light pollution, wildfires, disaster response,
smart growth, climate adaptation, energy transition, social justice, and much more.
Unfortunately, because the focus on identifying and communicating impacts and mitigations
related to satellite mega-constellations has been primarily on astronomy, most of the
communities working on environmental, ecological and social justice issues (including
SATCON2 Community Engagement Working Group A4 p 865 44
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non-profit organizations) are largely unaware of the challenges that thousands of new LEO
satellites, and associated space debris, could pose to current and future EO satellites.
While intentional and meaningful outreach to these communities has only recently started,
questions from them so far have included:
• Who is bearing the burden of costs associated with tracking these many objects,
mitigating potential issues, and the loss or reduction of public benefits, if the
operations of EO satellites are compromised?
• Will future launches of EO satellites be affected or reduced by more
congested LEOs?
• How will cascading collision events, especially with untracked debris, affect the EO
satellites we have come to depend on in respect of issues of great environmental
importance, such as monitoring pollution and land cover changes affecting people
and wildlife?
• What sustainability and carrying capacity studies are being carried out, if any, to
ensure the safety and health of the planet's atmosphere and the equitable access
to near-Earth orbits, especially among marginalized communities?
f. Community Engagement Working Group members pointed out that even with sophisticated
decommissioning plans in place, individual satellite operators can go, and already have gone,
bankrupt, potentially leaving thousands of satellites stranded in orbit, perhaps for thousands
of years. This is perhaps analogous to leaving wrecked cars by the side of the highway
indefinitely, a practice no modern society accepts.
III. Impacts on the natural and human environment identified or predicted from decommissioning
LEO satellites include:
a. Aluminum and rare-earth metals deposited mostly in the atmosphere and the oceans but
also on land during re-entry of satellites, either planned or accidental. Boley& Byers (2021)
estimate that from the eventual re-entry of the fewer than 2000 Starlink satellites already in
orbit as of this writing, the deposition of aluminum into the atmosphere will exceed that from
all natural causes, primarily the steady rain of small asteroids and micrometeoroids (roughly
50 tons per day), that Earth collects (e.g., Rojas et al., 2021).
b. The greatly increased likelihood, given the numbers of satellites planned in LEO, of unplanned
or uncontrolled re-entries resulting in the direct impact of satellites or satellite fragments
with the ground, possibly causing direct injury or loss of life to humans or animals. Residents
of the Pacific Northwest got a dramatic demonstration of such a scenario when a SpaceX
Falcon 9 made an uncontrolled re-entry into the atmosphere, producing a spectacular fireball
witnessed by thousands (Ives, 2021).
The Community Engagement Working Group makes the following recommendations regarding the
proven or plausible impacts on the human and natural environment of launching, operating, and
decommissioning LEO satellite constellations:
SATCON2 Community Engagement Working Group
A4 p.866
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1 Earth-orbiting space should be considered part of Earth's environment, legally and
otherwise. There was a strong consensus that the region of space occupied by Earth-orbiting
satellites and the night sky should be considered an integral part of the environment and of the
human experience of the natural world. To limit the concept of the environment to the surface
of Earth and its atmosphere but to exclude the starry night sky or even objects passing through
the atmosphere en route to or returning from LEO is to make an arbitrary distinction that defies
common sense and universal experience.
2 Satellite constellations should not be exempt from NEPA. There was strong consensus that
NEPA, which the FCC has so far declined to invoke in considering licence applications by potential
operators of satellite constellations, should in fact be applied, and that environmental impact
studies should be required components of such license applications.
3 Sovereignty should be respected with regard to space and the night sky. Even if the FCC does
not consider space to be part of the environment or subject to NEPA review, other nations can
and do consider space, the starry sky, the Milky Way, the planets and the Moon to be part of the
environment, nature, cosmology, cultural and spiritual heritage and practice. Introducing satellite
constellations to the night sky, especially if bright enough to be seen naked eye, thus threatens
the autonomy and wellbeing of people of other sovereign nations including Indigenous and First
Nations people, and undermines the concept of space as a commons as enshrined in the OST.
SATCON2 Community Engagement Working Group
A4 p.867
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BACKGROUND DOCUMENT
WHO European Ministerial
Conference on Health Systems:
"HeaLTH sYSTems,
HearmanDweaLTH"
Tallinn, Estonia, 25-27 June 2008
Performance
measurement for health
system improvement:
experiences, challenges
and prospects
Peter C, Smith, Elias Mossialos and
Irene Papanicolas
-------
Performance measurement for
health system improvement:
experiences, challenges and
prospects
Peter C. Smith, Elias Mossialos and Irene Papanicolas
A4 p.869
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Keywords:
DELIVERY OF HEALTH CARE - standards
QUALITY INDICATORS, HEALTH CARE
QUALITY ASSURANCE, HEALTH CARE - organization and administration
EUROPE
© World Health Organization 2008 and World Health
Organization, on behalf of the European Observatory on
Health Systems and Policies 2008
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Office for Europe to:
Publications
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Alternatively, complete an online request form for
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All rights reserved. The Regional Office for Europe of the
World Health Organization welcomes requests for permission
to reproduce or translate its publications, in part or in full.
The designations employed and the presentation of the
material in this publication do not imply the expression of any
opinion whatsoever on the part of the World Health
Organization concerning the legal status of any country,
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maps represent approximate border lines for which there may
not yet be full agreement.
The mention of specific companies or of certain
manufacturers' products does not imply that they are
endorsed or recommended by the World Health Organization
in preference to others of a similar nature that are not
mentioned. Errors and omissions excepted, the names of
proprietary products are distinguished by initial capital letters.
All reasonable precautions have been taken by the World
Health Organization to verify the information contained in this
publication. However, the published material is being
distributed without warranty of any kind, either express or
implied. The responsibility for the interpretation and use of
the material lies with the reader. In no event shall the World
Health Organization be liable for damages arising from its use.
The views expressed by authors, editors, or expert groups do
not necessarily represent the decisions or the stated policy of
the World Health Organization.
A4 p.870
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Contents
Page
Key messages i
Executive summary ii
Performance measurement for health system improvement: experiences,
challenges and prospects
Policy issue 1
Purpose of performance measurement 1
Defining and measuring performance 2
Methodological issues about performance measurement 6
Using performance measurement: key policy levers 9
Summary and conclusions 15
References 18
Authors
Ellas Mossialos, LSE Health and European Observatory on Health
Systems and Policies, London School of Economics and Political Science,
United Kingdom
Irene Papanicolas, LSE Health, London School of Economics and
Political Science, United Kingdom
Peter C. Smith, Centre for Health Economics, University of York, United
Kingdom
A4 p.871
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Performance measurement
Key messages
Performance measurement offers policy-makers a
major opportunity for securing health system
improvement and accountability.
Performance measuienient aims to improve the
quality of decisions made by all actors within the
health system
Secutinq improved performance measurement
often requires the active leadership of government.
Major improvements are still needed in data
collection, analytical methodologies, policy
development and implementation of health system
performance measurement.
Definitions of performance indicators should be
cleat, consistent and fit into a clear conceptual
fiamewoik
Policy-makers should pay particular attention to the
political and organizational context within which
performance data aie collected and disseminated.
Consideiable progress has been made in
developing peifnimance indicators for acute
hospital caie, pnmaiy caie and population health,
butfoi mental health, financial piotection and
health system responsiveness leseaich is at a much
earlier stage of development.
The development of individual performance
indicators requires concerted expert and political
attention, and these indicators should: aim to
provide information that is relevant to the needs of
specific actors; attempt to measure performance
that is directly attributable to an organization or
actor; aim to be statistically sound, easy to interpret
and unambiguous; and be presented with full
acknowledgement of any data limitations.
The piesentation of peifoimance measurement
data and how this influences its interpretation by
patients, providers and piactitioners and the public
requite more attention.
Public reporting has many benefits, but can lead to
adverse outcomes; mechanisms should be put in
place to monitor and counteract these adverse
outcomes.
An mipoitant use of performance measurement is
to ptovide feedback to clinical practitioners on their
actions and how these compare to those of their
peers.
Performance measurement systems should be
monitored frequently to ensure alignment with
other health system mechanisms and to identify
areas for improvement.
Experiments under way to examine how
performance measurement can be used in
conjunction with explicit financial incentives to
reward provider performance are a promising area
for policy and a priority for further research.
A better evidence base on which to underpin
performance measurement policy is needed, and
new initiatives should be subject to rigorous
evaluation.
i
A4 p.872
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Background document
Executive summary
Performance measurement offers policy-makers a major
opportunity to secure health system improvement and
accountability. Its role is to improve the quality of
decisions made by all actors within the health system,
including patients, practitioners, managers,
governments at all levels, insurers and other payers,
politicians, and citizens as financial supporters.
Recent major advances in information technology and
increasing demands for health system accountability and
patient choice have dnven rapid advances in health
system peiformance measuiement Health systems,
however, are still in the relatively early stages of
performance measurement, and major improvements
are still needed in data collection, analytical
methodologies, and policy development and
implementation.
Health system performance has a number of aspects -
including population health, health outcomes from
treatment, clinical quality and the appropriateness of
care, responsiveness, equity and productivity - and
progress is varied in the development of performance
measures and data collection techniques for these
different aspects. Considerable progress has been made
in such areas as acute hospital care, primary care and
population health, but in such areas as mental health,
financial protection and health system responsiveness,
research is at a much earlier stage of development.
The first requirement of any performance measurement
system is to formulate a robust conceptual framework
within which performance measures can be developed.
Definitions of performance indicators should then fit
into the framework and satisfy a number of criteria,
such as face validity, reproducibility, acceptability,
feasibility, reliability, sensitivity and predictive validity.
Besides paying attention to these technical
considerations, policy-makers should pay careful
attention to the political and organizational context
within which performance data are to be collected and
disseminated.
Numerous technical questions arise when analysing and
interpreting performance measures. Among the most
important are: what has caused the observed
performance and to what practitioners, organizations or
agencies should variations in performance be
attributed? In some areas, advanced analytical methods
of risk adjustment have been developed to help answer
the question about attribution.
In some aspects of health care, patient safety is a major
concern, and methods of statistical surveillance have
been developed to help detect anomalous performance
rapidly and confidently. An example of anomalous,
though not necessarily unsafe, performance is the
overuse of a particular intervention, and the need to
find out whether it means something unsafe for patients
would then follow the initial finding of an anomaly.
More attention should be paid to the presentation of
performance-measurement data and how patients,
providers, practitioners and the public inteipret it and
are influenced by it. For example, a particularly
contentious issue is the use of composite measures of
performance, which seek to combine several
performance indicators into a single measure of
organizational or system performance. These are
supeificially attractive, as they can help summarize lev h
of attainment in an accessible fashion, but they can ih>
lead to faulty inferences and should be used with
caution
Policy-makers can use performance measurement in a
number of ways to promote system improvement. It can
be used in public reporting <>f performance, sometimes
in the form of organizational report cards. This has been
found to have an important beneficial effect, particularly
on provider organizations. However, it has so far had
little direct effect on patients and can also lead to
adveise outcomes, such as avoidance of patients with
complex health problems. Mechanisms should be put in
place to monitor and counteract such tendencies.
Experiments are under way to examine how
performance measurement can be used with explicit
financial incentives to reward health care provider
performance. This is a promising policy area. However,
such schemes raise a number of important questions
about design, such as which aspects of performance to
target, how to measure attainment, how to set targets,
whether to offer incentives at the individual or group
level, how strong to make the link between
achievement and reward, and how much money to
attach to an incentive. So far, there is little convincing
research evidence of the effectiveness of such incentives,
and this is a priority for further research.
Targets, a quantitative expression of an objective to be
met in the future, are a particular form of incentive
mechanism. They have been particularly prevalent in the
area of public health. Their effectiveness in securing
major system improvements, however, has been
questioned, and it is unlikely that they will secure such
improvements unless aligned with other policy levers,
such as strong demociatic accountability, market
mechanisms or direct financial incentives.
Performance measurement can also be used to provide
feedback to clinical practitioners on their performance
relative to their peers. These feedback systems can
secure widespread improvements in performance.
However, to be successful, they need to be owned by
A4 p.873
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Performance measurement
the practitioners and usually require careful statistical
risk adjustment to control for confounding patient
characteristics. Also, the need to provide feedback that
does not immediately threaten the reputation or
livelihood of clinicians and other professionals can at
times conflict with the demand for public reporting.
Securing improved performance measuiement is an
important stewardship task of government, as many of
the benefits of performance measurement cannot be
realized without the active leadership of government,
whether through law, regulation, coordination or
persuasion. Stewardship responsibilities associated with
performance measurement can be summarized under
the following headings:
1. development of a clear conceptual framework and
a clear vision of the purpose of the performance
measurement system:
• alignment with accountability relationships;
• alignment with other health system mechanisms,
such as finance, market structure and information
technology;
2. design of data collection mechanisms:
• detailed specification of individual indicators;
• alignment with international best practice;
3. information governance:
• data audit and quality control;
• ensuring public trust in information;
• ensuring well-informed public debate;
4. devek ipment of analytical devices and capacity to
help understand the data:
• ensuring analysis is undertaken efficiently and
effectively;
• ensunng local decision-makers understand the
analysis,
• commissioning apptopriate research on, for
example, nsk adjustment, uncertainty and data
feedback mechanisms;
5. development of appropriate data aggregation and
presentational methods:
• ensuring information has appropriate effect on all
parties;
• mandating public release of summary comparative
information;
• ensuring comparability and consistency;
6. design of incentives to act on performance
measures:
• monitoring effect of performance information on
behaviour;
• acting to enhance beneficial outcomes and negate
any adverse consequences;
7. proper evaluation of performance-measurement
instruments:
• ensuring money is spent cost-effectively on
information resources;
8. managing the political process:
• developing and monitoring policy options;
• encouraging healthy political debate;
• ensuring that specific interest gtoups do not
capture the performance information system.
None of these roles need be undertaken by government
itself, but it must be ensured that they all function
effectively.
A4 p.874
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Performance measurement
Performance measurement for health system improvement: experiences, challenges
and prospects
Policy Issue
Information plays a central role in the ability of a health
system to secure improved health effectively and
efficiently for its population. It can be used in many
diverse ways, such as tracking public health, monitoring
health care safety, determining appropriate treatment
paths for patients, promoting professional improvement,
ensuring managerial control and promoting the
accountability of the health system to the public.
Underlying all of these efforts is the role performance
measurement plays in guiding the decisions that various
stakeholders - such as patients, clinicians, managers,
governments and the public - make in steering the
health system towards better outcomes.
Records of performance-measurement efforts in health
systems can be traced back at least 250 years (1,2).
More formal arguments for the collection and
publication of information on performance were
developed more than 100 years ago, when such
pioneers in the field as Florence Nightingale and Ernest
Codman campaigned for its widespread use in health
care. Until recently, professional, practical, and political
barriers have prevented these principles from becoming
a reality (3). For example. Nightingale's and Codman's
efforts were frustrated by professional resistance and,
until recently, information systems have failed to deliver
their promised benefits, in the form of timely, accurate
and comprehensive information.
Over the past 25 years, however, health system
peifomiante measurement and reporting have grown
substantially, thus helping to secure health system
improvement. Many factors have contributed to this
growth. On the demand side, health systems have come
under intense pressure to contain costs; also, patients
now expect to make more informed decisions about
their treatment, and strong demands have been made
for increased audit and accountability of the health
professions and health service institutions (4,5). On the
supply side, the great advances in information
technology have made it much cheaper and easier to
collect, process and disseminate data.
In many respects, the policy agenda is moving away
from discussions of whether performance measurement
should be undertaken and what data to collect and is
moving towards determining the best ways in which to
summarize and present such data and how to integrate
it successfully into effective structures for governance.
Yet, despite the proliferation of performance-
measuiement initiatives, there remain a large number of
unresolved questions .ibout the collection and
deployment of sucli infoimation. Health systems are still
experimenting with the concept of performance
measurement, and much still needs to be done to realize
its full potential.
This document leviews some of the main issues
emerging in the debate about performance
measurement and draws on a detailed collection of
essays by leading experts in the field. These essays were
prepared for the V/HO Ministerial Conference on Health
Systems, in Tallinn, Estonia, and are due to be published
after the conference by Cambridge University Press (6).
The document fust examines the purpose of
performance measuiement and the different areas for
which data are collected. It then examines the different
ways in which performance measurement has been
presented and used for health system impiovement
internationally. Finally, it discusses the majoi challenges
found in presenting and using performance measures
and concludes by presenting key lessons and future
priorities for policy-makers.
Purpose of performance measurement
Health systems are complex entities with many different
stakeholders, including patients clinicians, health caie
ptoviders, purchaser organizations, legulators, the
government and the bioadei public These stakeholders
are linked by a series of accountability relationships (Fig.
1). Accountability has two broad elements: the
rendering of an account (providing information) and the
consequent holding to account (sanctions or rewards for
the accountable party) Whatever the precise design of
the health system, the fundamental role of performance
measurement is to help hold its various agents to
account, by enabling stakeholders to make informed
decisions. It is therefore noteworthy that, if the
accountability relationships are to function properly, no
system of performance information should be viewed in
isolation from the broader system design within which
the measurement is embedded
Each of the relationships described in Fig. 1 has different
information needs in terms of the nature of the
information, its detail and timeliness, and the level of
aggregation required. For example, in choosing which
provider to use, a patient may need detailed
comparative data on health outcomes. In contrast, in
holding a government to account and in deciding for
whom to vote, a citizen may need highly aggregated
summaries and trends Many intermediate needs also
arise. In deciding whether providers are performing
adequately, a puichaser (such as a social insurer) may
need both broad, more aggregated information and
detailed assuiance of safety aspects. A fundamental
challenge for performance measurement is to design
information systems that serve these diverse needs.
Table 1 examines this issue in more detail.
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Background document
Fig. 1. A map of some important accountability relationships in the health system
In practice, the development of performance
measurement has rarely been pursued with a clear
picture of who the information users are or what their
information needs might be. Instead performance-
measurement systems have usually sought to inform a
variety of users, typically presenting a wide range of
data in the hope that some of the information collected
will be useful to different parties. Yet, given the diverse
information needs of the different stakeholders in health
systems, it is unlikely that a single method of reporting
performance will be useful for everybody. Instead, data
sources should be designed and exploited to satisfy the
demands of different users. This may often involve using
data from the same sources in different forms. A major
challenge for health systems is, therefore, to develop
more nuances in the collection and presentation of
performance measures for the different stakeholders
without imposing a huge burden of new data collection
and analysis.
Defining and measuring performance
In general, performance measurement seeks to monitor,
evaluate and communicate the extent to which various
aspects of the health system meet their key objectives.
Usually, those objectives can be summarized under a
limited number of headings - for example, health
conferred on people by the health system, its
responsiveness to public preferences, the financial
protection it offers and its productivity. Health relates
both to the health outcomes secured after treatment
and to the broader health status of the population.
Responsiveness captures aspects of health system
behaviour not directly related to health outcomes, such
as dignity, communication, autonomy, prompt service,
access to social support during care, quality of basic
services and choice of provider. Productivity refers to the
extent to which the resources used by the health system
are used efficiently in the pursuit of effectiveness.
Besides a concern for the overall attainment in each of
these areas, The world health report 2000 (7)
highlighted the importance of distributional (or equity)
issues, expressed in terms of inequity in health
outcomes, responsiveness and payment. Table 2
summarizes these largely universal aspects of health
performance measures.
Various degrees of progress have been made in the
development of performance measures and data
collection techniques for the different aspects of health
performance. In some areas, such as population health,
there are well-established indicators - for example,
infant mortality and life expectancy (sometimes adjusted
for disability). Even here, however, important further
work is needed. A particular difficulty with population
health measures is estimating the specific contribution
of the health system to health. To address this,
researchers are developing new instruments, such as the
concept of avoidable mortality (8,9).
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Performance measurement
Table 1. Information requirements for stakeholders in health care systems
Stakeholder
Examples of needs
Data requirements
Government
Monitoring the health of the nation
Setting health policy
Ensuring that regulatory procedures are working
properly
Information on performance at national and
international levels
Information on access and equity of care
Information on utilization of service and waiting times
Ensuring that government finances are used as intended
Population health data
Ensuring that appropriate information and research
functions are undertaken
Monitoring regulatory effectiveness and efficiency
Regulators
Protecting patient's safety and welfare
Ensuring broader consumer protection
Ensuring the market is functioning efficiently
Timely, reliable and continuous information on patient
safety and welfare
Information on probity and efficiency of financial flows
Payers
(taxpayers and
members of
Ensuring money is being spent effectively, efficiently and
in line with expectations
Aggregate, comparative performance measures
Information on productivity and cost-effectiveness
insurance funds)
Information on access to (and equity of) care
Purchaser
organizations
Ensuring that contracts offered to their patients are in
line with the objectives the patients expect
Information on patient experiences and patient
satisfaction
Information on provider performance
Information on the cost-effectiveness of treatments
Provider
organizations
Monitoring and improving existing services
Assessing local needs
Aggregated clinical performance data
Information on patient experiences and patient
satisfaction
Information on access and equity of care
Information on utilization of service and waiting times
Physicians
Staying up to date with current practice
Information on current practice and best practice
Being able to improve performance
Performance information benchmarks
Patients
Being able to make a choice of provider when in need
Information on alternative treatments
Information on location and quality of nearby
emergency health services
Information on quality of options for elective care
The public
Being reassured that appropriate services will be
available if needed in the future
Broad trends in and comparisons of system
performance at national and local level
Holding government and other elected officials to
account
Efficiency information
Safety information
The contribution of the health system to health care can
be more reliably captured in terms of clinical outcomes
for patients. Traditionally, this contribution has been
examined using post-treatment mortality, which is a
blunt instrument. However, increasing interest is
focusing on more general measures of improvements in
patient health status, often in the form of patient-
reported outcome measures. These measures are
derived from simple surveys of subjective health status
administered directly to patients, often before and after
treatment. Numerous instruments have been developed,
often in the context of clinical trials. These take the form
of detailed condition-specific questionnaires or broad-
brush generic measures (10).
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Background document
Table 2. Aspects of health performance measures
Measurement
area
Description of measures
Examples of indicators
Population health
Measures of aggregated data on the health of the
population
Life expectancy
Years of life lost
Avoidable mortality
Disability-adjusted life-years
Individual health
outcomes
Measures of individual's health status, which can be
relative to the whole population or among groups
Indicators that also apply utility rankings to different
health states
Generic measures:
• Short form 36 (SF-36)a
• EQ-5Db
Disease-specific measures:
• arthritis impact measurement scale
• Parkinson's disease questionnaire (PDQ-39)
Clinical quality and
appropriateness of
care
Measures of the services arid care patients receive to
achieve desired outcomes
Measures used to determine if best practice takes place
and whether these actions are carried out in a
technologically sound manner
Outcome measures:
• health status
• specific post-operative readmission and mortality rates
Process measures:
• frequency of blood pressure measurement
Responsiveness of
health system
Measures of the way individuals are treated and the
environment in which they are treated during health
system interactions
Measures concerned with issues of patient dignity,
autonomy, confidentiality, communication, prompt
attention, social support and quality of basic amenities
Patient experience measures
Patient satisfaction measures
Equity
Measures of the extent to which there is equity in health,
access to health care, responsiveness and financing
Utilization measures
Rates of access
Use-needs ratios
Spending thresholds
Disaggregated health outcome measures
Productivity
Measures of the productivity of the health care system,
health care organizations and individual practitioners
Labour productivity
Cost-effectiveness measures (for interventions)
Technical efficiency (measures of output/input)
Allocative efficiency (measured by willingness to pay)
a SF-36 is a multipurpose, short-form health survey with only 36 questions.
b EQ-5D is a standardized instrument for measuring the outcome of a wide range of health conditions and treatments. It provides a simple
descriptive profile and a single index value for health status that can be used in the clinical and economic evaluation of health care and in
population health surveys.
Source: Smith et al. (6).
To measure performance when monitoring outcomes
from health care interventions over time and between
providers, the policy challenge is to identify the most
appropriate choice of instrument. In England, for
example, the government has recently mandated the
use of the generic patient-reported outcome measure
instrument EQ-5D for use for all National Health Service
patients undergoing four common procedures. This
experiment will assess the costs of such routine use and
will test whether the resistance of some health
professionals to patient-reported outcome measures is
sustained. Also, while the relevance of patient-reported
outcome measures to acute care is clear, their
application to such areas as chronic disease and mental
illness remain less well developed.
Although clinical outcome measures are the gold
standard for measuring effectiveness in health care, their
use can be problematic - for example, if the outcomes
cannot realistically be assessed in a timely or feasible
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Performance measurement
Type of
indicator
Advantages
Disadvantages
Most useful areas
Outcome Often more meaningful to stakeholders
Attention directed to (and health goals
focused on) the patient
Encourages long-term health-promotion
strategies
Not easily manipulated
May be ambiguous and difficult to
interpret, as they are the result of many
factors that are difficult to disentangle
Takes time to collect
Requires a large sample size to detect
statistically significant effects
Can be difficult to measure -
example, wound infection
for
To measure quality of homogeneous
procedures
To measure quality of homogeneous
diagnosis with strong links between
interventions and outcomes
To measure quality of interventions
made to heterogeneous populations
that suffer from a common
condition
Process Easily measured without major bias or
error
More sensitive to quality of care
Easier to interpret
Require a smaller sample size to detect
statistically significant effects
Can often be observed unobtrusively
Provide clear pathways for action
Capture aspects of care valued by patients
(aside from outcomes)
Often too specific, focusing on a
particular intervention or condition
May quickly become dated as models
of care and technology develop
May have little value to patients unless
they understand how they relate to
outcomes
May be easily manipulated
To measure quality of care,
especially for treatments where
technical skill is relatively
unimportant
To measure quality of care of the
homogeneous conditions in
different settings
Source: Adapted from Davies (13) and Mant (14).
Table 3. Usefulness of structural outcome and process indicators
fashion. This is particularly important for chronic
diseases. Measures of the process then become
important signals of future success (11). Process
measures are based on actions or structures known to
be associated with health system outcomes, in either
health or responsiveness. An example of an action might
be appropriate prescribing, which is known from
research evidence to contribute to good outcomes (12).
Also, the concept of effective coverage is an important
population health process measure. Table 3 summarizes
the basic advantages and disadvantages of using
outcome and process indicators and the areas of
performance measurement where they are most useful.
Work in the area of responsiveness is inherently
challenging, as in principle it requires general surveys of
both users and non-users of health services. Also,
aggregating diverse areas into usable summary indicators
of responsiveness is problematic. The World Health
Survey of households in over 70 countries contained a
responsiveness module that offers some potential for
proposing operational solutions to the routine
measurement of health system responsiveness (15).
Financial protection from the catastrophic expenditure
associated with ill health is a fundamental health system
concern. Many high-income countries have introduced
universal insurance coverage to address this issue, but
even then there are quite large variations in measures of
financial protection between countries and over time.
The issue, however, is even more acute in many lower-
income countries, where there are massive variations in
the extent to which households (especially the poor) are
protected from catastrophic expenditure. There is
therefore increasing interest in WHO and the World
Bank developing reliable and comparable indicators of
financial protection (16). A major challenge is to move
beyond the immediate expenditure on health care, to
trace the longer-term implications for household wealth
and savings.
Finally, productivity (and efficiency) is perhaps the most
challenging measurement area of all, as it seeks to offer
a comprehensive framework that links the resources
used to the measures of effectiveness described above.
The need to develop reliable measures of productivity is
obvious, given the policy problems of trying to decide
where limited health system financial resources are best
spent and of trying to identify inefficient providers. The
experience of The world health report 2000 (7),
however, illustrates how difficult this task is at the macro
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Background document
Box 1. Hospital benchmarking in Finland
Background
In Finland, in 1997, the National Research and Development
Centre for Welfare and Health launched a research and
development project (Hospital Benchmarking) to produce
benchmarking information on hospital performance and
productivity (18). The main aims of the project were:
• to develop a new measure to describe the output of
hospitals that was better than traditional measures, such as
admissions or outpatient visits; and
* to provide the management of hospitals with benchmarking
data for improving and directing activities at hospitals.
Data collection
The project was expanded to cover nearly all publicly delivered
specialized health care in Finland and, in 2006, data from the
project was integrated into the production of national statistics.
Data for the Hospital Benchmarking project are collected
annually from hospitals, and they include both inpatient and
outpatient care, along with information on diagnoses and
procedures. The project produces a wide range of hospital and
regional (hospital-, district-and municipality-based) indicators
on hospital productivity and costs - by specialty, inpatient wards
and diagnosis-related groups. By using uniform personal
identity codes, the different episodes of care of the same
patient can be linked together.
Uses of data
The data allow regional measurement of productivity and costs,
which indicate, for example, how much the costs of a hospital
district or a municipality deviate from the national average and
how much of this deviation depends on the inefficient delivery
of services and the use of services per person.
Hospital Benchmarking data have been used increasingly for
appraising and directing hospital activities. Results from the
Hospital Benchmarking project indicate that productivity of
hospitals decreased somewhat during the years 2001-2005 and
that there are significant differences in productivity between
hospitals (19).
Box 2. OECD Health Care Quality Indicators Project
Background
Since its beginning, in 2001, the OECD Health Care Quality
Indicators Project has aimed to track the quality of health care
in a number of countries, to assess the quality of international
health care. This is done by developing a set of indicators based
on comparable data that can be used to investigate quality
differences in health care among countries.
Indicators
The five areas In which indicators are being collected are:
1. patient safety
2. quality of mental health care
3. quality of health promotion, illness prevention and primary
care
4. quality of diabetes care
5. quality of cardiac care.
The collection of indicators follows a twofold process. Initially,
data will be gathered from a limited set of new indicators
prepared by teams of internationally renowned experts in each
of the five areas. Then country experts in all five areas will
conduct work that will provide the basis for improving quality
data systems across countries.
Source: Health Care Quality Indicators Project (20).
level. And the accounting challenges of identifying
resources consumed become progressively more acute
as one moves to finer levels of detail, such as the meso
level (provider organizations, for example), the clinical
department, the practitioner, or - most challenging of all
- the individual patient or person (17). Box 1 gives
details of the Finnish experience with producing
benchmarking data to use for productivity improvement.
Methodological issues about performance
measurement
The diverse uses of health system performance measures
necessitate a wide variety of measurement methods,
indicators, analytical techniques and approaches to
presentation. Also, different methods of data
collection - such as national surveys, patient surveys,
administrative databases and routinely collected clinical
information - are needed to assemble these diverse
types of information. The area of performance under
scrutiny will determine the most appropriate data
collection technique. For example, when measuring
responsiveness, household or individual surveys are likely
to be the best sources of patient experiences and
perspectives, whereas when looking at specific clinical
outcomes, clinical registries may be a more informative
and cost-effective source of information. In practice,
although performance measurement efforts have
progressed over recent years, many health systems still
rely on readily available data as a basis for performance
measurement.
The first requirement in any performance measurement
system is to develop a robust conceptual framework
within which performance measures can be developed.
This should ensure that all major areas of health system
performance are covered by the measurement system,
that priorities for new developments can be identified
and that collection and analysis efforts are not
misdirected or duplicated. In short, the eventual
requirement is to develop an optimal portfolio of
performance-measurement instruments. An example of
such a framework is the Organisation for Economic Co-
operation and Development (OECD) Health Care Quality
Indicators Project, which seeks to assemble a suite of
performance indicators that are common to a large
number of national performance measurement schemes
(Box 2).
Detailed issues about methodology arise when
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Performance measurement
Table 4. Characteristics of good performance indicators
Stages
Characteristics of indicators
Development
of indicators
Face/content validity: the extent to which the
indicator accurately measures what it purports to
measure
Reproducibility: the extent to which the indicator
would be the same if the method by
which it was produced was repeated
Application
of indicators
Acceptability: the extent to which the indicator is
acceptable to those being assessed arid those
undertaking the assessment
Feasibility: the extent to which valid, reliable and
consistent data are available for collection
Reliability: the extent to which there is minimal
measurement error or the extent to which findings
are reproducible should they be collected again by
another organization
Sensitivity to change: the extent to which the
indicator has the ability to detect changes in the
unit of measurement
Predictive validity: the extent to which the
indicator has the ability to accurately predict
Box 3. Key considerations when addressing causality and
attribution bias
Users of performance measures should consider the following
recommendations when addressing causality and attribution
bias.
Reports of research that investigates a possible causal and
attributable link between the agents being assessed and the
quality outcome proposed should be evaluated with particular
attention to:
• the study methodology;
• its controls for confounding variables; and
• the generalizability of the study sample.
Prospective analyses to identify critical pathways involved in the
achievement of desired and undesired processes and outcomes
of care should be undertaken. These analyses should try to:
• identify possible corifounders; and
• identify the extent to which agents under assessment are or
can be clustered into homogeneous groupings.
In new performance measurement initiatives, sources of
random and systematic error in measurement and sampling
should be carefully considered when developing the design.
Procedures of data collection that maximize the reliability and
accuracy of data (both primary and secondary) used for quality
assessment should be institutionalized.
Risk-adjustment techniques should be employed when
evaluating the relationship between agents underassessment
and the quality indicators. Hierarchical models should be used
to account for the clustering of data within different levels of
the health system under analysis. The use of statistical methods,
such as propensity scores or instrumental variables, should be
considered.
Causality and attribution bias cannot be completely eliminated,
even when utilizing the best available statistical methods.
Unintended effects from biases in assessment of performance
should be monitored carefully, especially when reimbursement
or other incentives are linked to the measures.
Source: Adapted from Terris & Aron (23).
Source: Adapted from Campbell et al. (21).
considering the design of individual indicators. An
important consideration is the level at which to present
performance data. Possibilities include the macro level
(such as national life expectancy), the meso level (such
as post-operative mortality rates in hospitals) and the
micro level (such as health outcomes achieved by
individual practitioners). Table 4 summarizes some of the
characteristics of good indicators. The intention is to
develop performance measures that exhibit the
characteristics of acceptability, feasibility, reliability,
sensitivity to change and validity.
The following sections look more closely at the
methodological considerations that need to be taken
into account when selecting which indicators to use and
how to use and interpret them.
Attribution and causality
Fundamental questions that arise when seeking to
interpret many performance data are: what has caused
the observed performance and to which practitioners,
organizations or agencies should variations in
performance be attributed? Hauck, Rice & Smith (22)
show that there are immense differences in the extent
to which the health system influences performance
measures, ranging from a very large effect on
responsiveness measures (such as waiting time) to a
small effect on population mortality, which is heavily
influenced by factors outside the health system. Such
variations should be considered when holding providers
and other stakeholders to account. To guide policy,
improve service delivery and ensure accountability, it is
critical that the causality of observed measures is
attributed to the correct source(s). When using statistical
methods to evaluate causal relationships and guide
policy, researchers and policy-makers should be careful
to control properly for measurement and attribution bias
(23). Box 3 gives key considerations that users of
performance measures need to take into account when
addressing causality and attribution bias.
Risk adjustment is an approach widely used to address
the problem of attribution. It adjusts outcome data
according to differences in resources, case mix and
environmental factors, thereby seeking to enhance
comparability (Box 4). In health care, in particular,
variations in patient outcomes will have much to do
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Background document
Box 4. Statistical considerations when performing risk
adjustment
Risk adjustment often involves using statistical modelling
applied to large databases with information from many
providers. The techniques produce weighting schemes for
assessing patient risk. The statistical models can then be used to
estimate the expected outcome for a provider, given its mix of
patients or populations, its actual outcome is then compared
with this benchmark. The following should be considered when
performing risk adjustment.
• Optimal risk-adjustment models result from a
multidisciplinary effort that involves the interaction of
clinicians with statisticians, as well as with experts in
information systems and data production.
• Different practice patterns, patient characteristics and data
specifications may limit the transferability of models across
different countries. Before applying a model developed in
another setting, clinicians and methodologists should
examine its clinical validity and statistical performance.
• Decision-makers should be wary when drawing conclusions
about the performance of risk-adjustment models from
statistical summary measures (such as coefficient of
determination, R2, values), as these measures may not
capture the model's predictive ability for different patient
subgroups.
• In cases where it is believed that patient characteristics may
also influence differences in the treatment patients receive, it
may be more appropriate to apply risk stratification instead
of (or alongside) risk adjustment.
Source: Adapted from lezzoni (24).
with variations in patient attributes, such as age or
socioeconomic class, and any co-morbidities. Similar
considerations apply when comparing measures of
population health. In such cases, it is essential to employ
methods of risk adjustment when using indicators and
comparing agents. A key question then is: for what is
the agent under scrutiny accountable? In the short run,
for example, a health system has to deal with the
epidemiological patterns and risky behaviour it inherits.
This implies a major need for risk adjustment when
comparing it with other health systems. In the longer
run, one might expect the health system to be
accountable for improving epidemiological patterns and
health-related behaviour. The need for risk adjustment
then becomes less critical, as the health system is
responsible for many of the underlying causes of the
measured outcomes.
Since early efforts with diagnosis-related groups in the
United States, the methods of risk adjustment have
been steadily refined over a period of 40 years,
particularly in adjusting for outcomes for specific
diseases or health care treatments. A key issue remains
the quality (especially the completeness) of the data on
which risk adjustment is undertaken, especially the
presence of co-morbidities or other complications.
Recording these data depends (ultimately) on the
practitioners whose performance is being assessed, so
there is an ever-present threat to the integrity of the
data if the incentives associated with performance
comparison are too stark. Also, most risk-adjustment
efforts are still works in progress, and there is often a
need for careful qualitative clinical commentary on any
risk-adjusted data, as there are often technical
limitations to any scheme. Risk adjustment, however, is
almost always essential if performance measurement is
to secure credibility with practitioners, so it is important
that efforts to improve on current methodologies are
sustained.
A specific issue in the interpretation of many
performance data is random variation, which by
definition emerges with no systematic pattern and is
always present in quantitative data. Statistical methods
become central to determining whether an observed
variation in performance has arisen by chance, rather
than from variations in the performance of agents
within the health system. As a matter of routine,
confidence intervals should be presented alongside
performance indicators. In the health care area, a
challenge for such methods is to identify genuine
outliers in a consistent and timely fashion, without
signalling an excessive number of false positives. This is
crucial when undertaking surveillance of individual
practitioners or teams. In dealing with this situation, one
must ask: when does a deviation from expected
outcomes become a cause for concern and when should
a regulator intervene? Statistical methods of squeezing
maximum information from time series of data are now
reaching an advanced stage of refinement and offer
great scope for more focused intervention (25).
Composite measures
Health systems are complex entities with multiple
aspects, making performance very difficult to
summarize, especially through a single measure. Yet,
when separate performance measures are provided for
the many different aspects of the health system under
observation - such as efficiency, equity, responsiveness,
quality, outcomes and access - the amount of
information provided can be overwhelming. Such
information overload makes it difficult for the users of
performance information to make any sense of the data.
In response to these problems, the use of composite
indicators has become increasingly popular. Composite
indicators combine separate performance indicators into
a single index or measure and are often used to rank or
compare the performance of different practitioners,
organizations or systems, by providing a bigger picture
and offering a more rounded view of performance (26).
However, if composite indicators are not carefully
designed, they may be misleading and could lead to
serious failings if used for health system policy-making
or planning (27). One of the main challenges in creating
composite indicators is deciding which measures to
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Performance measurement
Table 5. Advantages and disadvantages of composite indicators
Advantages
Offer a broad assessment of system performance
Place system performance at the centre of the policy arena
Enable judgement arid cross-national comparison of health system
efficiency
Offer policy-makers at all levels the freedom to concentrate on
areas where improvements are most readily secured, in contrast to
piecemeal performance indicators
Clearly indicate which systems represent the best overall
performance and improvement efforts
Can stimulate better data collection and analytic efforts across
health systems and nations
Disadvantages
May disguise failings in specific parts of the health care system
Make it difficult to determine where poor performance is
occurring and, consequently, may make policy and planning more
difficult and less effective
Often can lead to double counting, because of high positive
correlation
May use feeble data when seeking to cover many areas, which
may make the methodological soundness of the entire indicator
questionable
May make individual measures used contentious and hidden, due
to aggregation of the data
May ignore aspects of performance that are difficult to measure,
leading to adverse behavioural effects
May only reflect certain preferences when inadequately developed
methods for applying weights to composite indicators are used
Source: Adapted from Smith (27).
include in the indicator and with what weights. As
composite indicators aim to offer a comprehensive
performance assessment, they should include all
important aspects of performance, even if they are
difficult to measure. In practice, however, there is often
little choice of data, and questionable sources may be
used for some components of the indicator.
Considerable ingenuity may therefore be needed to
develop adequate proxy indicators (26, 27).
Fundamental to composite indicators is the choice of
weights (or importance) to be attached to the
component measures. All the evidence suggests that
there exist great variations in the importance different
people attach to different aspects of performance, so
the specification of a single set of weights is
fundamentally a political action. This indicates that the
choice of weights requires political legitimacy on the
part of the decision-maker. Analysis can therefore
inform, but should not determine, the choice of
weights. There exists a body of economic methodology
for inferring weights, which includes methods for
calculating willingness to pay, for eliciting patient's
preferences from rankings of alternative scenarios, and
for directing making choices in experiments. These
economic methods, however, have not been widely
applied to the construction of composite indicators of
health system performance (27).
Besides capturing effectiveness, a primary benefit of
composite indicators is that they allow the construction
of measures of the overall productivity (or cost-
effectiveness) of a health system. In particular, a
composite measure of health system attainment can be
assessed alongside expenditure without the need to
assign an expenditure to specific health system activities.
This was a principle underlying The world health report
2000 (7). However, the response to that report
emphasized that many aspects of constructing
composite attainment and productivity indicators are
disputable. Table 5 takes a closer look at the advantages
and disadvantages of using composite indicators for
health performance assessment.
Using performance measurement: key policy levers
Rapid advances in technology and analytical
methodology, coupled with changing public and
professional attitudes, have made the use of large-scale
information systems for performance assessment and
improvement increasingly feasible (4). Experiences with
realizing the potential of new data resources to improve
system performance, however, have so far shown
inconsistent results, and no consensus exists yet on the
best way to proceed. This section looks at some of the
experiences in using data for performance improvement
and at the lessons learned to date.
Information systems
Many of the earliest efforts to use performance data
concentrated on collecting and organizing existing
administrative information and disseminating it for
management applications. These early efforts focused
mainly on cost containment and resource allocation.
Examples include the development of diagnosis-related
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Background document
Box 5. The Nordic collaboration
Background
A Nordic Council of Ministers working group, consisting of 3-4
representatives from each of the Nordic countries (Denmark,
Finland, Greenland, Iceland, Norway and Sweden), was
established in 2000. Its overall aim is to facilitate collaboration
between the Nordic countries through the development of
quality indicators arid the creation of a foundation for
evaluations that should benefit the public, health care
professionals and health managers.
Indicators
Six subgroups work on selecting generic and disease-specific
indicators and indicators within the areas of patient safety,
psychiatry, primary health care, acute somatic care, public
health and preventive health care, and patient-experienced
health care. So far, the joint quality indicators selected for the
Nordic countries fall under the following categories:
1. general and disease-specific indicators (mortality and survival
rates for common illnesses);
2. health promotion and ill health prevention;
3. mental health;
4. primary care;
5. patient safety; and
6. the patient experience.
Source: National Board of Health and Welfare (30),
groups to compare hospital costs in the United States
and the release of a suite of performance indicators in
England to help managers understand how their local
health systems compared with the rest of the country.
Although (from a managerial perspective) such methods
are valuable in better exploiting existing data sources,
little attention was given to the use of this information
for evaluating external accountability or clinical
treatment (28).
Later developments, such as the establishment of the
Canadian Institute for Health Information in 1994 and
the Nordic collaboration in 2000 (Box 5), used large
databases of performance measurement in more
creative ways to assist with evidence-based decision-
making in health planning and with accountability.
Initially, performance data were used mostly by federal
and provincial institutions. Reports and summary
statistics, however, have increasingly been made
available to the public - for example, in the form of the
Statistics Canada annual reports. The Canadian Institute
for Health Information also focused on analysing the
data collected to produce reliable summary indicators, to
better understand why trends or patterns emerge and,
thus, to best guide policy (29).
Recent technological developments have increased the
ability to store a greater volume of information with a
greater level of detail, distribute it more widely and
flexibly, and update it more quickly. In the future, the
development of the electronic health record -
containing all the information on a patient's health
history - offers vast potential for capturing performance
in many areas. Many challenges, however, need to be
addressed if this potential is to be transformed into
reality. First, due to the sheer amount of data and the
speed at which it can be processed, auditing its accuracy
is becoming increasingly important and challenging; the
possibility of error carries with it severe implications, if
increasing reliance is to be placed on performance data.
Second, the constant development of technology calls
for continual investment in (and maintenance of) the
information infrastructure and entails the need to ensure
that the increasing number of information systems are
mutually compatible, if their full value is to be exploited.
Third, coordination is crucial to ensuring that the
information collected is comparable across institutions
and settings. Finally, the storage and use of so much
information raises ethical concerns about patient privacy
(31).
Public reporting
The placement of information in the public domain, to
inform the public and other stakeholders about
purchaser and provider performance, is growing. This
information often takes the form of report cards or
provider profiles that summarizes measures, such as
waiting times, patient satisfaction ratings and mortality
rates, across providers. Two broad objectives lie behind
the public disclosure of information: first, to stimulate
quality improvement and, second, to enhance the more
general accountability of health system organizations
and practitioners to the public who fund and use them.
Public reporting can improve quality through two
pathways, as illustrated in Fig. 2: (1) a selection pathway,
whereby consumers become better informed and select
providers of higher quality; (2) a change pathway,
whereby information helps providers to identify the
areas of underperformance, thus acting as a stimulus for
improvement (32).
Both the United Kingdom and the United States have
experimented extensively with the use of public
disclosure of performance information. The United
States has issued report cards for more than 20 years,
with its first significant effort led by the federal
government agency that administers the Medicare
insurance programme. This initiative sought to inform
consumer choice and stimulate provider improvement.
Following complaints about the validity of the rankings,
it was rapidly withdrawn. However, it has since
prompted the development of many other performance
reports produced by state and federal governments,
employers, consumer advocate groups, the media,
private enterprise and business purchasers.
There is considerable evidence that publication of
provider performance measures leads to improved
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Performance measurement
Fig. 2. Pathways for improving performance through publicly reported data
Publicly reported
• safety
• patient-centredness
Source: Adapted from Berwick, James & Coye (32).
performance (33). Although the immediate purpose of
publishing provider performance measures has often
been to facilitate and inform patient choice, there is
little evidence that patients make direct use of report
cards. However, through their effect on the reputation
of providers, report cards do appear to promote
performance improvements in providers. Apart from
their effect on performance, there are growing public
demands to make important outcome information
public and, in this respect, report cards can assist
regulation and enhance accountability.
Starting in 1992, in the United States, two states (New
York and Pennsylvania) have experimented with public
reporting of post-operative mortality rates for coronary
artery bypass graft surgery. These rates are risk adjusted
and published at the level of both the hospital and the
individual surgeon. The associated confidence intervals
are also reported, and a number of empirical analyses
have examined the effects of these celebrated report-
card initiatives. There is no doubt that the schemes have
been associated with a marked improvement in risk-
adjusted mortality in the two states (34). However, there
is a debate about whether these results necessarily imply
that the schemes have been beneficial, and a number of
adverse outcomes have also been reported, as follows
(35,36).
* The coronary artery bypass graft surgery report
cards led to increased selection by New York and
Pennsylvania providers, who were more inclined to
avoid sicker patients (who might benefit from
treatment) and to treat increased numbers of
healthier patients (for whom the benefits of
treatment are more contested).
• The initiative has led to increased Medicare
expenditures with only a small improvement in
population health.
• Practitioners were concerned about the absence of
quality indicators other than mortality, about
inadequate risk adjustment and about the
unreliability of data.
In England, all National Health Service health care
organizations are issued an annual performance rating -
a report-card rating them from zero to three stars, based
on about 40 performance indicators. These ratings were
strongly promoted by the national government and
received much media and public attention. Poor
performance has put executives' jobs at risk, and the
initiative has had a strong effect on reported aspects of
health care, such as waiting times. However, it has also
induced some unintended behavioural consequences,
such as a lack of attention to some aspects of clinical
quality, which have not been reported. In contrast to the
English case, Scotland published a range of important
clinical outcome data in the 1990s without any
associated publicity. Many governors, clinicians and
managers were unaware of the initiative and few
incentives were attached to the reports. As a result these
indicators had very little impact on the behaviour of
practitioners or organizations (37). This experience
highlights the need to associate an incentive (which
might be financial or reputation- or market-based) with
a public-reporting scheme.
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Background document
Box 6. National quality indicators in Norway
Background
Norway started to use national quality indicators for specialized
health care services in 2003. By 2006, data for 21 indicators
were registered (11 for somatic care and 10 for psychiatric care)
and, in addition to the indicators, patient-experience surveys
were also included. Data reporting is compulsory, and data is
published on the Free Hospital Choice Norway web site (38),
along with other initiatives and information on the waiting
times for different treatments. Data are presented at the
hospital level along with data on national averages and
developments over time.
Aims
Some important aims of data collection are:
1. to create a base level of quality arid generate incentives for
health care personnel to improve quality;
2. to identify a base level of quality for management;
3. to support prioritization of health care services by political
and administrative entities;
4. to provide the public with information and create
transparency in health care services; and
5. to provide users with information to make decisions.
Norway offers another example of public disclosure of
performance information. Box 6 discusses the use of
national quality indicators in Norway.
Publicly reported information has had a limited direct
effect so far on patients and professionals, probably
because it is necessarily aggregated and because the
indicators reported are limited and inconsistent (39).
However, there is increasing evidence that health care
organizations do take notice of these data, which have
an important effect on their reputations, and that
publication of performance information has led to
concrete performance improvements (34,40).
Notwithstanding doubts about its effectiveness in
promoting system improvement, the publication of
performance information also serves an important
accountability role. There is therefore no doubt that
increased public reporting of outcomes of care is an
irreversible trend in most health systems. However, it can
lead to adverse outcomes, if not implemented and
monitored with care.
Experience to date suggests the following points should
be taken into account when implementing public
disclosure of data.
• Careful consideration should be given to the
purpose of the disclosure and to the type of
information the different health system
stakeholders want and are able to use.
• Careful consideration should be given to the effect
that public disclosure of information may have on
quality of care. Where appropriate, public
disclosure of information should be integrated with
other quality improvement strategies (41).
• To enhance their credibility and usefulness, public
performance reports should be created in
collaboration with physicians and other legitimate
interest groups (35, 41).
• When reporting data, careful risk adjustment
should be implemented to offer accurate
comparisons between providers and to ensure that
the legitimacy of the comparisons is accepted by
professionals (24, 41). Detailed information on the
risk-adjustment strategies used should be made
available alongside the reported information for
public scrutiny.
Incentives
There is no doubt that clinicians and other actors in the
health system generally respond as expected to financial
incentives (42). The incorporation of performance
measurement into financial-incentive regimes therefore
potentially offers a promising avenue for future policy,
and a number of experiments that attach financial
rewards to reported performance are now under way.
Historically, the use of indirect financial incentives in
health care has been proffered through systems of
accreditation that offer rewards in the form of access to
markets or extra payments, once specified structures of
care are put in place. Germany has an accreditation
system of this sort at the regional level, where specific
quality indicators are used for accreditation (43).
Accreditation is, however, a very blunt incentive
instrument. Policy is now shifting towards much more
direct and focused incentives. In particular, the United
States has been experimenting with financial incentives
in different contexts, such as the rewarding results
experiment, which uses incentives to improve quality
(44). However, these have so far been small-scale
experiments, and the results have been difficult to assess
with any confidence.
Many issues need to be considered when designing
performance-incentive schemes, including which aspects
of performance to target, how to measure attainment,
how to set targets, whether to offer incentives at the
individual or group level, how strong to make the link
between achievement and reward, and how much
money to attach to an incentive. Also, evaluating such
schemes is essential, but challenging. In most instances,
a controlled experiment is not feasible, as it is often not
feasible to establish a convincing do-nothing baseline
with which to compare the policy under scrutiny.
Moreover, constant monitoring is needed to ensure that
unintended responses to incentives (such as cream-
skirriming or other unwanted behavioural responses) are
not occurring, that the incentive scheme does not
jeopardize the reliability of the performance data on
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Performance measurement
Box 7. The contract for general practitioners. United Kingdom
Framework
In April 2004, a new general-practitioner contract took effect in the United Kingdom National Health Service. This new contract more
closely linked general practitioners with quality targets for both clinical and organizational activities through the Quality and Outcomes
Framework programme. The programme rewards general practitioners for meeting targets in targeted areas, measured by about 150
indicators. Each indicator has a number of points allocated to it, varying according to the amount and difficulty of work required to
successfully meet these criteria. A maximum of 1050 points can be earned, and up to 20% of general practitioner income is at risk under
the scheme.
Targeted areas
Indicators upon which points are allocated are measured for the following main categories (some smaller categories are omitted):
• clinical areas (76 indicators (focused on medical records, diagnosis, and initial and ongoing clinical management) and 550 points): such
as coronary heart disease, stroke and transient ischaemic attack, hypertension, hyperthyroidism, diabetes, mental health, chronic
obstructive pulmonary disease, asthma, epilepsy and cancer;
• organizational areas (56 indicators and 184 points): such as records and information about patients, communication with patients,
education and training, practice management and medicine management;
• patient experience (4 indicators and 50 points): such as appointment length and consulting with patients about other issues; and
• additional services (10 indicators and 36 points): such as cervical screening, child health surveillance, maternity services and
contraceptive services.
No risk adjustment is undertaken. Instead, practices may exclude certain patients from performance measurement, if the required
intervention is clinically inappropriate or if the patient refuses to comply.
Findings to date
• In preparation for the 2004 programme, general practitioners in the United Kingdom employed more nurses and administrative staff,
established chronic-disease clinics and increased the use of electronic medical records (46). Also, general practitioners are increasingly
delegating tasks to other members of clinical staff. For example a nurse may be asked to specialize in diabetes care (47).
• Although the Quality and Outcomes Framework programme was voluntary, in its first year of implementation almost all United
Kingdom practices chose the programme, with the median practice scoring 95.5% of the possible points available. In the clinical areas,
the median score was 96.7% (46). The achievements of years two and three of the contract have been similarly high (48).
• Interviews with general practitioners suggested they were concerned about the programme's focus on biomedical targets, which may
lead to a reduced focus on other important aspects of care and may interfere with their ability to treat the patient as a whole person
(47).
• There is little evidence of manipulation of the prevalence data on which performance is based. Flowever, some practices do appear to
be making excessive use of exception reporting (49).
• Although there is some evidence that the Quality and Outcomes Framework programme has improved patient care, quality was
already improving rapidly in primary care and the specific effect of the programme seems to have been small (50, 51).
Source: Adapted from Lester & Roland (52).
which it relies, and that it does not compromise
unrewarded aspects of performance.
The United Kingdom is experimenting with an ambitious
financial-reward system for general practitioners,
introduced in April 2004, under which about 20% of
earnings are directly related to their performance across
about 150 quality indicators (45) (Box 7). So far, it has
not been possible to attribute any major improvements
in general-practitioner performance, or other system
improvements, to this bold (and very expensive)
experiment. More generally, while performance-based
incentive schemes do appear to offer immense potential
for system improvement, there is a clear need for more
careful research to identify the best mechanisms for
harnessing their potential.
Targets
Health system targets are a specific type of performance
measurement and incentive scheme and are a
quantitative expression of an objective to be met in the
future. Targets have been brought to health policy from
the field of business, the main idea being that when
goals are explicitly defined as targets, more organized
and efficient efforts will be made to meet them. Targets
are expected to be SMART: specific, measurable,
accurate, realistic and time bound (53). If well designed,
targets can help organizations and practitioners focus
on a manageable number of achievable goals, which
thereby lead to system improvements. The governments
of many countries - including European Region Member
States (most notably, the United Kingdom), Australia,
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Background document
New Zealand and the United States - have
experimented with targets in health care.
However, evidence on the success nf using health
system targets is limited (54) They have traditionally
been used extensively in public health, but reports of
measurable success are rare The English experience with
the 1992 Health nf the Nation stiatecjy is typical The
strategy was based on the WHO health for dll initiative
and set a series of ambitious public health targets
Howevei, a careful independent evaluation in 1998
concluded that its "impact on policy documents peaked
as early as 1993, and, by 1997, its impact on local
policy-making was negligible" (55). Hunter summarized
its failings under six broad headings (56).
1. There appeared to be a lack of leadership in the
national government.
2. The policy failed to address the underlying social
and structural determinants of health.
3. The targets were not always credible and were not
formulated at a local level.
4. The strategy was poorly communicated beyond the
health system.
5. The strategy was not sustained.
6. Partnerships between agencies were not
encouraged.
In the past decade, targets have been an espe< lally
strong feature of English health care policy Starting in
1998, the Treasury issued strategic targets, called Public
Service Agreements, to all government departments,
including the health ministry (57). Public Service
Agreements were focused primarily on outcomes, such
as the improvement of mortality rates, reductions in
smoking and obesity, and reductions in waiting times.
The health ministry used the star rating report cards,
described above, as a key instrument to achieve these
objectives. In contrast to most national target systems,
this proved notably effective in securing some of the
targeted objectives in health care (58). This success can
be attributed to the following.
* The targets were precise, short-term objectives,
rather than long-term and general.
* Targets were based at the local level, rather than
the national level.
* Professionals were engaged in the design and
implementation of some of the targets. While this
ran the risk of leading to so-called capture by
professional interests, it also served to increase the
awareness of objectives.
* Organizations were given increased financing,
information and managerial capacity to respond to
challenging targets.
* Concrete incentives were attached to the targets.
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However, this success in health care was not replicated
in the area of public health, almost certainly because
managers felt health care targets were much more
amenable to health system intervention.
While targets provide a straightforward way of
highlighting key objectives and can be very successful if
designed and implemented correctly, there are notable
risks associated with their use (59). Box 8 identifies some
of the risks associated with increased reliance on targets.
The conclusions from this experience are that, while
performance targets offer some latitude for focusing
system attention on specific areas of endeavour, they are
unlikely to secure performance improvements, unless
implemented carefully alongside other improvement
initiatives, such as more general inspection and
regulation.
Professional improvement
Most of the uses of performance measurement
described above have been concerned with providing
some means of external assessment and scrutiny of the
health system, as a mechanism for prompting improved
peifomiance Yet, another important use of
performance measurement can be to provide feedback
for clinicians on their performance relative to their peers.
Databases that serve this purpose exist in many
countries. For example, in Sweden they take the form of
quality registers, where individual-based data on patient
characteristics, diagnoses, treatments, experiences and
outcomes are all collected voluntarily on the part of the
health care providers and shared with other members of
the register. The explicit aim of the quality registeis is to
facilitate the improvement of quality in clinical work
through continuous learning and development (60) (Box
9). Indeed there is a strong argument that performance
measurement should become an inherent part ot a
clinician's lifelong learning. This suggests the need for a
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Performance measurement
Box 9, Sweden's quality registers
The development of national quality registers in Sweden has
been a major effort in promoting performance improvement.
Sweden has about 50 active quality registers, with the first one
dating back to 1979.
The aim of a national quality register is to encourage good
medical practice through the comparison and evaluation of
outcome and quality information over time and between
providers.
A variety of organizational patterns are used, but each is
clinically led and typically maintained by a group (usually
located in one of the Swedish university hospitals) that collects,
assembles, analyses and distributes the data to its members.
Several meetings might be organized each year to discuss this
material. The participation of clinicians in a registry group is
voluntary, and in most cases registers develop gradually.
When a register is developed, the quality indicators and
reporting tools are established on the basis of consensus within
the medical specialty and are often refined from year to year.
Information on departments is anonymous. However, most
well-established registers do present department data publicly.
The quality registers provide clinicians with essential information
with which to compare performance and facilitate discussion on
improvement. Increasingly, data from quality registers have also
been used to support decision-making.
Source: Rehnqvist (60),
prominent role for performance measurement principles
in early clinical training.
Whether information for professional improvement
should be kept anonymous or be made available to the
public is widely debated. Evidence suggests that, to be
effective, such performance measurement schemes need
to be designed and owned by the professionals who use
them (61). It is argued that the most constructive
systems are those that encourage positive and
cooperative behaviour among clinicians and avoid public
threats to their professional or commercial standing,
which may encourage defensive behaviour that could
lead to cream skimming or other unwanted behavioural
responses. Indicators used for professional improvement
should therefore:
• reflect meaningful aspects of clinical practice with a
strong scientific underpinning;
• ensure risk adjustment of indicators;
• allow exclusion of certain patients, such as those
who refuse to comply with treatment;
• facilitate interpretability;
• represent services under a provider's control;
• ensure high accuracy; and
• minimize cost and burden.
Also, as well as measuring the outcomes of care, it is
important to seek to measure the extent of
inappropriate care (overuse or underuse of treatments).
The requirements of a successful professional-
improvement performance-measurement system may
therefore come into conflict with the requirements of
information systems designed to promote accountability
and patient choice. This is not to say that the tension
between these different needs and demands cannot be
resolved. Experiences from Sweden and elsewhere, such
as Denmark and the Netherlands, suggest that public
and professional needs can be reconciled - for example,
some quality registers do publish outcomes on individual
practitioners (62). In any case, patients will in all
likelihood increasingly demand that more performance
data be made available. The challenge for the professions
is to ensure that this trend is harnessed to good results,
rather than leading to defensive professional behaviour.
One solution lies in the careful development of
acceptable, statistical, risk-adjustment schemes and in
careful presentation of statistical data, so that the public
and media are better equipped to understand and
interpret the information that is made available to them.
Summary and conclusions
The ultimate goal of any performance-measurement
instrument is to promote the achievement of health
system objectives. Thus, its effectiveness should be
evaluated not in relation to statistical properties, such as
accuracy and validity, but should be evaluated more
broadly in relation to the extent to which it promotes or
compromises these objectives. Effective performance
measurement alone is not enough to ensure effective
performance management. The functions of analysis
and interpretation of performance data are also crucial.
Also, performance measurement is only one (albeit very
important) instrument for securing system improvement.
To maximize its effect, performance measurement needs
to be aligned with other aspects of system design, such
as financing, market structure, accountability
arrangements and regulation. Finally, a great deal of
attention needs to be paid to the political context within
which any performance-measurement scheme is
implemented. Without careful attention to these
broader health system considerations, the best
performance-measurement system will be ineffective.
Governments have a major stewardship role to play in
harnessing the full potential of performance
measurement for improving the health system. The
world health report 2000 (7) defined stewardship as
"defining the vision and direction of health policy,
exerting influence through regulation and advocacy, and
collecting and using information". The present
document has sought to outline how performance
measurement can help governments fulfil each of these
roles. It has argued that performance measurement
offers health systems major opportunities to secure
performance improvement and that no health system
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Background document
Box 10. Stewardship responsibilities associated with
performance measurement
Stewardship responsibilities associated with performance
measurement can be summarized under the headings that
follow. None of these roles need be undertaken by government
itself, but it must be ensured that they all function effectively:
1. development of a clear conceptual framework and a
clear vision of the purpose of the performance
measurement system:
• alignment with accountability relationships;
• alignment with other health system mechanisms, such as
finance, market structure and information technology;
2. design of data collection mechanisms:
• detailed specification of individual indicators;
• alignment with international best practice;
3. information governance:
• data audit and quality control;
• ensuring public trust in information;
• ensuring well-informed public debate;
4. development of analytical devices and capacity to help
understand the data:
• ensuring analysis is undertaken efficiently and effectively;
• ensuring local decision-makers understand the analysis;
• commissioning appropriate research on, for example, risk
adjustment, uncertainty and data feedback mechanisms;
5. development of appropriate data aggregation and
presentational methods:
• ensuring information has appropriate effect on all parties;
• mandating public release of summary comparative
information;
• ensuring comparability and consistency;
6. design of incentives to act on performance measures:
• monitoring effect of performance information on behaviour;
• acting to enhance beneficial outcomes and negate any
adverse consequences;
7. proper evaluation of performance-measurement
instruments:
• ensuring money is spent cost-effectively on information
resources;
8. managing the political process:
• developing and monitoring policy options;
• encouraging healthy political debate;
• ensuring that specific interest groups do not capture the
performance information system.
can be adequately steered without good performance
information and intelligence. The overarching role of
performance measurement is to enhance the decisions
made by actors throughout the health system.
Performance information can help governments directly
in formulating and evaluating policy and in undertaking
regulation. The broader stewardship role of
governments is, however, to ensure that the necessary
flow of information is available, functioning properly
and aligned with the design of the health system.
Performance measurement is a public good that will not
occur naturally. Governments therefore have a
fundamental role to ensure that the maximum benefit is
secured from performance measurement, whether
through law, regulation, coordination or persuasion.
Implementation then requires sustained political and
professional leadership at the highest level and also
assurance that the necessary analytical capacity is
available throughout the health system.
Some of the stewardship responsibilities of government
in the area of performance measurement are
summarized in Box 10.
Given the increasing demand for performance
measurement and given the large set of actors and
responsibilities, it is important that policy-makers
consider what makes performance indicators effective in
improving system performance and accountability.
Although there is no conclusive answer to this question,
experience has suggested that any policy development
should embrace the following.
1. A clear conceptual framework and a clear vision of
the purpose of the performance-measurement
system should be developed and should be aligned
with the accountability relationships inherent in the
health system.
2. Performance indicators should attempt to measure
performance that is directly attributable to an
organization or actor, and not to environmental
factors (such as patient attributes or socioeconomic
factors).
3. Definitions of performance indicators should be
clear and consistent and should fit into the
conceptual framework chosen.
4. Indicators should aim to measure concepts that are
relevant to the needs of specific actors and should
not focus merely on measuring what is available or
easy to measure.
5. Indicators should aim to be statistically sound and
should be presented in a way that is
straightforward to interpret, thus reducing the
likelihood of manipulation or misinterpretation.
6. Indicators should be presented with full
acknowledgement of any data limitations,
including uncertainty estimates and lack of
timeliness. Further exploration of improved
processes for handling measurement errors is
needed, as such errors may confound true
performance differences.
7. More attention should be paid to the presentation
of performance data and how this influences their
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Performance measurement
interpretation by patients, providers and provider
organizations,
8. Attention should bp given to enhancing the
capacity to understand and use information among
managers and clinicians. Use of peitnimance data
should become an intrinsic part ot clinical
education and lifelong professional development,
9. Incentives that act on peitmmance measures
should be carefully designed The impact of
performance information on behaviour should be
carefully monitored, and actions should be taken to
enhance beneficial outcomes and to negate any
adverse consequences.
10. Policy-makers should pay particular attention to the
broader health system, to ensure that performance
measurement is aligned with the design of
mechanisms, such as finance and market
structures, and to recognize the organizational
context within which performance data are
collected and disseminated.
11. Performance measurement systems should be
monitored frequently and evaluated to identify
opportunities for improvement and any unintended
side-effects.
12. The political aspects of performance measurement
should be managed effectively. Among other
things, this involves ensuring that specific interest
groups do not capture the performance
information system and also involves encouraging
healthy political debate
Health systems ate still in an early stage of performance
measurement, and major steps can still be taken to
improve the effectiveness of their measurement systems.
Performance measurement, however, offers
opportunities for major health system improvements.
Advances in technology are likely to increase this
potential still further, and the increasing public demands
for accountability and information will reinforce current
trends. There is therefore a policy-making imperative to
consider carefully the role of performance measurement
in the health system, to implement initiatives of proven
effectiveness, to undertake careful trials of less
established mechanisms and to monitor and update
performance measurement systems as new knowledge
and capacity emerge.
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Background document
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7. The world health report 2000: health systems:
improving performance. Geneva, World Health
Organization, 2000 (http://www.who.int/entity/whr/
2000/en/index.html, accessed 13 May 2008).
8. Holland W. European Community atlas of 'avoidable
death'. Oxford, Oxford University Press, 1988.
9. Nolte E, McKee M Does healthcare save lives?
Avoidable mortality revisited. London, The Nuffield Trust,
2004.
10. Fitzpatrick R. Individual health outcomes from health
care interventions. In: Smith PC et al., eds. Performance
measurement for health system improvement:
experiences, challenges and prospects. Cambridge,
Cambridge University Press (in piess).
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caie, Milbank Memorial Fund Quarterly, 1966,
44(3):166-206.
12. Naylor DC, Iron K, Hancia K. Measuring health
system performance: problems and opportunities in the
era of assessment and accountability. In: Smith PC, ed.
Measuring up: improving health system performance in
OECD countries. Paris, Organisation for Economic Co-
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13 Davies H Measuring and reporting the quality of
health care: issues and evidence from the international
research literature Edinburgh, NHS Quality
Improvement Scotland, 2005 (http://www nhshealth
qualitynrg/nhsc|is/files/Davies%20Papet pdf, accessed 13
May 2008)
14. Mant J. Process versus outcome indicators in the
assessment of quality of health care. International
Journal for Quality in Health Care, 2001, 13(6):475-480.
15. Valentine N et al. Responsiveness In Smith PC et al.,
eds. Performance measurement for health system
improvement: experiences, challenges and prospects.
Cambridge, Cambridge University Press (in press).
16 Wagstaff A. Financial protection. In: Smith PC et al.,
eds. Performance measurement for health system
improvement: experiences, challenges and prospects.
Cambridge, Cambridge University Press (in press).
17. Street A, Hakkinen U. Health system In Smith PC et
a I., eds. Performance measurement for health system
improvement: experiences, challenges and prospects
Cambridge, Cambridge University Press (in press)
18. Linna M. Benchmarking hospital productivity. Berlin,
Bertelsmann Foundation Health Policy Monitor, 2006
(http://www.hpm.org/en/Surveys/STAKES/Q7/
BenchmarkingJiospital_productivity.html, accessed 13
May, 2008).
19. Sairaaloiden tuottavuuden kehitys 2001-2005 [The
development of hospitals' profitability, 2001-2005],
Helsinki, Finnish National Research and Development
Centre for Welfare and Health, 2007 (Tilostotiedote
Statistikmeddelande 5/2007; http://www.stakes.fi/
tilastot/tilastotiedotteet/2007/Tt05_07.pdf, accessed 13
May 2008),
20. Health Care Quality Indicators Project [web site].
Pans, Organisation tm Economic Co-opwation and
Development (http //www oecd org/docunient/34/
0,3343,en_2649_201185_37088930_1_1_1_1,00 html,
accessed 13 May 2008).
21 Campbell SM et a I Research methods used in
developing and applying quality indicators in primary
care. Quality and Safety in Health Care, 2002, 11:358-
364,
22. Hauck K, Rice N, Smith P. The influence of health
care organisations on health system performance.
Journal of Health Services Research and Policy, 2003,
8(2):68-74.
23. Terris DD, Aron DC Attnbution and causality in
health care performance measuiement In Smith PC et
al„ eds. Performance measurement for health system
improvement experiences challenges and prospects
Cimbndge, Cambudge University Press (in press)
24. lezzoni, L. Risk adjustment for performance
measurement. In: Smith PC et al,, eds. Performance
measurement for health system improvement:
experiences, challenges and prospects. Cambridge,
Cambridge University Press (in press).
25. Grigg O, Spiegelhalter D. Clinical surveillance and
patient safety. In: Smith PC et al., eds. Performance
measurement for health system improvement:
experiences, challenges and prospects. Cambridge,
Cambridge University Press (in press).
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Performance measurement
26. Goddard M, Jacobs R. Using composite indicators to
measure performance in health care. In: Smith PC et al,,
eds. Performance measurement for health system
improvement: experiences, challenges and prospects.
Cambridge, Cambridge University Press (in press).
27. Smith PC Developing composite indicators for
assessing health system efficiency In Smith PC, erj
Measuring up impn wmq the perk miance < if health
systems in OECD countries Pans, Organisation foi
Economic Co-opeiation ,ind Development, 2002 295
316.
28. Smith PC. The use of performance indicators in the
public sector. Journal of the Royal Statistical Society,
1990, 153(1)53-72.
29 Wolf son M, Alvarez R. Towards integrated and
coheient health information systems for performance
monitoring: the Canadian experience. In: Smith PC, ed.
Measuring up: improving health system performance in
OECD countries. Paris, Organisation for Economic Co-
operation and Development, 2002:133-155.
30. Nationella kvalitetsindikatorer inom halso- och
sjukvarden [National Quality Indicators in the health care
system], Stockholm, National Board of Health and
Welfare, 2006 (http://www.socialstyrelsen se/NR/
rdon lyres/2 8769 591-A924-4AD9-ADD8-
352B79875D51/5783/200610713.pdf, accessed 13 May
2008).
31. Sequist T, Bates D. Information technology and
performance measurement. In: Smith PC et al, eds.
Performance measurement for health system
improvement: experiences, challenges and prospects.
Cambridge, Cambridge University Press (in press).
32. Beiwick DM, James B, Coye MJ. Connections
between guality measurement and improvement.
Medical Care, 2003, 41(Suppl 1)130-138
33. H lb bard JH, Stockard J, Tusler M. Hospital
performance reports impact on quality, market share,
and reputation Health Affairs, 2005, 24(4) 1150-1160
34 Shekelle PG Public reporting of quality information.
In Smith PC et al., eds. Performance measurement for
health system impn wement experiences challenges and
prospects Cambridge, Cambridge University Piess (in
press).
35. Schneider EC, Epstein AM. Influence of cardiac-
surgery performance reports on referral practices and
access to care. New England Journal of Medicine, 1996,
335(4) :251 256.
36. Dranove D et al. Is more information better? The
effects of "report cards" on health care providers.
Journal of Political Economy, 2003, 111 (3) 555 588.
37. Mannion R, Goddard M. Impact of published clinical
outcomes data: case study in NHS hospital trusts. British
Medical Journal, 2001, 323:260-263.
38. Fritt Sykehusvalg Norge [Free Hospital Choice
Norway] [web site], Oslo, Social- og Helsdirektoratet
(http //www.trittsykehusvalg.no, accessed 13 May 2008).
39. Marshall MN et al. Public reporting on quality in the
United States and the United Kingdom. Health Affairs,
2003, 22(3) 134-148.
40. Marshall MN et a I The public release of
performance data, what do we expect to gain? A review
of the evidence. Journal of the American Medical
Association, 2000, 283(14)1866-1874.
41 Marshall MN et al Public disclosure of performance
data learning from the US experience. Quality in Health
Care, 2000, 9 53-57
42. Dudley RA. Pay -for-performance research: how to
learn what clinicians and policy makers need to know.
Journal of the American Medical Association, 2005,
294(14)1821-1823
43. Der Gemeinsame Bundesausschuss [web site],
Siegburg, Gemeinsamer Bundesausschuss
(http://www.g-ba.de/, accessed 13 May 2008).
44. Ensuring quality providers: a purchaser's toolkit for
using incentives. Washington, National Health Care
Purchasing Institute, 2002.
45. Smith PC, York N. Quality incentives: the case of
U K general piactitioners. Health Affairs, 2004,
22(3):112-118.
46. Doran T et al. Pay-for-performance programs in
family practices in the United Kingdom. New England
Journal of Medicine, 2006, 355(4):375-384.
47. Roland MO et al. Financial incentives to improve the
quality of primary care in the UK: predicting the
consequences of change. Primary Health Care Research
and Development, 2006, 7(1):18-26.
48. Burr T. NHS pay modernisation: new contracts tor
general practice services in England. London, National
Audit Office, 2008 (http.//www.nao.org,uk/publications/
nars fn mi the
Quality and Outa mes Framewi irk 2001-2006 Leeds,
The Information Centre for Health and Social Care,
2007.
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-------
Background document
52. Lester H, Roland M. Performance measurement in
primary cate lir Smith PC et a I,, eds. Performance
measurement for health system improvement:
experiences, challenges and prospects. Cambridge,
Cambridge University Press (in press).
53. van Herten LM, Gunning-Schepers LJ. Targets as a
tool in health policy. Part 1: lessons learned. Health
Policy, 2000, 53(1): 1-11.
54. Wismar M et al., eds. Good governance for
implementing health targets. Maidenhead, Open
University Press (in press).
55. Health of the nation - a policy assessed. London,
Department of Health, 1998.
56. Hunter D. England. In: Marinker M, ed. Health
targets in Europe: polity, progress and promise. London,
BMJ Books, 2002:148-164.
57. Smith PC. Perfomiance budgeting in England: public
service agieements In Robinson M, ed. Performance
budaeting linking funding and results. Houndmills,
Palgiave Macmillan, 2007.211-233.
58 Bevan G, Hood C. Have targets improved
peifomiance in the English NHS? British Medical Journal,
2006, 332:419-422.
59. Smith PC. Targets in the English health system. In:
Wismai M et al, eds Good governance for
implementing health targets. Maidenhead, Open
University Pi ess (in press)
60. Rehnqvist N. Improving accountability in a
decentralized system: a Swedish perspective. In: Smith
PC, ed. Measuring up: improving the performance of
health systems in OECD countries. Paris, Organisation
for Economic Co-operation and Development, 2002:87-
96.
61. Rowan K, Black N A bottom-up approach to
performance indicators through clinician networks
Health Care UK, 2000, Spring 42-46.
62. Den Danske Kvalifetsmoclels organisation [The
Danish Quality Model Oiganization] |web site) Arhus,
Danish Institute for Quality and Accieditation in
Healthcare, 2007 (http //www kvalitetsinstitut dk/
sw179.asp , accessed 13 May 2008).
20
A4 p.894
-------
World Health Organization
Regional Office for Europe
Scherfigsvej 8,
DK-2100 Copenhagen 0,
Denmark
Tel.: +45 39 17 17 17.
Fax: +45 39 17 18 18.
E-mail: postmaster@euro.who.int
Web site: www.euro.who.int
This report is one of three background documents prepared for the WHO
European Ministerial Conference on Health Systems: "Health Systems, Health
and Wealth", held on 25-27 June 2008 in Tallinn, Estonia. Together, these
reports demonstrate that:
• ill health is a substantial burden economically and in terms of societal well-
being;
• well-run health systems can improve health and well-being, and contribute
to wealthier societies, and
• strategies are available to improve health systems' performance.
These are the key themes of the Conference. These detailed syntheses highlight
important research findings and their implications, and underline the challenges
that they pose for policy-makers. They support the Conference position that
cost-effective and appropriate spending on health systems is a good investment
that can benefit health, wealth and well-being in their widest senses.
WHO European Ministerial
Conference on Health Systems:
"HeauH sYSTems,
HeaLTH anpweaLTH"
Tallinn, Estonia, 25-27 June 2008
These three background documents together provide the theoretical
foundations around which the aims, arguments and rationale for the
Conference are oriented. Document 1 gives the background evidence on the
cost of ill health and is supported by twin volumes on health as a vital
investment in eastern and western Europe. Documents 2 and 3 represent
concise synopses of the two comprehensive Conference volumes being
coordinated by the European Observatory on Health Systems and Policies.
These volumes on health systems, health and wealth and performance involve
a range of leading experts and will be made available to delegates in draft for
comment. They will be revised in light of feedback before publication at the
end of 2008.
Background document #2
Performance measurement for health system improvement:
experiences, challenges and prospects
This summary makes the case for performance measurement as key tool for
policy-makers endeavouring to improve health systems in the European Region.
It highlights the various elements required of a comprehensive health system
performance measurement framework; pinpoints how performance
measurement can be used in practice; and stresses the role of government
stewardship in securing improved performance. It reviews existing evidence
and provides examples of the empirical application of performance
measures, demonstrating that if governments invest in health
they can expect those resources to be used well.
A4 p.895
EUROPE
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Sodium Fluorosilicate
Material Safety Data Sheet
Responsible Care*
Good Chemistry at Work
Page 1/9
Chemical: Sodium Fluorosilicate
NFPA: H=3 F=0 l= 0 S=None
HMIS: H=3 F=0 R=0 PPE= Supplied by user;
dependent on conditions
MSDS Number:
Effective Date:
Issued by:
NaSiF6-1103
11 October 2003
Solvay Chemicals, Inc. Regulatory Affairs Department
Not valid three years after effective date or after issuance of superseding MSDS, whichever is
earlier. French or Spanish translations of this MSDS may be available. Check www.solvaychemicals.us
or call Solvay Fluorides, LLC to verify the latest version or translation availability.
Material Safety Data Sheets contain country specific regulatory information; therefore, the MSDS's
provided are for use only by customers of Solvay Fluorides, LLC in North America. If you are located
in a country other than the United States, please contact the Solvay Group company in your country
for MSDS information applicable to your location.
1. Company and Product Identification
1.1
Product Name:
Chemical Name:
Synonyms:
Chemical Formula:
Molecular Weight:
CAS Number:
EINECS Number:
Grade/Trade Names:
Sodium Fluorosilicate
Sodium Silicofluoride
Sodium Fluosilicate, Sodium Fluorosilicate, Sodium Silica Fluoride,
Disodium Hexafluoro- Silicate(2-)
Na2SiF6
188.1
16893-85-9
240-934-8
N/A
1.2
1.3
1.4
Recommended Uses: Fluoride source for water
Supplier:
Solvay Fluorides, LLC
PO BOX 27328 Houston, TX 77227-7328
3333 Richmond Ave. Houston, Texas 77098
Emergency Telephone Numbers
General: 1-877-765-8292 (Solvay Fluorides, LLC)
Emergencies (USA): 1-800-424-9300 (CHEMTREC®)
Transportation Emergencies (INTERNATIONAL/MARITIME): 1-703-527-3887 (CHEMTREC®)
Transportation Emergencies (CANADA): 1-613-996-6666 (CANUTEC)
Transportation Emergencies (MEXICO-SETIQ): 91-800-00-214-00 (MEX. REPUBLIC)
-0-11 -525-559-1588 (elsewhere)
MSDS No. NaSiF6-1103 Revised 10-11-03
Copyright 2003, Solvay Fluorides, LLC
A subsidiary of Solvay Chemicals, Inc.
All Rights Reserved.
www.solvaychemicals.us 1.800.765.8292
Solvay
Fluorides
A Subsidiary of Solvay Chemicals, Inc.
A4 p.896
-------
Sodium Fluorosilicate
Material Safety Data Sheet
2. Composition/Information on Ingredients
INGREDIENTS
Sodium Silicofluoride
Water
Insoluble Matter
FORMULA
Na2SiF6
H20
WT. PERCENT
> 98.0%
< 0.5%
< 0.5%
CAS#
16893-85-9
7732-18-5
3. Hazards Identification
Emergency Overview:
• Hazardous product for the human health and the aquatic environment.
• Presents hazards from its ionizing fluorine.
• In case of decomposition, releases hydrogen fluoride.
3.1 Route of Entry: Inhalation: Yes Skin: Yes Ingestion: Yes
3.2 Potential Effects of exposure:
• Irritating to mucous membranes, eyes and skin.
• Risk of cardiac and nervous disorders.
• Chronic exposure to the product can cause bone fluorosis.
Inhalation:
• Nose and throat irritation.
• Spasmodic cough and difficulty in breathing.
• At high concentrations, risk of hypocalcemia (possible life-threatening lowering of serum
calcium) with nervous problems (tetany) and cardiac arrhythmia (heart irregularity).
• In case of repeated or prolonged exposure; risk of sore throat, nose bleeds,
chronic bronchitis.
Eyes: Severe eye irritation, watering, and redness.
Skin contact:
• Irritation, redness and swelling of the skin.
• In case of prolonged contact: risk of burns.
Ingestion:
• Severe irritations, burns, perforation of the gastrointestinal tract accompanied by shock.
• Nausea, vomiting (bloody), abdominal cramps and diarrhea (bloody).
• Risk of hypocalcemia (possible life-threatening lowering of serum calcium) with nervous
problems (tetany) and cardiac rhythm disorders.
• Risk of convulsions, loss of consciousness, deep coma and cardiopulmonary arrest.
• Risk of general symptoms having a severe prognosis.
Carcinogenicity: See section 11.3
MSDS No. NaSiF6-1103 Revised 10-11-03
Copyright 2003, Solvay Fluorides, LLC
A subsidiary of Solvay Chemicals, Inc.
All Rights Reserved.
www.solvaychemicals.us 1.800.765.8292
A4 p.897
-------
Sodium Fluorosilicate
Material Safety Data Sheet
4. First-Aid Measures
4.1 General Recommendations: Strict hygiene during and at the end of working shifts
Inhalation:
• Remove the subject from dusty environment.
• Oxygen or cardiopulmonary resuscitation if necessary.
• Consult with a physician in case of respiratory symptoms
Eyes:
• Consult with an ophthalmologist immediately in all cases.
• Take to hospital immediately.
• Flush eyes with running water for 15 minutes, while keeping the eyelids wide open.
Skin:
• Remove contaminated shoes, socks and clothing; while washing the affected skin with
soap and water for 15 minutes. Double bag all contaminated clothing for disposal.
• Cover with an anti-bacterial cream.
• Provide clean clothing.
• Consult with a physician in cases of persistent pain or redness.
Ingestion:
• Contact a physician for immediately in all cases.
• Take to hospital.
If the subject is completely conscious:
• Rinse mouth with fresh water.
• Give to drink 3-4 glasses of milk or a 1 % aqueous calcium gluconate solution.
• If the subject presents nervous, respiratory or cardiovascular disorders:
administer oxygen.
If the subject is unconscious:
• NEVER GIVE ANYTHING BY MOUTH TO AN UNCONSIOUS PERSON
• Classical resuscitation measures.
4.2 Medical Treatment/Notes to Physician: Exposed person should be observed for
48-72 hours for delayed onset of edema.
Inhalation: Pre-existing respiratory diseases may be aggravated including asthma
and emphysema.
5. Fire-Fighting Measures
5.1 Flash point: Non flammable
5.2 Auto-ignition Temperature: Not applicable
5.3 Flammability Limits: Not applicable
5.4 Unusual Fire and Explosion Hazards: Formation of dangerous gas/vapors in case of
decomposition (see section 10)
MSDS No. NaSiF6-1103 Revised 10-11-03
Copyright 2003, Solvay Fluorides, LLC
A subsidiary of Solvay Chemicals, Inc.
All Rights Reserved.
www.solvaychemicals.us 1.800.765.8292
A4 p.898
-------
Sodium Fluorosilicate
Material Safety Data Sheet
5.5 Extinguishing Methods
Common:
• In case of fire in close proximity, all means of extinguishing are acceptable.
• Use extinguishing media appropriate for surrounding fire.
Inappropriate extinguishing means: No restriction.
5.6 Fire Fighting Procedures:
Specific hazards: Non-combustible
Protective measures in case of intervention:
• Wear self contained breathing apparatus when in close proximity or in confined spaces.
• When intervening in close proximity wear acid resistant over-suit.
• After intervention, proceed to clean the equipment (take a shower, remove clothing
carefully, clean and check).
Other precautions: Control the use of water due to environmental risk (see section 6).
6. Accidental Release Measures
6.1 Precautions:
• Follow the protective measures given in section 8.
• Avoid dispersing the dust into a cloud.
6.2 Cleanup methods:
• Collect the product with suitable means avoiding dust formation.
• Place everything into a closed, labeled container compatible with the product.
• For disposal methods, refer to section 13.
6.3 Precautions for protection of the environment:
• Immediately notify the appropriate authorities in case of significant discharge.
• Do not discharge into the environment (sewers, rivers, soils,...).
7. Handling and Storage
7.1 Handling:
• Use only equipment and materials which are compatible with the product.
• Keep away from heat sources.
• Keep away from reactive products (see section 10)
7.2 Storage:
• Keep in original packaging, and tightly closed.
• Keep away from reactive products (see section 10).
7.3 Specific Uses: See Section 1.2
7.4 Other precautions:
• Warn people about the hazards of the Sodium Silicofluoride.
• Avoid dust and formation of dust clouds.
• Follow the protective measures given in section 8.
7.5 Packaging: Paper lined with PE.
MSDS No. NaSiF6-1103 Revised 10-11-03
Copyright 2003, Solvay Fluorides, LLC
A subsidiary of Solvay Chemicals, Inc.
All Rights Reserved.
www.solvaychemicals.us 1.800.765.8292
A4 p.899
-------
Sodium Fluorosilicate
Material Safety Data Sheet
8. Exposure Controls/Personal Protection
8.1 Exposure Limit Values: Sodium Fluorosilicate
Authorized limit Values TLV® ACGIH®-USA (2002) OSHA PEL NIOSH REL (1994)
Fluorides 2.5 mg/m3 (as F) 2.5 mg/m3 (as F) None
ACGIH® and TLV® are registered trademarks of the American Conference of Governmental Industrial Hygienists.
8.2 Exposure Controls:
• Follow the protective measures given in section 7.
• Maintain employee exposures to levels below the applicable exposure limits.
8.2.1 Occupational Exposure Controls:
8.2.1.1 Ventilation: Provide local ventilation suitable for the dust risk.
8.2.1.2 Respiratory protection:
• Self/contained breathing apparatus in medium confinement/insufficient oxygen/in
case of large uncontrolled emissions/in all circumstances when the mask and
cartridge do not give adequate protection.
• Use only respiratory protection that conforms to international/national standards.
• Use only NIOSH approved respirators.
• Comply with OSHA respiratory protection requirements.
8.2.1.3 Hand protection:
• Protective gloves - chemical resistant:
• Recommended materials: PVC, neoprene, and rubber.
8.2.1.4 Eye protection: Dust proof goggles.
8.2.1.5 Skin protection:
• Overalls.
• Apron/boots of PVC, neoprene, rubber in case of dusts.
8.3 Other precautions:
• Do not smoke, eat and drink in the working area.
• Take off contaminated clothing immediately after work.
• Shower and eye wash stations.
• Consult the industrial hygienist or the safety manager for the selection of personal
protective equipment suitable for the working conditions.
MSDS No. NaSiF6-1103 Revised 10-11-03
Copyright 2003, Solvay Fluorides, LLC
A subsidiary of Solvay Chemicals, Inc.
All Rights Reserved.
www.solvaychemicals.us 1.800.765.8292
A4 p.900
-------
Sodium Fluorosilicate
Material Safety Data Sheet
9. Physical and Chemical Properties
9.1 Appearance: Free-flowing crystals
Odor: White
Color: Odorless
9.2 Important Health, Safety and Environmental information:
pH: Not applicable
Change of state:
Melting point: Decomposes @ 500°C (932°F)
Boiling point: Not applicable
Decomposition Temperature: 500°C (932°F)
Flash Point: Not applicable
Flammability: Non Flammable
(solid, gas)
Explosive Properties: Not available
Oxidizing Properties: Not available
Vapor Pressure: Not available
Relative Density:
Specific gravity (H20=1): 1
Bulk Density: 10.8 grams/ml (90 lbs/ft3)
Solubility: 40 mg/l at 20°C (68°F) Remark: Atmospheric pressure
Partition coefficient: Not applicable
Viscosity: Not applicable
Vapor Density (air=1): Not available
Evaporation Rate: No data
9.3 Other Information: No data
Surface Tension: No data
MSDS No. NaSiF6-1103 Revised 10-11-03
Copyright 2003, Solvay Fluorides, LLC
A subsidiary of Solvay Chemicals, Inc.
All Rights Reserved.
www.solvaychemicals.us 1.800.765.8292
A4 p.901
-------
Sodium Fluorosilicate
Material Safety Data Sheet
10. Stability and Reactivity
Stability: Stable under certain conditions (see below).
10.1 Conditions to avoid: Temperatures above decomposition temperature see section 9.
10.2 Materials and substances to avoid:
• Strong acids-reacts
• Strong alkalis-reacts
• Oxidizing agents-reacts
• Metals-reacts
10.3 Hazardous decomposition products:
• Hydrofluoric Acid
• Fluorine
10.4 Hazardous Polymerization: Not applicable
10.5 Other information: None
11. Toxicological Information
11.1 Acute toxicity:
Inhalation: No data available.
Oral: LD50, rat, 125mg/kg (Sodium hexafluorosilicate)
Dermal: No data available.
Irritation: No data available.
Sensitization: No data available.
Comments: No data available.
11.2 Chronic toxicity: No data available.
11.3 Carcinogenic Designation: None
12. Ecological Information
12.1 Acute ecotoxicity: No data available.
12.2 Chronic ecotoxicity: No data available.
12.3 Mobility: No data available.
12.4 Degradation
Abiotic: No data available.
Biotic: No data available.
12.5 Potential for bioaccumulation: No data available.
Page 7/9
MSDS No. NaSiF6-1103 Revised 10-11-03
Copyright 2003, Solvay Fluorides, LLC
A subsidiary of Solvay Chemicals, Inc.
All Rights Reserved.
www.solvaychemicals.us 1.800.765.8292
A4 p.902
-------
Sodium Fluorosilicate
Material Safety Data Sheet
13. Disposal Considerations
13.1 Waste treatment: Consult current federal, state and local regulations regarding the proper
disposal of this material.
13.2 Packaging treatment: Consult current federal, state and local regulations regarding the
proper disposal of emptied containers.
13.3 RCRA Hazardous Waste: Not listed.
14. Transport Information
Mode
DOT
IMDG
IATA
UN Number
UN 2674
UN 2674
UN 2674
Class
6.1
6.1
6.1
Proper Shipping Name
Sodium Fluorosilicate
Sodium Fluorosilicate
Sodium Fluorosilicate
Hazard label
Toxic
Toxic
Toxic
Subsidiary
Not a marine pollutant
Not a marine pollutant
Not a marine pollutant
Placard
Toxic
Toxic
Toxic
Packing Group III III III
MFAG
Emergency Info
ERG: 154
EmS: 6.1-04
ERG Code: 6L
15. Regulatory Information
National Regulations (US)
TSCA Inventory 8(b): Yes
SARA Title III Sec. 302/303 Extremely Hazardous Substances (40 CFR355): No
SARA Title III Sec. 311/312 (40 CFR 370):
Hazard Category: None
SARA Title III Sec. 313 Toxic Chemical Emissions Reporting (40 CFR 372): No
CERCLA Hazardous Substance (40CFR Part 302):
Listed: No
Unlisted Substance: No
State Component Listing: No Data.
National Regulations (Canada) Canadian DSL Registration: DSL
WHMIS Classification: D2B - Material causing other toxic effect
This product has been classified in accordance with the hazard criteria of the Controlled Products Regulations and the
MSDS contains all the information required by the Controlled Products Regulations.
MSDS No. NaSiF6-1103 Revised 10-11-03
Copyright 2003, Solvay Fluorides, LLC
A subsidiary of Solvay Chemicals, Inc.
All Rights Reserved.
www.solvaychemicals.us 1.800.765.8292
A4 p.903
-------
Sodium Fluorosilicate
Material Safety Data Sheet
Labeling according to Directive 1999/45/EC.
Category ID Phrase
Symbols T Toxic
Phrases R 23/24/25 Toxic by inhalation, in contact with skin and if swallowed.
Phrases S 1/2 Keep locked up and out of reach of children.
26 In case of contact with eyes, rinse immediately with plenty of
water and seek medical advice.
45 In case of accident or if you feel unwell, seek medical advice
immediately (show the label where possible).
16. Other Information
16.1 Ratings:
NFPA (NATIONAL FIRE PROTECTION ASSOCIATION)
Health = 3 Flammability = 0 Instability = 0 Special = None
HMIS (HAZARDOUS MATERIAL INFORMATION SYSTEM)
Health = 3 Fire = 0 Reactivity = 0 PPE = Supplied by User; dependent on local conditions
16.2 Other Information:
The previous information is based upon our current knowledge and experience of our product and
is not exhaustive. It applies to the product as defined by the specifications. In case of combinations
of mixtures, one must confirm that no new hazards are likely to exist. In any case, the user is not
exempt from observing all legal, administrative and regulatory procedures relating to the product,
personal hygiene, and integrity of the work environment. (Unless noted to the contrary, the technical
information applies only to pure product).
To our actual knowledge, the information contained herein is accurate as of the date of this
document. However, neither Solvay Fluorides, LLC nor any of its affiliates makes any warranty,
express or implied, or accepts any liability in connection with this information or its use. This
information is for use by technically skilled persons at their own discretion and risk and does not
relate to the use of this product in combination with any other substance or any other process.
This is not a license under any patent or other proprietary right. The user alone must finally determine
suitability of any information or material for any contemplated use, the manner of use and whether
any patents are infringed. This information gives typical properties only and is not to be used for
specification purposes.
TRADEMARKS: All trade name of products referenced herein are either trademarks or registered
trademarks of Solvay Fluorides, LLC or other Solvay Company or affiliate unless otherwise identified.
16.3 Reason for revision:
Supersedes edition: Sodium Fluorides Inc. MSDS dated 3/4/97.
Purpose of revision: Change Company name and MSDS format
MSDS No. NaSiF6-1103 Revised 10-11-03
Copyright 2003, Solvay Fluorides, LLC
A subsidiary of Solvay Chemicals, Inc.
All Rights Reserved.
www.solvaychemicals.us 1.800.765.8292
A4 p.904
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Air Quality, Atmosphere & Health (2019) 12:519-527
https://doi.Org/10.1007/sl 1869-019-00672-1
CrossMark
International prevalence of chemical sensitivity, co-prevalences
with asthma and autism, and effects from fragranced
consumer products
Anne Steinemann1,2
Received: 12 December 2018 /Accepted: 23 January 2019 /Published online: 12 February 2019
(Q The Author(s) 2019
Abstract
Chemical sensitivity is a medical condition characterized by adverse health effects from exposure to common chemical pollutants
and products. This study investigated the prevalence of chemical sensitivity in four countries—the United States (US), Australia
(AU), Sweden (SE), and the United Kingdom (UK). In addition, it investigated the co-prevalence of chemical sensitivity with
medically diagnosed multiple chemical sensitivities (MCS), fragrance sensitivity (health problems from fragranced products),
asthma/asthma-like conditions, and autism/autism spectrum disorders (ASDs). Using nationally representative population sam-
ples in each country, data were collected in June 2016 and June 2017 through on-line cross-sectional surveys of adults (n = 443 5).
Results found that, across the four countries, 19.9% of the population report chemical sensitivity, 7.4% report medically
diagnosed MCS, 21.2% report either or both, and 32.2% report fragrance sensitivity. In addition, 26.0% of the population report
asthma/asthma-like conditions, of which 42.6% report chemical sensitivity and 57.8% fragrance sensitivity. Also, 4.5% of the
population report autism/ASDs, of which 60.6 % report chemical sensitivity and 75.8% fragrance sensitivity. Among individuals
with chemical sensitivity, 55.4% also report asthma/asthma-like conditions, 13.5% autism/ASDs, and 82.0% fragrance sensitiv-
ity. Although the prevalence of chemical sensitivity across the countries is statistically different, its co-prevalences with other
conditions are statistically similar. Results also found that, for 44.1% of individuals with chemical sensitivity, the severity of
health effects from fragranced products can be potentially disabling. Further, 28.6 % of those with chemical sensitivity have lost
workdays or a job, in the past year, due to exposure to fragranced products in the workplace. Results indicate that chemical
sensitivity is widespread across the four countries, affecting over 61 million people, that vulnerable individuals such as those with
asthma and autism are especially affected, and that fragranced consumer products can contribute to the adverse health, economic,
and societal effects.
Keywords Chemical sensitivity • Multiple chemical sensitivities • MCS • Fragrance • Asthma • Autism
Introduction
Chemical pollutants have been associated with deleterious
effects on the environment and human health. A constellation
Electronic supplementary material The online version of this article
(https://doi.Org/10.1007/sll869-019-00672-l) contains supplementary
material, which is available to authorized users.
H Anne Steinemann
anne.steinemann@unimelb.edu.au
1 Department of Infrastructure Engineering, Melbourne School of
Engineering, The University of Melbourne,
Melbourne, Victoria 3010, Australia
2 College of Science and Engineering, James Cook University,
Townsville, Queensland 4811, Australia
of adverse health effects have been associated with chemical
sensitivity, a medical condition that is typically initiated and
triggered by exposure to common petrochemical products and
pollutants, such as pesticides, building materials, solvents,
new carpet and paint, and consumer products (Ashford and
Miller 1998; Caress and Steinemann 2003; Steinemann
2018c). Health effects associated with these chemical expo-
sures include headaches, dizziness, seizures, heart arrhythmia,
gastrointestinal problems, mucosal symptoms, breathing dif-
ficulties, and asthma attacks (Steinemann 2018c, d, f, 2019;
Ashford and Miller 1998). Notably, these volatile chemical
products that are associated with adverse health effects are
also primary sources of indoor and outdoor air pollutants
(McDonald et al. 2018; Ott et al. 2007).
Among these sources of exposure, fragranced consumer
products can be a primary trigger of health problems.
Springer
A4 p.905
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520
Air Qual Atmos Health (2019) 12:519-527
Fragranced consumer products (or fragranced products)—
chemically formulated products with the addition of a fra-
grance or a scent (Steinemann 2015)—include a range of
items such as air fresheners, laundry products, cleaning sup-
plies, personal care products, colognes, and household items.
An individual "fragrance" in a product is typically a complex
mixture of several dozen to several hundred compounds,
many derived from petrochemicals (Sell 2006). Fragranced
products have been associated with adverse health and societal
effects in the general population (Caress and Steinemann
2009b; Steinemann 2016,2017, 2018a, b), and especially vul-
nerable sub-populations such as those with asthma (Weinberg
et al. 2017, Steinemann et al. 2018, Steinemann 2018g), au-
tism (Steinemann 2018e), and chemical sensitivity (Caress
and Steinemann 2005, 2009a, b; Steinemann 2018c, d, f,
2019).
Relatively little is known about the prevalence of chemical
sensitivity at the national or international levels, or its co-
prevalence with other health conditions. One challenge is the
lack of an internationally consistent definition and diagnostic
criteria (e.g., Lacour et al. 2005; MCS 1999; De Luca et al.
2011; Genuis 2010). Another challenge is that different stud-
ies often use different terms and criteria for assessment. While
chemical sensitivity is a common and general term, other
terms include chemical intolerance (Palmquist et al. 2014;
Miller 2001), toxicant-induced loss of tolerance (Miller
1997), and multiple chemical sensitivities (Ashford and
Miller 1998). Further, chemically sensitive individuals may
manifest the condition even though they lack a specific diag-
nosis. Nevertheless, prior studies have operationalized charac-
teristics of chemical sensitivity in order to investigate the
condition.
Prior national prevalence studies of chemical sensitivity in
the general population include the following. In the US, two
surveys, conducted 2002-2003 («= 1057) and 2005-2006
(n= 1058), found respectively a prevalence of 11.1% and
11.6% self-reported chemical sensitivity, and 2.5% and 3.9%
medically diagnosed MCS (Caress and Steinemann 2005,
2009a). Chemical sensitivity was assessed as being "allergic
or unusually sensitive to everyday chemicals like those in
household cleaning products, paints, perfumes, detergents, in-
sect spray, and things like that." In Japan, a survey in 2012
(n = 7245) estimated a prevalence of 7.5% of chemical intol-
erance (Azuma et al. 2015). In Denmark, a survey in 2010
(n = 2000) found a prevalence of 8.2% of chemical intol-
erance (Skovbjerg et al. 2012). Chemical intolerance was
assessed in these two studies using the Quick
Environmental Exposure and Sensitivity Inventory
(QEESI) criteria (Miller and Prihoda 1999). Also in
Denmark, a survey in 2006 (n = 6000) found a prevalence
of 27% reporting symptoms related to inhalation of air-
borne chemicals such as perfume, motor vehicle exhaust,
and cleaning agents (Berg et al. 2008).
Springer
This present study investigates the prevalence of chemical
sensitivity across four countries, and its co-prevalences with
medically diagnosed MCS, fragrance sensitivity, asthma/
asthma-like conditions, and autism/ASDs. This study also ex-
amines the types of health effects associated with exposures to
fragranced consumer products, and societal effects such as
access to public places, lost workdays and lost jobs, and pref-
erences for fragrance-free environments. It provides a meta-
analysis and synthesis of the individual studies in each country
(Steinemann 2018c, d, f, 2019), together with new statistics on
the co-prevalences among the conditions, offering greater
depth and breadth of findings into the pervasiveness and ef-
fects of chemical sensitivity in the general population and in
vulnerable sub-populations.
Methods
Four national cross-sectional surveys, using the same instru-
ment implemented in each country's native language, were
conducted of adults in the United States (US), Australia
(AU), United Kingdom (UK), and Sweden (SE). Sample pop-
ulations were representative of the general populations ac-
cording to age, gender, and region (n= 1137, 1098, 1100,
1100; respectively; confidence limit = 95%, margin of error =
3% for all studies). Using randomized participant recruitment
(SSI 2016), the surveys drew upon large web-based panels
(with over 5,000,000; 200,000; 900,000; 60,000 people, re-
spectively) held by Survey Sampling International. The sur-
vey instrument was developed and tested over a two-year
period before full implementation in June 2016 (US, AU,
UK) and June 2017 (SE). The survey response rate was
94%, 93%, 97%, and 92% (respectively), and all responses
were anonymous. The research study received ethics approval
from the University of Melbourne. Survey methods are de-
tailed in the Electronic supplementary material (ESM-
Methods).
Descriptive statistics and cross-tabulations determined per-
centages according to each response and sub-population; see
Electronic supplementary material (ESM-Data).
Prevalence odds ratios (PORs) measured the strength of
associations to determine whether one sub-population is pro-
portionally more affected than another. Chi-squared analyses
compared proportions among countries to determine whether
a statistically significant difference exists. All POR and Chi-
squared analyses were performed using a 95% confidence
interval (CI) or a 95% confidence level, respectively.
To promote comparability, the survey replicated questions
from previous studies of chemical sensitivity, MCS, asthma/
asthma-like conditions, autism/ASDs, and fragrance sensitiv-
ity (Steinemann 2016, 2017, 2018a, b, c, d, e, f, g, 2019;
Steinemann et al. 2018; Kreutzer et al. 1999; Caress and
Steinemann 2005, 2009a, b), as follows.
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Air Qual Atmos Health (2019) 12:519-527
521
For chemical sensitivity, the survey asked, "Compared to
other people, do you consider yourself allergic or unusually
sensitive to everyday chemicals like those in household
cleaning products, paints, perfumes, detergents, insect spray
and things like that?" For medically diagnosed MCS, the sur-
vey asked, "Has a doctor or health care professional ever told
you that you have multiple chemical sensitivities?"
For asthma/asthma-like conditions, the survey asked, "Has
a doctor or health care professional ever told you that you have
asthma or an asthma-like condition?" If the respondent an-
swered yes, the survey then asked to specify whether "asth-
ma" or an "asthma-like condition" or both.
For autism/autism spectrum disorders (ASDs), the survey
asked, "Has a doctor or health care professional ever told you
that you have autism or autism spectrum disorder?" The sur-
vey then asked to specify whether autism, ASD, or both.
For fragrance sensitivity, the survey asked, "Do you expe-
rience any health problems when exposed to (fragranced prod-
uct or exposure context)?" If the respondent answered yes, the
survey then asked about which health problems they experi-
enced. An individual was considered to characterize fragrance
sensitivity if they reported one or more types of health prob-
lems from exposure to one or more types of fragranced con-
sumer products or exposure contexts.
Fragranced products were categorized as follows: (a) air
fresheners and deodorizers (e.g., sprays, solids, oils, disks),
(b) personal care products (e.g., soaps, hand sanitizer, lotions,
deodorant, sunscreen, shampoos), (c) cleaning supplies (e.g.,
all-purpose cleaners, disinfectants, dishwashing soap), (d)
laundry products (e.g., detergents, fabric softeners, dryer
sheets), (e) household products (e.g., scented candles, rest-
room paper, trash bags, baby products), (f) fragrance (e.g.,
perfume, cologne, after-shave), and (g) other.
Exposure contexts included the following: air fresheners or
deodorizers used within indoor environments, scented laundry
products coming from a dryer vent, being in a room after it
was cleaned with scented cleaning products, being near some-
one wearing a fragranced product, and exposure to other types
of fragranced consumer products.
Health effects were categorized as follows: (a) migraine
headaches, (b) asthma attacks, (c) neurological problems
(e.g., dizziness, seizures, head pain, fainting, loss of coordina-
tion), (d) respiratory problems (e.g., difficulty breathing,
coughing, shortness of breath), (e) skin problems (e.g., rashes,
hives, red skin, tingling skin, dermatitis), (f) cognitive prob-
lems (e.g., difficulties thinking, concentrating, or remember-
ing), (g) mucosal symptoms (e.g., watery or red eyes, nasal
congestion, sneezing), (h) immune system problems (e.g.,
swollen lymph glands, fever, fatigue), (i) gastrointestinal
problems (e.g., nausea, bloating, cramping, diarrhea), (j) car-
diovascular problems (e.g., fast or irregular heartbeat, jitteri-
ness, chest discomfort), (k) musculoskeletal problems (e.g.,
muscle or joint pain, cramps, weakness), and (j) other.
Societal effects included the following: ability to access
restrooms, businesses, and other locations that use air fresh-
eners or other fragranced products; loss of workdays or lost
jobs due to illness from fragranced product exposure in the
workplace; disabling health effects from exposure to
fragranced products; and preferences for fragrance-free work-
places, healthcare facilities, and healthcare professionals.
Results
Results are presented herein for individual countries (US, AU,
UK, SI:, respectively) and as summaries across all four coun-
tries. Tables 1, 2, 3, 4, and 5 provide the main findings. Full
results, including data and statistics for each individual coun-
try and summaries, according to questionnaire responses and
sub-populations, are provided as Electronic supplementary
material (ESM-Data).
Prevalence of chemical sensitivity and diagnosed MCS
Across the four countries in = 4435), 19.9% of the general
population report chemical sensitivity (25.9%, 18.9%,
16.3%, 18.5%), 7.4% report medically diagnosed MCS
(12.8%, 6.5%, 6.6%, 3.6%), and 21.2% report either or both
chemical sensitivity/MCS (27.5%, 19.9%, 18.0%, 19.5%)
(Table 1).
Among those with chemical sensitivity, 29.2% report diag-
nosed MCS (42.9%, 29.0%, 30.2%, 14.7%). Among those
with diagnosed MCS, 80.1% report chemical sensitivity
(86.9%, 84.5%, 74.0%, 75.0%). For those with either or both
conditions, 93.7% report chemical sensitivity (93.9%, 95.0%,
90.4%, 95.3%) and 33.6% report diagnosed MCS (46.3%,
32.6%, 36.9%, 18.7%) (Table 1).
For chemical sensitivity, the proportions among the
four countries are statistically different (p < 0.001, Chi-
square test), and for diagnosed MCS, the proportions are
statistically different (p < 0.001, Chi-square test). Also,
among those with chemical sensitivity who also report
diagnosed MCS, the proportions are statistically different
(p < 0.001). However, among those with diagnosed MCS
who also report chemical sensitivity, the proportions are
statistically similar (p = 0.687).
Chemical sensitivity and fragrance sensitivity
Across the countries, 32.2% of the general population
report fragrance sensitivity (34.7%, 33.0%, 27.8%,
33.1%). Further, 82.0% of individuals with chemical sen-
sitivity also report fragrance sensitivity (81.0%, 82.6%,
77.7%, 86.8%). Thus, individuals with chemical sensitiv-
ity are more likely to be fragrance sensitive than the gen-
eral population (Table 1). For fragrance sensitivity, the
Springer
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Air Qual Atmos Health (2019) 12:519-527
Table 1 Prevalences and co-prevalences of chemical sensitivity, diagnosed MCS, fragrance sensitivity, asthma/asthma-like conditions, and autism/ASDs
US AU UK SE Average
Chemical sensitivity
25.9%
18.9%
16.3%
18.5%
19.9%
MCS
42.9%
29.0%
30.2%
14.7%
29.2%
Fragrance sensitivity
81.0%
82.6%
77.7%
86.8%
82.0%
Asthma
35.0%
32.9%
39.7%
31.4%
34.8%
Asthma/asthma-like conditions
59.2%
56.5%
57.0%
49.0%
55.4%
Autism
8.2%
8.2%
10.1%
5.4%
8.0%
Autism/ASDs
13.3%
13.0%
16.2%
11.3%
13.5%
MCS
12.8%
6.5%
6.6%
3.6%
7.4%
Chemical sensitivity
86.9%
84.5%
74.0%
75.0%
80.1%
Fragrance sensitivity
86.2%
91.5%
89.0%
90.0%
89.2%
Asthma
40.0%
40.8%
49.3%
42.5%
43.2%
Asthma/asthma-like conditions
71.0%
74.6%
74.0%
62.5%
70.5%
Autism
15.2%
28.2%
21.9%
22.5%
22.0%
Autism/ASDs
23.4%
39.4%
37.0%
32.5%
33.1%
Chemical sensitivity/MCS
27.5%
19.9%
18.0%
19.5%
21.2%
Chemical sensitivity
93.9%
95.0%
90.4%
95.3%
93.7%
MCS
46.3%
32.6%
36.9%
18.7%
33.6%
Fragrance sensitivity
78.9%
82.1%
77.3%
86.9%
81.3%
Asthma
33.5%
32.1%
39.9%
30.4%
34.0%
Asthma/asthma-like conditions
57.2%
56.4%
57.1%
47.7%
54.6%
Autism
7.7%
9.2%
9.6%
6.5%
8.3%
Autism/ASDs
12.8%
14.7%
16.7%
12.1%
14.1%
Fragrance sensitivity
34.7%
33.0%
27.8%
33.1%
32.2%
Chemical sensitivity
60.4%
47.2%
45.4%
48.6%
50.4%
MCS
31.7%
18.0%
21.2%
9.9%
20.2%
Chemical sensitivity/MCS
62.7%
49.4%
50.0%
51.1%
53.3%
Asthma
35.0%
32.9%
39.7%
31.4%
34.8%
Asthma/asthma-like conditions
59.2%
56.5%
57.0%
49.0%
55.4%
Autism
8.2%
8.2%
10.1%
5.4%
8.0%
Autism/ASDs
13.3%
13.0%
16.2%
11.3%
13.5%
Asthma/asthma-like conditions
26.8%
28.5%
25.3%
23.2%
26.0%
Chemical sensitivity
57.0%
37.4%
36.7%
39.2%
42.6%
MCS
33.8%
16.9%
19.4%
9.8%
20.0%
Chemical sensitivity/MCS
58.7%
39.3%
40.6%
40.0%
44.7%
Fragrance sensitivity
64.3%
55.6%
54.0%
57.3%
57.8%
Autism/ASDs
13.1%
10.2%
11.9%
10.2%
11.4%
Autism/ASDs
4.3%
3.7%
4.7%
5.1%
4.5%
Chemical sensitivity
79.6%
65.9%
55.8%
41.1%
60.6%
MCS
69.4%
68.3%
51.9%
23.2%
53.2%
Chemical sensitivity/MCS
81.6%
78.0%
63.5%
46.4%
67.4%
Fragrance sensitivity
83.7%
82.9%
84.6%
51.8%
75.8%
Asthma/asthma-like conditions
81.6%
78.0%
71.2%
42.9%
68.4%
Table interpretation: for each condition (in italics), the first row indicates the prevalence in the general population, and rows below that indicate the co-
prevalances. For instance, for chemical sensitivity for the US, the prevalence among the general population is 25.9% and, among these individuals,
42.9% also report diagnosed MCS
Springer
A4 p.908
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Air Qual Atmos Health (2019) 12:519-527
523
Table 2 Exposures to fragranced
consumer products and associated
health problems
Fragrance sensitive
32.2%
82.0%
89.2%
81.3%
Health problems from exposure to:
Air fresheners or deodorizers
17.4%
54.8%
65.9%
53.5%
Scented laundry products from a dryer vent
7.6%
26.4%
49.6%
26.5%
Room cleaned with scented products
15.7%
53.8%
65.9%
52.4%
Someone wearing a fragranced product
20.1%
56.5%
66.1%
55.3%
Other type of fragranced consumer product
18.6%
58.9%
68.0%
57.1%
Gen pop general population, ChemSens chemical sensitivity, MCS diagnosed MCS, ChemSens/MCS chemical
sensitivity/diagnosed MCS
Gen pop ChemSens MCS ChemSens/
MCS
proportions among the four countries are statistically dif-
ferent (p < 0.03, Chi-square test). However, among those
with chemical sensitivity who also report fragrance sensi-
tivity, the proportions are statistically similar (p = 0.795).
Chemical sensitivity, asthma, and fragrance
sensitivity
Across the countries, 26.0% of the general population report
diagnosed asthma/asthma-like conditions (26.8%, 28.5%,
25.3%, 23.2%). In addition, 55.4% of individuals with chem-
ical sensitivity also report asthma/asthma-like conditions
(59.2%, 56.5%, 57.0%, 49.0%), and 42.6% of individuals
with asthma/asthma-like conditions also report chemical sen-
sitivity (57.0%, 37.4%, 36.7%, 39.2%). Further, 57.8% of
individuals with asthma/asthma-like conditions are also fra-
grance sensitive (64.3%, 55.6%, 54.0%, 57.3%). Thus, indi-
viduals with chemical sensitivity are more likely to report
asthma/asthma-like conditions, and individuals with asthma/
asthma-like conditions are more likely to be chemically sen-
sitive and fragrance sensitive, than the general population
(Table 1). Among those with chemical sensitivity who also
report asthma/asthma-like conditions, the proportions among
the four countries are statistically similar (p = 0.496).
Chemical sensitivity, autism, and fragrance sensitivity
Across the countries, 4.5% of the general population re-
port diagnosed autism/ASDs (4.3%, 3.7%, 4.7%, 5.1%).
In addition, 13.5% of individuals with chemical sensitiv-
ity also report autism/ASDs (13.3%, 13.0%, 16.2%,
11.3%), and 60.6% of individuals with autism/ASDs also
report chemical sensitivity (79.6%, 65.9%, 55.8%,
41.1%). Further, 75.8% of individuals with autism ASDs
are also fragrance sensitive (83.7%, 82.9%, 84.6%,
51.8%). Thus, individuals with chemical sensitivity are
more likely to report autism/ASDs, and individuals with
autism/ASDs are more likely to be chemically sensitive
Table 3 Health problems (frequency and type) reported from exposure to fragranced consumer products
Gen Pop ChemSens MCS ChemSens/
MCS
Fragrance sensitive 32.2% 82.0% 89.2% 81.3%
Type of health problem:
Migraine headaches
12.6%
36.9%
41.7%
36.4%
Asthma attacks
7.0%
25.2%
33.2%
24.6%
Neurological problems (e.g., dizziness, seizures, head pain, fainting, loss of coordination)
5.1%
17.7%
22.9%
17.2%
Respiratory problems (e.g., difficulty breathing, coughing, shortness of breath)
16.7%
50.2%
50.4%
48.5%
Skin problems (e.g., rashes, hives, red skin, tingling skin, dermatitis)
9.1%
29.9%
44.2%
29.7%
Cognitive problems (e.g., difficulties thinking, concentrating, or remembering)
4.3%
15.5%
28.0%
15.5%
Mucosal symptoms (e.g., watery or red eyes, nasal congestion, sneezing)
13.2%
39.4%
43.9%
38.2%
Immune system problems (e.g., swollen lymph glands, fever, fatigue)
2.7%
9.8%
21.9%
9.7%
Gastrointestinal problems (e.g., nausea, bloating, cramping, diarrhea)
3.8%
12.9%
22.2%
12.8%
Cardiovascular problems (e.g., fast or irregular heartbeat, jitteriness, chest discomfort)
3.2%
11.0%
21.7%
11.3%
Musculoskeletal problems (e.g., muscle or joint pain, cramps, weakness)
2.5%
9.0%
21.0%
9.2%
Other
2.0%
3.2%
2.6%
3.1%
Springer
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524 Air Qual Atmos Health (2019) 12:519-527
Table 4 Societal effects of fragranced consumer products
Gen pop
ChemSens
MCS
ChemSens/
MCS
Fragrance sensitive
32.2%
82.0%
89.2%
81.3%
Disabling health effects from fragranced consumer products
29.1%
44.1%
61.7%
43.4%
Unable or reluctant to use restrooms in public place because of air freshener,
13.3%
37.4%
54.6%
37.3%
deodorizer, or scented product
Unable or reluctant to wash hands in public place because of fragranced soap
10.4%
32.1%
53.0%
32.5%
Want to leave a business quickly because of fragranced product
17.0%
51.0%
56.8%
49.4%
Prevented from going someplace because of fragranced product that would
16.0%
46.5%
65.0%
46.2%
cause sickness
Lost workdays or job in past year due to sickness from fragranced product
9.0%
28.6%
45.0%
28.0%
exposure in workplace
Supportive of fragrance-free policy in the workplace
Yes
47.8%
70.2%
69.9%
69.5%
No
20.4%
10.9%
19.7%
11.7%
Prefer fragrance-free healthcare facilities and professionals
Yes
51.4%
75.4%
76.5%
74.4%
No
22.1%
11.9%
15.3%
12.8%
and fragrance sensitive than the general population
(Table 1). Among those with chemical sensitivity who
also report autism/ASDs, the proportions among the four
countries are statistically similar (p = 0.624).
Chemical sensitivity and effects from fragranced
products
Fragranced products pose particular problems for the chemi-
cally sensitive. Results are summarized in this section and in
Tables 2, 3, and 4. Full results for each country, according to
the general population and sub-populations of those with
chemical sensitivity, diagnosed MCS, and chemical sensitivi-
ty/MCS, are provided as Electronic supplementary material
(ESM-Data).
Among chemically sensitive individuals, 82% are fra-
grance sensitive, reporting adverse health effects from
fragranced consumer products. Fragranced products and ex-
posure contexts that are associated with health problems in-
clude but are not limited to the following: air fresheners and
deodorizers (54.8%), scented laundry products coming from a
dryer vent (26.4%), being in a room recently cleaned with
Table 5 Demographic
information
Gen pop
ChemSens
MCS
ChemSens/
MCS
Total (AO 4435
(% relative to general population) 100.0%
Male/female
All males 49.1%
All females 51.0%
Gender and age
Male 18-24 6.5%
Male 25-34 10.2%
Male 35^14 11.2%
Male 45-54 10.9%
Male 55-65 10.3%
Female 18-24 7.1%
Female 25-34 11.5%
Female 35^14 12.2%
Female 45-54 11.3%
Female 55-65 9.0%
884
19.9%
40.1%
59.9%
5.4%
11.7%
9.7%
7.7%
5.6%
8.1%
12.8%
14.7%
13.6%
10.7%
329
7.4%
56.2%
43.8%
11.1%
19.6%
14.8%
5.4%
5.3%
6.1%
10.9%
8.5%
11.7%
6.7%
943
21.2%
41.6%
58.4%
6.4%
12.2%
10.1%
7.5%
5.5%
8.0%
12.4%
14.2%
13.4%
10.4%
Springer
A4 p.910
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Air Qual Atmos Health (2019) 12:519-527
525
scented products (53.8%), being near someone wearing a
fragranced product (56.5%), and other types of fragranced
consumer products (58.9%) (Table 2).
Types of adverse health effects associated with these
fragranced product exposures, for chemically sensitive indi-
viduals, include respiratory problems (50.2%), mucosal symp-
toms (39.4%), migraine headaches (36.9%), skin problems
(29.9%), asthma attacks (25.2%), and neurological problems
(17.7%), among others (Table 3).
Disabling health problems can result from fragranced prod-
uct exposures. The severity of health problems associated with
fragranced products was investigated, using criteria from each
country's disability legislation (ADAAA 2008, DDA 1992,
EA 2010, DA 2008). Among those adversely affected by
fragranced products, for 29.1% of the general population,
44.1% of individuals with chemical sensitivity, and 61.7%
of individuals with diagnosed MCS, the health effects from
fragranced product exposures are reported as potentially dis-
abling (Table 4, and ESM-Data Table 20).
Societal access can be restricted by fragranced products.
For individuals with chemical sensitivity, 37.4% are unable
or reluctant to use public restrooms that have an air freshener,
deodorizer, or scented product; 32.1% are unable or reluctant
to wash hands in a public place if the soap is fragranced;
51.0% enter a business but then leave as quickly as possible
due to a fragranced product; and 46.5% have been prevented
from going someplace because a fragranced product would
make them sick (Table 4).
Lost workdays and lost jobs are associated with exposure
to fragranced products: 9% of the general population, 28.6%
of individuals with chemical sensitivity, and 45.0% of indi-
viduals with diagnosed MCS, have lost workdays or lost a job,
in the past year, due to illness from fragranced product expo-
sure in the workplace. For individuals with chemical sensitiv-
ity, this loss represents more than 23 million people in the four
countries (Table 4 and ESM-Data Table 29; USCB 2018, ABS
2018, ONS 2018, SCB 2018).
Fragrance-free policies receive strong support. Among
those with chemical sensitivity, 70.2% would be support-
ive of a fragrance-free policy in the workplace (compared
to 10.9% that would not). Also, 75.4% would prefer that
healthcare facilities and healthcare professionals be
fragrance-free (compared to 11.9% that would not).
Thus, more than six times as many individuals with chem-
ical sensitivity would prefer that workplaces, healthcare
facilities, and healthcare professionals were fragrance-
free than not (Table 4).
Among the general population, 47.8% would be sup-
portive of a fragrance-free policy in the workplace (com-
pared to 20.4% that would not). Also, 51.4% would prefer
that healthcare facilities and healthcare professionals be
fragrance-free (compared to 22.1% that would not).
Thus, more than twice as many individuals in the general
population would prefer that workplaces, healthcare facil-
ities, and healthcare professionals were fragrance-free
than not (Table 4).
Demographic proportions of chemical sensitivity are
40.1% male and 59.9% female, and diagnosed MCS are
56.2% male and 43.8% female, compared with the general
population proportions of 49.1% male and 51.0% female.
Thus, chemical sensitivity has a female bias (+ 8.9%), and
diagnosed MCS has a male bias (+ 7.1%). Relative to gender
and age, the highest bias for chemical sensitivity is female 35-
44 (+ 2.5%) and for diagnosed MCS is male 25-34 (+ 9.4%)
(Table 5).
Discussion and conclusion
Chemical sensitivity is pervasive across the four countries,
affecting an estimated 61 million adults (USCB 2018, ABS
2018, ONS 2018, SCB 2018). Individuals with chemical sen-
sitivity, asthma/asthma-like conditions, and autism/ASDs all
have a higher prevalence of fragrance sensitivity than those
without these conditions.
Chemically sensitive individuals are proportionally more
likely to report asthma/asthma-like conditions (POR 5.54;
95% CI 4.74-6.49), autism/ASDs (POR 6.68; 95% CI 4.98-
8.97), and fragrance sensitivity (POR 18.54; 95% CI 15.32—
22.43) than non-chemically sensitive individuals.
Also, individuals with asthma asthma-like conditions are
proportionally more likely to report chemical sensitivity
(POR 5.54; 95% CI 2.23-3.99) and fragrance sensitivity
(POR 4.54; 95% CI 3.93-5.23) than individuals without
asthma/asthma-like conditions. In addition, individuals with
autism/ASDs are proportionally more likely to report chemi-
cal sensitivity (POR 7.55; 95% CI 5.57-10.24) and fragrance
sensitivity (POR 7.25; 95% CI 5.21-10.10) than individuals
without autism/ASDs.
Even though the prevalences of each chemical sensitivity,
diagnosed MCS, and fragrance sensitivity among the four
countries are statistically different, the co-prevalences of con-
ditions are statistically similar for chemical sensitivity with
fragrance sensitivity, chemical sensitivity with asthma/
asthma-like conditions, and chemical sensitivity with autism/
ASDs.
Further, the proportion of individuals with diagnosed MCS
who also report chemical sensitivity is statistically similar
across the countries. However, the proportion of individuals
with chemical sensitivity who also report diagnosed MCS is
statistically different across the countries.
Study strengths include the following: (a) sample popula-
tions are statistically representative of the general populations
according to age, gender, and region in each country; (b) sur-
vey respondents were randomly recruited from large web-
based panels that reflect population characteristics; and (c)
Springer
A4 p.911
-------
526
Air Qual Atmos Health (2019) 12:519-527
the survey replicated questions from previous national popu-
lation studies for consistency and comparability. Study limi-
tations include the following: (a) only adults ages 18-65 were
surveyed, which excludes data from other age groups; (b) the
survey relied on self-reported data, although self-report is a
standard and widely accepted approach for epidemiological
research; and (c) the cross-sectional design of the survey ob-
tains data from one point in time, although the survey can be
repeated.
In conclusion, the study indicates that chemical sensitivity
is an international public health problem. Further, individuals
with chemical sensitivity report a higher co-prevalence of fra-
grance sensitivity, asthma asthma-like conditions, and autism/
ASDs than individuals without chemical sensitivity. Exposure
to fragranced consumer products can exacerbate the adverse
health and societal effects, especially for these vulnerable sub-
populations with chemical sensitivity, as t h m a/ a st h m a -1 i k e
conditions, and autism ASDs. Reducing exposure to
fragranced products, such as through fragrance-free policies,
can reduce adverse effects for not only vulnerable individuals
but also the general population.
Acknowledgements I thank the anonymous reviewers of this article for
their very helpful comments. I also thank John Barrie and Survey
Sampling International for their valuable contributions. This article is
written as a tribute to my departed colleague, Dr. Stanley Caress.
Funding The survey research in Australia was supported in part by the
Australian Government's National Environmental Science Program
through the Clean Air and Urban Landscapes Hub.
Compliance with ethical standards
The research study received ethics approval from the University of
Melbourne.
Open Access This article is distributed under the terms of the Creative
Commons Attribution 4.0 International License (http://
creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
distribution, and reproduction in any medium, provided you give
appropriate credit to the original author(s) and the source, provide a link
to the Creative Commons license, and indicate if changes were made.
Publisher's note Springer Nature remains neutral with regard to jurisdic-
tional claims in published maps and institutional aifiliations.
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Requesting Presidential Intervention
Regarding Red Hill Bulk Fuel Storage Facilities
& Ongoing Matters of Ecocide against the Hawaiian Kingdom
From: Bronson Azama, Hawaiian Kingdom Subject
To White House Environmental Justice Advisory Council or to whom it may concern:
My name is Bronson Azama, I am of Kanaka Maoli ancestry. My family has lived in the islands
of Hawai'i for over two thousand years. I am a subject of the Hawaiian Kingdom and am a
citizen of the United States under duress. I write to you today to bring attention to the ecocide
happening on the island of O'ahu due to the ongoing leakage of the Red Hill Bulk Fuel Storage
Facilities utilized by the United States Navy. These leakages have poisoned our Sole Source
Aquifer which is impacting the capital of both our nation [Hawaiian Kingdom] and now the
illegitimate State of Hawai'i.
There have been several leaks since 2014, which have now resulted in the poisoning of our
aquifer. However, anecdotal evidence from interviews with individuals who have worked at
these facilities indicates that the deteriorated and aged facilities leak daily. This groundwater
threatens not only the people living on the island currently but also our future generations.
Our ancestors have taught us the importance of being accountable to future generations, this
issue goes beyond the law, beyond a judge, but a simple morale issue of being accountable to our
children's, children's, children, and beyond. What is happening on our islands is ecocide, there is
a long list of grievances from Kanaka Maoli caused by the United States since the illegal
overthrow of 1893 with aid from United States Marines, followed by the illegal annexation via a
joint resolution, not a treaty. And now as there are further investigations and questions into the
legalities of the illegal military occupation of our homeland, we are faced with a water crisis!
These lands that are illegally occupied which we have title to, are suffer from further
decapacitization by the United States military via the Red Hill crisis among many other issues.
Whether doing so intentionally or otherwise is not up for debate, my point is this issue of our
A4 p.914
-------
Aquifer being poisoned is an extension of the illegal occupation of our islands and is essentially
an ecocide of our people.
We need to bring our people environmental and social justice, this can be done by first the
closure of the Red Hill Bulk Fuel Storage facilities and implementation of Post-Closure
requirements to purify the poisoned water, bedrock, and surrounding environment. As well as the
compensation to residents affected. Following these steps, the White House needs to revisit the
issue surrounding the illegal occupation of the Hawaiian Islands, and address the restoration of a
nation-to-nation relationship between the United States and the Hawaiian Kingdom.
This has no animosity toward the United States, we are simply asking your powerful nation and
its leaders to do the right thing. Do the Earth and the people who call it home not deserve such
healing9 You who are reading are included as people of the Earth. When we all heal, and when
we heal others, we find our collective resurgence that supports all.
It is never too late to right a wrong!
Ke aloha nui,
Bronson Azama
A4 p.915
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Contact info : Karen L. Martin at wheiac@epa.gov or by phone 202-564-0203
Objective: Provide comments relevant to the performance scorecard that is being developed by
the White House Environmental Justice Advisory Council to assess the progress of federal
agencies in addressing current and historic environmental injustice.
On behalf of The Chisholm Legacy Project, we offer the following recommendations to the
White House Environmental Justice Advisory Council and the Council on Environmental
Quality regarding development of the Justice40 Scorecard:
We agree with White House Environmental Justice Advisory Council's (WHEJAC)
concerns around use of the term "disadvantaged community." Terms that might be more
appropriate to consider include overburdened, underinvested in, or historically
disenfranchised/marginalized. We advocate for language that assigns a level of culpability to
government actors for historical and ongoing neglect and outright abuse. We also advocate for
framings that acknowledge that while these communities may be overburdened and historically
marginalized, they do not lack agency. Interventions must first and foremost recognize a
community's right to self-determinism. For the sake of this written comment, we will be using
the phrases "frontline and fenceline communities" and "EJ communities." In addition, we will
be referencing the WHEJAC Recommendations and EO 12898 Revisions Report, dated May 21,
2021, hereafter called the May 2021 Report.
In the development of a Justice40 scorecard, input throughout the entire process must
be driven primarily by stakeholder representatives, such as BIPOC communities, Black femmes
from frontline and fenceline communities, those living in public housing, communities that
were excluded from the REAP Program, etc. In the process of data collection in EJ communities,
research entities should engage in just models of collaborative relationship and mutually
beneficial partnership led by affected communities. The Chisholm Legacy Project will be
publishing a guiding document for this relationship in the coming months. Additionally, when
seeking collaborations, partnerships, and mentorship opportunities, nontraditional indicators of
success and leadership must be considered to meaningfully incorporate the lived experiences of
BIPOC/Black femme voices in frontline and fenceline communities.
Frontline and fenceline communities are often distrustful of government engagement.
In order to rebuild trust, government actors must authentically transfer power to communities
rather than simply consulting after decisions have been made. To this end, we find the
following graphic from Facilitating Power useful. True, meaningful, and transformative change
happens when communities own the changes to their own circumstances. It is imperative that
the Justice40 Scorecard create requirements for agencies to defer to community decision-
making.
A4 p.916
-------
THE SPECTRUM OF COMMUNITY ENGAGEMENT TO OWNERSHIP
$ % Facilitating
Pow«r
STANCE
TOWARDS
COMMUNITY
I COLLABORATE I DEFER TO
> 5>
Marginalization
community Deny access to
engagement decision-making
goals processes
message to Your voice, needs
community & interests do not
matter
Closed door
meeting
Misinformation
Systematic
resource 100%
allocation Systems Admin
Provide the
community with
relevant information
IVe will keep you
informed
Fact sheets
Open Houses
Presentations
Billboards
Videos
70-90%
Systems Admin
10-30%
Promotions and
Publicity
Tokenization
Gather input from
the community
We core what you
think
Public Comment
Focus Groups
Community Forums
Surveys
60-80%
Systems Admin
20-40%
Consultation
Activities
Ensure community
needs and assets
are integrated into
process & inform
planning
You are making
us think, (and
therefore act)
differently about
the issue
Community
organizing &
advocacy
House meetings
Interactive
workshops
Polling
Community forums
50-60%
Systems Admin
40-50%
Community
Involvement
Delegated
Power
Ensure community
capacity to play a
leadership role in
implementation of
decisions
Your leadership
and expertise are
critical to how we
address the issue
MOU'S with
Community-based
organizations
Community
organizing
Citizen advisory
committees
Open Planning
Forums with Citizen
Polling
20-50%
Systems Admin
50-70%
Community
Community
Ownership
Foster democratic
participation and equity
through community-
driven decision-
making; Bridge divide
between community &
governance
It's time to unlock
collective power
and capacity for
transformative
solutions
Community-driven
planning
Consensus building
Participatory action
research
Participatory budgeting
Cooperatives
80-100%
Community partners
and community-driven
processes ideally
generate new value and
resources that can be
invested in solutions
WHEJAC must more clearly expound on its commitment to "do no harm." Immediate
direct effects of any action or lack of action are not the only effects that should be considered.
Medium- and long-term outcomes, especially in continued or emerging disparities, should be
monitored. In addition, consideration should be given to "loss and damage" in frontline and
fenceline communities in the form of reparations (e.g., payments to BIPOC who developed
health conditions as a result of living in HUD financed homes that were built on toxic sites).
Pollution and toxins in the air, water, and soil are among the most immediate threats to these
communities and must be addressed in a holistic, intersectional manner to alleviate the
disproportionate burden that is experienced. For instance, coal ash is a major threat to public
health. The recommendation and metric guidelines outlined in the May 2021 Report for clean
up in the Tennessee Valley Authority region should include the monitoring and evaluation of
key performance indicators with mechanisms of measurement developed through community-
led, democratic decision-making processes. These guidelines and metrics should also be applied
to a|l toxic coal ash regions, including those outside of TVA territory, and should include
equitable compensation for victims.
Additionally, because Black and other communities of color are disproportionately
exposed to PM2.5 and other air pollutants in vehicle exhaust, we recommend direct funding
towards the installation of green barriers between EJ communities and transportation
A4 p.917
-------
corridors, with air monitors that can measure improvement in air quality installed in all
metropolitan and suburban areas. These communities should be the first considered for
accelerated transition to electric public transportation, with the requirement that the electricity
is not derived from dirty energy sources.
In addition to WHEJAC's goal of replacing lead water pipes, we should be ensuring that
everyone in the United States has reliable access to safe and clean drinking water. Citizen
science opportunities can help ensure progress. While expanding criteria to the Drinking Water
State Revolving Fund (DWSRF), WHEJAC should also incentivize states to include
unincorporated townships, specifically freedmen's settlements such as Sandbranch, Texas. The
Sandbranch community and many other freedmen's settlements like it, currently have no
running water or wastewater infrastructure.
There is an immense amount of energy democracy work already occurring at the
community level. We recommend WHEJAC catalog action taken to localize energy and uplift
energy democracy and justice in marginalized communities through mechanisms such as
microgrids, solar coops, etc. WHEJAC should also measure the degree of interdisciplinary,
intersectional solutions by monitoring engagement of diverse community members to ensure
climate action does not lead to further subsequent inequities. Additionally, the Department of
Energy needs to take a more active stance in making clean energy resources accessible to
communities by partnering with community members in the expansion of renewable energy.
Application processes for grant programs require time and technical expertise to participate.
The burden should not be on the most affected and least resourced communities.
Divestment and investment must be utilized to equitably transition to a living economy
away from dirty energy. Therefore, WHEJAC must more clearly define the threshold of
divestment from fossil fuels, plastics, dangerous chemicals, and nuclear energy by 2030 that is
addressed in the May 2021 report. Updated language from most recent IPCC report about
divesting from so-called "clean" solutions that are neither clean nor in the best interest of
frontline communities must be adopted by WHEJAC. Furthermore, there must be more clearly
outlined mechanisms and oversight in place to make sure banks are investing 40+% in frontline
and fenceline communities. These may require a separate team to track and analyze the
monitoring and enforcements. This should include requirements and metrics for community
ownership, asset ownership, and overall lending and investing practices being non-extractive.
Additionally, with regards to green bank financing, we recommend including "no interest" loans
to increase community participation and mitigate the risk of default.
Finally, we have significant concerns regarding gaps in data acquisition and coverage in
the Climate Economic Justice Screening tool. These gaps will lead to too many communities
falling through the cracks, which points to an incomplete commitment to Justice40, and
therefore they must be addressed while the screening tool is still in beta. These concerns are
(but are not limited to) the following:
A4 p.918
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Clean energy and energy efficiency:
Affordable and sustainable housing:
-Urban Heat Island is not accounted for
-Ignores community planning
-Ignores Radon
Clean transit:
-Ozone (03) not accounted for
-Focus seems to be on pass through vehicles not community access to multimodal transit
-Percentage of roads improved with bicycle lanes
-Percentage of roads improved with sidewalks
-Number of bus routes
-Number of bus shelters
Reduction and remediation of legacy pollution:
-Leaking underground storage tanks are more than likely going to be missed
-RMP facilities cover a lot but facilities can also have TRI and NPDES but not be RMP facilities
Health Burdens:
-Access to medical facilities
-Food deserts
Additionally, datasets used for the scorecard and the mapping are not well designed to address
wealth gaps. Income and household value are both accounted for, but with so many people -
especially in EJ communities - renting or living in public housing or living with little to no
income, not including non-housing assets as another economic indicator can misrepresent the
economic situation of many communities (including high net wealth communities as well).
We look forward to continuing to engage with WHEJAC and CEQ and hope that our
recommendations on behalf of the equity of frontline and fenceline communities will be
integrated into the development of the Justice40 Scorecard. Thank you.
A4 p.919
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February 24, 2022
re: WHEJAC February 2022 Meeting Public Comments
Dear White House Environmental Justice Advisory Council:
Un dangkulo na si Yu'us ma'ase, Olomwaay arid thank you very much for allowing us, Our Common Wealth
670 (OCW 670) to take part in this discussion of Environmental Justice. We the undersigned are a
grassroots non-profit organization of community advocates, scholars, environmental activists, specialists,
and policy makers from the Commonwealth of the Northern Mariana islands (CNMI), continental US, and
the Indo Pacific Region.
Our primary concerns are with ever increasing US military expansion in personnel, vehicles, and with the
frequency of exercises on our lands, and within the surrounding waters of the Oceanic region. The current
and proposed levels of military training and testing simply cannot be supported by our small population,
limited island land mass, scarce environmental resources, and fragile island ecosystems. Past war activities
have already done great harm and left a myriad of military debris, unexploded ordnance (UXO), and
pollution on our land and in our ocean. Further long-term irreparable damage will be inevitable not only
to our environment, but also to our cultural traditions, and ways of life. The Department of Defense (DoD)
continues to insist that our islands (less than 184 square land miles) are the only place on earth to house
the proposed Commonwealth Joint Military Training (GMT) and provide for the enormously impactful
Mariana Training and Testing (MITT) Study Area of nearly one million square nautical miles that surrounds
our islands, seas and skies.
Mariana Islands Training Guan\»
Burdening our archipelago with the responsibility of housing this many personnel and allowing an
increased frequency in bombing of the Northern Island of Farallon de Medinilla (FDM) is unjust, not to
mention sonar and in-water explosions in the MITT, and live-fire ranges on Pagan and Tinian. This is
especially incongruent with our ways of life given our ancient fishing traditions and ancestral connections
to these lands, waters and skies.
A4 p.920
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There is a glaring lack of oversight and meaningful engagement by the DoD with the Indigenous peoples
of the Marianas at their hosted public meetings. DoD has fallen well short of providing pertinent
information to our community in their draft Environmental Impact Statements (EIS) in an accessible and
timely manner, and in their responses to public comments. There are extremely limited translation
services, most questions go unanswered, and our people, especially our elders or "man'amko" are given
limited time to express themselves, which is inconsistent with, and disrespectful of local cultural norms.
This has been exacerbated now that DoD is relying solely on the CNMI Bureau of Military Affairs to
communicate plans with our regulatory agencies, and leaders for pertinent discourse. Time and again the
Bureau does not include communication with our House of Representatives, and to date, not with the
general public either. Indeed, the Bureau's states that their mission is:
"To improve communication, coordination and response of the CNMI government to the
United States military, facilitate the military's integration into the community, and to
ensure the relationship between the military and the CNMI is one based on mutual respect
and benefit"
However, nothing is stated concerning sharing of pertinent planning information with the general public
for discourse and comment nor is consent. In no way does this contribute to an engaged EIS process as
required by the Clean Water Act (CWA).
As to the Bureaus' mission to, "facilitate the military's integration into the community", this statement
leads us to believe that integration is a primary goal rather than outcome of proper consent and
consultation of military planning. Our community of little over 55,000 people, has an ROTC in every single
high school. This rampant recruitment process pulls young people away from our local workforce to serve
the military abroad. In addition, DoD has continually competed with our own regulatory agencies to
recruit experts to complete the EIS process. DoD can, and do offer higher salaries, so experienced local
professionals that used to review EISs on behalf of the CNMI have left our local workforce and are now
making assessments on behalf of the DoD's desired outcomes. This is a process that leads to data bias and
does not adequately allow for a just assessment of our environmental concerns.
As to the Bureaus' mission to, "...ensure the relationship between the military and the CNMI is one based
on mutual respect and benefit," the DoD has failed to complete baseline studies of water, sediment and
biota since the late 1990's at the persistent request of the CNMI environmental agencies. These studies
are needed so they may demonstrate the impact to the environment over time and to ensure
accountability for remediation and restoration. To date, no baseline levels have ever been completed to
our knowledge, much less shared with the CNMI regulatory community. This shows the general disrespect
displayed by the DoD and the one sidedness of the benefits.
In addition, the CWA requires all CNMI public and private agencies to abide by local regulations for the
protection of our scarce natural resources and our water quality. However, the DoD has forgone obtaining
the same local Coastal Management Permits that we must adhere to locally. This is allowed legally even
when their proposed actions are inconsistent with CNMI local laws and policies that aim to protect our
marine and terrestrial resources. DoD continually conducts the bare minimum of environmental
assessments and suggests using substandard management efforts, yet claim their plans and exercises
meet all environmental compliance standards. Many times, DoD cites the studies they have funded that
ultimately support their preferred activities, and dismiss others cited by CNMI agencies and the public
that do not.
A4 p.921
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As another example, the proposed ruling by the National Marine Fisheries Services and the National
Oceanic and Atmospheric Association seeks to exempt the DoD from abiding by regulations set forth in
the designation of several critical coral habitats in Marianas waters (See
https://www.federalregister.gov/documents/2020/ll/27/2020~21226/endangered~and~threatened~
species~critical~habitat~for~the~threatened~indo~pacific~corals).
Inexplicably, the DoD is proposing a new land lease on the islands of Tinian and Pagan forthe GMT despite
the longstanding acknowledgement within the CNMI Covenant that no additional lands would be leased
for such purposes. This is a breach of public trust and an egregious overreach of power that disregards
Indigenous sovereignty in both the legal and socio-cultural sense. Allowing Live-fire training on leased
lands that will be returned to the Commonwealth, even more polluted than after WWII, is problematic
from both a socio-economic and environmental justice perspective. DoD has made it clear that cleaning
up the existing UXO on FDM and on the leased military lands of Tinian is not a requirement or a priority.
In closing, DoD activities do not sufficiently support local stewardship, cultural norms or practices, reflect
best practices to meet local requirements, and do not offset socio-economic impacts to our underserved
and indigenous population.
Respectfully,
02/24/2022
Theresa Arriola, Chair Date
Sophia E. Perez, Vice Chair Date
02/24/2022
02/24/2022
Sheila J. Babauta, Secretary Date
02/24/2022
Kathy L. Yuknavage, Treasurer Date
Our Common Wealth 670
Saipan, CNMI
www.ocw670.com
@ourcommonwealth670
ourcommonwealth670@gmail.com
A4 p.922
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November 29, 2020
To Whom It May Concern:
I am writing on behalf of the Towboat and Harbor Carriers Association to strongly
request that the Champlain Hudson Power Express (CHPE) cable route application as
proposed in the Hudson River be denied.
"the Applicants recognize that there is significant waterborne commerce on the Hudson
River, with the majority of the cargo originating from the Ports of New York and New
Jersey."1
The Maritime Industry strongly feels that vessel safety has been dismissed in this process
and that safe navigation will be compromised in the Hudson River by this or any cable
seeking to run parallel in navigable waters. The first and hopefully last cable to run
parallel A vast and powerful river, the Hudson has long been a vital piece in our nations
Maritime Transportation System (MTS) serving New York State and our Nation
connecting cities/ports world-wide with numerous ports along the Hudson including the
State Capital Port Albany/.
"The Port Industry of New York and New Jersey accounted for nearly $12 billion in tax
revenue, supported over 500,000 jobs, and was responsible for $36.1 billion in personal
and $99.5 billion in business income in the region in 2019, according to a new economic
impact study released today by the New York Shipping Association"2.
"In addition to the indisputable statistics through 2019, the pandemic has highlighted for
the nation what we have always known - our supply chain is the lifeline of the economy
and we must keep it working efficiently," 3
1 HDR Letter October 18, 2010, Sean Murphy
2 New York Shipping Association, 2020 Economic Report
3 IBID
A4 p.923
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STATE POLICY 3
"Th e installation and operation of the transmission cables may affect navigation or future
dredging activities which may, in turn, affect the operation of port facilities in New York
City and Albany. However, the applicant has consulted with appropriate port facility
operators and agreed to site the project in a manner that would not hamper or interfere
with port activities."4
The mission of Harbor Safety, Navigation and Operations Committee of the Port of New
York and New Jersey is: "To develop non-regulatory solutions to operational challenges
in the Port of New York and New Jersey. " The Energy Sub-Committee has worked
closely with numerous Alternative/Conventional Energy proposals to develop workable
sensible proposals and met with the CHPE consultants' numerous times to discuss cable
routing. At each meeting the Energy Sub-Committee raised several concerns regarding
the proposed cable route and installation. At first the consultant informed the Energy
Sub-Committee that they were negotiating with the New York State Department of
Conservation (DEC) to route the cable outside the channel in shallow water and that the
route would not be the same as presented however, the CHPE route is very similar though
not identical to the first proposal but still does not meet navigation safety concerns and
therefore the Applicant has met but NOT consulted with the appropriate port facility
operators.
STATE POLICY 2
"Should the bi-pole occupy any federally maintained navigation channels it will be buried
at least 15 feet below the authorized depth in a single trench within those channels. In this
matter, the siting of the cable at these depths will minimize conflicts with water based
navigation by substantially avoiding anchor strikes and potential future navigational
improvements."5
All waters are navigable whether maintained or not and therefore the cable must be
buried at least 15-feet when sited in navigable waters. Varying in size and use, anchors
have long been a staple of the shipping industry performing many functions including
anchoring, docking, and emergencies. While docks and anchorages are predictable,
4 NYSDOS Letter June 8, 2011, Signed by Daniel E. Shapiro, First Deputy Secretary of
State
5 IBID
A4 p.924
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emergencies are not. The Hudson River varies in channel width and depths is primarily
rock and can narrow to 400 feet in width. The primary tool to mitigate non-controllable
factors is the anchor. Non- controllable external factors include diminishing visibility
(fog, snow, and thunderstorms), Ice, or other vessels or internal casualty factors (loss of
engines or steering). As non-controllable factors can occur anytime and anywhere in any
navigable waters where anchors are the primary tool for crew and cargo safety.6
Risk of fouling an anchor on a cable has many impacts to include but not limited to loss
of assets, supply chain schedules, asset/human casualties, and/or environmental damage.
Vessels transiting the River trade in various liquid products including Albany exports of
ethanol.
The Energy Sub Committee and the Towboat and Harbor Carriers Association have
serious concerns with the proposed cable routing and burial depths for this project and
strongly object to burial depths as proposed. Burial depths should be analyzed, verified,
and certified by the applicant and MUST be for ALL navigational waters maintained or
not maintained. Two experts Malcom Sharpies P.E, Offshore Electrical Cable Burial for
Wind Farms: State of the Art. Standards and Guidance & Acceptable Burial Depths.
Separation Distances and Sand Wave Effect and Dr. Charles Aubeny testimony in Trans
Bay Cable LLC vs. M/V Ocean Life calculate anchor penetration significantly deeper
than the deepest burial depth proposed for the CHPE. The anchor is an important ship-
handling tool and often the only tool available in an emergency. Commercial vessels
often times have to anchor unexpectedly in an emergency situation due to diminishing
weather and visibility, to avoid collision or running aground. Mariners also rely on the
anchor for ship-handling maneuvers such as turning a vessel with the following tide or to
keep the vessel under control when approaching a berth or anchorage. The anchor is very
effective but not a precision instrument. Routing underwater infrastructure (cable,
pipelines, etc.) parallel to the navigable waters is very likely to complicate anchoring
restricting vessel safety for crew and cargo. An effort to avoid the cable or the anchor
snagging the cable could result in a serious marine incident at a significant environmental
and economic cost.7
Navigation Safety must be preserved in all navigable waters of the Hudson River as
stated by the CAPT Black, United States Coast Guard, Chief of Prevention by direction
of the District Commander in a letter dated July 19, 2017 to Stephen Ryba, Chief
Regulatory Branch, U.S. Army Corps of Engineers. During Superstorm Sandy, over 60
6 TRANS BAY CABLE LLC, Plaintiff, v. M/V OCEAN LIFE, et al, Defendants.
7 TRANS BAY CABLE LLC, Plaintiff, v. M/V OCEAN LIFE, et al, Defendants.
A4 p.925
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commercial U.S Flagged vessels sheltered at anchored in the Hudson River until storm
waters receded and terminals opened. Protected United States mariners and vital cargoes
will be at risk without the ability to anchor.
The OSPARS Commission cable routing recommendations includes as follows:8
protected areas, environmentally sensitive and/or valuable areas with e.g., habitats
and species sensitive to physical disturbance or damage where the cable laying
activity or operation would result in adverse effects should be avoided;
• Running the cable parallel to navigable waters make it impossible to avoid
adverse effects to navigation safety and marine environment
shortest possible length;
The CHPE proposal is the Longest proposed length
• bundling with existing cables and pipelines, where it is safe to do so;
• No other cable or pipeline runs parallel to navigable waters. One cable
running parallel is unfit for rendering this proposal for perpendicular
crossings.
minimal number of crossings with other cables or pipelines to reduce the
number of crossing structures.
The CHPE cable intends to cross numerous cables and pipelines
"Another condition requires that the applicant verify the transmission cables' burial depth
on a periodic basis so that they do not become a hazard to navigation or marine
resources."9OSPAR Commission Environmental Impacts are listed as follows:10
8 Guidelines on Best Environmental Practice (BEP) in Cable Laying and Operation
9 IBID
10 Guidelines on Best Environmental Practice (BEP) in Cable Laying and Operation
A4 p.926
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"Contamination Impacts" - "Release of harmful substances or nutrients may
take place while the cable is laid due to displacement and resuspension of
contaminated sediment (see disturbance) or because of damage to cables with
subsequent release of insulation fluids. Contamination may also occur due to
accidents and technical faults during construction". TDI funded report details
projected impacts "CHPE Navigation Risk Assessment"
"Contamination Impacts" will occur during sheer and jet plow
applications and again each and every time the cable is found to not be
buried and/or shifted and required to be relocated. It should also be noted
that the cable is slated to be abandoned on our nation's waterway during
the end of its life cycle. Duty to Give Adequate Notice of the Obstruction
In addition to installing a submerged structure in accordance with the
permit issued by the Army Corps of Engineers, the owner of the
submerged structure must properly mark it. A party owning and
maintaining a submerged structure above the mud line has a duty to warn
of the potential obstruction to navigation. Notice of the submerged
structure must be adequate to apprise mariners of its location and
characteristics. The signage must be visible from passing vessels and
located close to the obstruction. Duty to Inspect the Obstruction Once a
submerged obstruction is installed, the party owning it has a duty to
adequately inspect it and correct all failures.
Dielectric fluid Impacts - Pressure blow of dielectric fluid leak in the
Hudson River cost $10 million to clean up plus civil penalties. A similar
blow in Long Island Sound cost $30 million n a matter of first impression,
the U.S. Court of Appeals for the Second Circuit has ruled that an oil-
filled submerged electrical transmission cable is a "facility" under the Oil
Pollution Act of 1990 (OP A). Power Authority of the State of New York v.
M/VEllen S. Bouchard, et. al.. No. 19-1140-cv, 2020 WL 4355268 (2d
Cir. July 30, 2020). The Second Circuit's decision turned on interpreting
the OPA definition of "facility," and marked the first time this statutory
term has been construed by an appellate court. The court held
unanimously that the cable in question is an OPA "facility," and thus falls
within the purview of the OPA liability scheme.
A4 p.927
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"Electro-magnetic impacts" - "Magnetic fields generated by cables may impair
the orientation of fish and marine mammals and affect migratory behavior". A
TDI funded report details projected impacts at various burial depths.
• "Electro-magnetic impacts" - In a report written for HDR/DTA
(Consultants for TDI dated March 3, 2011) to calculate DC magnetic
fields all studies were done at either 6 or 8 foot burial depths. It is
understood that TDI plans to not bury the cable in significant portions of
the Hudson River, therefore this report is inconclusive to the impacts to
marine resources. What is known is that even at 6 or 8 foot proposed
burial depths magnetic compasses for vessel navigation will be
compromised. The Magnetic Compass is the cornerstone of all
Navigation and required by law to be carried aboard vessel.
Unknown/sporadic deviation of the Magnetic Compass by magnetic fields
emitted by cables would severely impact navigation safety in the event of
Electronic Navigation Failure caused internally or externally (Lightning
Strike, Cyber Attack). Erroneous deviation of the magnetic compass due
to the impact of cabling lying parallel to the navigable channel may
exacerbate the situation of trying to navigate in reduced visibility, thus
adding an unnecessary level of additional risk to the mariner
"Reef Effect Impacts" - "The submarine cables themselves, if not buried, will
also provide a solid substrate for a variety of species. This 'reef effect' has been
extensively discussed in literature (see OSPAR 2009) and may lead to the
introduction of non-local fauna and thus to an alteration of the natural benthic
community."
"Reef Effect Impacts" - When cost to bury exceed company profits the
utilization of non-purpose Levee mattress will be laid over the cable to
save cost on major waterbodies including the Hudson River. The use of
Levee Mattresses (designed to hold back Levees in the Western Rivers
increase reef effect impacts. The impacts of Reef Effects have not been
discussed and therefore inconclusive.
A4 p.928
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"Thermal Impacts" - "When electric energy is transported, a certain amount
gets lost as heat, leading to an increased temperature of the cable surface and
subsequent warming of the surrounding environment".
"Thermal Impacts" are a factor of transmission cables however not
identified was the Thermal Impacts in shallow burial depths or on the river
bed where the cable is proposed to be sited for a great majority of its route
and therefore inconclusive to the impacts to the marine environment
including shortnose sturgeon and its marine environment.
New York is our home. Over 31,000 New York City residents earn their livelihood in the
maritime industry. New York is now the second largest port in the United States and soon
to be the LARGEST. Because we recognize the importance of balancing the working
waterfront activities, we support environmental stewardship balanced with economic
growth and welcome the opportunity to partner with DEC, FERC, and US ACE to create a
sensible to approach to cable routes. While these utility projects are important, the risks
are too great to dedicate the bottoms of our navigable waterways to subsurface
infrastructure. These projects should not be permitted in navigable waters unless they are
perpendicular to the navigable channel and buried safely to avoid any chance of anchor
strike or snag.
I wish to thank you in advance for your considerations to our needs and if you have any
questions or concerns please feel free to email me at dirctor@TBHC.com
Sincerely,
CAPT Eric Johansson, Executive Director
Towboat and Harbor Carriers Association
Port of New York/New Jersey
A4 p.929
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Case 3:17-cv-02162-JSC Document 1 Filed 04/18/17 Page 1 of 24
MICHAEL CONNETT, ESQ., CA Bar No. 300314
CHRIS NIDEL, ESQ., D.C. Bar No. 497059
Food & Water Watch
1814 Franklin St., Suite 1100
Oakland, California 94612
Telephone: (510) 922-0720
Facsimile: (310) 922-0723
Attorneys for Plaintiffs
UNITED STATES DISTRICT COURT
FOR THE NORTHERN DISTRICT OF CALIFORNIA
AT SAN FRANCISCO
FOOD & WATER WATCH; AMERICAN )
ACADEMY OF ENVIRONMENTAL )
MEDICINE; FLUORIDE ACTION NETWORK: )
INTERNATIONAL ACADEMY OF ORAL
MEDICINE & TOXICOLOGY; MOMS
AGAINST FLUORIDATION; AUDREY
ADAMS, individually and on behalf of KYLE
ADAMS; KRISTIN LAVELLE, individually and
on behalf of NEAL LAVELLE; and BRENDA
STAUDENMAIER, individually and on behalf
of KO STAUDENMAIER and HA YD EN
STAUDENMAIER,
Plaintiffs,
vs.
U.S. ENVIRONMENTAL PROTECTION
AGENCY, an agency of the United States;
SCOTT PRUIT, Administrator, U.S.
Environmental Protection Agency, in his official
capacity,
Defendants.
1. Plaintiffs FOOD & WATER WATCH; AMERICAN ACADEMY OF ENVIRONMENTAL
MEDICINE; FLUORIDE ACTION NETWORK; INTERNATIONAL ACADEMY OF ORAL
MEDICINE & TOXICOLOGY; MOMS AGAINST FLUORIDATION; AUDREY ADAMS,
individually and on behalf of KYLE ADAMS; KRISTIN LAVELLE, individually and on behalf of
NEAL LAVELLE; and BRENDA STAUDENMAIER, individually and on behalf of KO
STAUDENMAIER and HAYDEN STAUDENMAIER (collectively "Plaintiffs") bring this suit against
1
Civ. No.
COMPLAINT
COMPLAINT
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Case 3:17-cv-02162-JSC Document 1 Filed 04/18/17 Page 2 of 24
Defendants, the U.S. ENVIRONMENTAL PROTECTION AGENCY and SCOTT PRUITT, in his
official capacity as Administrator of that Agency (collectively "EPA"), to compel the initiation of
rulemaking pursuant to the Toxic Substances Control Act ("TSCA"), 15 U.S.C. § 2605(a), to prohibit the
addition of fluoridation chemicals to drinking water supplies.
I. BACKGROUND
2. Industrial-grade fluoride chemicals (i.e., hydrofluorosilicic acid, sodium silicofluoride, and
sodium fluoride), derived primarily from the phosphate fertilizer industry, are added to many public
water supplies in the United States in an attempt to reduce tooth decay.
3. Approximately 200 million Americans live in communities with artificially fluoridated water.
Even people who don't live in fluoridated areas now regularly consume fluoridated water since many
processed foods and beverages are made in fluoridated areas.
4. Water fluoridation began in the 1940s based on the mistaken premise that fluoride's primary
benefit to teeth comes from ingestion.
5. It is now universally recognized by dental researchers, including the Centers for Disease
Control's (CDC) Oral Health Division, that fluoride's primary benefit comes from topical application.
Fluoride does not need to be swallowed, therefore, to prevent tooth decay.
6. The National Academy of Sciences (NAS) has repeatedly stated that fluoride is not an essential
nutrient. Fluoride does not need to be swallowed, therefore, to prevent any disease or promote any health
benefit.
7. Water fluoridation has been rejected or discontinued by the vast majority of European countries
without any demonstrated adverse effect on cavity rates.
8. Whereas fluoride's benefits to teeth come from topical contact, fluoride's health risks come
from ingestion. One of the risks of fluoride ingestion is dental fluorosis, a hypomineralization of tooth
enamel that produces noticeable discoloration of the teeth.
COMPLAINT
A4 p.931
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Case 3:17-cv-02162-JSC Document 1 Filed 04/18/17 Page 3 of 24
9. According to a 2011-2012 national survey by the CDC, a staggering 58% of American
adolescents now have dental fluorosis, with 23% of adolescents suffering advanced forms of the
condition. When present on the front teeth, dental fluorosis (even in its"mild" forms) is an aesthetically
objectionable condition that can cause children significant social anxiety and embarrassment.
10. The rate of dental fluorosis among U.S. children is far higher today than was the case when
fluoridation first began in the 1940s, and is several times higher than the rate documented in the 1980s.
The continued increase in fluorosis over the past 60 years highlights the fact that American children are
being exposed to unprecedentedly high doses of fluoride, primarily but not exclusively through water
fluoridation.
11. The prevalence and severity of dental fluorosis is significantly greater in areas with fluoridated
water than in areas without. This is because children in fluoridated areas receive larger cumulative doses
of fluoride than children in non-fluoridated areas.
12. A primary concern with fluoride's impact on human health today is its deleterious effect on the
brain.
13. In 2006, the National Research Council (NRC) concluded that "it is apparent that fluorides have
the ability to interfere with the functions of the brain."
14. Over 300 published, peer-reviewed studies have reported that fluoride interferes with the brain.
This includes over 50 studies linking fluoride exposure to cognitive impairments in human populations.
The majority of these studies have been published within the past 10 years.
15. In 2014, fluoride was added to the list of chemicals "known to cause developmental neurotoxicity
in human beings" in a review published by Lancet Neurology. Fluoride is one of only 12 chemicals that
are on this list, alongside lead, mercury, and PCBs.
16. Many of the studies investigating fluoride's impact on the brain have found adverse neurotoxic
effects at doses ingested by a large number of Americans living in fluoridated communities.
COMPLAINT
A4 p.932
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Case 3:17-cv-02162-JSC Document 1 Filed 04/18/17 Page 4 of 24
17. EPA's safety standards for fluoride dosing remain focused on preventing severe dental fluorosis
and/or crippling skeletal fluorosis, and do not account for fluoride's effects on the brain. Yet, studies in
humans and animals show that fluoride causes adverse neurotoxic effects at doses that are lower than
those which produce severe dental and skeletal fluorosis. Safety standards solely designed to protect
against severe dental and skeletal fluorosis will thus not protect against fluoride's neurological effects.
18. EPA has promulgated Guidelines for Neurotoxicity Risk Assessment (hereafter, Guidelines),
which set forth the principles, concepts, and procedures that EPA has stated it "will follow" when
"evaluating data on potential neurotoxicity associated with exposure to environmental toxicants."
19. Despite the voluminous peer-reviewed scientific literature on fluoride neurotoxicity in humans,
animals, and cell cultures, EPA has never applied its own Guidelines to fluoride.
20. Application of EPA's Guidelines to the human, animal, and in vitro research on fluoride
neurotoxicity would show that (1) neurotoxicity is a hazard of fluoride exposure, and (2) the risk of this
hazard exists at doses that are now ingested by millions of Americans living in fluoridated communities.
21. Neurodevelopmental disabilities, including learning disabilities and attention deficit hyperactivity
disorder, are now widespread in the United States. Data from the CDC shows that 1 in 6 U.S. children
now suffer from a neurodevelopmental disability.
22. In a nation besieged by neurological disorders of poorly understood etiology, both in young
children and the elderly, minimizing exposures to known neurotoxic substances must be a public health
priority.
4
COMPLAINT
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II. JURISDICTION AND VENUE
24. On November 22, 2016, a group of organizations and individuals, including Plaintiffs, petitioned
EPA to exercise its authority under Section 6 of TSCA, 15 U.S.C. § 2605, to prohibit the addition of
"fluoridation chemicals" to drinking water supplies based on the voluminous peer-reviewed research
linking fluoride exposure to neurotoxicity. (The one and only chemical use of "fluoridation chemicals"
is to fluoridate drinking water.)
25. By letter dated February 17, 2017, EPA denied the Petition.
26. Plaintiffs have a right to bring this action pursuant to TSCA, 15 U.S.C. § 2620(b)(4), which
authorizes petitioners to commence a civil action in a district court of the United States to compel the
EPA Administrator to initiate a rulemaking proceeding as requested in the petition.
27. This Court has jurisdiction pursuant to 15 U.S.C. § 2620(b)(4)(A) and 28 U.S.C. § 1331.
28. Venue is properly vested in this Court under 28 U.S.C. § 1391(e) as Plaintiff KRISTIN
LAVELLE resides in Berkeley California, and Plaintiff FOOD & WATER WATCFI has a regional office
in Oakland, California.
III. PARTIES
29. Plaintiff FOOD & WATER WATCH ("FWW") is a national, non-profit, public interest consumer
advocacy organization with its headquarters in Washington, D.C. and a regional office in Oakland,
California.
30. FWW's mission includes educating consumers about the health and safety of our food and water
systems and as such FWW advocates on behalf of the public for policies promoting environmental
protection and the long-term well-being of individuals and communities.
31. FWW's members live in fluoridated communities across the United States, and as with virtually
all Americans, regularly purchase processed foods and beverages that are contaminated with fluoridated
water. Since the labels on processed foods and beverages do not identify whether the products are made
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with fluoridated water, it is often not possible for consumers to know which particular food or beverage
is contaminated. There is therefore a credible threat that FWW's members will be exposed to fluoridated
water and the health risks associated therewith, even if they purchase home water filtration systems to
remove the fluoride out of the tap water entering their homes.
32. Jessica Trader is an FWW member and a San Francisco business owner. San Francisco adds
industrial fluoride chemicals to its water. Jessica has moderate-to-severe dental fluorosis from over-
exposure to fluoride as a child. As a result of her fluorosis, Jessica's teeth have noticeable white and
brown stains, which have caused her social anxiety and embarrassment. Jessica is concerned about the
impact that her prior and ongoing exposures to fluoridation chemicals could have on her health and has
spent significant money in order to limit her exposure to this toxicant, including through the purchase and
installation of a professional water filtration system that removes fluoride.
33. Dayna Stephens is a FWW member and professional saxophonist. Dayna currently resides in
Patterson, New Jersey. Although Patterson does not fluoridate its water, Dayna's musical career requires
him to spend a large percentage of his time travelling throughout the United States. Dayna suffers from
Focal Segment Glumereal Sclerosis (FSGS), a cause of kidney disease in children and adolescents as
well as a leading cause of kidney failure in adults. Dayna underwent dialysis for his kidney failure and
underwent kidney transplant surgery. It is well established in the scientific literature that kidney disease
greatly increases an individual's susceptibility to fluoride's toxicity. Dayna is aware of this research, and
is very concerned about the impact fluoride ingestion could have on his health. While at home, and while
travelling, Dayna spends a significant amount of time and money to avoid exposure to fluoridation
chemicals from tap water, processed foods, and processed beverages.
34. Rosemary Fletcher is an FWW member and resident of Greenville, South Carolina, which adds
industrial fluoride chemicals to its water. Rosemary is an African American woman on a fixed income
who used to be dependent on a wheel chair due to a painful arthritic condition. After learning that her
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condition could be exacerbated by fluoride exposure, Rosemary stopped drinking fluoridated water and
experienced a major improvement in her symptoms. After several months of diligently eliminating
fluoridated water, Rosemary was able to abandon her wheel chair, and has not needed it since. Rosemary
continues to take every measure possible to avoid exposure to fluoridated water, including by purchasing
bottled water for her home drinking water needs. Rosemary's reliance on bottled water has created a
financial hardship for her, as she has very limited financial resources.
35. Franzi and Randy Talley are FWW members, restaurant owners, and residents of Asheville,
North Carolina, which adds industrial fluoride chemicals to its water. Approximately nine years ago,
Franzi was diagnosed with breast cancer, which she treated with chemotherapy. Subsequent to
chemotherapy, tests revealed that Franzi had an underactive thyroid gland, as evident by low circulating
thyroid hormone levels in her blood. The low thyroid function persisted for years, and was accompanied
by substantial fatigue. Last year, after learning of credible medical science linking fluoride exposure to
decreased thyroid function, Franzi stopped drinking the fluoridated city water. Franzi's thyroid hormone
levels began to increase within months of making this switch, and are now almost back to normal.
Franzi's energy level has also notably improved during this time as well. Avoiding fluoridated water is
therefore a critical health priority for Franzi as she seeks to continue her recovery. Both her and her
husband Randy continue to diligently do what they can to avoid fluoridated water, both for themselves
and the customers they serve. They would like to install a water filtration system at their restaurants
which can remove the fluoride, but they have run into technical difficulties implementing a filtration
system that is capable of removing fluoride that is also compatible with their operations.
36. Karen Spencer is an FWW member and resident of Gloucester, Massachusetts which adds
industrial fluoride chemicals to its water. Karen long suffered from various health problems beginning
the month her city began fluoridation in 1981. Her symptoms include rashes, hives, gastrointestinal
problems, arthritis, general fatigue, pain, chronic dizziness and intermittent short periods of profound.
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debilitating and overwhelming fatigue. In 2014, Karen began to strictly eliminate her exposure to
fluoridated water to see if it would improve her health. In 9 days, she noted a dramatic improvement in
all her symptoms, including cessation her neurological symptoms. Karen has continued to strictly avoid
fluoridated water and food and has made a recovery from the illnesses that caused her decades of misery.
37. Plaintiff FLUORIDE ACTION NETWORK ("FAN") is a project of the American Environmental
Health Studies Project, Inc. FAN is an organization of scientists, doctors, dentists, environmental health
researchers, and concerned citizens working to raise awareness about the impact of current fluoride
exposures on human health. FAN's members live in fluoridated communities across the United States,
and many have expended significant sums of money to avoid the fluoride added to tap water and
processed foods and beverages. Many of FAN members have suffered dental fluorosis and other harm as
a result of their fluoride exposures, and have credible concerns about the impact that ongoing exposures
to fluoridated water will have on their health.
38. Julie Simms is a FAN member, FWW member, and resident of Seattle, Washington, which adds
industrial fluoride chemicals to its water. For more than a decade, Julie experienced constant, daily
headaches. She experimented with numerous therapies to cure her of the condition, but nothing worked.
Then, in 2013, a friend suggested that Julie stop drinking fluoridated water. Julie was very skeptical of
this suggestion as she had long been a supporter of water fluoridation, believed in its safety and efficacy.
Nevertheless, at the insistence of her friend, Julie stopped drinking fluoridated water and to her great
surprise, the headaches became substantially less painful within just 3 days, and were completely gone
within weeks. Julie has continued to spend the necessary resources to avoid fluoridated water and
consequently her daily headaches have not returned. Based on her experience, Julie's doctor has advised
that she continue to refrain from fluoridated water, not just for drinking and cooking, but bathing as well.
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39. Plaintiff AUDREY ADAMS, individually and on behalf of her son KYLE ADAMS, resides in
Renton Washington. The Adams are served by Soos Creek Water and Sewer District, a wholesale water
purveyor receiving pre-treated water from Seattle Public Utilities ("SPU"). SPU adds industrial fluoride
chemicals to its water supply. Kyle has autism and has specific metabolic weaknesses that heighten his
sensitivity to many chemicals, including fluoride. Kyle's doctor concurs that Kyle must refrain from
exposure to fluoridated water for drinking, cooking and bathing, as he has a consistent history of
suffering severe reactions when exposed to fluoridated water. These reactions include (but are not
limited to) intense pain and headaches, with resulting extreme hyperactivity, accelerated heart rate and
intensification of autistic symptoms. Audrey Adams continues to expend substantial time and money
ensuring that Kyle is not exposed to fluoridated water, including the ongoing purchase of spring water
and reverse osmosis filtered water for all drinking and cooking and special water filtration for showering.
Kyle's continued ability to work, recreate, communicate, participate in community outings and even to
sleep are reliant on strict avoidance of all sources of fluoridated water.
40. Plaintiff KRISTIN LAVELLE, individually and on behalf of her 12-year-old son NEAL
LAVELLE, is a resident of Berkeley, California. Kristin is an occupational health therapist, and is
concerned about the adverse effects that fluoride exposures could have on her and her family's health,
including her son Neal. Since Berkeley adds industrial fluoride chemicals to its water, Kristin purchased
a $2,000 whole house water filtration system in May of 2015. Although the filter was advertized to
reduce over 80% of the fluoride, and although Kristin has dutifully followed all of the maintenance
requirements, recent test results show that the filter is not removing any of the fluoride. Kristin has thus
purchased a new countertop water filter, which will require ongoing replacements of the filter cartridge,
and is considering purchasing a replacement filtration system. In addition to the expenses that Kristin
has incurred in trying to remove the fluoride chemicals from her tap water, Kristin also spends significant
time and money to minimize her and Neal's exposure to fluoridated water when away from home.
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41. Plaintiff BRENDA STAUDENMAIER, individually and on behalf of her children KO
STAUDENMAIER and HAYDEN STAUDENMAIER, is a resident of Green Bay, Wisconsin, which
adds industrial fluoride chemicals to its water. Due to her concerns about the impact of fluoride on her
and her children's health, Brenda has purchased a water filtration system to filter the fluoride out of the
water. The filtration system requires that the filter cartridges be replaced approximately every six
months. Each cartridge costs approximately $137.50, so Brenda has to pay approximately $275 a year to
ensure access to fluoride-free water at home. Brenda is a single mother living on a low income, and $275
a year represents a substantial expense for her.
42. Plaintiff AMERICAN ACADEMY OF ENVIRONMENTAL MEDICINE was founded in 1965.
and is an international association of physicians and other professionals that provides research and
education in the recognition, treatment and prevention of illnesses induced by exposures to biological and
chemical agents encountered in air, food and water.
43. Plaintiff INTERNATIONAL, ACADEMY OF ORAL MEDICINE & TOXICOLOGY
("IAOMT") has been dedicated to its mission of protecting public health through the practice of
biological dentistry since it was founded in 1984. A worldwide organization of over 800 dentists,
physicians, and research professionals in more than 14 countries, IAOM'Fs mission is accomplished by
funding and promoting relevant research, accumulating and disseminating scientific information,
investigating and promoting non-invasive scientifically valid therapies, and educating medical
professionals, policy makers, and the general public.
44. Plaintiff MOMS AGAINST FLUORIDATION ("MOMS") is a nonprofit organization
that educates mothers, pregnant women, families, medical professionals, and all citizens about the now
known health effects and ethical issues of ingesting artificial fluoridation chemicals to our water supply.
MOMS takes the position that using the public's drinking water to deliver a drug in indiscriminate doses
that vary widely from person to person without is a violation of the medical right to informed consent.
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IV. STATUTORY FRAMEWORK
45. Section 6 of the Toxic Substances Control Act (TSCA) invests EPA with the authority and duty
to take certain prescribed actions if it determines that "the manufacture, processing, distribution in
commerce, use, or disposal of a chemical substance . . . presents an unreasonable risk of injury to health."
15 U.S.C. § 2605(a). In making this determination, TSCA commands that EPA consider not only risks to
the general public, but to "susceptible subpopulationjs]" as well. 15 U.S.C. § 2605(b)(4)(A).
46. TSCA commands that EPA conduct its risk evaluation "without consideration of costs or other
nonrisk factors." 15 U.S.C. § 2605(b)(4)(A).
47. If EPA determines that a chemical substance presents an unreasonable risk to the general public
or susceptible subpopulation(s), the Agency "shall" take action "to the extent necessary to protect
adequately against such risk using the least burdensome requirements." 15 U.S.C. § 2605(a). The
actions that EPA may take include: (1) prohibiting the manufacture and distribution of the substance for a
"particular use," and (2) prohibiting "any manner or method of commercial use" of the substance. 15
U.S.C. § 2605(a)(2) & (5).
48. EPA's authority to prohibit and regulate the use of chemical substances under TSCA
encompasses drinking water additives. EPA recognized this in its June 12, 1979 Memorandum of
Understanding (MOU) with the FDA, in which the Agency stated unequivocally that it has authority "to
regulate direct and indirect additives to drinking water as chemical substances and mixtures under
TSCA." As EPA explained in the MOU, "[a]lthough Section 3(2)(B) of TSCA excludes from the
definition of 'chemical substance' food and additives as defined under FFDCA, the implicit repeal by the
[Safe Drinking Water Act] of FDA's authority over drinking water enables EPA to regulate direct and
indirect additives to drinking water as chemical substances and mixtures under TSCA."
49. In proposing and promulgating a rule under 15 U.S.C. § 2605(a), the EPA shall consider and
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publish a statement addressing, inter alia, the (A) the effects of the chemical substance on human health
and the exposure of human beings to it; (B) the benefits of the chemical substance; and (C) the
reasonably ascertainable economic consequences of the rule. 15 U.S.C. § 2605(c)(2)(A).
V. STATEMENT OF FACTS
A. The National Research Council's 2006 Review and Subsequent Peer-Reviewed Research
Demonstrates Fluoride's Ability to Harm the Brain
50. In 2003, the EPA asked the National Research Council (NRC) to review the adequacy of EPA's
Maximum Contaminant Level Goal (MCLG) for fluoride, which then and now is set at 4 mg/L. In
response, the NRC reviewed the existing research on fluoride toxicity and concluded, in March 2006,
that the MCLG is not protective of public health and should be lowered.
51. The NRC conclusion was based on fluoride's adverse effects on bone and teeth, but the NRC also
raised numerous concerns about the potential for fluoride to cause other systemic harm, particularly to
the endocrine and nervous systems.
52. With respect to the endocrine system, the NRC concluded that fluoride is an "endocrine
disrupter," that can alter the function of numerous endocrine glands in the body, including the thyroid
gland. The NRC reviewed numerous studies linking fluoride to altered thyroid function, noting that "[i]n
humans, effects on thyroid function were associated with fluoride exposures of 0.05-0.13 mg/kg/day
when iodine intake was adequate and 0.01-0.03 mg/kg/day when iodine intake was inadequate." These
doses are ingested by many people living in fluoridated areas. In light of the established link between
thyroid function and neurological health, the NRC called for more research into fluoride's role "in the
development of several diseases or mental states in the United States."
53. With respect to the nervous system, the NRC concluded: "On the basis of information largely
derived from histological, chemical, and molecular studies, it is apparent that fluorides have the ability to
interfere with the functions of the brain."
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54. The NRC's conclusion about fluoride's interference with the brain rested primarily on its review
of animal studies, because few human studies were available at the time of the NRC review. In the last
decade, however, many studies have reported links between fluoride exposure and cognitive deficits in
humans, providing additional foundation for concerns about fluoride's threats to the brain.
55. At the time, the NRC only had five human studies on fluoride's cognitive effects to consider in
drawing its conclusions; however, there are now over 50 studies linking fluoride to cognitive deficits in
humans, as reflected by reduced 1Q scores, impaired performance on the Neurobehavioral Core Test
Battery (NCTB) test, and impaired performance on the Rey Osterrieth Complex Figure test. In addition,
at least three studies have found that the human fetal brain is damaged by elevated prenatal fluoride
exposures, which may be one of the mechanisms by which fluoride lowers 1Q.
56. The evidence linking fluoride to neurotoxicity in humans is far more extensive today than it was
when NRC published its review in 2006, and is far more extensive than the evidence for most of the
other chemicals known or suspected to be neurotoxins. Despite this fluoride continues to be used as a
water additive.
57. A recent systematic review of suspected developmental neurotoxins by EPA scientists found that
few chemicals have been linked to neurotoxicity in humans. The EPA scientists stated that chemicals
linked to neurotoxicity in humans are "gold standard" chemicals that warrant prioritization.
58. In the case of fluoride, not only is there human data on neurotoxicity, there are so many human
studies linking fluoride to neurotoxic effects that fluoride has been classified by experts as one of only 12
chemicals "known to cause developmental neurotoxicity in human beings
59. Fluoride's ability to impair cognition in humans is consistent with animal studies showing that
fluoride exposure impairs learning and/or memory capacity in rodents under carefully controlled
laboratory conditions. There are now at least 45 animal studies linking fluoride to cognitive deficits in
rodents.
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60. Fluoride's ability to harm the brain has been further confirmed by over 100 animal studies
published since the NRC review which show that fluoride exposure produces a range of adverse
neuroanatomical and neurochemical alterations in the brain, including at concentrations that humans
experience in fluoridated areas in the United States.
61. It has been 10 years since the NRC determined that the MCLG for fluoride be lowered based on
the available data, and the data has continued to mount exponentially, but the EPA has ignored NRC's
recommendations and failed to act to protect the public health.
B. Fluoride Poses Neurotoxic Risks at Doses Comparable to the Doses Ingested in Fluoridated
Communities in the United States
62. A frequent claim made by those who continue to promote fluoridation is that the water fluoride
concentrations associated with neurotoxicity in humans are not relevant to the water fluoride
concentrations in the United States; that the drinking water concentrations linked to neurotoxicity exceed
the concentration used in domestic water fluoridation programs (0.7 mg/L).
63. In support of this claim, proponents of fluoridation often point to the highest water fluoride
concentrations that have been linked to neurotoxicity, while ignoring the lowest concentrations (and even
the typical concentrations) that have been associated with harm.
64. This focus on the highest concentrations that cause harm as the starting point for analysis, rather
than the lowest concentrations, clashes with standard tenets of risk assessment, including EPA's
Guidelines.
65. The focus on the water fluoride concentrations associated with neurotoxic harm also overlooks
the fact that it is the total daily dose of fluoride that causes toxicity (i.e., how much fluoride a person
actually ingests), not simply the concentration of fluoride in the water. For example, a person consuming
two liters of water containing 0.7 mg/L fluoride (the concentration used in fluoridation programs) will
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consume the same waterborne dose as a person consuming water with 1.4 mg/L (a concentration that has
repeatedly been linked to IQ loss). Some Americans, including athletes, manual laborers, and diabetics,
consume large quantities of water, far in excess of two liters a day. Further, many of the studies which
have investigated fluoride's impact on IQ have been conducted in rural China, where very few children
are exposed to fluoride toothpaste and other fluoridated dental products. Since the vast majority of
American children use fluoridated dental products, and since use of fluoridated dental products during
the early years of life can result in substantial fluoride ingestion, an American child can receive the same
daily dose of fluoride as a Chinese child despite having less fluoride in the water.
66. Contrary to the oft-repeated claim that fluoride neurotoxicity is only found at irrelevantly high
water fluoride concentrations, the existing studies of fluoride-exposed human populations consistently
find neurotoxic impacts within water fluoride concentrations that the EPA currently considers safe (< 4
milligrams/liter), with many of these studies finding IQ loss at just 0.8 to 2 mg/L.
67. In total, there are 24 published studies reporting statistically significant reductions in IQ in areas
with water fluoride concentrations less than the EPA's MCLG.
68. Many of the studies investigating fluoride's effect on IQ have provided individual-level data on
fluoride exposure, including: (a) daily fluoride dose from all sources, (b) urine fluoride level, (c) serum
fluoride level, and (d) dental fluorosis status. Each of these metrics have been found to correlate with
reduced IQ.
69. The daily fluoride dose associated with reduced IQ in endemic fluorosis areas is exceeded by
many Americans living in fluoridated areas.
70. The urine fluoride level associated with reduced IQ in children in endemic fluorosis areas is
exceeded by many Americans living in fluoridated areas.
71. The urine fluoride level associated with cognitive impairment in adults in endemic fluorosis areas
is exceeded by many Americans living in fluoridated areas.
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72. The serum fluoride level associated with reduced IQ in endemic fluorosis areas is exceeded by
many Americans living in fluoridated areas.
73. Studies have found that children with mild, moderate, and moderate/severe fluorosis have lower
IQs than children with no fluorosis. Consistent with this, studies of rodents have repeatedly found
neurotoxic effects, including learning impairments, among rats with only mild forms of fluorosis. As
noted by Niu, et al, "these findings indicate that fluoride . . . can influence spontaneous behaviors and
lower the learning ability of rats before the appearance of dental lesions."
74. The studies linking fluorosis to cognitive deficits become extremely significant to the question of
U.S. regulatory policy when considering the rate of dental fluorosis among the U.S. population.
75. CDC s 2011-2012 National Health and Nutrition Examination Survey (NHANES) found dental
fluorosis in 58.3% of the surveyed adolescents, including an astonishing 21.2% with moderate fluorosis,
and 2% with severe. Since there are an estimated 42-million adolescents currently living in the U.S., the
NHANES data suggests that up to 24-million adolescents now have some form of dental fluorosis, with
over 8 million adolescents having moderate fluorosis, and 840,000 having severe fluorosis.
76. The NHANES survey does not provide data on the respective rates of fluorosis in fluoridated vs.
non-fluoridated communities, but research has repeatedly confirmed that both the prevalence and severity
of dental fluorosis are greater in U.S. communities with fluoridated water than in communities without.
Stopping the addition of fluoride to drinking water will thus reduce the number of children developing
dental fluorosis, and the accompanying neurotoxic risks associated with the doses that produce fluorosis.
77. Recent epidemiological studies in Canada, England, and the United States provide further reason
for concern about the neurotoxic dangers posed by fluoridation. In 2016, researchers from Canada found
that urinary fluoride levels were significantly correlated with learning problems. In 2015, Malin and Till
found a significant correlation between the prevalence of water fluoridation at the state level in the U.S.
and Attention-Deficit Hyperactivity Disorder (ADHD). Another 2015 study, by Peckham et al., found
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that fluoride levels greater than 0.7 mg/L significantly correlated with higher rates of hypothyroidism in
the United Kingdom, even after controlling for the covariates of age, gender, and index of deprivation.
The correlation between fluoridation and hypothyroidism, which is biologically plausible and consistent
with prior animal and human studies, provides further mechanistic support for the capacity of fluoridated
water to cause neurotoxic effects. Finally, recent epidemiological and laboratory studies strongly suggest
that fluoridating water with hydrofluorosilicic acid increases the corrosion of lead (a potent neurotoxin)
from brass pipes and fittings, resulting in elevated blood lead levels. This provides yet another
mechanism whereby fluoridation can produce adverse neurotoxic effects at relevant use and exposure
levels.
78. Studies of rodents further demonstrate the neurotoxic hazards of the fluoride doses ingested in
fluoridated areas. The National Toxicology Program has estimated that over 10% of children living in
fluoridated areas will receive a comparable waterborne fluoride dose as rats drinking water with 9 mg/L.
This is significant because studies have repeatedly found neurotoxic effects among rats drinking water
with just 1 to 9 mg/L; including oxidative stress, alterations in neurotransmitters, learning impairment,
behavioral changes, and pathological changes in the synaptic structure.
79. Studies of cells have found that fluoride can damage brain cells at concentrations as low as 9 parts
per billion. Most Americans living in fluoridated areas have more than 9 parts per billion fluoride in
their blood, with some individuals having 50 to 100+ parts per billion in their blood. Since fluoride
circulating in the blood has access to the brain, and since the blood brain barrier loses its efficacy with
aging> many Americans will have fluoride levels in their brain that are known to harm brain cells in
carefully controlled laboratory experiments.
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C. Susceptible Subpopulations Are at Heightened Risk of Fluoride Neurotoxicity
80. EPA's Guidelines recognize that individual susceptibility to the neurotoxicity of environmental
toxicants can vary by a factor of ten or more, and is influenced by factors such as nutritional status, age,
genetics, co-exposure to other toxicants, and disease.
81. Each of these factors—nutritional status, age, genetics, co-exposure to other toxicants, and
disease—are known to influence an individual's susceptibility to chronic fluoride toxicity.
82. Recent research has specifically demonstrated that nutrient deficiencies and genetics amplify
fluoride's neurotoxicity. Zhang et al. (2015), for example, reported that certain COMT gene
polymorphisms greatly influence the extent of IQ loss resulting from fluoride exposure, which is
consistent with research on other neurotoxins, including methyl mercury.
83. While the full range of individual susceptibility to fluoride neurotoxicity in the U.S. cannot be
precisely calculated, a number of identifiable subpopulations are clearly at elevated risk, including:
a. Infants: Although breast fed infants receive the lowest fluoride intake by bodyweight
(<0.001 mg/kg/day) of all age-groups, this situation is flipped on its head when infants are
fed formula reconstituted with fluoridated water, as infants consuming fluoridated
formula receive the highest dosage of any age group in the population. In fact, the
average daily dose received by an infant receiving fluoridated formula exceeds the dose
that has been associated with reduced IQ in studies of Chinese children. Not only do
formula-fed infants receive an unnaturally high dose, they have an impaired ability to
excrete the fluoride they ingest, retaining up to 87% of the absorbed dose. As a result of
this high body burden, infants exposed to fluoridated water suffer far higher rates of dental
fluorosis, thus demonstrating their vulnerability to fluoride's systemic effects.
b. Elderly. As noted in EPA's Guidelines, "[T]he aged population is considered to be at
particular risk [of neurotoxicity] because of the limited ability of the nervous system to
COMPLAINT
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Case 3:17-cv-02162-JSC Document 1 Filed 04/18/17 Page 19 of 24
regenerate or compensate to neurotoxic insult." This is of concern because the brain will
be more exposed to fluoride in older age due to the (1) increased level of fluoride
circulating in the serum as a result of age-related degenerations in kidney and bone health,
and (2) increased permeability of the blood-brain barrier. Consistent with this, studies
have found a very high prevalence of cognitive impairment (up to 82%) among elderly
individuals in endemic fluorosis areas.
c. Individuals with suboptimal nutrient intake: It has been known for over 70 years that
suboptimal nutrient intake (e.g., calcium, vitamin C, vitamin D, iodine, etc) render
individuals more susceptible to fluoride toxicity. This is of significant concern vis-a-vis
fluoride neurotoxicity in the U.S. as suboptimal nutrient intake remains a widespread
problem. For example, 86% percent of African Americans, for example, do not get
enough calcium; the median urine iodine concentrations for women of child-bearing age
"border on insufficiency"; and 6% of Americans have a vitamin C deficiency.
d. Individuals with COMTgene polymorphisms: The study by Zhang et al. (2015) suggests
that children with the COMT val/val genotype suffered a five-fold larger drop in IQ than
children with the COMT val/met and met/met genotypes.
e. Individuals with kidney disease: The kidneys are the principal way that the human
excretes fluoride. When the kidneys are damaged, the ability to excrete fluoride becomes
impaired, leading to an excess accumulation of fluoride in the body. It is well established,
therefore, that individuals with advanced kidney disease are at far higher risk of suffering
fluoride toxicity.
f. African Americans: The African American community suffers disproportionate risks
from fluoride exposure, as it has a heightened prevalence of multiple risk factors for
fluoride toxicity, including elevated use of infant formula, elevated exposure to lead,
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Case 3:17-cv-02162-JSC Document 1 Filed 04/18/17 Page 20 of 24
depressed calcium and anti-oxidant intake, and significantly higher rates of dental
fluorosis, including in its moderate and severe forms.
84. These susceptible subpopulations will suffer neurotoxic effects at doses of fluoride exposure that
are lower than the genera] population.
D. A Reference Dose Protective Against Fluoride Neurotoxicity Is Incompatible with Water
Fluoridation if Standard Risk Assessment Procedures Are Applied
85. Because of the wide range of sensitivity in the human population to neurotoxicants, EPA's
Guidelines endorse the application of "uncertainty factors" (UF) when converting the "lowest observable
adverse effect level" (LOAEL), "no observable adverse effect level" (NOAEL) or Benchmark Dose
(BMD) level into a safe "reference dose" (RfD). Typically, the uncertainty factors are at least one order
of magnitude (i.e., a factor of 10).
86. Application of a single uncertainty factor of 10 to the dose of fluoride associated with harm
and/or the doses associated with no effect, produce RfD that is far below the levels that most Americans
now receive in fluoridated areas. The dose that would protect against fluoride neurotoxicity according to
EPA's Guidelines, and standard risk assessment procedures, is incompatible with the doses of fluoride
ingested in fluoridated areas.
87. Application of EPA's BMD methodology to available dose-response data (Xiang et al.) indicates
that ingestion of 0.7 mg fluoride per day is associated with an average loss of 2.5 1Q points when
compared to a child with no fluoride exposure. This is a dose of fluoride that tens of millions of
American children living in fluoridated communities now ingest.
88. A recent published quantitative risk analysis by a former Senior EPA risk assessment scientist
concludes that fluoride ingestion should be kept below 0.05 mg/day if neurotoxicity is to be avoided.
Virtually every person living in a fluoridated area consumes more than 0.05 mg/day from fluoridated tap
water and processed foods and beverages made with fluoridated water.
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Case 3:17-cv-02162-JSC Document 1 Filed 04/18/17 Page 21 of 24
89. The reduction in IQ associated with fluoride exposure is severe enough in some children to
produce mental retardation, the impact of which is obvious and catastrophic. However, even the loss of a
single IQ point is associated with significant economic loss. As calculated by Spadaro et al., a loss of a
single IQ point causes an average drop in lifetime earnings of $18,000 in 2005 U.S. dollars, which, when
adjusted for inflation, amounts to $22,250 in current dollars.
90. Since 200 million Americans now live in areas where water is fluoridated, and since virtually all
Americans consume processed foods and beverages made with fluoridated water, even a small reduction
in IQ from fluoridated water stands to have immense economic consequences.
E. Recent Studies Show that Fluoridation Presents Little Meaningful Benefit to Teeth
91. Fluoridation chemicals are the only chemicals added to municipal water that don't treat the water
itself. The sole purpose of adding fluoridation chemicals to water for use as a drug to reduce tooth decay,
a non-waterbome disease. Current research, however, demonstrates that the purported dental benefits
from fluoridation are much smaller than previously believed, with many studies failing to find any
measurable, clinically significant difference in tooth decay between fluoridated and non-fluoridated
areas.
92. There are no randomized controlled trials on the effectiveness of fluoridation, and few of the
available studies adequately account for potential confounders like socioeconomic status, sealants, and
dietary habits. The evidence has thus been characterized by the Cochrane Collaboration as having "high
risk of bias' and limited applicability to modern lifestyles.
93. Notwithstanding these methodological limitations, modern studies of fluoridation and tooth decay
have found that the difference in cavity rates between fluoridated and non-fluoridated areas is small,
inconsistent, and often non-existent, particularly in the permanent teeth.
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Case 3:17-cv-02162-JSC Document 1 Filed 04/18/17 Page 22 of 24
94. Because of the meager differences in cavities now seen between fluoridated and non-fluoridated
areas, sensitive measurements of tooth decay must be utilized in order to detect any differences in decay.
But, even when sensitive measurements are utilized, the differences remain small in absolute terms,
inconsistent, and greatly overshadowed by the influence of other factors known to affect decay.
95. Studies from Canada, Cuba, Finland, Germany, and the United States did not detect any
measurable increase in decay following the termination of water fluoridation programs.
F. Fluoridation Is Unnecessary as There Are Safer, More Effective Alternatives, Including
Topical Fluoride Products
96. The addition of fluoridation chemicals to drinking water began in the U.S. prior to the advent of
topical fluoride products in an era when public health authorities believed fluoride's predominant benefit
to teeth comes from ingestion. Things have changed dramatically since that time.
97. Today, over 95% of toothpastes contain fluoride, as do many other dental products, and dental
researchers now universally acknowledge that fluoride's predominant benefit is topical, not systemic. As
explained in the Journal of the American Denial Association, "fluoride incorporated during tooth
development is insufficient to play a significant role in cavity protection." (Featherstone 2000) The
Centers for Disease Control has confirmed the primacy of fluoride's topical mechanisms, declaring that
"fluoride's predominant effect is pas/eruptive and topical." (CDC 2001) The NRC has confirmed this as
well, stating that "the major anticaries benefit of fluoride is topical and not systemic." (NRC 2006)
98. Since fluoride's primary benefit comes from topical contact with the teeth, there is little benefit
from swallowing fluoride, in water or any other product. In fact, a recent NIH-funded prospective study
of the relationship between tooth decay and total daily fluoride ingestion failed to find a detectable
relationship between the two. (Levy et al. 2009). Other recent studies investigating the relationship
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Case 3:17-cv-02162-JSC Document 1 Filed 04/18/17 Page 23 of 24
between tooth decay and individual biomarkers of fluoride intake (e.g., toenail fluoride content and
dental fluorosis) have reported similar results.
99. The widespread availability of topical fluoride products highlights the lack of necessity of adding
fluoridation chemicals to water, particularly since the quality of evidence for fluoride toothpastes has
been recognized as vastly superior to the quality of evidence for water fluoridation. Furthermore, it is
well established that western countries that do not fluoridate their water have tooth decay rates that are
just as low, and often lower, as western countries that do fluoridate their water.
100. While fluoride toothpastes and other fluoridated dental products carry their own potential hazards
when ingested, these products—unlike drinking water—are not designed to be ingested. Further, unlike
the addition of fluoridation chemicals to drinking water, the use of topical fluoride products does not
result in the contamination of processed foods and beverages, thus making it easier to regulate the
amount of fluoride ingested when topical fluoride products are the vehicle for delivering fluoride to those
who want it.
VI. CAUSE OF ACTION
101. TSCA provides that a party that petitions EPA under 15 U.S.C. § 2620 is entited to a de novo
review by a federal district court if EPA denies the petition.
102. If the petitioner demonstrates to the court by a preponderance of evidence that "the chemical
substance or mixture to be subject to the proposed rule presents an unreasonable risk of injury to health
or the environment, without consideration of costs or other nonrisk factors, including an unreasonable
risk to a potentially exposed or susceptible subpopulation, under the conditions of use," there is
reasonable, "the court shall order the Administrator to initiate the action requested by the petitioner." 15
U.S.C. § 2620(4)(B).
105. On November 22, 2016, Plaintiffs submitted a Petition to EPA, supported by over 300 attached
studies, documenting each of the allegations contained in Paragraphs 2 to 23 and 50 to 100 above.
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Case 3:17-cv-02162-JSC Document 1 Filed 04/18/17 Page 24 of 24
106. EPA denied Plaintiffs Petition on February 17, 2017 based on a legally erroneous, factually
incorrect, and scientifically flawed assessment, wherein, inter alia, the EPA (A) erroneously interpreted
the Frank R. Lautenberg Chemical Safety for the 21st Century Act as placing onerous new evidentiary
burdens on citizen petitioners, (B) dismissed studies relied upon by Plaintiffs on demonstrably false
grounds, and (C) failed to consider the research on fluoride neurotoxicity through the framework of its
Guidelines on Neurotoxicity Risk Assessment.
107. Plaintiffs are therefore entitled to a de novo judicial review of the Petition.
VII. PRAYER FOR RELIEF
108. WHEREFORE, Plaintiffs respectfully request that the Court grant the following relief;
a. Declare that Plaintiffs have demonstrated by a preponderance of the evidence that
artificial fluoridation of drinking water supplies presents an unreasonable risk of injury to
health or the environment, without consideration of costs or other nonrisk factors,
including an unreasonable risk to a potentially exposed or susceptible subpopulation,
pursuant to 15 U.S.C. § 2620(b)(4)(B)(ii).
b. Order EPA to initiate the action requested by Plaintiffs in their petition pursuant to 15
U.S.C, § 2620(b)(4)(B).
c. Award Plaintiffs their costs of suit and reasonable fees for attorneys and expert witnesses
in this action pursuant to 15 U.S.C, § 2620(b)(4)(C).
d. Grant Plaintiffs such further and additional relief as the Court may deem just and proper.
Respectfully submitted this 18th day of April, 2017.
Michael Connett
Attorney for Plaintiffs
24
COMPLAINT
A4 p.953
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JS-CAND 44 (Rev. 07/16)
Case 3:17-cv-02162-JSC Document 1-1 Filed 04/18/17 Page 1 of 1
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A4 p.954
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Excepts from:
Space Sustainability: Stakeholder Engagement Study Outcome Report,
May 2021, United Nations Office for Outer Space Affairs (UNOOSA)
https://www.unoosa.org/documents/pdf/studies/Space-Sustainabilitv-Stakeholder-Engagment-Studv-Outcome-Report.pdf
Executive Summary
This report captures the views of over 50 key stakeholders from the global space community exploring the
subject of'space sustainability'... One key outcome of this study was that many felt sustainability needs to
be urgently mainstreamed across the global space sector. This sense of immediacy appears to be of
relevance regardless of whether the term was being applied to an operational, policy, legal, economic, or
environmental setting.
... now is the time to scale up our focus on space sustainability issues. Only by putting sustainability at
the heart of global space activities, we will ensure the investments being made in space today, can deliver
returns for generations to come.
Context
Global space activities are booming. In 2020 the world registered 1,260 new satellites and other space
objects with the United Nations Office for Outer Space Affairs (UNOOSA). This is nearly 10% of all
objects - ever registered - with the UN since 1957. Over 65 countries now conducting space activities.
Satellite mega-constellations are an operational reality. Globally, unprecedented levels of both up and
downstream space activities are being unlocked.
Indeed, the Earth's orbital space environment is a limited resource, the continuous creation of space
debris, the increasing complexity of space operations are all example trends affecting the long-term
sustainability of space activities.
Findings
... exponential increase of space debris and large constellations, cluttering our extremely limited
usable orbits, which are Low Earth Orbit (LEO) and Medium Earth Orbit (MEO), also jeopardizing
humanity's access to space.
... carrying-capacity of the nearEarth environment
Trends were noted that sees an increasing number of satellites being launched even though similar services
(i. 24/7 Earth Observation coverage with similar technical capabilities) are offered by other companies,
creating a competition on our trajectories, which can be worrisome in the medium term, keeping in mind
the limited nature of our orbital environment.
"We need to presence the orbital environment, a bit like keeping a national park safe. We may need 'park
rangers' to monitor and clean up space. " - Christopher D. Johnson, Secure World Foundation
"If space becomes critically unsafe, it will not be selectively unsafe, but unsafe for everyone. "
- Prof. Nayef A1 Rodhan, Geneva Centre for Security Policy
which are the most effective in maintaining sustainable space activities?
- Adherence to existing international space law.
- Applications of new space technologies.
1
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- Steps to mitigate the economic cost of space sustainable practices.
- Increase transparency and information sharing practices between actors.
- Enhance platforms for multi-stakeholder dialogue.
- Increasing public awareness and interest in space sustainability issues.
.. all the six options seemed to go a long way to forming the core component of any policy response to space
sustainability. However... there is no one stop solution or mitigation mechanism for the global space
community when tackling space sustainability topics. In other words, not all space actors have the capacity
to implement the required range of components to deliver space sustainability.
we should learn lessons from other policy areas such as the Antarctic Treaty System outside of the spatial
context to find solutions to the externality problem of space debris and to save our trajectories from the
"tragedy of the global commons".
the need for engaging in more research and study into standardizing a common set of space sustainability
indicators. Several technical operations experts... argued forcefully that there was much research to be done
to develop specific metrics. One illustrative example of this lack of empirical assessment methods given is
that the actual carrying capacity of LEO and MEO orbital pathways is a relatively unknown and
chronically understudied concept... In the absence of such metrics, nobody can understand the actual
impact of the objects being in the same orbit at the same time. In accordance, until sufficient metrics and
definitions (i. carrying capacity or space traffic footprint) are established it was brought forward by some
respondents that space sustainability measures cannot be sufficiently embedded into the regulatory and
licencing processes. The interviewers did however, identify a counterargument emerging from some
responders stating that sufficient metrics do exist to ensure space sustainability, the problem is rather
finding consensus on which metrics to use.
When it comes to the role debris removal can play in space sustainability it was raised by several
commentators that only a handful of actors are leading the way in investing in existing space debris
removal missions. .. we must avoid the trap of focusing too much on technological fixes to issues that
have policy roots. In other words, ... prevention is always better than mitigation. Technology was
therefore often characterised as a "trick" for the symptoms that can sometimes lead us to forget about the
underlying problem... there is sometimes so much public communication on the technology side, a general
audience might think that there is already a complete solution for our shared space sustainability
challenges.
a key element to delivering space sustainability will be a combination of industry-led best practices, and
international guidance and national level regulations... we should not forget the user community, such as
the downstream market is also able to gain access to such platforms for discussion, as well as the astronomy
and science community to participate in the process. Therefore, the value of not only cross-sectoral but also
multidisciplinary discussions was highlighted as a core component of the road ahead.
extending the conversation beyond the space sector to the general public could apart from it being
appropriate in view of space being the "province of all humankind" help push the often painfully slow
policymaking process forward more quickly and decisively... The arts and entertainment industry in
particular has already implicated itself with the underlying issue (as demonstrated by the film Gravity) and
could help improve conditions for policymaking on the back of heightened public understanding of the
space sustainability challenge.
society's critical dependency on space applications should be directly brought to the attention of the
public when addressing the issue... we need to make space actors understand the scope of their
dependencies; how sustainability issues are directly affecting them, and what would happen if they lost
their space capabilities.
2
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it is worth demonstrating the economic benefit of space sustainability practices combined with a long term
perspective when creating awareness. In that sense, if you act responsively now, in the short term, it is an
additional cost, but in the long term, it is a cost avoidance strategy. In other words, responsible behaviour
today means prosperity tomorrow.
we must pay close attention to the new market trend towards miniaturization and cost efficient small
and microsatellite production and launch, which does not seem to support the inclusion of the "space
sustainability element".
we should be guided by scientists and professionals on the environmental challenges and learn from
our past mistakes concerning climate change on Earth, to be able to extend our focus to the spatial
element of our environment and our irreversible dependence on it.
most particularly UNOOSA, the United Nations' dedicated entity to outer space affairs, can help to get
ahead of the impending near Earth environmental damage curve.
research could focus on meeting frequent questions that were being posed, such as what is the carrying
capacity of LEO? What will be the impact of mega-constellations on collision avoidance manoeuvres?
we need to set up the prioritisation of space sustainability as a policy challenge of global importance...
LEO and MEO and large satellite constellations are the most pressing issues, both in terms of their
impact on the potential of a space debris disaster and their interference with space observation from
the Earth. We need to concentrate on national regulation at present to ensure, as mega-constellations
continue to enter the space environment, their entry and setup are as professionally managed as possible.
emphasising the huge dependency both our societies and economies have already developed on space
infrastructure.
space, especially LEO, MEO and GEO, is a finite resource.
Conclusions
We should quickly move beyond generalities. We need to support the maturation of the policy debate on
space sustainability. This can be done by breaking down the concept into core components and domains.
Common interpretations and linguistics labels will help discussion on the subject both at the cross-sectional
and international level, especially when considering defining the concept of space sustainability
Much of society remains unaware of their irreversible reliance on access to the global space
infrastructure for their daily lives.
Communication about the global challenge of space sustainability is key. There is a massive awareness
gap to be overcome, even in the space community, but more especially among political decision-makers
and the general public
space sustainability matters more today than ever before
In summary, space sustainability will not happen by itself. Concerted, collective and committed action is
required, including at the UN level. The clock is already ticking; the decisions we make in the
next few years will define how successful we are in achieving sustainable space operations for generations
to come.
3
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K A priority for action
This publication is intended to raise awareness amongst stakeholders of the effects of mercu
It is designed for the use of government officials, community leaders, and/or workers to provi
intended to contribute in building public support and capacity to take preventive actions.
This publication exists also in French and Spanish. [I've attached the Spanish
http://www.unep.orq/hazardoussubstances/Mercurv/MercurvPublications/ReportsPubli'
US/Default.aspx
The document can be used in a number of ways:
¦ for reference,
¦ to train staff,
¦ to present or hand out as copies directly from the toolkit,
¦ to develop materials specific to your community.
How is it laid out?
The package begins with a user's guide, providing information on general awareness raising
businesses.
The package includes an introductory bookletj/vhich provides a general overview of the mer
A4 p.958
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There follows a set of 5 modules that describe different aspects of the mercury issue:
MODULE 1: Mercury in Products and Wastes
MODULE 2: Mercury and Industry
MODULE 3: Mercury Use in Artisanal and Small Scale Gold Mining
MODULE 4: Mercury Use in Healthcare Settings and Dentistry
MODULE 5: Cultural Uses of Mercury
The organization of the modules allows you to go directly to the topic of interest. I
issue and what people need to know in order to recognize and reduce sources of e:
providing examples of how some mercury exposure situations have been handled.
A series of associated presentations have been prepared for use in awareness raisir
Introduction to the Mercury Issue
Module 1: Mercury in Products and Wastes
Module 2: Mercury and Industry
Module 3: Mercury Use in Artisanal and Small Scale Gold Mining (for Government Offic
Module 3: Mercury Use in Artisanal and Small Scale Gold Mining (for Miners)
Module 4: Mercury Use in Healthcare Settings and Dentistry (for Government Officials)
Module 4: Mercury Use in Healthcare Settings and Dentistry (for Healthcare Workers)
Module 5: Cultural Uses of Mercury
If you believe anything is missing or develop additional materials you think would
email address: mercurv@unep.org
www.chem.unep.ch/mercurv/awareness raising.../G 01-16 BD.pdf
p. 1
Module 5
Cultural Uses
of Mercury
p. 2
KEY MESSAGES
¦ Mercury has been used for hundreds of years for cultural and religious reasons and has, on occasion,
had mythological associations.
A4 p.959
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¦ A number of practices exist today that use mercury, including: Santeria (an Afro-Hispanic belief
system), Palo Mayombe (Caribbean), Candomble (Afro-Brazilian), Voodoo (Afro-Haitian), Espiritismo
(Puerto Rican) and Yoruba Orisha (Afro-Hispanic). Mercury is also used in Hindu practice as a major
constituent of Parad, from which religious relics are made.
¦ In some cases, mercury is injected subcutaneously, intravenously or intramuscularly to improve athletic
prowess or protect users from evil.
¦ Exposures resulting from cultural uses depend to a large extent on the nature of the practice:
swallowing elemental mercury capsules and inhalation of mercury vapour are the most common
exposure routes.
WHY IS THIS IMPORTANT TO YOU?
Direct and prolonged exposure to mercury is a human health hazard and has an impact on the
downstream environment.
People using mercury for cultural uses are often unaware of mercury's toxicity and associated
risks.
Often the mercury vapour exposure from cultural use is second-hand, from magico-religious
mercury use by a prior occupant of a dwelling.
The storage, transport and handling of mercury for these purposes can impose risk by introducing
opportunities for spills and vapour releases.
p. 3
For the Public
Be aware of dangers of mercury and the risks of mercury use! There is no safe way to use mercury and
scientists have found no safe mercury level in the human body.
Help raise awareness about mercury exposure risks with your family and in your community.
Dispose of mercury-containing products separately, not with other trash.
For Governments and Health Care Workers
Identify communities or cultural groups that use mercury for cultural/religious purposes and
investigate the impacts.
Embark on a public awareness campaign for mercury reduction with targeted cultural groups, engaging
health professionals and cultural/spiritual leaders.
Develop and distribute informative material for the public on mercury and its toxic effects.
Ask the mass media (newspapers, magazines, radio and television) to help you educate the
community on the dangers of the use of mercury.
A4 p.960
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Encourage reduced mercury use through voluntary promotional initiatives or through regulation of
production and sales.
Measure mercury concentrations in dwellings and commercial establishments in the affected area
and use this information to communicate risks.
Take part in the UNEP Global Mercury Partnership. Go to
www.chem.unep.ch/mercury/partnerships/new partnership.htm for more information,
p. 4
What is the history of mercury use for cultural purposes?
> Mercury has been used for hundreds of years for cultural and religious reasons and has, on occasion,
had mythological associations.
> Mercury was brought to the New World by Spaniards for use in extracting gold from ores. Its
amalgamating properties led to a belief that mercury attracts good fortune, wealth and love.
> Other characteristics of mercury have led to a range of beliefs. Some people believe its characteristic
sudden movements mean it will furnish remedies more quickly. It is also said to prevent
evil or bad luck from sticking to a person because it seems slippery.
> China's first emperor, Qin Shi Huang Di (260 BC - 210 BC) took mercury pills in an attempt to achieve
eternal life, but instead he died from mercury poisoning.
> In the 13th through 17th centuries, mercury was used in India in elixirs believed to confer immortality.
What are common cultural practices that use mercury?
Mercury has long been used in ethnocultural or religious practices such as Santeria (an Afro-
Hispanic belief system), Palo Mayombe (Caribbean), Candomble (Afro-Brazilian), Voodoo
(Afro-Haitian), Espiritismo (a spirit-focused belief system native to Puerto Rico) and Yoruba
Orisha (Afro-Hispanic).
Most of these uses are associated with African roots, and many of them are related the Roman Catholic
teachings of Spaniards. The use of mercury - also known as azogue (Spanish) or vidajan (Creole) for such
practices - has been documented in many countries, including by minority populations in large cities.
Mercury is also used in revised Wiccan (witchcraft) practices. Mercury is employed in Hindu practices as
a major constituent of Parad, from which religious relics are made.
How and why is the mercury used?
Sometimes mercury is used to facilitate or to hasten desired results, such as:
> Sprinkled on the floor to protect occupants of a car, home etc.. This is done in children's rooms, and in
cars to prevent accidents.
> Used with water and a mop for spiritual cleaning of a dwelling.
A4 p.961
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> Added to oil lamps and candles which are then burned to ward off evil spirits; bring good luck, love or
money; or to hasten other spells.
> Used in various ways to cast love spells (Greenberg, 1999), heal or dispel evil influences.
Cultural and/or religious practices with mercury use include:
> Carried in amulets, ampoules, vials or pouches worn around the neck or carried on the person.
> Used to make religious statues or other objects, such as parad shivling (see Case Study 14).
p. 5
> Applied to the skin or used in bathwater, perfumes, lotions or soaps.
> Injected subcutaneously to ward off evil and protect against exposure to disease while traveling(Prasad,
2004) or intramuscularly to help athletes build muscle mass (Celli and Khan, 1976).
> Ingested for superstitious or medicinal purposes (Greenberg, 1999), including steeped in raw milk
before the milk is drunk.
> Mercury and mercury compounds are also used in culturally specific medicinal compounds, such as
Asian medicines (see Module 4).
Some examples of risks associated with common practices:
Mercury capsules: Mercury capsules known as Azogue, sold in religious stores, are sometimes used as a
Mexican folk remedy for indigestion or gastroenteritis blockages (empacho). Ingestion of the heavy,
mobile liquid mercury is believed by practitioners to dislodge gastrointestinal blockages, particularly in
children (Geffner and Sandler, 1980). Mercury ingestion generally leads to both digestive and renal
problems and neurological symptoms. Diagnosis is complicated by the similarity between the symptoms
from consuming the mercury and the symptoms of the illness it is used to treat.
Mercury use in the home: Mercury is sometimes kept in containers, such as pots or cauldrons, in the
home. These are sometimes sealed but other times left open to
"purify" the air. In the Palo belief system a significant quantity of mercury is one of the most
important of many special and mystical ingredients when brewing up the cauldron which is
believed to have a spirit in it. Sometimes mercury is mixed with water, ammonia or camphor, or a
magnet is placed in it. Other times it is kept in a gourd or piece of fruit. The most common use of
elemental mercury in Latin American and Caribbean communities in New York City is in a container in
the home. This practice is found in more than 30% of homes in Latin American communities and in about
25% of homes in Caribbean communities in New York City (Johnson, 1999).
A major problem associated with ritualistic mercury use, is the contamination of wastewater. Johnson
reported that 27% of users dumped their residual, unused mercury down the drain, and more enters
wastewater from the practices of putting mercury in bathwater and mopping the floor with it, when the
mercury in the bottom of the bucket is inadvertently dumped out with the residual soapy water.
Additionally, absorbed and ingested mercury is excreted in urine and faeces.
A4 p.962
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What are the risks?
> Exposures resulting from cultural uses depend to a large extent on the nature of the practice:
- The most common exposure pathway is through inhalation of mercury vapours. This is of
particular concern especially in closed spaces. Approximately 75-85% p. 6 of inhaled mercury vapour is
absorbed and enters the bloodstream. Any mercury held in unsealed containers or spilled will result in
mercury vapour.
- In particular, the practice of sprinkling mercury in a car can result in very high vapour concentrations,
especially after the closed vehicle has stood in the sun
on a warm day. Similarly, vapour concentrations in contaminated dwellings can increase in colder
weather, when the room or apartment is closed and possibly heated (Johnson, 1999).
> Special risks are involved in the storage, transport and handling of mercury which introduce
opportunities for spills and exposures, both immediate and longer term.
> Unsuspecting persons can be poisoned by exposure to mercury spilled by previous residents of
their dwelling. Mercury can linger in cracks in the floor, carpeting, dirt and even concrete for many
years, slowly volatilizing.
What can you do?
> Be aware of the risks of mercury use and share this knowledge with your family and friends!
> Always dispose of mercury and mercury containing products as separate hazardous waste (see Module
1).
> Non-governmental organizations can initiate a public awareness campaign with governments to
investigate this issue and with cultural groups in your area who are known to use mercury.
What can healthcare professionals do?
> Be aware of the symptoms of mercury poisoning and how patients might be exposed to mercury.
> Help bring together community groups and leaders and government (for example the Health
Department) personnel to discuss ways to publicize the risks associated with mercury.
> Design and distribute information posters on mercury exposure, risks and symptoms in the local
language for public gathering places and see that these are placed in clinics, doctors' offices and
hospitals.
What can governments do?
> Measure contamination levels at locations where mercury is sold and/or used to IflCttSUTC and
communicate risks.
A4 p.963
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> Meet with members of cultural groups using mercury, engaging health professionals, cultural/spiritual
leaders and local distributors (e.g., botanicas owners and sanadores) in the discussion. These meetings can
serve as a forum to understand the use of mercury and share ideas. They could also be useful forums to
explore alternatives to mercury use.
> Develop printed informative material based on documented risks, such as leaflets or posters, on
mercury exposure and toxicity in local languages.
p. 7
> Distribute or post these in targeted public places, transportation centers, government buildings,
hospitals, schools and particularly stores that sell mercury.
> Encourage mercury use reduction by promoting voluntary initiatives or regulating import or sales of
mercury and mercury containing products.
> Require that mercury be labeled as hazardous and that signs regarding exposure risks be posted at point-
of-sale.
> Prohibition of the sale of mercury can be effective in reducing mercury use for cultural purposes
and is most effective with inspection follow-ups. Prohibition can lead to a significant increase in cost
of mercury capsules on the black market (see Case Study 13).
> Secure proper waste management facilities. See Module 1.
The UNEP Global Mercury Partnership is open to new partners. Joining the partnership can be an
excellent opportunity to network with experts and build capacity.
What are the potential barriers in changing cultural practices?
For many ritual and cultural uses of mercury, safer substitutes are identified and readily available.
There is a general lack of awareness of the risks of mercury use as well as available alternatives
amongst cultural leaders, communities, health care professionals and people who sell the products.
It is usually difficult at first for individuals to consider changing long-standing cultural or traditional
practices. Furthermore, experience has shown that even if users recognize that mercury is considered
toxic, they may believe that its ritualistic or supernatural nature renders it harmless or the user beyond
harm.
Strong messaging including concrete examples demonstrating the risks can have an impact.
Convincing cultural leaders of mercury risks is of uppermost importance. Trusted health care leaders can
play a big role in relaying the message.
p. 8
Example: The use of mercury in Santeria
A4 p.964
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Santeria is an Afro-Hispanic belief system. The use of mercury for Santeria and other spiritual practices
has been reported in the Dominican Republic, Cuba and other Caribbean islands, Suriname, Belize,
Trinidad, Jamaica, Peru, Ecuador, Argentina, Brazil, Colombia, Mexico, Venezuela, Guyana, France, the
Netherlands and Puerto Rico (Wendroff, 1991). Santeria was actively suppressed in Cuba after Fidel
Castro's revolution - particularly during the 1960s. However, oppression has now largely ended, and the
popularity and practice of Santeria has increased in Cuba during the 1990s.
Mercury is used in a variety of ways that pose a poisoning risk to users. Some typical uses identified in
Santeria are:
• Place mercury in water or in a tea bag with some coins.
• Carry a capsule of mercury in an amulet on a chain or between two coins in a
wallet.
• Throw a capsule of it in bath water.
• Swallow a capsule of mercury mixed with holy water.
• Burn mercury in a candle.
• Wash the house with water containing mercury to purify it.
• Put mercury under the bed.
• Swallow a capsule of mercury, sometimes mixed with water, for stomach
ailments or cancer.
• Take mercury with beer to increase virility.
• Rub a mixture of mercury and alcohol on an area affected by arthritis.
• Put mercury in a glass near a candle so that it evaporates quickly.
• Mix mercury with other ingredients for use in sorcery.
• Apply mercury to the skin during massages.
In communities and regions where these practices are prevalent, mercury is typically sold in capsules
from "botanicas" or "yerberias," which are small, privately owned shops that sell popular religious
articles, as well as a variety of products believed to have medicinal or healing properties. Mercury is
sometimes sold in gelatin capsules with a capacity of more than 13.5 g, but which typically contain 8-9 g
mercury (Riley et al., 2001). A capsule can contain up to 10 times more mercury than one thermometer.
Small glass jars, plastic bottles or plastic bags are sometimes used as well, containing as much as 65
grams of mercury.
Most customers arrive at botanicas with a prescription received from a sanador. Besides selling products,
some botanicas offer spiritual inquiry services for clients. Usually these consultations are offered in a
room inside the botanicas that has been designed for that purpose. Generally, the person that offers these
consultations is a spiritualist medium or santero. Some botanica owners function as counselors for their
clients and offer social and emotional support.
See Case Study 13# for further information.
p. 9
Example: Hindu mercury use in Parad
Parad is an amalgamation of mercury and other metals that is used to make relics for worship of God in
the Hindu tradition. Solidifying mercury is an ancient Vedic science. 'Dharnidhar Samhita' (scripture) has
prescribed sixteen steps through which elemental mercury has to pass to purify it and bring out its
beneficial qualities before it is alloyed (mixed with other metals) to make parad, which can be molded
A4 p.965
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into any solid form. Parad is traditionally made of silver and mercury, but it is now often made of mercury
and tin, with trace amounts of other metals.
To people who practice this, the benefits of parad are said to be many and varied, and may include:
• Vaastu or Tanrik dosh nivaran (removes bad luck from the workplace or home).
• Curing a range of diseases.
• Warding off evil spirits.
• Establishing an inner spiritual balance.
• Increasing willpower.
• Stopping nightmares.
• Resolving marriage problems.
In Hindu culture, it is traditionally believed that the worship of parad shivling (an abstract image of God,
an icon or statue) will destroy sins. It is said in Brahma Purana scripture that any person who worships
parad idols devotedly will receive full worldly pleasures - glory, honor, high office, fame, sons, grandsons
and learning - and upon death attain supreme destination (salvation). Various religious objects are made
of parad and sold in markets in India. These include: beads worn around the waist or neck, amrit (a nectar
or ambrosia) cup, Shivling (an abstract image or statue of God), Lakshmi (a representation of the Goddess
of wealth), and a Ganesh (an idol of Lord Ganesh). India has many Shiva temples, which have parad
shivlings. Sales of parad statues, jewelry and other artifacts through websites and television are
widespread in India.
See Case Study 14# for further information,
p. 10
CASE STUDY 14:
PUERTO RICO: PROHIBITION OF MERCURY SALES IN BOTANIC AS
In 1991 the Puerto Rico Department of Consumer Affairs (DACO) issued an order prohibiting the
distribution and sale of mercury capsules.
The order followed a visit to a botanica by an inspector of the Department of Health. In the botanica, the
inspector bought two capsules of silvery liquid. These capsules were analyzed by the Department of
Health and it was confirmed that they contained mercury. The average price of a mercury gelatin capsule
in botanicas at the time the research was done was $US 2.00, although some botanicas charged as much as
$5.00. (The price of the mercury had increased significantly after the Department of Health prohibited its
sale in botanicas. Prior to this regulation a capsule of mercury could be bought for $US 0.75.)
DACO intervened at the level of the two mercury distributors in Puerto Rico. The presidents of both
companies denied having sold capsules of mercury to owners of botanicas. They agreed to impose a fine
of $10,000 on people who violated this prohibition.
Despite the fact that most botanicas owners are aware of the regulation, a significant percentage of
botanicas continue to sell capsules of mercury. In a study that followed the prohibition 132
botanicas were identified in 74 towns:
A4 p.966
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• The majority of the botanicas were located in the coastal areas. 41% of 76 botanicas visited by
researchers sold mercury. Researchers found that botanica owners were reluctant to speak about
mercury because of a ban on sales, and most initially denied that they had any for sale.
• In 7 cases, owners of botanicas that did not carry mercury sent the customers to others who did
sell it or recommended that they obtain it from thermometers.
• About 50% of botanicas owners knew that the sale of mercury was prohibited because it can damage
health, and they adhered to the restrictions. These owners do not have mercury for sale and they tell
customers who ask that the sale of mercury has been prohibited because it is dangerous for health.
• Some owners of botanicas know that the sale of mercury is prohibited, but continue selling it to
their clients. Some of these owners advise customers on how to utilize mercury in a way that they
say is not toxic. These people very likely continue selling mercury because they are not convinced
that mercury is toxic or because they have a financial interest in selling mercury that outweighs its
negative health effects. Other owners of botanicas sell mercury knowing its toxic potential but
believing that if it is used in a certain way the mercury will not do damage - these owners tend to
advise customers on the toxic potential of mercury.
p. 11
CASESTUDY14
• According to owners, candles are the most frequently sold product.
Santeria spiritual leaders (sanadores), in the western part of Puerto Rico were interviewed to find out how
they use mercury and whether they know of its risks. Of the 24 interviewed, all but two admitted knowing
of mercury use, six knew that it was dangerous to health, and four knew that its sale was prohibited.
Botanicas are an important source of information and support system for a significant part of the Puerto
Rican population. They perform important therapeutic, economic and social functions in the community.
Their name evokes uses of medicines and natural substances, and their context implies traditions of
healing and popular medicine. The botanicas have a great variety of products available.
While some botanica owners function like sanadores, others merely sell products for a profit whether they
believe in their effectiveness or not. Some attribute the effectiveness of the products to the faith that the
user places in them and confess that most of the products they sell are simply not necessarily effective.
SOURCE: This is based on a case study from a Spanish language document: Course notes Sistemas
Folcloricos de Ayuda, Modulo 8: El mercurio: http://www.uprm.edu/socialsciences/sfaenlinea/idl5.htm.
By Mario Nunez-Molina. Universidad de Puerto Rico, Recinto Universitario de Mayagiiez
CASE STUDY 15:
TOXICS LINK STUDIES MERCURY LEVELS IN PARAD
The Indian non-governmental organization Toxics Link initiated a study of Parad following the creation
of a 500 kg Parad shivling at Siddha Ashram. Their objective was to identify the extent of this traditional
use of mercury and the cultural significance of Parad, identify possible sources of Parad in the region,
A4 p.967
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determine the material composition of Parad, and test the leaching behavior of Parad in milk (this test was
chosen because the shiv puja involves immersion and bathing of shivling by milk and drinking of that
milk by the devotees). Studies revealed that the primary chemical composition of Parad by % weight is tin
74.8 %, mercury 24.9 %, and other metals at low percentages (including silver at 0.04%). Tests showed
that mercury in Parad does indeed leach in milk and water, potentially exposing anyone who drinks milk
that has been used to soak Parad relics or drinks from Parad cups. Toxics Link is working to raise
awareness and educate the public directly on the toxicity of mercury.
Acknowledgement
This case study was provided by Toxics Link, a non-governmental organization in India. Toxics Link
emerged from a need to establish a mechanism for disseminating credible information about toxics in
India, and raising the level of toxics debate. Currently it has a main office in New Delhi as well as offices
in Mumbai and Chennai. "The Ritual Use of Mercury," an audio
(broadcast) segment.
p. 12
CASESTUDY14 & 15
"The Ritual Use of Mercury," an audio (broadcast) segment.
For more information see:
Fact Sheet - National Association of County and City Health Officials.
http://www.naccho.org/topics/environmental/mercurv/upload/MercurvFactsheet.pdf
The UNEP Global Mercury Partnership:
www.chem.unep.ch/mercury/partnerships/new partnership.htm
p. 13
REFERENCES
Celli, B. and M. A. Khan, 1976. Mercury embolization of the lung. New England
Journal of Medicine, 295(16), 883-885.
Geffner, M. E. and A. Sandler, 1980. Oral metallic mercury: A folk remedy for
gastroenteritis. Clinical Pediatrics, June 1980.
Greenberg, M. I., 1999. Mercury Hazard Widespread in Magico-Religious Practices
in U.S. Emergency Medicine News, 21(8), 24-25.
Johnson, C., 1999. Elemental mercury use in religious and ethnic practices in Latin
American and Caribbean communities in New York City. Population and
Environment, 20(5), 443-453.
Gonzalez-Wippler, 1976. Santeria: Magia Africana en Latinoamerica. Mexico:
Editorial Diana.
Nunez, L. 1992. Santeria: A practical guide to Afro-Caribbean Magic. Texas: Spring
Prasad, V. L., 2004. Subcutaneous injection of mercury: "Warding off evil".
A4 p.968
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Environmental Health Perspectives, 112(13), 1326-1328.
Riley, D.M., C.A. Newby, T.O. Leal-Almeraz, and V.M. Thomas, 2001. Assessing
elemental mercury vapour exposure from cultural and religious practices.
Environmental Health Perspectives 109(8), 779-784.
Schoeny, R., 2005. Ritual Use of Mercury. Presentation to the Regional Awareness-
Raising Workshop on Mercury Pollution, Post of Spain, Trinidad and Tobago, 18-21
January 2005.
Toxics Link, 2006. Mercury: Poison in our neighborhood.
USEPA, 2004. Task Force on Ritualistic Uses of Mercury Report. United States
Environmental Protection Agency Office of Emergency and Remedial Response.
Washington, DC 20460. EPA/540-R-01-005, December 2002.
Wendroff, A. P. 2005 Magico-Religious Use in Caribbean and Latino Communities:
Pollution, Persistence, and Politics. Environmental Practice 7:2:87-96.
Acknowledgements:
Arnold P. Wendroff, Ph.D.
Mercury Policy Project
Copyright © United Nations Environment Programme, 2008
Disclaimer
This publication is intended to serve as a guide. While all reasonable precautions have been taken
to verify the information contained in this publication, this published material is being distributed
without warranty of any kind, either expressed or implied. UNEP disclaims any responsibility
for possible inaccuracies or omissions and consequences that may flow from them. The
responsibility for the interpretation and use of the material lies with the reader. Neither UNEP nor
any individual involved in the preparation shall be liable for any injury, loss, damage or prejudice
of any kind that may be caused by persons who have acted based on their interpretation and
understanding of the information contained in this publication.
The designations employed and the presentation of the material in this publication do not imply
the expression of any opinion whatsoever on the part of the United Nations or UNEP concerning
the legal status of any country, territory,
A4 p.969
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NYDIA M. VELAZQUEZ
132 Cannon Building
Washington, DC 20515
(202)225-2361
12th District, New York
COMMITTEE ON BANKING AND
FINANCIAL SERVICES
815 Broadway
Brooklyn, NY 11206
(718) 599-3658
DISTRICT OFFICES:
SUBCOMMITTEE ON HOUSING AND
COMMUNITY OPPORTUNITY
SUBCOMMITTEE ON GENERAL OVERSIGHT
AND INVESTIGATION
173 Avenue B
New York, NY 10009
(212)673-3997
COMMITTEE ON SMALL BUSINESS
SUBCOMMITTEE ON REGULATION AND
PAPERWORK REDUCTION
Congress of tfje SBntteb §>tate£
ufie of &epregentattoe*
Masfytngton, BC 20515-3212
50-07 108th Street
2nd Floor
Queens, NY 11368
(718) 699-2602
May 5, 1997
The Honorable Henry Waxman
2204 Rayburn House Office Building
Washington, D.C. 20515
Dear Representative Waxman:
I would like to bring to your attention a concern raised by a New York constituent. Dr.
Arnold Wendroff, of the Mercury Poisoning Project, has sent me a packet of materials detailing a
very hazardous threat to the health of many of my constituents: the long-term exposure to
mercury in Latin American and Caribbean communities as a result of its domestic use for magico-
religious and ethno-medical purposes.
Mercury metal is sold in unlabeled containers for such purposes by shops called botanicas,
which recommend it be used in ways likely to contaminate dwellings with mercury, exposing all
household members to toxic mercury levels. According to Dr. Wendroff, The EPA has the
authority to regulate the sale and use of mercury for domestic use under the Toxic Substances
Control Act, but to date has not used its authority to mitigate this disturbing hazard.
Furthermore, Dr. Wendroff informs me that 90% of mercury sold for these purposes bears no
label, and thus violates the Consumer Product Safety Commission's regulations mandating that all
toxic substances bear identification and warning labels.
I would appreciate it if you or one of your staffers could take a look at this material and
perhaps offer suggestions as to how to proceed with this matter.
Sincerely,
cc: The Honorable Charles Schumer
Dr. Arnold Wendroff
THIS STATIONERY PRINTED ON PAPER MADE OF RECYCLED FIBERS
A4 p.970
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NYDIA M. VELAZQUEZ
132 Cannon Building
Washington, DC 20515
(202)225-2361
12th District, New York
COMMITTEE ON BANKING AND
FINANCIAL SERVICES
DISTRICT OFFICES:
SUBCOMMITTEE ON HOUSING AND
COMMUNITY OPPORTUNITY
815 Broadway
Brooklyn, NY 11206
(718)599-3658
SUBCOMMITTEE ON GENERAL OVERSIGHT
AND INVESTIGATION
173 Avenue B
New York, NY 10009
(212) 673-3997
COMMITTEE ON SMALL BUSINESS
SUBCOMMITTEE ON REGULATION AND
PAPERWORK REDUCTION
Congress of tfje Winittb States
%)ou$t of Eepregentattoetf
miafnngton, MC 20515-3212
50-07 108th Street
2nd Floor
Queens, NY 11368
(718)699-2602
May 5, 1997
Dr. Arnold P. Wendroff
Mercury Poisoning Project
544 Eighth Street
Brooklyn, NY 11215
Dear Dr. Wendroff:
I appreciated hearing from you again last week. I am sending you a copy of the letter I
prepared for Rep. Waxman, the Ranking Member of the House Government Reform and
Oversight Committee and a leading environmentalist in the House of Representatives. I sent this
letter, along with a copy of the packet you sent me, to Greg Dotson on Waxman's staff, and I will
let you know when I hear something back from him. Should you have any questions in the
meantime, please don't hesitate to call me.
Sincerely,
THIS STATIONERY PRINTED ON PAPER MADE OF RECYCLED FIBERS
A4 p.971
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COMMITTEE ON SMALL BUSINESS
RANKING DEMOCRATIC MEMBER
2241 Rayburn Building
Washington, DC 20515
(202)225-2361
COMMITTEE ON BANKING AND
FINANCIAL SERVICES
DISTRICT OFFICES;
SUBCOMMITTEE ON HOUSING AND
COMMUNITY OPPORTUNITY
815 Broadway
Brooklyn, NY 11206
(718)599-3658
SUBCOMMITTEE ON CAPITAL MARKETS,
SECURITIES, AND GOVERNMENT
SPONSORED ENTERPRISES
Congress ot tfye Umteb States?
173 Avenue B
New York, NY 10009
(212)673-3997
CONGRESSIONAL HISPANIC CAUCUS
^ousfe of &epre£entattoes;
OTastfjington, 2BC 20515
16 Court Street
Suite 1006
Brooklyn, NY 11241
(718} 222-5819
CONGRESSIONAL CAUCUS FOR
WOMEN'S ISSUES
CONGRESSIONAL
PROGRESSIVE CAUCUS
NYDIA M. VELAZQUEZ
12th District, New York
August 8, 2000
Dr. Arnold P. Wendroff, Ph.D.
Mercury Poisoning Project
544 Eighth Street
Brooklyn, NY 11215-4201
Dear Dr. Wendroff:
I have received a copy of the July 25, 1999 that you sent to Vice President Gore. I am aware of
the advocacy that you have been doing on behalf of victims of mercury poisoning in New York City
for many years. I appreciate the work that you have done to bring this issue to light.
I agree with you that the high levels of exposure to mercury in households in the Bronx create a
huge danger for the communities this effects. Community education and awareness needs to be a
priority in order to ensure that families know the warning signs of exposure and prevention techniques.
Also, another look must be made toward the marketing and sale of mercury. This is a
dangerous and unregulated substance that can cause serious harm upon prolonged exposure. I have
included some suggestions for some regulators that you might consider reaching out to in your battle to
protect the children of the Bronx.
There are three Federal entities that control the availability of the elemental mercury consumer
product: the Fond and Drug Administration, the consumer Product Safety Commission, and the
Environmental Protection Agency.
Food and Drug Administration
The FDA is responsible for ensuring that drugs for use by humans are safe and effective, that
foods are safe, wholesome, and sanitary, and that regulated products are accurately, informatively, and
honestly prepared. You may wish to contact the legislative liaison at the FDA at (301) 443-3793) to
discuss controlling mercury as a drug, food, or food supplement.
THIS STATIONERY PRINTED ON PAPER MADE OF RECYCLED FIBERS
A4 p.972
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Consumer Product Safety Commission
The mission of the CPSC is to protect the public against unreasonable risks of injuries
and deaths associated with consumer products. If the mercury product is not considered to be
marketed as a drug, food, or food supplement, control of the product may be possible under the
jurisdiction of the CPSC. You may wish to contact the legislative liaison at the CPSC (301) 504-
0515 to discuss controlling the mercury as a consumer product.
Environmental Protection Agency
The mission of the EPA is to protect public health and improve the natural environment.
You may wish to contact the legislative liaison at the EPA (202) 260-7808 to discuss controlling
the mercury product as a chemical in the environment.
Thank you again for reaching out to your legislators and representatives to spread the
word about the importance of this issue. Please feel free to contact me about your concerns on
this and any other issue.
Sincerely,
NYDIA M. VELAZQUEZ
Member of Congress
A4 p.973
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SCIENTIFIC CORRESPONDENCE
Domestic mercury pollution
Sir—Milis in his recent Scientific Corre-
spondence' identified a previously unsus-
pected source of atmospheric mercury and
speculated on its toxicity. Here, I report
another novel source of mercury pollution
in predominantly domestic settings,
where it has hitherto been thought a rar-
ity2. I believe this is the first mention of
widespread domestic exposure to mercury
vapour.
Mercury metal is used in Latin Ameri-
can and Caribbean communities for occult
purposes. It is sold in shops called botan-
icas which stock medicinal plants, magical
medicines, incense, candles and per-
fumes'. These and other religious articles
are dispensed to adherents of syncretistic
Afro-Caribbean/Latin American religions,
such as Santeria and Voodoo, as well
as to the general public.
In a survey of 115 botanicas in 13 cities
with large Hispanic populations in the
United States and Puerto Rico, 99 were
found to sell mercury. A brief survey of
botanicas in Mexico, Colombia and the
Dominican Republic revealed that they
too dispense mercury.
Botanicas typically dispense mercury
in gelatin capsules, or occasionally glass
vials. Of 41 samples purchased, the
median amount dispensed was 8.5 g, with
a mean of 9.0 g, a range of 1.5 to 31.3 g and
a modal cost of $1.00. Of 28 botanicas
visited in New York City, 13 prescribed
that mercury be sprinkled on the floor or
mixed with soap and water used to mop
the floor, to rid the house of evil influ-
ences or for other purposes. Some botan-
icas suggested repeated application at
intervals of three days to a week, until the
desired result is attained. One shopkeeper
recommended placing mercury in an open
container with a magnet. Any of these pro-
cedures would liberate mercury vapour
directly into the room's atmosphere.
Several shopkeepers recommended
that mercury should be carried on the
person, kept in containers in the house,
placed in bath water, or mixed with per-
fume, soap solutions or ammonia and
camphor. Others prescribed placing mer-
cury in devotional candles.
Mercury also presents an occupational
hazard. My colleague twice observed
shopkeepers spill mercury without remov-
ing or chemically neutralizing it. One pro-
prietress said that she intentionally scat-
tered mercury about her botanica to
"bring good things", as well as adding a bit
to each prescription she dispensed.
It is evident that the concentration of
mercury vapour in room air will vary
widely, depending on such factors as quan-
tity dispensed, amount used, frequency of
application, type of floor surface, air tem-
perature, volume of room, height above
floor level and ventilation. It is equally
NATURE • VOL 347 ¦ 18 OCTOBER 1990
apparent that the proposed 1 [ig m"J "up-
per limit for long-term exposure to mer-
cury vapour in the air" cited by Mills'
could easily be exceeded by repeated
applications in a small apartment.
The most likely victims of these prac-
tices are young children, exposed to the
highest levels of vapour as they sleep,
crawl and play on contaminated floors4'.
Mercury vapour enters the fetus via the
placenta, and the infant via breast milk".
One result of mercury vapour's neurotoxi-
city on penetrating the blood-brain bar-
rier7 is the subtle personality change called
erethism. It seems likely that children are
the principal victims of mercurial ereth-
ism, which is characterized by hostility,
withdrawal, tendency to resent being
observed, quick temper, loss of self con-
fidence and loss of memory'". Sunder-
man's advice" of "giving careful consid-
eration to intoxication from undetected
exposure to mercury
in patients
encountering depressions, behavioural
and neurological disorders", is worth
heeding, particularly in the evaluation of
emotionally disturbed children.
There seems ample justification for a
programme to measure mercury vapour
levels and to test exposed individuals.
Sociologial research is also required to
develop an effective health-education
programme for botanica owners and their
clients.
Arnold P. Wendroff
Occupational Therapy Program,
Columbia University,
630 West 168th Street,
New York, New York 10032, USA
1. Mills, A. Nature 346, 615 (1990),
2. McNeil, N. I., Olver, R. E.. issler, H. C. & Wrong, 0. M.
l.jncet i, 270 (1984).
3. Murphy. J, M. Santeria: An African Religion in America.
(Beacon, Boston, 1988).
4. Curtis, H. A., Ferguson, S. D., Kell, R. L. & Samuel, A. H.
Archs dis. Childhood 62, 294 (1987).
5. Hardy, H. L & Finkel. A. ). Hamilton A Hardy's Industrial
Toxicology4th ecin 101 (Wright, Boston, 1983).
6. Battigelli, M. C. in Environmental and Occupational Medi-
cine. (ed. Rom, W. N.) 453 (Little Brown, Boston, 1983).
7. Choi, B. H. Progr. Neurobiol. 32, 449 (1989).
i 8, Sunderman, F.W. dn/i. C//n. Lafc. Sc/. 18. 99(1988).
A4 p.974
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ENVIRONMENTAL REVIEW
Magico-Religious Mercury
Use In Caribbean and Latino
Communities: Pollution,
Persistence, and Politics
Arnold P. Wendroff
Elemental mercury is put to magico-religious uses, most
problematically the sprinkling of mercury on floors of homes
in Caribbean and Latino communities. Indoor mercury spills
are persistent and release toxic levels of mercury vapor
over long periods of time. Surveys in these communities
have demonstrated widespread and large-scale mercury sales
for ritualistic use, elevated mercury vapor levels in public
hallways, increased amounts of mercury in wastewater, and
elevated urine mercury levels in Latino children. Yet no
clear connection has been drawn between ritualistic mer-
cury use and these elevated levels, nor has any pathology
been associated with such use. Social, political, and eco-
nomic factors have acted to preclude advocacy for these
affected communities, whose members are largely unaware
of their mercury exposure (frequently secondhand) and of
its adverse health effects. Without the political mandate to
act, environmental agencies have not allocated the re-
sources necessary for environmental professionals to assess
and respond to this latent environmental health disaster.
Steps to investigate and respond to this impending public
health emergency are suggested, as presently there is no
coordinated plan for assessing and remediating the tens of
thousands of dwellings around the country likely to be
contaminated with actionable levels of mercury vapor.
Environmental Practice 7:87-96 (2005)
In 1989, a "learning disabled," ethnically Puerto Rican
ninth-grader in Brooklyn, New York, told his chemistry
teacher that his mother sprinkled mercury on the floor of
their apartment to keep away witches. The teacher's curi-
osity was aroused; he investigated, found mercury to be
widely sold in the community for such uses (Wendroff,
1990), and concluded that his student exhibited symptoms
of erethism arising from exposure to mercury vapor. The
boy was anorexic, irritable, had short-term memory loss,
and exhibited an aversion to being observed, periodically
placing his head on his desk and covering it with his
inverted loose-leaf notebook (Hartman, 1995). This chance
observation was the starting point of much of the research
described below.
Nature of the Problem
It has long been recognized that small mercury spills in
homes, most commonly from broken thermometers, can
produce elevated levels of mercury vapor for long periods
of time (Carpi and Chen, 2001; US Environmental Protec-
tion Agency, Region 1, 2005). When such spills are reported
to public health authorities, assessment and cleanup activ-
ities are regularly initiated and contaminated areas are
evacuated. Such government concern about mercury tox-
icity is not in evidence, however, when it comes to other
forms of domestic mercury contamination. In some Ca-
ribbean and Latino communities, folkloric practices and
religious beliefs associated with Santeria, Espiritismo, and
Voodoo attribute to mercury the power to attract good
and repel evil. In these neighborhoods, elemental mercury
is sold for magico-religious and ethnomedical uses by shops
called botdnicas (in the Southwest, herboristerias or yerbe-
rias) in unlabeled vials and fragile gelatin capsules con-
taining an average weight of 10 grams of the metal. The
only laws governing such sales appear to be federal and
local labeling regulations, regulations that are generally
flaunted, as over 90% of mercury sold by botdnicas bears
no labeling at all. Many, perhaps a majority, of ritualistic
mercury users are ignorant of either the toxicity of mer-
cury vapor, particularly to the developing brain (Goldman
Affiliation of author: Mercury Poisoning Project, Brooklyn, New York
Address correspondence to: Arnold P Wendroff, Mercury Poisoning
Project, 544 Eighth St., Brooklyn, NY 11215-4201; (fax) 718-499-8336;
(e-mail) mercurywendroff@mindspring.com.
© 2005 National Association of Environmental Professionals
DOI: 10.1 01 7/S1 46604660505012X
Mercury Use in Caribbean and Latino Communities 87
A4 p.975
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and Shannon, 2001), or of the persistent nature of mercury
spills (US Environmental Protection Agency, 2002).
Even small, thermometer-sized mercury spills are ex-
tremely persistent and can generate problematic levels of
mercury vapor for many years. A fever thermometer typ-
ically contains 0.7 grams of mercury. One study found
residual mercury from a broken thermometer on a tiled
bathroom floor continuing to emit substantial levels of
mercury vapor after a period in excess of 15 years. The
authors concluded that "mercury released from household
devices can contaminate indoor residential environments
for decades after the first release of this metal, ... [and]
this exposure route may raise significant concerns regard-
ing mercury health effects in young children" (Carpi and
Chen, 2001). The actual mercury vapor measured in a
recent Agency for Toxic Substances and Disease Registry
(ATSDR) investigation of a thermometer mercury spill found
that this "small amount of elemental mercury can be readily
volatilized by vacuuming and has the potential to pose a
long-term human health exposure concern" (Nehls-Lowe
and Morrison, 2004). Given the fact that mercury for magico-
religious uses is typically sold in 10-gram units, it is rea-
sonable to assume that spills resulting from such use are a
great deal more problematic.
Several articles, reports, and conferences have addressed the
putative adverse health effects of elemental mercury expo-
sure across its spectrum of ethnomedical and magico-
religious uses. The ethnomedical uses include ingestion of
mercury to treat abdominal complaints, and intravenous
and subcutaneous injection of mercury to boost energy and
to protect against infections and evil influences (Celli and
Khan, 1976; Geffner and Sandler, 1980; Hryhorczuk, 2004;
Prasad, 2004; Trotter, 1985). The magico-religious uses in-
clude placing mercury in perfume and candles, mopping
the floor with it, and mixing it into bathwater (Greenberg,
1999; Wendroff, 1990). The most environmentally problem-
atic uses, and apparently some of the most common, in-
volve placing mercury in a variety of open or unsealed
containers and directly sprinkling mercury on floors and
furnishings and inside motor vehicles (Riley et al., 2001). In
1990, the Surgeon General of the Public Health Service
wrote: "The ritual of sprinkling mercury on the floor to
ward off'evil spirits' is practiced by selected minority groups
and may pose potential hazards to those who encounter the
mercury" (Novello, 1990). Fifteen years later, these rituals
involving mercury are still generally considered a "poten-
tial" (versus an actual) health threat, largely because eco-
nomic and political pressures have operated to retard
substantive investigation of the problem.
Scale of Ritualistic Mercury Use
Although, to date, ritualistic mercury spills have not been
reported to health authorities, have not been aggressively
investigated by these authorities, and have not been de-
scribed in first-hand case studies in the medical literature,
the belief in their occurrence appears to be well founded
given the conspicuous place mercury occupies in the be-
liefs and practices of Hispanic communities. A 1990 survey
of 100 Caribbean and Latino women at a public hospital in
Brooklyn, New York, found 25% familiar with esoteric uses
of mercury (US Environmental Protection Agency, 2002, p. 3).
A 1993 survey of ritualistic mercury use in Hartford, Con-
necticut, and its environs documented substantial botanica
sales and use in this largely Puerto Rican community (His-
panic Health Council, 1993; US Environmental Protection
Agency, 2002, p. 2). A survey of a largely Dominican com-
munity in Massachusetts found that 38% of respondents
either used mercury themselves or knew someone who had
used it, with 12% of respondents reporting that mercury
was sprinkled around a child's crib or bed (Latowsky, 2003).
A similar survey in New York City found that "[f]orty-four
percent of the respondents from the Caribbean and 27
percent from Latin America stated that elemental mercury
is used in their homes, cars or carried on their person in
these cultural practices" (Johnson, 1999). A survey in Chi-
cago found 16 out of 79 Latinos (mainly women) who had
used mercury on several occasions (Chicago Department
of Public Health, 1997). Given these statistics, it is virtually
certain that spills from the ritualistic use of mercury occur
with significant frequency, that they result in contaminat-
ing dwellings with high levels of mercury vapor (Green-
berg, 1999), and that such contamination results in mercury
absorption by the occupants of those dwellings "orders of
magnitude greater than (methyl) mercury exposures from
eating fish or from the leaching of mercury from amalgam
fillings" (Wendroff, 1997). The Natural Resources Defense
Council has estimated that in the Bronx, New York, ritu-
alistic mercury use "would be likely to cause long-term
contamination of more than 13,000 homes or apartment
buildings each year" (Quintero-Somaini et al., 2004).
Community Response
The likelihood of contamination of large numbers of Ca-
ribbean and Latino homes with substantial amounts of
elemental mercury presents a challenge to environmental
professionals and a potentially enormous problem for fed-
eral agencies (among them the US Agency for Toxic Sub-
stances and Disease Registry, the Centers for Disease Control
88 Environmental Practice 7 (2) June 2005
A4 p.976
-------
and Prevention, and the US Environmental Protection
Agency) and for state and local health departments. Unlike
exposure to methylmercury in fish or to elemental mer-
cury in amalgam dental fillings, exposures to magico-
religious mercury spills (1) cannot be limited by changes in
diet or dentistry, (2) are likely to entail enormous costs to
government for their remediation (Malecki et al., 1995),
and (3) have the potential to engender panic among fam-
ilies with pregnant women and small children living in
communities where large numbers of dwellings have been
contaminated by ritualistic mercury spills (Edelstein, 1988).
In contrast to the relative ease of checking dwellings for the
presence of lead, radon, and asbestos, assessment of mer-
cury vapor cannot be performed by do-it-yourself lay oc-
cupants. Detecting low levels of mercury vapor necessitates
inspection by environmental professionals employing so-
phisticated instrumentation. Unseen mercury droplets lurk
in porous flooring, and micro-droplets formed when spills
are vacuumed adhere to all interior surfaces.
In typical "toxic disasters," blame for widespread residen-
tial toxic exposures lies with corporate and government
polluters. When such deep-pocketed polluters are identi-
fied, the wrath of the affected communities is focused on
them and remediation and compensation are sought (Edel-
stein, 1988) and often gained. In one recent case, a corpo-
ration responsible for numerous residential mercury spills
spent over 140 million dollars in cleanup costs and in-
spected over 200,000 homes for the presence of mercury
(US Agency for Toxic Substances and Disease Registry,
2001; Williamson, 2000). This program resulted in a run on
the market for portable mercury vapor analyzers, includ-
ing 140 instruments leased from one manufacturer (Illinois
Attorney General, 2000) and 100 purchased from another
(Fenzel, 2005). A class-action lawsuit determined the de-
fendant gas distribution company and its contractors to be
liable for negligence, willful and wanton conduct, property
damage, and medical expenses resulting from mercury spills
from gas distribution equipment in homes (Circuit Court
of Cook County, 2001).
By contrast, communities affected by ritualistic mercury
contamination of dwellings cannot place the blame on
corporate negligence and greed. "Any harm resulting
from these practices is not only self-inflicted but also
culturally sanctioned. Moreover, no readily apparent
epidemic of mercury-related disease has generated the
overtly 'visible victims' often necessary to bring about
aggressive remedial action on the part of already over-
burdened public health officials. Attempts to call atten-
tion to the risks involved have regularly met [with]
indifference and sometimes even outright hostility" on
the part of those charged with safeguarding the public
health (Foreman, 1998).
Community-based environmental justice organizations have,
for the most part, not yet engaged in the issue of ritualistic
mercury contamination of dwellings. Despite their acknowl-
edgment that "community members were the only experts
who could gather information on such things as angler
practices [contributing to methylmercury exposure] and
the home remedies used by Latinos ..." (Corburn, 2002)
and their awareness of ritualistic mercury sales by botani-
cas in their neighborhoods, many have refrained from ad-
dressing this issue.
As a result of this indifference, in the 15 years since the
health threat posed by ritualistic mercury use has been
described in both the medical literature (Greenberg, 1999;
Prasad, 2004; Riley et al., 2001; Wendroff, 1990, 1991) and
the mass media (Castillo, 2004; Ojito, 1997; Rauch, 1991;
Vinicio, 2001), there has been essentially no advocacy on
this issue from Caribbean or Latino community organiza-
tions, medical professionals, or political representatives.
Packard et al. (2004) recently made the statement that
"illnesses 'emerge' from the suffering of individual patients
to become medically recognized problems and public health
issues." As no one appears to be suffering from mercury
poisoning, no one is advocating for government to sub-
stantively address the issue, aside from a few nominal and
inconclusive pilot studies. The relatively straightforward
research needed to demonstrate mercury contamination of
dwellings and to correlate it with biomarkers of mercury
absorption has not been conducted. Government knows
what to do, but evidently feels that an actual demonstra-
tion of ritualistic mercury contamination, especially with
attendant clinical involvement, would open a Pandora's
box that it would rather leave undisturbed.
The following example illustrates governmental ambiva-
lence on this issue. The US Agency for Toxic Substances
and Disease Registry (1999) has stated, " There is an urgent
need to obtain information on the levels of exposure from
these [ritualistic] practices to determine if children or adults
are at risk. Mercury vapor concentrations may be much
higher after use during the winter months when the heat is
turned on and the windows are closed, so data that reflect
a variety of exposure scenarios are also needed." Yet despite
this declared "urgent need," the agency in question has of
yet funded no research to meet it.
Mercury Use in Caribbean and Latino Communities 89
A4 p.977
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Real Estate Industry Response
Although the real estate industry has moved to protect
tenants from residential toxic exposures, most notably from
lead in paint, landlords tend to act only when litigation-
driven regulations are enacted (Cahn and Thompson, 2003).
Economic constraints make it difficult for landlords, and on
occasion for government agencies as well, to apply the Pre-
cautionary Principle, which states that if reasonable evi-
dence of toxic exposures exists, then efforts to reduce or
eliminate such exposures should be implemented "even in
the absence of clear, scientific evidence of harm" (Raffensperger
and Tickner, 1999) and that "to wait for scientific certainty
(or near certainty) is to court disaster" (Wyman and Steven-
son, 2001). In strictly economic terms, then, it is under-
standable that the applicability of the Precautionary Principle
to ritualistic mercury exposure has essentially been ignored
by the real estate industry, by government, and by the en-
vironmental medical profession, though it is nonetheless
deplorable. This is of course hardly the first instance in
which, in the collision of economic interest with the Pre-
cautionary Principle, the Precautionary Principle has had to
give way.
An instance of such a failure to act prior to "scientific
certainty" began with an editorial preface to an article on
ritualistic mercury contamination of homes, appearing in
an environmental publication serving the real estate in-
dustry. The editors wrote, "Phase I Environmental Site
Inspectors should be sure to notify their lender clients
about the risk of mercury contamination in certain resi -
dential neighborhoods. Frequently, lenders are unaware of
the variety of risks endangering the value of their residen-
tial real estate owned. The following is just one of the
many ways lenders' collateral can be jeopardized" (Wen-
droff and Jetter, 1999). Yet despite such editorial admoni-
tion and the wealth of circumstantial evidence of serious
and widespread ritualistic mercury contamination pre-
sented in the article itself and in several subsequent studies
(Garetano, 2004; Latowsky, 2003), to date there has been no
apparent interest on the part of the real estate industry, or
the environmental assessment profession serving it, in as-
sessing and addressing the widespread contamination of
homes with ritualistic mercury.
It seems likely that when the extent and impact of this
environmental health threat are ultimately demonstrated,
testing of housing stock for mercury vapor at the time of
transfer will be mandated, as is currently the case with
lead, radon, and asbestos. The political constraints retard-
ing the implementation of such a program will no doubt
be very great. The New York City Housing Authority
(NYCHA), possibly somewhat more of an advocate for
tenant protection than the private housing sector, has failed
to assess its own heavily Caribbean and Latino housing
developments and has declined an offer from outside to
provide free surveillance of mercury vapor levels in public
housing hallways, this despite its own assurance that
"NYCHA is giving serious consideration to the mercury
issue" (Clarke, 2002). This same communication stated that
the New York City Department of Health recommended
that NYCHA await the results of an investigation by the
New Jersey Department of Environmental Protection. When
that study demonstrated that there were elevated mercury
vapor levels in Latino housing (Stern et al., 2003), NYCHA
still did not assess its own buildings for elevated levels of
mercury vapor. The US Department of Housing and Urban
Development (HUD) has displayed the same apparent in-
difference to addressing this issue. A HUD official wrote to
acknowledge "a potential environmental health threat caused
by contamination of homes, including HUD properties,
through ritualistic uses of mercury," and went on to state
that HUD was awaiting results of studies from the Centers
for Disease Control and the US Environmental Protection
Agency (USEPA) before being able to "justify in-depth
environmental assessments" (Teninga, 2002).
Government Agency Response
The Agency for Toxic Substances and Disease Registry's
chronic minimal risk level for domestic mercury vapor
exposure is 0.2 /i-g/m3, and USEPA's domestic mercury
vapor evacuation was recently lowered to 1 /i-g/m3 by joint
ATSDR, USEPA, and Washington, DC, Department of Health
consultation over a mercury spill incident so as to be more
protective in cases of fetal exposure (Blum and Fernandez,
2003; US Agency for Toxic Substances and Disease Registry,
2003). Government has no direct mandate to lower the
body mercury burden of individuals with clinically ele-
vated mercury levels resulting from fish consumption or
amalgam dental fillings; however, when mercury contam-
ination of a dwelling is suspected, government has often
assumed responsibility for assessment and frequently for
decontamination (Baker et al., 2005; Malecki et al., 1995).
The same will likely be the case in ritualistic mercury spills,
when it generally will be impossible to determine who is
legally responsible for the spills and when occupants and
frequently landlords will be unable to pay the cleanup
costs. As experience with the assessment and cleanup of
ritualistic mercury spills mounts, growing familiarity with
the pattern and intensity of mercury distribution will make
90 Environmental Practice 7 (2) June 2005
A4 p.978
-------
the identification of ritualistic mercury contamination more
assured.
Mounting evidence suggests that large numbers of homes
in Caribbean and Latino communities are contaminated
with actionable levels of mercury vapor. Much of this
mercury contamination was likely caused by prior mercury-
using occupants. This residential contamination is believed
to result in significant second hand exposure (Greenberg,
1999; Johnson, 1999). Occupational exposures are likely to
occur in shops that sell mercury. The New York City De-
partment of Health inspected 20-odd botanicas, many of
them known to have sold the metal. Several had elevated
mercury vapor levels, and one had from 13 to 17 fJ-g/m3 in
the store itself and from 4 to 7 fJ-g/m3 in stairwells and
hallways leading to the three floors of apartments above
(New York City Department of Health and Mental Hy-
giene, 2000). The New Jersey Department of Environmen-
tal Protection found substantially elevated indoor air mercury
vapor levels in public vestibules and hallways of heavily
Hispanic multifamily housing. It reported that although
"most indoor samples were low ... about 17% of buildings
had average air levels above 20 ng/m3, with one building
average at 299 and a maximum internal reading of 2000
ng/m3 [2.0 jJiglm3, or twice the recommended evacuation
level]" (Stern et al., 2003). A recent survey found that of
four apartments actually entered, the mercury levels inside
were on an average 5.5 times (ranging from 3.8 to 8.8 times)
higher than those detected at the doorjamb in the hallway
(Puchalik, 2005). One investigator stated, "The cultural use
of mercury has been identified as a potential source of
mercury vapor exposure in [these] New Jersey residential
settings. In this instance, elemental mercury may be inten-
tionally dispersed within a residence.... We conclude that
indoor mercury vapor concentrations are substantially ele-
vated over outdoor concentration in many instances. The
concentrations in some buildings approach levels of public
health concern" (Garetano, 2004).
In late 2001, the US Environmental Protection Agency began
a simulation to measure mercury vapor levels from ritu-
alistic spills in a home. Mercury was sprinkled on carpet-
ing inside a house trailer and vapor levels were monitored.
A final report has yet to be released, owing to the fact that
external reviewers found flaws in the simulation design,
which tested only a single type of flooring and simulated
neither the effects of walking on it nor of vacuuming it.
More problematic still was the incongruity of the experi-
mental results with real-world experience of domestic mer-
cury spills requiring lengthy decontamination to reduce
mercury vapor to a reoccupation level below 1 fJ-g/m3. The
authors concluded, "Intentional ritual sprinkling of metal-
lic mercury.. .may initially produce indoor air mercury
vapor levels above the ATSDR suggested residential occu-
pancy level, and in some cases, above the action level, but
the concentration decreases over time and generally falls
below the residential occupancy level" (Singhvi et al., 2004).
The authors go on to state that "ATSDR has proposed a
residential occupancy level of 1.0 microgram per cubic
meter of air (1 pLg/m3) as the mercury level considered 'safe
and acceptable' for occupancy of any structure after a spill,
provided that no mercury is present" (US Agency for Toxic
Substances and Disease Registry, 2001).
Contrast these simulation findings with the actual case of
a thermometer containing approximately 0.7 grams of mer-
cury that was broken on the dresser and hardwood floor of
a bedroom occupied by a pregnant woman. The occupants
cleaned up the visible droplets and then vacuumed the
floor. Five days later, mercury vapor levels in the bedroom
were over 14 fJ-g/m3, and the occupants were advised to
evacuate the bedroom and ventilate it. Seven days after the
initial spill, the bedroom had levels of 2 to 3 jig/m3, or
twice the current recommended evacuation level (Nehls-
Lowe and Morrison, 2004). This scenario, involving a minute
amount of mercury—probably well under 0.5 gram—
should be compared with the situation in which the aver-
age 10-gram quantity of ritualistic mercury is spilled in the
home, no attempt is made promptly to clean it up, it is
tracked about to other rooms and to adjacent hallways and
apartments, and in many cases the floors are routinely
vacuumed.
Data on botanica mercury sales in the heavily Hispanic
Bronx, New York, indicated a range of 25,000 to 155,000
9-gram mean-weight-units of mercury sold in one year
(1995), with some 30% of those units likely to be sprinkled
on floors (Zayas and Ozuah, 1996). The enormous sales
and ritualistic use of elemental mercury in New York City
and its environs, estimated at between 500 and 3,000 pounds
per year in the Bronx alone (Baard, 2001; Zayas and Ozuah,
1996), has a significant but little appreciated environmental
impact. Ritualistic mercury is placed in bathwater and in
water for mopping floors, and unused mercury is dumped
down drains (Johnson, 1999). Ingested and inhaled mer-
cury is also excreted in feces and urine and, along with
discarded mercury, may substantially add to the mercury
burden of wastewater (New York City Department of En-
vironmental Protection, 2004). These uses and excretory
and disposal pathways allow mercury to enter the aquatic
Mercury Use in Caribbean and Latino Communities 91
A4 p.979
-------
environment. In the New York/New Jersey harbor, the me-
dian source of mercury influx has been found to be di-
vided equally between emissions from electric power plants
and emissions resulting from the religious and cultural
uses of mercury, each estimated at from 200 to 600 kilo-
grams per year (de Cerreno, Panero, and Boehme, 2002).
Several analyses for metals influent to New York City's
wastewater treatment plants have found excesses of mer-
cury apparently associated with ritualistic mercury use.
The New York City Department of Environmental Protec-
tion therefore sampled a small, overwhelmingly Domini-
can residential area and found major excesses of mercury,
10 to 100 times above the norm (albeit associated with
copper, lead, and zinc). The source of this mercury seems
likely to be from the contamination of drain traps when
ritualistic mercury is disposed (New York City Department
of Environmental Protection, 2004).
Biomarker Studies
A pilot study of pediatric urine mercury levels of His-
panic children in the Bronx found 5% with what were
deemed to be clinically elevated levels of 5 to 11 /zg/L
(Ozuah et al., 2003). A recent Centers for Disease Control/
New York City Department of Health study of urine
mercury levels of over 400 Caribbean and Latino children
in New York City found one with a notifiable level of 24
jjig/L (Jeffery, 2004). The notifiable urine mercury level in
New York State is 20 /zg/L. Another mercury biomarker
study is under way in New York City as part of a citywide
health and nutrition examination survey. A study in Chi-
cago found none of the 400 Latino children tested had
elevated urine mercury levels (Rogers, Caldwell, and Mc-
Cullough, 2004). Both blood and urine mercury levels are
being measured in a representative sample of 2,000 adults
in New York City, the urine mercury levels being mea-
sured because of concern over ritualistic mercury expo-
sure (New York City Department of Health and Mental
Hygiene, 2004). Unfortunately, these several urine mer-
cury level investigations were designed without reference
to recent findings that urine mercury levels resulting from
exposure to low levels of mercury vapor, i.e., "below 10 fig/
m3" are "likely to be indistinguishable from background
urinary mercury levels" (Tsuji et al., 2003), so their con-
clusions are essentially invalid. Scientists from the Centers
for Disease Control and Prevention and the New York
City Department of Health and Mental Hygiene have
stated that their results have been released in a public
forum, although no manuscripts have been published as
yet (Jeffery, 2005; Rubin, 2005).
Discussion
Fear of the prospect of having to evacuate and decontam-
inate many thousands of homes in Caribbean and Latino
communities around the country has undoubtedly acted to
retard substantive environmental and clinical assessment
of the ritualistic mercury problem. At the August 2004
conference of the International Society for Environmental
Epidemiology, the oral session on "Urban/Ritualistic Mer-
cury Exposure: Assessment to Intervention" demonstrated
government ambivalence toward addressing the problem
by its failure to mention any substantive governmental
"assessment" or "intervention." The tenor of the session
illustrated the issues addressed by J. H. Perkins's editorial,
"Mercury: Persistence, Pollution, and Politics," which ex-
amined economic and political pressures faced by environ-
mental scientists attempting to assess and minimize mercury
emissions from coal-fired power plants (Perkins, 2004).
Although smokestack emissions far exceed ritualistic mer-
cury releases, they pose only an indirect threat to human
health via bioaccumulation in the aquatic food chain,
whereas if elemental mercury is sprinkled on the floors of
a home, "the apartment or dwelling certainly will become
contaminated with mercury [and] subsequent inhabitants
will never know they are facing the potential for continu-
ing, potentially serious exposure to mercury" (Greenberg,
1999).
The failure of government to act on this issue is traceable
in part to racial, ethnic, and religious factors inherent in
ritualistic mercury use and to the absence of community
advocacy. Embarrassment over the self-inflicted nature of
the mercury contamination accounts in some measure for
such absence. This combination of fear, embarrassment,
and lack of community advocacy is well illustrated in Paul's
article, "Mercury Rising" (2003), which additionally shows
how anthropologists, environmental scientists, and physi-
cians have allowed political pressures to influence their
professional judgment. One anthropologist interviewed sug-
gests that because remediation of mercury-contaminated
dwellings is expensive, will lead to evacuations, and so will
anger both the evacuated tenants and their landlords, "you
have eventually solved nothing"; further, it intimates that
the status quo of domestic mercury exposure be allowed to
continue. A physician quoted as stating, "We may be deal-
ing with tons of mercury going into the air, and here we
are talking about ounces going into the environment through
ritualistic use," ignores the fact that a small amount of
mercury in a dwelling can result in dangerously high vapor
concentrations. The same erroneous correlation of gross
environmental pollution with individual health threat is to
92 Environmental Practice 7 (2) June 2005
A4 p.980
-------
be seen in the suggestion by an environmental health ad-
vocate that "a focus on ritualistic [mercury] use is a diver-
sion from much larger sources of contamination ... [such
as from] coal-burning power plants and medical inciner-
ators" (Paul, 2003).
A good example of how academics and medical profes-
sionals have elided and glossed over this issue can be seen
in a major edited work on Latino health. Although the
editors (Aguirre-Molina, Molina, and Zambrana, 2001) and
chapter authors (e.g., Zambrana and Flores, 2001) were
well aware of the magico-religious uses of mercury and
had been provided with extensive documentation on the
subject, their section on environmental health entirely omit-
ted mention of the contamination of dwellings from rit-
ualistic mercury use. Their sole reference to mercury
exposure in the Latino community was that "[s]hops called
botdnicas ... sell metallic mercury (azogue) as an ethno
medical remedy" (Wendroff, 1990), this despite the facts
that the reference they cited (1) bore the title "Domestic
Mercury Pollution," (2) made no mention whatsoever of
mercury as an "ethno-medical remedy," (3) repeatedly em-
phasized the hazards of maternal-fetal and pediatric mer-
cury vapor exposure, and (4) ended with a suggestion that
clinical, environmental, and sociological research into these
exposures was "required to develop an effective health-
education programme for botanica owners and their cli-
ents" (Wendroff, 1990).
The president of the Latin American Foundation for En-
vironmental Protection in Miramar, Florida, stated that he
"tried to reach the politicians to get a better grant for
research, [as] its [ritual mercury contamination] a very
serious issue. The reason I believe politicians don't want to
do anything about it is because the religious beliefs are too
strong for politicians to get involved. My personal opinion
is that they don't want to touch that issue" (LaPeter and De
La Garza, 2004). A spokeswoman for the Miami-Dade
County Health Department echoed these sentiments: "We
can talk about the health issues of mercury in general....
But when it's something related to religion in rituals, it's
not something we deal with" (Fleshier, 2004). In 1993, 31
of 78 botdnicas surveyed in Puerto Rico were found to
be selling mercury (Nunez-Molina, 1993). The US EPA
Region 2 and the Puerto Rican Ministry of Health have
repeatedly been requested to investigate the environmental
health impact of ritualistic mercury use in Puerto Rico, but
they have failed to do so. A government-sponsored study
in French Guiana found high hair mercury levels in eth-
nically Haitian women and children, "likely resulting from
the use of mercury for religious rituals" (Cordier et al.,
1998), but no follow-up research was conducted to prove or
disprove this hypothesis.
A further example of governmental ambivalence on this
issue is the statement by the US Agency for Toxic Sub-
stances and Disease Registry (cited earlier) proclaiming "an
urgent need" to determine levels of adult and child expo-
sure to ritualistic mercury and recognizing that research
on "a variety of exposure scenarios" is needed. Yet despite
the proclaimed urgency of need, to date there has been no
serious government-sponsored research to measure air mer-
cury vapor levels inside living quarters in communities
likely to be contaminated by ritualistic mercury use. At the
recent USEPA-sponsored symposium, "Mercury: Medical
and Public Health Issues," a senior ATSDR science advisor
only briefly discussed "ethnic and folk uses of mercury"
(Risher and Amler, 2004). Over the past 15 years, many
government environmental health professionals have pri-
vately expressed their reservations about government's abil-
ity to substantively address this racially divisive, politically
and fiscally explosive issue until there is significant de-
mand for such intervention from the Caribbean and La-
tino communities themselves.
Recommendations
Sooner or later, government agencies and the environmen-
tal profession will have to respond forcefully to this loom-
ing environmental health disaster. At present, their denial
that there is a serious problem has resulted in a lack of
both conceptual and logistical infrastructure to deal with
the need to assess very large numbers of homes for mer-
cury contamination and even larger numbers of individ-
uals for mercury exposure and absorption.
For the problem of ritualistic mercury contamination to be
taken seriously by both the public health and the environ-
mental health communities, botanica mercury sales must
be correlated with domestic mercury contamination, with
elevated body-mercury burden, and, ultimately, with pa-
thology. There should be little technical difficulty in car-
rying out such research, but it is clear that without advocacy
on the part of the affected communities, government will
not allocate resources to gather the necessary data. There-
fore, advocacy is the first requirement for conducting the
necessary research. Advocacy will, in turn, come about
only when the members of the Caribbean and Latino com-
munities, especially community leaders, are, by a program
of education, made fully aware of the health threat posed
Mercury Use in Caribbean and Latino Communities 93
A4 p.981
-------
to their infants, their children, and themselves by the use of
ritualistic mercury in their homes.
To date, the standard biomarker of elemental mercury
exposure has been the urine mercury level (Goldman and
Shannon, 2001). As already noted, however, the validity of
this measure for the low levels of mercury vapor likely to
be the norm in contaminated dwellings (<10 /xg/m3) has
recently been called into doubt (Tsuji et al., 2003). One
possible response to this is to separate screening for mer-
cury exposure from screening for mercury absorption. Total
mercury levels in unwashed hair include mercury absorbed
into the blood and incorporated into the hair structure
and adsorbed mercury on the surface of the hair, which is
indicative of ambient mercury exposure. Automated in-
strumentation, requiring no wet chemistry, can analyze
hair samples for mercury content accurately, rapidly, and
economically (Cizdziel, Hinners, and Heithmar, 2002). In-
dividuals with elevated hair mercury levels would then be
further examined for signs and symptoms of mercury ab-
sorption and their dwellings screened for elevated levels of
mercury vapor.
It is likely that a convincing demonstration that ritualistic
mercury use has contaminated large numbers of homes
will precipitate a demand for assessment and remediation
that can only be met by government action. Accurate real-
time assessment of mercury vapor levels below the 1 fJ-g/m3
range will require large numbers of portable atomic ab-
sorption spectrometers (Garetano, 2004). Large numbers
of such instruments will be needed in a mercury emer-
gency, along with trained operators (Illinois Attorney Gen-
eral, 2000). Their lack is certain to be a major constraint in
both assessment and remediation efforts. Public health and
environmental health agencies should be acquiring them
now.
When, under a functioning government program of as-
sessment and remediation, dwellings are found to be con-
taminated with mercury vapor levels above 1 jig/m3, until
remediation can be initiated it should be possible to post-
pone evacuation of occupants by the provision of some
form of mercury-vapor filtration system. At least one man-
ufacturer has developed such a filter for domestic use,
which it claims is able to "remove mercury vapor from a
10ft2 room, with carpeting in approximately 4 hours" (Sip-
erstein, 2004). Such filters need to be further developed,
tested, certified, and stockpiled. Their availability would
greatly reduce the need for the evacuation of large num-
bers of dwellings, which in any event would likely prove
impracticable, given the numbers of people involved and
the difficulty bound to be encountered in finding alterna-
tive accommodations for them.
The unhappy public health consequences of past violations
of the Precautionary Principle should alone be sufficient to
induce government to delay no longer in confronting the
substantial threat to health posed by the ritualistic use of
mercury in the home. Common prudence requires that, in
concert with the public health and the environmental health
communities, it act now.
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COMMENTS AND CORRECTIONS
by Arnold P. Wendroff, PhD March, 2013
"Elemental Mercury Poisoning Presenting as Hypertension in a Young
Child"
by: E. Brannan, S. Su, & B. Alverson. Pediatric Emergency Care, August, 2012
"The uncontrolled use of ceremonial mercury is widespread, not currently being evaluated effectively, and
is certainly not well appreciated,"1 The illustrative case, "Elemental Mercury Poisoning Presenting as
Hypertension in a Young Child,"2 demonstrates these points, insofar as it overlooked information that
clinicians serving and Latino communities need to be aware of. The paper suggests that the source of the
mercury contaminating the Puerto Rican patient's home was from ritualistic mercury use by the prior
Dominican3 occupant, but makes no mention that this is the first report reasonably associating magi co-
religious mercury use with mercury poisoning. In other words, this appears to be an index case of
elemental mercury poisoning from inhalation exposure to mercury vapor resulting from the ritualistic use
of elemental mercury in the home. It illustrates the most common scenario, second-hand exposure to
mercury vapor from elemental mercury sprinkled or accidentally dropped on a floor during a ritual
performed by a prior occupant, in this case, at least in part at the site of an altar on a bedroom dresser.3'4
When the Dominican woman's subsequent apartment was tested, after her occupancy of some 3 months,
markedly elevated mercury vapor levels were found, with the highest level, 5|ig/m3, in the same locale as
in her prior apartment, namely on the floor by her bedroom dresser, the site of her altar as reported by
neighbors, where the mercury vapor level was 34|ig/m3.3 The generally recommended evacuation level
for mercury vapor in a home is 10|ig/m3, with a reoccupancy level of 1 |ig/m3.5 Unfortunately, neither the
Dominican woman or her teen age daughter were tested for elevated urine mercury levels (UMLs), until
well after the initial case of acrodynia was reported.
The mercury vapor levels in the Puerto Rican family's carpeted apartment would likely have been much
higher, had their landlord not employed a contractor to clean the apartment after the Dominican occupants
departure. The commercial cleaner employed a powerful truck-mounted vacuum cleaner which would
have exhausted most of the mercury in the carpeting to the outside air.6 However, enough mercury
remained in the carpeting to grossly contaminate the Puerto Rican family's brand new vacuum to a level
of 90|ig/m3.7
In cases of mercury poisoning by vapor inhalation, it is essential that all occupants of the contaminated
dwelling are promptly tested for the presence of elevated UMLs, as all are exposed to mercury vapor.
When this testing was somewhat belatedly performed, the patient's 8 year old sister, 10 year old brother
and 32 year old mother were all found to have highly elevated UMLs, of 73, 38 and 49|ig/L respectively.
The notifiable UML is 20 |ig/L. The two siblings were chelated with DMSA.8'9 The father, who lacked
health insurance, was not tested.7
It is noteworthy that all family members other than the 3 year old girl were asymptomatic, despite their
exposure to high levels of mercury vapor and high UMLs, as were the prior occupants, a mother and her
teen-aged daughter, who were presumably exposed to far higher levels of mercury vapor, and of a longer
duration. The latter two women were never tested, despite their long residence in two mercury-
contaminated dwellings, which would appear to be a lapse on the part of the RIDOH.
There could have been no clinical suspicion that any of them were at risk of intoxication, had not the 3
year old exhibited signs of acrodynia. Their exposure to toxic levels of mercury vapor would have
continued were it not for their clinicians astute diagnosis of nowadays rare acrodynia. A somewhat
A4 p.985
-------
similar case of mercury poisoning of three siblings, with a 33 month old girl presenting with acrodynia,
resulting from exposure to mercury from a broken clinical thermometer, led her physician to suggest that
"Cases of chronic mercury poisoning may be missed, even today, and all paediatricians and child
psychiatrists should familiarize themselves with the clinical picture."10
The dermatological aspects of the case described by Brannan et. al. were described in an earlier paper,
whose authors also speculated that the source of the mercury was its ritualistic use.11 They stated that
"Prompt diagnosis and treatment of this disorder may help prevent long-term neurological sequelae."
Such prevention can only be achieved by promptly testing all members of a mercury-contaminated
home, especially pregnant women and children.
1. Greenberg, MI. Mercury Hazard Widespread in Magico-Religious Practices in U.S. Emergency
Medicine News 1999;XXI:8:24-25
2. Brannan EH, Su S, Alverson BK. Elemental Mercury Poisoning Presenting as Hypertension in a
Young Child. Pediatric Emergency Care. 2012;28:812-814.
3. John Leo, Emergency Response, Rhode Island Department of Environmental Management. Personal
communication. 3/11/11
4. Rhode Island Department of Environmental Management. Emergency Response Report. Date
Responded 2/25/2011. Investigated by J Leo.
5. U.S. EPA Region 5. Mercury Response Guidebook. July 2004:Attachment E:3
6. D. Chevrette, Landlord, 117 Dexter Street, Cumberland, RI. Personal communication 3/3/11
7. T. Hamilton, Industrial Hygienist, OccuHealth, Inc. Personal communication 3/3/11
8. D. M . Mother of 3 children, Personal communication. 11/27/12
9. S. Malcolm. Primary care physician to Puerto Rican family. Personal communication. 11/27/12
10. Muhlendahl, KEv, Intoxication from mercury spilled on carpets. The Lancet. 1990:336:1578
11. Mercer JJ, Bercovitch L, Muglia JJ. Acrodynia and Hypertension in a Young Girl Secondary to
Elemental Mercury Toxicity Acquired in the Home. Pediatric Dermatology. 2012:29:199-201
[ NOTE: These comments and corrections have not been published. ]
A4 p.986
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THE LANCET Neurology
http://www.thelancet.com/iournals/laneur/article/PIIS1474-4422(14)70116-4/fulltext
The Lancet Neurology, Volume 13, Issue 7, Pages 646 - 647, July 2014
doi: 10.1016/S1474-4422( 14)70116-4Cite or Link Using DPI
Copyright © 2014 Elsevier Ltd All rights reserved.
Neurodevelopmental toxicity: still more questions than answers
Arnold P Wendroff
In their Review, Grandjean and Landrigan expressed concern about the neurodevelopmental toxicity of
methylmercury,! but did not assess the dangers of serious and widespread inhalation exposures to elemental mercury
vapour (Hgo) from its magico-religious uses in some Caribbean and Latino communities and the presumptive associated
latent epidemic of developmental neurotoxicity this constitutes.
In the belief that it attracts good and repels evil, practitioners of folk magic and Caribbean religions including
Espiritismo, Santeri'a, and Voodoo, sprinkle mercury on floors and furnishings where it accumulates levels of mercury
vapour, about 80% of which is inhaled or absorbed, [about 80% of which inhaled is absorbed.] The Hg+ ion is the toxic
moiety in methylmercury. Mercury vapour, like methylmercury, is lipophilic and readily crosses the placental and
blood—brain barriers and enters breast milk.
The mean weight of mercury sold by botanicas for ritualistic use is about 10 g. Mercury spilt during ritualistic
ceremonies that permeates flooring and furnishings can persist for decades, during which time it continually produces
mercury vapour. Hence, most exposures are probably second-hand, from ritualistic spills by previous occupants of an
individual's dwelling.2, 3 Unlike methylmercury ingested in seafood, occupants of such contaminated dwellings cannot
control their inhalation exposure and will be unaware of the neurotoxicity of residual mercury in flooring.
Mercury sales in The Bronx in New York (USA), where many people of Caribbean origin live, suggest that in 1995 alone,4
between 25 500 and 155 000 homes might have been contaminated with mercury and data from similar Caribbean
communities in New Jersey showed that at least 2% of apartments had mercury vapour consistent with its cultural use. 5
Environmental health scientists, long aware of the hazards posed by ritualistic mercury use and its probable
neurodevelopmental sequelae, have not put into action the "precautionary approach that emphasizes prevention and
does not require absolute proof of toxicity" advocated for by the authors.i Despite Grandjean's previous observation
that in "some ethnic groups, metallic mercury is used for magical purposes that may cause substantial exposure to
mercury vapor",6 these exposures and their neurodevelopmental affects [effects] are not routinely assessed.
That ritualistic mercury exposure contributes to the "silent pandemic of neurodevelopmental toxicity"! is suggested by
a case of acute magico-religious mercury poisoning in a 3-year-old Puerto Rican girl, apparently due to ritualistic
mercury spills by the previous Dominican occupants of the apartment in which she lived. 2, 3
Despite more than two decades of awareness of these ritualistic practices and a variety of research on ritualistic
mercury sales, use, and reported environmental and clinical mercury levels, the authors' observation that recognition
of widespread subclinical toxicity often did not occur until decades after the initial evidence of neurotoxicity is
exemplified by the failure of government agencies and the environmental medical community to substantively assess
these exposures.
A4 p.987
-------
I declare no competing interests.
:es
1 Grandjean P, Landrigan PJ. Neurobehavioral effects of developmental toxicity. Lancet Neurol 2014; 13: 330-338.
Summary I Full Text I PDF(609KB) I PubMed
2 Mercer J J, Bercovitch L, Muglia JJ. Acrodynia and hypertension in a young girl secondary to elemental mercury
toxicity acquired in the home. Pediatric Dermatology 2012; 29: 199-201. PubMed
3 Brannan EH, Su S, Alverson BK. Elemental mercury poisoning presenting as hypertension in a young child. Pediatric
Emergency Care 2012; 28: 812-814. PubMed
4 Zayas LH, Ozuah PO. Mercury use in espiritismo: a survey of botanicas. Am J Public Health 1996; 86: 111-112.
PubMed
5 Garetano G1, Stern AH, Robson M, Gochfeld M. Mercury vapor in residential building common areas in communities
where mercury is used for cultural purposes versus a reference community. Sci Total Environ 2008; 397: 131. 19
PubMed
6 Grandjean P. Mercury. In: Landrigan PJ, Etzel RA, eds. Textbook of children's environmental health. Oxford: Oxford
University Press, 2014: 273-280.
a Mercury Poisoning Project, 544 8th Street, Brooklyn, NY 11215, USA
http://www.thelancet.com/journals/laneur/article/PIIS1474-4422(14)70121 -8/fulltext
The Lancet Neurology, , Pages 648 - 649, July 2014
I Next_Aiticte>
doi: 10.1016/S1474-4422114)70121-8Cite or Link Using DPI ~
Copyright © 2014 Elsevier Ltd All rights reserved.
Neurodevelopmental toxicity: still more questions than answers
— Authors' response
Original Text
E
We are grateful for the comments on our review. ¦ Our aim was to present a balanced assessment based on our best
professional judgement concerning toxicity of industrial chemicals to the developing human brain. The diversity of
opinion expressed in these letters reflects the serious absence of neurotoxicity information about most chemicals, but
we interpret all four letters as supportive of a call for intensified research.
Goldstein and Saltmiras echo Mortsanto's oft-repeated defence that glyphosate is a safe herbicide. Still, the toxicity
documentation publicly available on this widely used substance is limited. We have been unable to find documentation
of any neurotoxicity testing of glyphosate considered valid by the US Environment Protection Agency. Experimental
evidence lends support to the likelihood of neurotoxicity.. On the basis of clinical reports mentioned by Goldstein and
Saltmiras, we therefore believe that glyphosate should be considered a neurotoxic hazard. Monsanto's argument for
safety relies on the relative absence of research results rather than on data documenting safety.
A4 p.988
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We agree with Feldman that fluoride is important for children's oral health. However, the fact that a trace element has
beneficial effects at low doses in specific tissues does not negate the possibility that neurotoxicity might also be
occurring, especially at increased levels of exposure. Indeed, concerns about fluoride toxicity were already raised by a
National Research Council expert committee. 3 Feldman describes the recent meta-analysis^ as selective and based on
old, confounder-ridden studies. In support of her claims, she refers to two previous reports that reviewed some of the
same studies, although without access to important background information. Feldman makes other serious errors—eg,
by linking, without justification, a rise in population mean intelligent quotient (IQ) to the introduction of water
fluoridation.
Similarly, Gelinas and Allukian dispute the validity of previous studies on fluoride exposure and neurobehavioural
deficits. We do not deny the importance of a dose-response relation, which has been a unifying concept in toxicology
since the time of Paracelsus. However, as we emphasised in our Review, emerging evidence on developmental
neurotoxicity makes it clear that the timing of exposure is also of great importance, especially during highly vulnerable
windows of brain development. Due to the growing evidence on adverse effects, US authorities now recommend that
fluoridation of community water should not exceed 0-7 mg/L.5
We agree with Wendroff's perspective, but have been unable to identify epidemiological support for a claim of
developmental neurotoxicity from exposure to mercury vapour. As elemental mercury might soon be added to the
list of confirmed developmental neurotoxicants, we support the evidence-informed prevention of mercury
exposures suggested by Wendroff.
In writing our Review, we have tried to steer a middle course between advocates for particular public-health actions
and spokespersons for the chemical industry. We believe that sufficient evidence is already available that industrial
chemicals endanger human brain development and that unrestrained production and release of such chemicals are
short-sighted, dangerous, unsustainable, and fundamentally immoral. We call for a thorough revision of chemical
safety policies and for the establishment of a documentation centre on developmental neurotoxicity modelled after
the International Agency for Research on Cancer.
We declare no competing interests.
References
1 Grandjean P, Landrigan P.J.. Neurobehavioural impact of developmental toxicity. Lancet Neurol 2014; 13: 330-338.
Summary | Full Text | PDF(609KB) | PubMed
2 Cattani D, de Liz Oliveira Cavalli VL, Heinz Rieg CE, et al. Mechanisms underlying the neurotoxicity induced by
glyphosate-based herbicide in immature rat hippocampus: Involvement of glutamate excitotoxicity. Toxicology 2014;
320: 34-45. PubMed
3 National Research Council (NRC). Fluoride in drinking water: a scientific review of EPA's standards. Washington, DC:
The National Academies Press, 2006.
A4 p.989
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4 Choi AL, Sun G, Zhang Y, Grandjean P. Developmental fluoride neurotoxicity: a systematic review and meta-analysis.
Environ Health Perspect 2012; 120: 1362-1368. PubMed
5 US Environmental Protection Agency. EPA and HHS Announce New Scientific Assessments and Actions on Fluoride.
http://vosemite.epa.gov/opa/admpress.nsf/6427a6b7538955c585257359003f0230/86964af577c37ab285257811005a841
7i0penDocument. (accessed May 23, 2014).
a Department of Environmental Medicine, University of Southern Denmark, Odense, Denmark
b Department of Environmental Health, Harvard School of Public Health, Boston, MA 02215, USA
c Department of Preventive Medicine, Mount Sinai School of Medicine, New York, NY; USA
A LATENT EPIDEMIC OF NEURODEVELOPMENTAL DEFICITS DUE TO EXPOSURE TO
MERCURY PUT TO MAGICO-RELIGIOUS USE IN CARIBBEAN & LATINO COMMUNITIES
Initial Draft: letter to editor ~ The Lancet Neurology — in press for July 2014
Clinicians concerned about neurodevelopmental toxicity of methylmercury,1 have neglected to assess serious
and widespread inhalation exposures to elemental mercury vapor (Hg°) emanating from its magi co-religious
uses in some Caribbean and Latino communities, and its presumptive associated latent epidemic of
developmental neurotoxicity. The Hg+ ion is the toxic moiety in methylmercury. Mercury vapor, like
methylmercury, is lipophilic, readily crossing placental and blood-brain 'barriers', and entering breast milk.
In the belief that it attracts good and repels evil, practitioners of folk magic, Caribbean religions including
Espiritismo, Santeria and Voodoo,3 sprinkle mercury on floors and furnishings, where it evolves
developmentally neurotoxic levels of mercury vapor, -80% of which inhaled is absorbed.
The mean weight of mercury sold by botanicas for ritualistic use is ~10g.a'b Ritualistic spills permeate flooring
and furnishings, persisting for decades, while continually evolving mercury vapor.c Hence, most exposures are
likely at second-hand, from ritualistic spills by prior occupants.2'3>d Unlike methylmercury ingested in seafood,
occupants of ritualistically-contaminated dwellings cannot control their inhalation exposure, are unaware of
residual mercury in flooring, and of the existence and neurotoxicity of mercury vapor.
Mercury sales in the heavily Caribbean Bronx, New York, suggest that in 1995 alone, 2% to 12% of homes
were ritualistically contaminated,® and data from similar Caribbean communities in New Jersey, found at least
2% of apartments with the presence of mercury vapor consistent with its cultural use.f'g'h
Environmental health scientists, long aware of hazards posed by ritualistic mercury use,a and likely
neurodevelopmental sequelae, have failed to operationalize the "precautionary approach that emphasizes
prevention and does not require absolute proof of toxicity."1 Despite Grandjean's observation that "In ... some
ethnic groups, metallic mercury is used for magical purposes that may cause substantial exposure to mercury
vapor,"4 these exposures and their neurodevelopmental impact have yet to be assessed. They have been no
measurements of mercury vapor levels in occupied dwellings, and of their correlation with biomarker mercury
levels and neurodevelopmental sequelae of exposed occupants.
That ritualistic mercury exposure contributes to the "silent pandemic of neurodevelopmental toxicity"1 is
suggested by a case of acute magi co-religious mercury poisoning of a three year-old Puerto Rican girl,
apparently due to ritualistic mercury spills by the prior Dominican occupant of her apartment. 2'3 Although
neither paper mentioned it, her eight and ten year-old siblings and 32 year-old mother had highly elevated urine
mercury levels of 73, 38 and 49|ig/L respectively, yet were asymptomatic, albeit with no neurological
assessment.5
A4 p.990
-------
Despite over two decades of awareness of these practices, and a variety of published research on ritualistic
mercury sales, use, and associated environmental and clinical mercury levels,1 the authors' observation that
"recognition of widespread subclinical toxicity often did not occur until decades after the initial evidence of
neurotoxicity," is exemplified by the failure of government agencies and the environmental medical community
to substantively assess these exposures, due to a variety of political and economic, as opposed to medical,
rationales.-"
Documentation of the environmental health threat posed by magi co-religious mercury use is accessible using
the key words < mercury Santeria >.
References
1. Grandjean P, Landrigan PJ. Neurobehavioral effects of developmental toxicity. Lancet Neurology 2014; 13:330-38
2. Mercer JJ, Bercovitch L, Muglia JJ. Acrodynia and Hypertension in a Young Girl Secondary to Elemental Mercury
Toxicity Acquired in the Home. Pediatric Dermatology 2012; 29:2:199-201
3. Brannan EH, S Su, BK Alverson. Elemental Mercury Poisoning Presenting as Hypertension in a Young Child.
Pediatric Emergency Care 2012;28:812-814
4. Grandjean P. Mercury. Chapter 29 in: Textbook of Children's Environmental Health PJ Landrigan, RA Etzel eds.
Oxford University Press. 2014; 273-280
5. M D. Mother of the mercury poisoned child. Personal communication. December 27, 2012
a) Wendroff, AP Domestic mercury pollution Nature [letter] 347, 623 (18 October 1990)
b) Sciammarella E. Mercury Use in the Hispanic Community of Chicago Illinois Morbidity and Mortality Review 4:2
Spring 2000
c) Carpi A, Chen Y-F. Gaseous Elemental Mercury as an Indoor Air Pollutant Environmental Science and Technology
35:21: 4170-4173 2001
d) Lee, R, Middleton, D. editors. Children's Exposure to Elemental Mercury - A National Review of Exposure Events
Agency for Toxic Substances and Disease Registry February 2009
e) Zayas L, Ozuah P. Mercury Use in Espiritismo: A Survey of Botanicas American Journal of Public Health
86:1:111-112 January 1996
f) Maddaloni, M. Mercury Vapor Sampling in Targeted Housing: Investigation of Ritualistic Mercury Use FY 11
Regional Applied Research Effort Proposal U.S. EPA/Region 2/Office of Research and Development n.d. -July
2010
g) Garetano G, et al. Mercury vapor in residential building common areas in communities where mercury is used for
cultural purposes versus a reference community Science of the Total Environment 397:131-139 2008
h) Garetano G. An Evaluation of Potential Exposure to Mercury in a Community Where Mercury is Used for Cultural
Purposes Doctoral Dissertation, School of Public Health , University of Medicine and Dentistry of New
Jersey. January 2006
A4 p.991
-------
i) Ozuah PO. et.al. Mercury Exposure in an Urban Pediatric Population Ambulatory Pediatrics 3:1:24-26 January-
February 2003
j) Wendroff, AP. Magico-Religious Mercury Use in Caribbean and Latino Communities: Pollution, Persistence, and
Politics Environmental Practice 7:2:87-96 June 2005
Arnold P. Wendroff, Ph.D.
Mercury Poisoning Project
www.mercurvpoisoningproiect.org
mercurvwendroff@mindspring .com
(718) 499-8336
A4 p.992
-------
Letters to the Editor
AMERICAN
JOURNAL
OF
Public
Health
Magico-Religious
Mercury Use and
Cultural Sensitivity
In his recent commentary, "AIDS
Prevention and Cultural Sensitivity: Axe
They Compatible?" Bayer concluded,
"Homilies about cultural sensitivity must
be replaced by a forthright acknowledge-
ment that we cannot seek radical behav-
ioral and normative change while adher-
ing to a dictum that serves principally to
protect the status quo.",(P897)
Although Bayer specifically addresses
acquired immunodeficiency syndrome
(AIDS), his logic pertains to other com-
plaints possessing culturally determined
risk factors, including intoxication result-
ing from the magico-religious use of
mercury in Hispanic and Caribbean
homes.2 Although the Environmental Pro-
tection Agency (EPA) has recently initi-
ated a public awareness campaign to deal
with "the burning or sprinkling of elemen-
tal mercury in homes and cars,"3 there has
March 1995, Vol. 85, No. 3
been resistance on the part of numerous
Hispanic "stakeholder" organizations to
"regulatory action" involving the sale of
illegally unlabeled mercury for magico-
religious and ethnomedical use.4
Despite urging EPA "to begin its risk
communication efforts quickly in order to
show its concern for the affected
population,"4^7) the three national His-
panic stakeholder organizations EPA con-
sulted felt that a more active intervention,
such as enforcing the existing Federal
Hazardous Substances Act labeling re-
quirements (16 CFR §§1500-1512),
"would send the message of government
interference in the practicing of one's
religion."4(p8' The stakeholder organiza-
tions agreed that "any discussion of the
religious implications of [mercury use]
should be omitted from the risk communi-
cation message."4(p7)
EPA stated that "because of the
cultural aspects of this problem [of magico-
religious mercury use], any regulatory
action would probably be very difficult to
enforce."4*?6' Similar sentiments have been
voiced by the Consumer Product Safety
Commission (CPSC), which has refused
to exercise its subpoena powers to exam-
ine the sales records of distributors of
illegally unlabeled or inadequately la-
beled mercury. Such records provide data
on the amount of mercury sold for
magico-religious purposes, as well as the
geographical distribution of such sales,
and would eliminate "many [of the]
uncertainties ... regarding the extent...
of use of mercury in these practices. "4(p3>
Both EPA's and CPSC's actions (or
inactions) illustrate Bayer's observation
that "acceding to the demands of cultural
sensitivity... not only is not a prerequisite
for effective public health practice but
would be inimical to the goals of ...
American Journal of Public Health 409
prevention." Both EPA and CPSC appear
to have acceded to these demands by
failing to enforce existing culturally neu-
tral regulations requiring adequate label-
ing of mercury. They are thus maintaining
the status quo at the expense of protecting
the public's health. ~
Arnold P. Wendroff, PhD
Requests for reprints should be sent to Arnold
P. Wendroff, PhD, 544 Eighth St, Brooklyn,
NY 11215-4201.
References
1. Bayer R. AIDS prevention and cultural
sensitivity: are they compatible"} Am J Public
Health. 1994;84:895-898. Commentary.
2. Wendroff AP. Domestic mercury pollution.
Nature. 1990;347:623. Letter.
3. EPA warns health officials of mercury threat
toHispanics. The Nation's Health. 1994(May/
June):5.
4. RM2 Assessment Document for Cultural Uses
of Mercury. Washington, DC: Office of
Prevention, Pesticides and Toxic Sub-
stances, US Environmental Protection
Agency; June 9,1993.
410 American Journal of Public Health
A4 p.993
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http://religiondispatches.org/is-religion-wrecking-our-air/
Is Religion Wrecking Our Air?
By Jay Wexler Books, Culture, Science April 4, 2016
What more important natural resource could there be than the air we breathe every minute of every
day? And yet, air pollution remains rampant throughout the world. The World Health Organization has
estimated that air pollution causes seven million deaths per year from problems such as heart disease,
respiratory ailments, and cancer. Major sources of air pollution include mobile sources like cars and
trucks and stationary sources like factories and power plants. Relatively minor sources range from
cigarettes and hairspray to volcanoes and cow farts.
When it comes to our air, the biggest hazard posed by religion is that religious people really like
burning stuff. Whether they are burning incense or firecrackers or logs or paper or pieces of cardboard
put together to resemble a small house, religious believers around the globe can't seem to get enough
of using fire to celebrate their traditions.
Consider Lag B'Omer. This is a relatively minor Jewish holiday that young people celebrate all over
Israel by lighting enormous bonfires to commemorate the death of a famous rabbi and the end of a
plague that was killing a different rabbi's students. Even though I was raised Jewish, I had never heard
of the holiday until my colleague Jack Beermann told me about it. Jack, who was nice enough to hire
me when he chaired the Appointments Committee at my law school fourteen years ago, despite the
fact that I misspelled his name in my cover letter, visits Israel often. "When I was there on Lag B'Omer,
the whole country smelled like a bonfire that night and the next day," he said to me one day when I
was explaining my book project to him. "Also, my clothes smelled like a bonfire, of course, so it must
require lots of extra laundering."
According to news reports, there are so many bonfires lit on Lag B'Omer that satellite images reveal a
smoky haze hovering over Israel during the holiday. Scientific research has shown that visits to
emergency rooms for asthma and chronic obstructive pulmonary disease (COPD) occurrences go way
up because of the smoke, which is hardly surprising since the concentration of particulate matter on
the evening of the holiday can spike to as much as ten times the normal level. Government officials in
Israel are well aware of the problem. A study authorized by the Knesset showed that the bonfires
contribute to the problem of global warming, and that body has recommended (though not required)
that people refrain from lighting them. The message has not been well received in most quarters.
When an influential local mayor launched a campaign to convince residents to find alternative
methods of celebrating the holiday, the people became outraged. As one journalist wrote: "In an
instant, the popular mayor became the local killjoy, the Grinch who was trying to steal Lag B'Omer.
The local press and town Internet forum erupted with residents blasting [the mayor] for his attempt to
extinguish the flames. 'Next thing you know he'll be ordering us not to light Hanukkah candles,' one
angry resident wrote." In fact, Hanukkah candles do contain hazardous substances like toluene,
benzene, and formaldehyde, so it wouldn't be entirely shocking if somebody did try to ban them.
Beyond bonfires, the burning of incense is a fairly long-standing and ubiquitous religious practice
found in all sorts of traditions, including Christianity, Hinduism, and Buddhism. Although incense can
be sweet-smelling and pleasant, it is also really dangerous. For whatever reason (the smell, the
A4 p.994
-------
context, the different treatment by the media, the extreme irrationality of all human beings), people
who would go miles out of their way to avoid breathing in the smoke from a single cigarette often
have no problem hanging out for hours at a temple or church where the air is filled with billowing
plumes of hazardous incense smoke.
When I was visiting Hong Kong, I spent an hour or so at the School of Public Health at the Chinese
University of Hong Kong, talking to a research scientist named Kin-Fai Ho, whose work focuses on the
effects of toxic air pollutants on human health. Professor Ho was part of a team of scientists who were
granted rare access inside of two temples in Hong Kong so they could study the effects of incense
burning on the air quality. The team found that during peak times, when incense was being burnt in
high quantities, the air was far more polluted than during nonpeak times. At one of the temples, for
instance, the peak carbon-monoxide level was three times the nonpeak level, and the average benzene
concentration was almost eight times more than the government's recommendation for public places.
When I asked Dr. Ho how incense smoke compares with cigarette smoke, he said the two were
comparable with respect to particulate matter, carbon monoxide, and polycyclic hydrocarbons.
Temples and the people visiting them have several alternatives that can help reduce the risk from
incense smoke. In their paper, Ho and his coauthors write that "visitors may decrease the number of
incense sticks burned and period of stay at temples." In my travels, I did visit temples that tried to
suggest limits on how many incense sticks people should burn. Some temples have tried to deal with
this problem by extinguishing incense sticks after they have been burning for a while. Particularly in
Hong Kong, I sometimes saw large buckets of water standing near places where large amounts of
incense were being burnt, and every once in a while, a temple worker would grab a bunch of sticks and
douse them in the water. There is one suggested possible solution, however, that Dr. Ho was not very
optimistic about. So-called environmentally friendly incense, which is marketed in some places as a
way of reducing the environmental and health impacts of incense burning, turns out, according to a
new study that Ho was working on, to have slightly fewer particulate matter emissions but little effect
on the amount of toxic pollutants emitted. On my way out of the interview, looking in that journalistic
way for the bottom line, I asked Dr. Ho whether he thought incense-smoke inhalation was a problem.
He looked at me and responded calmly, "Yeah, it's a big problem."
Another problem is fireworks. As someone who has always hated fireworks and would rather stay
inside with my head under a pillow than endure a loud, smoky Fourth of July celebration with ten
thousand people staring at the sky and going "ooooh" and "ahhh" over and over for half an hour, I find
it hard to understand the appeal. But still, people love watching fireworks! Every celebration these
days, from the biggest national holiday to the most insignificant home-run hit by a last-place baseball
team down 14-0 in the bottom of the eighth inning, seems to be marked by a blast of colorful
explosions. Religious celebrations are no exception. Chinese New Year celebrations, which for some
take on a religious meaning (many believe the fireworks ward off evil spirits); the Muslim holiday of
Eid, which marks the end of the Ramadan fasting period; the Hindu festival of lights known as Diwali;
and many other religious holidays and festivals around the world are celebrated with the abundant
lighting of firecrackers and fireworks.
Unfortunately, for those of us who need to breathe air in order to live, the smoke produced by
fireworks can be quite dangerous. According to one academic paper that showed the effects of
fireworks on air pollution during Diwali in India, "fireworks contain harmful chemicals such as
potassium nitrate, carbon and sulphur apart from an array of chemicals such as strontium, barium,
sodium, titanium, zirconium, magnesium alloys, copper and aluminum powder to create the colourful
effects. On burning they release gases such as carbon monoxide and nitrogen dioxide." The study
concluded that fireworks contributed to excessive ozone pollution spikes during the holiday, and that
"high ozone levels combined with pollution due to fireworks might be critical for elderly people and
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children with heart and respiratory ailments." Another Indian expert similarly concluded, "Gaseous air
pollutants along with other toxic gases emitted due to burning of firecrackers aggravates the chance
of attack among asthma patients. The patients with heart disease, chronic bronchitis and low immune
system are also at high risk."
The realization that fireworks significantly raise air pollution levels has led officials in Beijing to call for
a reduction in the use of pyrotechnics during the Chinese New Year period, and it's one reason, among
others, that Abu Dhabi police have warned Eid celebrants not to use illegal fireworks in the United
Arab Emirates. Even in the United States, some critics have called for the federal government to
regulate fireworks, rather than exempting them from the ambit of the Clean Air Act. The EPA has
refused, claiming that "Congress did not intend to require EPA to consider air-quality violations
associated with such cultural traditions in regulatory determinations."
Although most people probably conjure up images of a dark and smoggy sky when they think about air
pollution, in fact indoor air pollution may be nearly as dangerous as outdoor pollution, particularly in
developing countries where people routinely burn coal and biomass fuel for cooking and heating their
homes. Indoor air pollution also provides the context for one of the most bizarre examples of a
religious practice that has created environmental problems in the United States.
Mercury is an element that people generally do not want to mess with. Touching it, eating it, or, most
dangerously, breathing in the vapors that it releases can be extremely dangerous, potentially causing
respiratory problems and damage to the nervous system. Given the perils of inhaling mercury vapors,
it might be surprising to learn that some religious believers actually sprinkle the silver liquid metal
inside their homes to ward off evil spirits. The practice puts not only current residents at risk but also
future ones, as mercury can remain in fabrics and carpets for up to a decade, releasing dangerous
vapors the entire time.
Back in 1989, a middle school chemistry teacher in Brooklyn named Arnold Wendroff was teaching
his students about the periodic table. When he asked his students if they knew what mercury was
used for, he fully expected someone to mention thermometers. Instead, one of his students
answered that his mother, a Santeria practitioner originally from Puerto Rico, liked to sprinkle it
around their apartment to fend off witches. Witches? Concerned and curious, Wendroff soon
became a one-man watchdog of the ritualistic use of mercury. He learned that many practitioners of
Caribbean religions like Santeria, Palo, and Voodoo believe that mercury can bring good luck and
keep evil spirits at bay. In large US cities with substantial populations of these believers, practitioners
purchase capsules containing a small amount of liquid mercury from so-called botanicas, which are
essentially stores that sell religious paraphernalia.
The practitioners then do things like sprinkle the mercury on floors, furniture, or car interiors, or mop
the floor with it, or burn it in candles, or mix it with perfume, or even swallow it. Because mercury
vapors are so dangerous to inhale and because the mercury remains in the environment for so long,
Wendroff concluded that the ritualistic use of mercury posed a significant health hazard that the
government needed to address.
Through Wendroff s efforts, the EPA became aware of the problem in the early 1990s and started
considering whether to do anything about it. The agency has several statutes that it could have used
to regulate the ritual use of mercury inside homes, most importantly the Toxic Substances Control
Act, or TSCA, which allows the agency to take a wide variety of regulatory actions against substances
that pose an unreasonable risk to the environment or public health. To look into the issue, the EPA
established a task force that conducted research and interviewed interested parties. Ultimately,
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though, the agency decided against using the TSCA, opting instead to work together with states and
municipalities to spread the word about the dangers of mercury through education and community
outreach.
In the wake of the task force's decision, Wendroff continued to call for further efforts to address the
indoor religious mercury problem, talking to the media, writing papers in scientific journals, and
interacting with various governmental units. In 2005, he asked the Office of the Inspector General at
EPA to "determine whether EPA had adequately investigated whether [indoor religious mercury]
contamination poses an environmental health threat and, if so, had EPA substantively acted to
address its dangers." Unsurprisingly, the OIG concluded that EPA had acted properly and
recommended no further action. On the other hand, the office did release a report on its
investigation "to further emphasize that the ritual use of mercury poses a health risk." This final
conclusion does seem to be accurate. A 2011 article in the New York Times, for instance, reported on
the case of a three-year-old who suffered mercury poisoning when her family moved into a Rhode
Island apartment that had been the site of ritual mercury use by a former tenant many years earlier.
###
Excerpted from When God Isn't Green: A World-Wide Journey to Places Where Religious Practice and
Environmentalism Collide by Jay Wexler (Beacon Press, 2016). Reprinted with Permission from Beacon
Press.
Jay Wexler
Jay Wexler is a professor at the Boston University School of Law, where he has taught environmental
law and church-state law since 2001. He is the author of three previous books, including Holy
Hullabaloos and The Odd Clauses.
When God Isn't Green: A World-Wide Journey to Places Where Religious Practice and Environmentalism
Collide Jay Wexler, Beacon Press, March 15, 2016
Sources cited:
On the ritualistic use of mercury generally and Arnold Wendroff s campaign to fight it, see Emily Yehle, "EPA
Weighs Threats Posed by Mercury Used in Religious Rituals," New York Times, May 18, 2011; Lauryn
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A4 p.997
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Schroeder et al., "Ritualistic Use of Mercury Remains a Mystery—but Health Effects Aren't," MedillReports
Chicago, March 14, 2013, http://news.medill.northwestern.edu/chicago/news.aspx?id=219201; Leonora LaPeter and
Paul de la Garza, "Mercury in Rituals Raises Alarms," St. Petersburg Times Online, January 26, 2004. For a
piece written by Wendroff himself, see Arnold P. Wendroff, "Magico-Religious Mercury Use in Caribbean and
Latino Communities: Pollution, Persistence, and Politics," Environmental Practice 7, no. 2 (June 2005): 87-96.
The relevant EPA documents on ritualistic use of mercury are EPA Office of Inspector General, Public Liaison
Report, EPA Is Properly Addressing the Risks of Using Mercury in Rituals, Report No. 2006-P-00031, August
31, 2006; and EPA, Task Force on Ritualistic Use of Mercury (Washington, DC: December 2002),
http://www.epa.goy/superfund/community/pdfs/mercury.pdf.
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Northeast -1
Maine, Massachusetts, Rhode Island, Connecticut, New Hampshire, Vermont,
New York, Pennsylvania, New Jersey, Delaware, Maryland, DC
Full Name (First and Last): John Daleo
Name of Organization or Community: PlaneSense 4 Long Island
City and State: Roslyn Heights
Brief description about the concern: NextGen is ruining the suburbs. The program may work for the
FAA and airline industry to increase the throughput at airports by allowing planes to fly in a closer flight
path and lower for longer periods of time. FAA claims safety. I wouldn't know so much about that, but
what I do know as a resident on the ground under the NextGen flight path to JFK arrivals is that there
was absolutely NO consideration afforded to me as a citizen nor the other residents who have to endure
this.
What do you want the WHEJAC to advise the White House Council on Environmental Quality to do?: I
am a reasonable man. I understand I live in the NY metro area with major airports 20 miles away. I had
reasonable expectations when I moved from Queens to Nassau County (suburbs) that I would get away
from the noise/pollution. This has NOT been the case due to NextGen. I want WHEJAC to advise the
White House Council to force the FAA review flight paths for equitable distribution. If they are able to
fly over the same homes time and time again via satellite then they can be given rotated paths that
share the burden. The reason they won't do this is for fear that MORE citizens will complain, but if they
disperse equitably then we are all in the same boat. Airline industry must be served - agreed. But the
rights of those on the ground can't be overlooked in the process. Unfortunately this is happened and
allowed.
Full Name (First and Last): Tania Giacomini
Name of Organization or Community: 10,000 Hawks
City and State: New Haven, CT
Brief description about the concern: My family and I are concerned with the the noise level and
frequency of noise; the amount of exhaust fumes released into the air - thus air quality and the
increased automobile traffic.
What do you want the WHEJAC to advise the White House Council on Environmental Quality to do?:
To maintain the airport as a small general aviation airport and not increase the commercial flights. Also
to prohibit this becoming a freight/cargo airport.
Full Name (First and Last): Cynthia Jennings
Name of Organization or Community: Connecticut Coalition for Environmental Justice (CCEJ)
City and State: Hartford, Connecticut
Brief description about the concern: My concern is based on the impact of the COVID-19 Virus and it's
variants relative to those individuals who live in Environmental Justice Communities. Obtaining statistics
on the death rate in these communities is almost impossible, and we are left to estimate how many
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people are dying, and why the death rate is so much higher in our communities. I would also like
protocol for public health and public safety of those individuals living in EJ communities, in particular for
what they should do to protect their health if they refuse the vaccine, and what the long-term effects
related to cardiovascular impacts are after they have been infected with COVID. Also, I would like
monies to be specifically set aside for environmental clean up of EJ communities to prevent the
destruction of lung health and immune health BEFORE Covid or some other pandemic continues to kill
off a substantial number of people with already compromised lungs and immune systems.
What do you want the WHEJAC to advise the White House Council on Environmental Quality to do?:
I would like WHEJAC to advise the White House Council to identify every Environmental Justice
Community through community mapping, with the associated risks (i.e. pulmonary, cardiac; immune
systems) and I would like WHEJAC to identify specific monies to be spent on environmental cleanup and
pandemic devastation prevention in these EJ communities, and I would like WHEJAC to have CRIMINAL
ENFORCEMENT FOR MONIES THAT ARE STOLEN OR REPURPOSED FOR EJ COMMUNITIES, AND ARE USED
FOR OTHER PURPOSES. Covid monies are critical to saving lives in EJ communities, and for these monies
to be withheld from EJ communities is criminal. Monies designated for these purposes are to be
STRICTLY ENFORCED for use ONLY in these communities, and there should be severe warnings on
repurposing or misappropriation of these monies, as well as PROVISION OF TRAINING TO ALL EJ
COMMUNITIES ON HOW TO UTILIZE THESE MONIES TO SAVE LIVES AND REDUCE RISK OF LIFE TO THOSE
LIVING IN EJ COMMUNITIES.
Thank you.
Attorney Cynthia Jennings
Hartford, Connecticut
I'm the Executive Director of the Eastern PA Coalition for Abandoned Mine Reclamation (EPCAMR), and
would like to provide comments following the January 26 & 27th Public Meeting. I realize that the
deadline of February 9th has passed to submit the comments formally, however, I had gathered
additional information following that date that is included within the body of the comments here that I
would not have had in late January. I have offered some feedback after reviewing the Climate and
Economic Justice Screening Tool. I've noticed a lot of coalfield communities that have abandoned mine
lands and legacy abandoned mine features and water quality pollution associated with abandoned mine
land issues are not even a part of this map whatsoever, here in PA, let alone Appalachia or nationally for
that matter. Leaving out the coalfield communities and watersheds that are impacted by abandoned
mine lands from the Justice 40 seems to go against what the Administration has been talking about all
along when they were going to make it a priority to make investments in them. If these communities are
left out and the criteria suggested below aren't considered, it could leave many communities out in the
dark and not considered for much-needed funding opportunities from many of the agencies that are a
part of the IWG, including funding from the recent Infrastructure bill funding. I have presented many of
the criteria below to the PA Office of Environmental Justice for consideration and review and have had
conversations with their Staff on advocating for the inclusion of many of the data listed below related to
legacy abandoned mines and mine water pollution as determined under the (Title IV) Surface Mining
Control & Reclamation Act of 1977, as amended. We've worked with Justin Dula, Acting Director of the
PA DEP Office of Environmental Justice, and Tom McKeon, MPH, PhD Student with the Department of
Geography and Urban Studies from Temple University that is currently an Environmental Justice Intern.
EPCAMR would ask that you please consider the same. While these are specifically referring to PA, many
of the data layers are already uniform across States in the Federal e-Abandoned Mine Land Inventory
System (AMLIS) updated by the Office of Surface Mining Reclamation & Enforcement (OSMRE) in the US
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Department of the Interior. • Unreclaimed AML sites (feature points) contained within PI & P2
Problem Areas •% vegetated (a lack of vegetative cover may indicate loss of habitat, forests, and green
space)* AML Sites contained within Problem Areas that are listed as "Undetermined" (No
Priority)* Existing AMLgrayfield sites as determined by the US EPA (Earth Conservancy has these sites
funded under the US EPA Region 3, for example)*lf we are going to refer to the need for air quality
standards, we include location of mine fires that currently have little to no capturing of any air quality
monitoring data from gas emissions from the surface of the underground fires* Locations of wildcat
sewers (raw or leaking sewage discharges) or combined sewer overflows [might be on 303(d) List for
sewage as source of pollution]* Unemployment Rate (at what level? Municipal, City, County)* County
or Municipal owned AML parcels 'Subsidence Prone Areas 'Abandoned Mine Drainage (AMD) water
pollution discharge points (Priority 3 points within the Problem Areas)* Underserved School Districts
• Communities where coal mining jobs are being actively reduced due to shutdown of coal-fired plants (I
recall a few coal-fired places in SW PA) *Cancer clusters or some other health-related cluster
• Excessive Radon levels (Geological boundary of the Reading Prong-similar to a Limit of Coal Measures
Boundary)*Expand buffer area around current EJAs from one-mile to ten miles (or more appropriate
number)*303 D impaired stream*Air quality advisory due to particulate matter* Documented private
and/or public drinking water well contamination*Existing Consent Order and Agreement for pollution
impacts*Dimentia clusters (associated with heavy metal contamination)*Renal failure clusters
(associated with heavy metal contamination)* Hazardous Sites Cleanup and Reclamation Act sites*Past
investment of funds addressing mine reclamation (water, land or fires)* Area in a Qualified Hydrologic
Unit Please take a look at EPCAMR's ArcGIS PA AML Dashboard and data compilation that we've created
which includes the CDC's Social Vulnerability Index (2018) and PA e-AMLIS data.
Here are two additional data layers that you may want to review and consider. We have talked with
many other States throughout Appalachia with AML and AMD issues and some do have this type of
information and others don't. We've even helped some States pull this type of information together
through small grants over the years with our partners from Central Appalachia. As far back as 2012,
EPCAMR even provided a significant amount of GIS data on abandoned mine lands and mine water
pollution to researchers that were working with Geisenger, John Hopkins Education and Research
Center, and the National Institute of Occupational Safety & Health. The research was from 2012.
Associations of the Burden of Coal Abandoned Mine Lands with Three Dimensions of Community
Context in Pennsylvania Ann Y. Liu,l Frank C. Curriero,1,2 Thomas A. Glass,3Walter F. Stewart,4 and
Brian S. Schwartzl,3,4. Legacy Pollution sites in the tool that you have presented are more related to
Hazardous Waste and Superfund sites. They do not include abandoned mine sites and mine water
pollution that in PA impacts over 7,000 miles of streams and an estimated 150,000 acres conservatively,
of abandoned mine lands. For areas and communities where Active Mining (Title V) of the Surface
Mining Control & Reclamation Act, is located, these points of interest might also want to be considered.
Presence of: Coal Mining Operations, Anthracite River Dredge, Discharge Point, Mineral Preparation
Plant, NPDES Discharge Point, Refuse Disposal Facility, Surface Mine, Underground Mine, Industrial
Mineral Mining Operations, Discharge Point, Mineral Preparation Plant, NPDES Discharge Point, Surface
Mine, Underground Mine, I hope that these comments will possibly be considered or at least reviewed
by the WHEJAC. Respectfully submitted, Bobby Hughes, Eastern PA Coalition for Abandoned Mine
Reclamation (EPCAMR)
Full Name (First and Last): Gretchen Fitzgerald
Name of Organization or Community: concerned citizen
City and State: West Hurley NY
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Brief description about the concern: EJ considerations for older adults - especially those who have
chronic illnesses and are homebound.
What do you want the WHEJAC to advise the White House Council on Environmental Quality to do?:
It is critical to take into consideration the special environmental justice issues specific to older adults.
Adults over the age of 65 are a growing percentage of the population in the United States and are
particularly vulnerable to both short-term and long-term consequences of climate change due to
physical age-related changes. These health risk factors are more potent for older adults with low
incomes, which is the only age group that is currently showing an increasing number of people in
poverty. In addition, while many people of younger age groups may either live or work in communities
more highly exposed to pollutants, older adults with chronic illnesses or disabilities are less able to leave
their homes and therefore are exposed to harmful chemicals and pollutants 24 hours a day. This is
especially true for residents of skilled nursing facilities and assisted living facilities. These facilities tend
to be clustered in and around urban communities, which tend to have more environmental health issues
compared to rural areas. Older adults can be exposed to dangerous pollutants both inside and outside
the facilities, so both must be assessed and monitored frequently to avoid exacerbations of disease and
subsequent hospitalizations. The White House Council on Environmental Quality must prioritize the
needs of low-income older adults considering their risk of exposure and their vulnerability due to age-
related changes and coexisting chronic illnesses.
Full Name (First and Last): Dr. Sacoby Wilson
Name of Organization or Community: Center for Community Engagement, Environmental Justice, and
Health
City and State: College Park, Maryland
Brief description about the concern: In response to the WHEJAC public meeting on developing a
scorecard for federal agencies as they try to address environmental justice issues, I, Dr. Sacoby Wilson,
Director of the Center for Community Engagement, Environmental Justice, and Health (CEEJH) at the
University of Maryland School of Public Health, would like to provide written recommendations. Federal
agencies should be reviewed across criteria developed from the 17 Principles of Environmental Justice
and CEJA's 8 Principles of Collaboration. - Agencies should be evaluated for each criteria on a scale of 0-
5 points using publicly available information on the agency website, and interviews with agency
representatives. The full breakdown of scoring should include the following elements:
Please see the emailed pdf.
What do you want the WHEJAC to advise the White House Council on Environmental Quality to do?:
Pease see the emailed pdf for full list of recommendations.
Southeast -2
West Virginia, Virginia, Kentucky, Tennessee, North Carolina, South Carolina,
Georgia, Alabama, Mississippi, Arkansas, Louisiana, Florida
Dear WHEJAC members,
At the January 26, 2022 WHEJAC meeting, I heard Dr. Bullard highlight the need for guardrails in the
spending of federal infrastructure funding and the need to organize, to mobilize, to build the justice
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framework into that funding. As I waited for my turn to speak (which never came), that message
resonated a lot for me: to be laser-focused, so we don't get what we are always getting: nothing; to
make sure we are on this and stay on it every day, 24/7. Inspired by the call to "stay on it", I submit the
following comments to ask that you consider them as you continue to provide advice and make
recommendations to the White House on environmental injustices that is likely few have commented
on, but that are in urgent need of "guardrails" so that federal agencies, and states receiving federal
funding, like Florida where I reside, don't add more harm and marginalization in our communities. The
EJ issues I present below are within the scope of the WHEJAC charter. Recommend Environmentally Just
Policies to Build Back Better Nights! A few days before the WHEJAC hearing, driving back from the
Everglades, my son & I made a stop to take pictures of the enormous quantity of WASTED but "energy
efficient" LED lighting, at a sports field at the very edge of the Everglades, illuminating even the clouds at
night. Earlier that night, we also took photos of white fog and clouds illuminated by the bright bluish
white "energy-efficient" LEDs in a Florida Power & Light solar farm within one of the last remaining
natural dark sky areas in the Everglades, and primary habitat for the federally endangered Florida
Panther, our FL state animal. These environmental impacts are happening in many communities, but like
most forms of pollution, harmful artificial light at night tends to affect our EJ communities
disproportionally more. And NEPA is failing in this regard, as many federally-funded transportation
projects are adding new unnecessary, inappropriate, excessive and harmful LED lighting, to the
detriment of people and wildlife, as documented by plenty of peer-reviewed research. There is NO
environmental justice, in energy efficiency and renewable energy, if the health & quality of the night is
NOT taken into account. We need to Build Back Better Nights! To that end, I ask you to please include
these in your recommendations to the Chair of the Council on Environmental Quality (CEQ) and to the
White House Interagency Council on Environmental Justice (Interagency Council): (1) All federal
agencies, particularly the US Dept of Transportation and US Dept of Energy, must improve their
guidance and regulations, to ensure they adequately evaluate and address the potential direct, indirect
and cumulative impacts of harmful light at night in our communities and our sensitive habitats.
Particular attention is needed to meaningfully address the huge increase of light pollution, including
agency policies that bias our federal government to install harmful blue-rich white LED lighting because
they tend to consider them more energy efficient than other alternatives. This is happening in many
communities, including low income communities of color where excessive bright and low-quality glaring
lighting often ends up serving as yet another form of targeted policing that in addition cause detrimental
impacts to the wellbeing of people and wildlife. Federally-funded infrastructure projects should in fact
do the opposite: they should be opportunities to remove or replace lighting that is harmful to people,
wildlife and the environment. A book by Simone Browne, titled Dark Matters: On the Surveillance of
Blackness, explains the roots of this form of artificial light environmental injustice. (2) In the EPA EJ
Screen Tool, include data layers that depict artificial light pollution at night. Data also exists to help
tackle the inequity of access to nearby nature at night. Low income families should not have to settle for
overlit urban communities, including glaring LED billboards outside bedroom windows, like many do in
downtown Miami. We all deserve the benefits of healthy lighting at night, when and where needed, and
affordable nearby access, without long drives to far away areas, to enjoy the wonder of stars, the sight
of fireflies and the songs of wildlife at night. Recommend Policies to Prevent Harm by the Rush to
Commercialize & Industrialize Space. I ask you to imagine a future in our children's lifetime without
Earth observation satellites to monitor the vital signs of our planet, such weather, and without GPS
satellites providing location services. Imagine our future adult children no longer able to get early
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warnings for hurricanes, tornadoes, or wildfires. Imagine them not being able to know where to bring
relief after natural or climate-fueled disasters, like Hurricane Maria that affected my family in the island
of Puerto Rico. Imagine an enormous amount of dangerous debris, orbiting Earth's atmosphere at
speeds many times faster than bullets, that no longer allows people to put any satellites in orbit, to
explore space, or to even defend the only planet they will ever truly call home. That future is NOT
fiction. A few months ago (October 2021), a former NASA administrator said "if we don't take action
now to mitigate the debris problem.... space will no longer be accessible". This nightmare is happening
because the USA government lacks comprehensive national laws and regulations to prevent commercial
exploitation at or near spaceport sites, and at our very own atmosphere and near-Earth orbital
environment: all to our detriment. For instance, the FCC is categorically excluding megaconstellations
(swarms) of commercial satellites from companies like SpaceX. That means there are no NEPA
environmental impact assessments, no analysis of alternatives, no meaningful public participation, and
little to no involvement by other federal agencies, including EPA, NOAA, USGS, DOI and others that
should have a say. This is further compounded by the FAA having a conflicting mandate that encourages
the agency to promote expansions of and new commercial spaceports from which to launch rockets
with big payloads carrying large numbers of satellites (and other objects) for private profit. This is
playing out right now in places like Boca Chica, near Brownsville at the TX border, that have long
experienced environmental injustices. I ask that you "Look Up" for our EJ communities being impacted
by a billionaire space industry with no guardrails, threatening the future of us all. To that end, I ask that
you also address this matter in your recommendations to CEQ and the Interagency Council by including
the following: (3) To prevent yet another crisis, and one that will make it next to impossible to solve the
social and environmental injustices already in our EJ communities, the USA federal government should
pause how it is regulating space commercialization to urgently examine and improve our national
policies, in a comprehensive and transparent process and in concert with other countries and the United
Nations: because we all stand to lose if we don't do this right. I hope my plea to you leads to meaningful
actions on these important matters. I don't want anyone to ever say "I'm grateful we tried" while saying
goodbye to the wonder of starry nights, to the sight of "cucubanos" enchanting Puerto Rico nocturnal
landscapes, to the songs of coquis singing at night, or to the hopes of children dreaming of becoming
astronauts while looking up. For further reference, I'm attaching excerpts from a report prepared last
year by the United Nations Office for Outer Space Affairs (UNOOSA), and excerpts from a report to
which I contributed as part of an effort funded by the National Science Foundation to understand some
of the impacts to science and society from the growing number of satellite constellations (SATCONs).
Sincerely, Diana Umpierre, AICP, GISP, Pembroke Pines, Florida
Full Name (First and Last): Enid Sisskin
Name of Organization or Community: Gulf Coast Environmental Defense
City and State: Gulf Breeze, FL
Brief description about the concern: Open burning/open detonation is an antiquated method of
disposing of munitions. It hurts military families and communities located near military bases.I will be
submitting longer comments by email.
What do you want the WHEJAC to advise the White House Council on Environmental Quality to do?:
The military needs to dispose of their munitions in a safer and more responsible manner.
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Full Name (First and Last): Christine Louis-Jeune
Name of Organization or Community: Stop The Burn, Go Green Campaign
City and State: Belle Glade, Florida
Brief description about the concern: The issue of pre-harvest sugarcane burning is not only a danger to
the quality of our environment but to public health as well. Several studies have shown the impact of
smoke pollution to our health. The main issue with sugarcane burning is that most of our resident
cannot just "avoid it". During lockdown after the announcing of COVID-19, I worked at a clinic. Everyday,
I saw the number individuals that would seek medical aid for this virus. I saw a number of elderly and
youthful individuals pleading to be seen by a medical profession. Whether it was because air of our
community directly affected their health or because they need medical treatment, they all had one thing
in common. The smoke from the agricultural burning made breathing a sport. Agricultural burning is
extremely detrimental to our youth and elderly. Not to mention the number of immunocompromised
residents in the tri-city area who have to deal with other health issues on the daily. In 2019, the senate
passed the Right to Farm Act, which protects farmers from facing the consequences that result from
harmful farming practices. The health of the public should always be prioritized over a multi-billion
dollar company such as US. Sugar. Pre-harvest sugarcane burning practices did not stop during the
pandemic. So amidst the "black snow" and heavy smoke that is produced by this method of harvest,
residents also had to compromise with the ways they had cope with being laid off, stuck at home, and
an influx of bills but no active income. Even now, this is still a relevant matter in our community. We
should not have to endure the frequent air pollution for the sake of farmers profit. We deserve better.
Without us, there would be no need to harvest any crops. Why is it still a question to consider our
health?
What do you want the WHEJAC to advise the White House Council on Environmental Quality to do?:
I need WHEJAC to advise the White House Council on Environmental Quality to assist the public in
tackling the issue of historical, environmental injustice in Belle Glade, FL. The practice of pre-harvest
sugarcane burning is outdated. There are healthier ways to harvest for profit without capitalizing on the
health of marginalized communities. A beneficial method is already being utilized in select areas in south
Florida by the same company, US Sugar, that refuses to acknowledge the 30+ year issue of air pollution
caused by them.
Full Name (First and Last): Tracy Marcello
Name of Organization or Community: Stop the Burn
City and State: Tequesta, Florida
Brief description about the concern: Stop the Burn is asking U.S. Sugar and other large sugar farming
operations to stop using field burning practices. These daily burns affect the marginalized communities
surrounding the fields, including Belle Glade, Pahokee, and South Bay. This discriminatory practice is
outdated and has been scientifically proven to diminish the air quality in these surrounding areas,
causing undue harm to children and people with asthma and other medical conditions who live in these
areas.
What do you want the WHEJAC to advise the White House Council on Environmental Quality to do?:
Stop issuing burn permits to these sugar corporations so they are forced to begin using green farming
practices (which they already use for their organic sugar production). These daily burns are outdated,
discriminatory, and extremely harmful to the most vulnerable Florida populations.
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My name is Theresa Coffey, my mom has lived in Louisa, VA 23093 for 60 years. We are having multiple
problems with I company I have been trying to get help, but it has been difficult this all started right
when COVID started so it has been struggle to get help. I have included photos and videos of the
emissions, smoke, ash and dust coming from the plant. You also see how close they are to us. They are
currently operating off a temporary permit and try to get a permanent permit. I apologize for the
difference format. This asphalt plant is 50 ft from my mom's home is Louisa County, Virginia. We are
having multiple issues with this company and it has been going on over a year now. We have been
trying to get help with this issue, but due to COVID it has been a struggle trying to get assistance. My
mom and I are thankful we have been connected with amazing resources. The letter below is what I sent
to DEQ: I have recently learned that a permit application is pending regarding the Boxley Zion-
Crossroads asphalt plant in Louisa. I would like to request a formal public notice and an opportunity for
public comment on the pending permit application. Given the plant's proximity to my property and
home (just 50 feet away), a public comment opportunity would allow me, my family, and neighbors to
voice our concerns. Some of the harms I plan to share, experienced as a direct result of the Boxley Zion-
Crossroads asphalt plant, are: • ODOR: The plant emits an odor that not only smells like tar and
chemicals, but also threatens my own and my family's health. The plant's fumes have caused my mother
to suffer headaches and caused me to experience a burning sensation in my nose and throat. When I
sought medical advice about these ailments, my nurse informed me that the plant's emissions are
hazardous, and recommended that my mother and I double mask, limit time outdoors, and change
clothes after being outdoors. • NOISE: When the plant operates, it generates a loud, persistent hum,
audible from inside my home. The trucks entering and exiting the plant also produce excessive noise by
beeping when backing up, using air brakes, and slamming their tailgates. • DUST: The plant's operations
generate a considerable about of dust that comes onto my property, caking the ground, our cars, and
everything else in a layer of dust. The odor, noise, and dust created by the plant are prohibiting me and
my family from able to enjoy our property. We are no longer unable to work from home and cannot
host cookouts or invite family over. Thank you for your consideration. Please reply to this email so I can
be sure that DEQ has received it. This a news story
https://www.wric.com/news/taking-action/louisa-familv-savs-thev-had-no-idea-their-new-neighbor"
would-be-an-asphalt-plant/ I can also forward the permit, it has not been approved by DEQ, let me
know if you need it. Your assistance will be greatly appreciated. Thank you, Theresa Coffey
Full Name (First and Last): Sonia Baez-Hernandez
Name of Organization or Community: Miami Climate Alliance
City and State: Homestead, FL
Brief description about the concern: I am concerned for the lack adaptations and mitigations for
frontlines communities (African American aboriginal people, Latinos and poor. According to Mallory," it
is important "identify disadvantaged communities long plagued by environmental hazards, but it won't
include race as a factor in deciding where to devote resources." In addition, climate change reports
point out that climate change has genocidal proportions. We have the right to life and we are human
too. How the WHEJAC will protect the rights of disadvantaged communities?
What do you want the WHEJAC to advise the White House Council on Environmental Quality to do?:
How the WHEJAC will protect the rights of disadvantaged communities? What are the solutions,
adaptations and mitigations plan for frontline communities? It is any plant for "climate, clean energy
and environmental improvements to communities "that have been left out and left behind for far too
long"
A4 p.1006
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Midwest -3
Ohio, Indiana, Michigan, Illinois, Missouri, Wisconsin, Minnesota, Iowa, Kansas,
Nebraska, South Dakota, North Dakota
Full Name (First and Last): Matthew Young
Name of Organization or Community: BeechWood Inc.
City and State: Saint Paul, MN
Brief description about the concern: I hope to address meeting attendees on the invaluable role of
incorporating more social work practices in the delivery of environmental justice goals across their
implementation in rural and urban communities alike.
What do you want the WHEJAC to advise the White House Council on Environmental Quality to do?:
I would encourage WHEJAC to advise the White House Council on Environmental Quality around better
targeting of funding and other professional resources for social workers who desire to work with
environmental justice-focused organizations.
Southwest -4
Texas, Oklahoma, New Mexico, Arizona
Full Name (First and Last): Sarah Bishop Merrill
Name of Organization or Community: SAVERGV
City and State: Harlingen, TX
Brief description about the concern: Representing the EJ communities' needs here in the Lower Rio
Grande Valley, we in SAVERGV find that the monies appropriated for more of the obsolete Border Wall
could be used for improving our air and water quality, and to resist, or replace 2 planned LNG projects,
the Jupiter project and others with renewable energy projects, offshore wind, kinetic (wave) energy,
solar arrays, etc. Methane releases are so far worse than C02 that we must end the use of natural gas as
a "transitional fuel," which it is not. The carbon footprints of these planned projects will be huge, and is
already contributing to the many more 100 degree days here.
What do you want the WHEJAC to advise the White House Council on Environmental Quality to do?:
Empower EPA and other federal agencies to take up the slack left by the Texas agencies like TCEQ
(allows excessive amounts of chemicals other states long ago banned), and raise the bar for FERC
approval or permitting of the LNG plants of TXLNG and RioGrandeLNG, Next Decade. Although FERC now
has some new commissioners, had approved the 2 LNG export and processing projects, though we did
prevail on ANNOVAto cancel their LNG plans. European banks supported us in resisting LNG near the
sacred site of the Corrizo Comedcrudo tribe here, but 2 Planned LNG projects remain threatening this
fragile habitat and the Bahia Grande. We want the White House to claw back the funding appropriated
for a useless Border Wall, including even the lights and other disturbances of this irreplaceable eco-
system and set of habitats for our several endangered and listed species, e.g., The Ocelot, the Aplomado
Falcon, Piping Plover, not to mention needed Sea Grasses, Oyster beds, etc. Please stop the Wall, the
A4 p.1007
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LNG, and fund our schools for ventilation projects to improve IAQ. We also have colonias here which
lack standard sewers and streetlights. Septic tanks flood each time it rains, so that conditions are
favorable for cholera and other illnesses among the EJ communities. We need repaired levees, not more
wall segments. Ladders, and boats, planes and tunnels can easily defeat this Wall. Real diplomacy with
Mexico and the northern Triangle Central American countries, such as that VP Harris has been starting,
is the only authentic solution, requiring time and resources we can recoup from the huge costs of LNG
and the WALL. SpaceX is also here, testing the SuperHeavy, far larger than any rocket ever launched
from Earth. Debris from the planned failures necessary for engineering design has littered our lovely
pristine beach at Boca Chica, and nearby public lands. The costs of establishing these Wildlife Refuges,
e.g., Laguna Atascosa Nat'l Wildlife, Santa Ana, and the Bahia Grande Restoration, ... should not be
ignored: we must NOT permit more Wall, nor LNG, whose Methane and possible VCE (Vapor Cloud
Explosion) are hugely costly, as are all the fossil fuel emissions..., in creating extreme weather, as in
Hurricanes Harvey, Alex, Dolly, etc. We must get these TX agencies working better (TCEQ is under review
by the TX "Sunset Commission") so that we have full EIS, not just EAs, for LNG and SpaceX projects. Our
group has delayed them, and through FAA required more analysis of significant impacts, but we need
more help in regulating and preventing harm from these fossil fools! Thank you for your help. I would
specifically like to ask a question about VENTILATION and both outdoor and indoor air testing. I am
contacting ASHRAE but find there mainly just referrals to contractors: How can we get the state of the
art equipment down here to TEST our air? I want to help my School District write grants to obtain this
EPA funding for which we are getting the RFPs now that I am in touch with WHEJAC, but worry that we
won't even be able to study the need and document needs quantitatively. What best practices do you
recommend, and how can we have access to these? Will there be training sessions for local contractors
or should we build that into our grant proposals? Most contractors are not up to speed, especially in
the Rio Grand Valley, -since there is a negative attitude we are working to overcome, as Beto O'Rourke
(Candidate for TX Governor) said last Friday, the attitude that "this is good enough for the Valley," —
that we somehow don't deserve state-of-the-art technologies and trained workers in these crucial fields
of air and water quality testing. TCEQ is so unqualified, some of my STUDENTS at TSTC-Harlingen were
working for the agency while they were still students with us, to help TCEQ crunch numbers and do
testing, - TCEQ was so lacking in trained staff. This gives new meaning to the phrase "Underserved
communities." We need your help soon, as construction is about to start once a FID is made for LNG.
Thanks in advance!
I am herein submitting my comments for the White House Environmental Justice Advisory Council
Virtual Public Meeting on February 24, 2022: As a member of the Multicultural Alliance for a Safe
Environment (MASE), I am working to increase community dialogue with federal and state regulators
overseeing the cleanup of toxic radioactive pollution in the historic Grants Uranium Mining District.
Background: A total of 87 uranium mines and 5 uranium mills located within the San Mateo Creek Basin
have unleashed radioactive contaminants to our regional air, water and soil within the larger, more
extensive Rio San Jose Basin. Around 500 abandoned uranium mines are located within the Navajo
Nation. The Department of Energy has surveyed these legacy mines under its Defense-Related Uranium
Mines program, but more work and funding is required to address the numerous abandoned mines and
waste rock piles that continue to pose hazards to human health and the environment. Several
generations living near abandoned uranium mines have already been impacted by particulate matter
containing uranium and metals.
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Legacy uranium mills in the Grants Uranium Mining District also left behind millions of tons of unlined
tailings piles that continue to seep contaminant plumes of uranium, selenium and other constituents
into our shrinking drinking water supplies. A new study notes that the Southwestern United States is
experiencing its driest conditions in at least 1,200 years due to human-caused climate change.
Problem: Now the prospect of new uranium production in the same Mining District looms on the
horizon of a damaged and degraded basin before long overdue mine remediation even begins. DOE has
published back to back requests for Information on its proposed establishment of a new domestic
uranium reserve; its proposed HALEU program; and even Consent-Based Siting for the end product of
enriched uranium - spent, but highly radioactive nuclear fuel rods. How can Justice40 communities be
centered in any of these DOE initiatives when we are still faced with an onslaught of legacy
contamination from DOE defense-related contamination 40 years after the last uranium mine ceased
operating?
Recommendations to the Council on Environmental Quality: The Multicultural Alliance for a Safe
Environment has long advocated for an end to exemptions from the protections afforded by federal
laws and regulations such as the Safe Drinking Water Act, the Clean Air Act, and the National
Environmental Policy Act where they are most needed - in overburdened environmental justice
communities. We urge federal and state regulators not to approve any new mining plans of operation in
New Mexico until the complete reclamation of groundwater, soil, and air contamination in the Grants
Mining District is fully achieved. Instead, investments should be made to carry out the cleanup of legacy
contamination from uranium mines and mills in the Grants Mining District, which in turn, will stimulate
new job creation. MASE further urges all federal and state regulatory agencies, including the DOE, to
promote the right to clean, sustainable water sources and clean air for all overburdened populations
within their jurisdictions as an element of Justice40. The Multicultural Alliance for a Safe Environment
endorses the development of alternative energy sources that are renewable and which will sustain,
rather than destroy, our multicultural landscapes and natural ecosystems. Submitted by: L.
Watchempino, Pueblo of Acoma, New Mexico
West -5
Colorado, Wyoming, Montana, Idaho, Washington, Oregon, Utah, Nevada,
California, Alaska, Hawaii
Full Name (First and Last): Pamela Miller
Name of Organization or Community: Alaska Community Action on Toxics
City and State: Anchorage, AK
Brief description about the concern: Plastics and associated toxic chemicals threaten the health, well-
being, and food security of Arctic Indigenous Peoples. Climate warming, toxic chemicals, and plastics are
interconnected and existential threats to the health and safety of northern and Arctic Indigenous
peoples. Additional comments submitted by email.
What do you want the WHEJAC to advise the White House Council on Environmental Quality to do?:
Urgent action is needed by this Administration to curb fossil fuel, chemicals and plastics production and
to prevent these threats and further harm, protect health, and human rights.
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Full Name (First and Last): Pamela L. Perez, PhD
Name of Organization or Community: California State University, Northridge
City and State: Tarzana, California
Brief description about the concern: The Tree as a Cyclical and Natural Water and Air Producing Agent
Trees have two primordial functions, which benefit the health of our planet.1) Trees collect water.
They produce water.2) Trees produce oxygen, while absorbing toxic gases from the air. THE WATER
PRODUCING ACTION OF THE TREE: The natural simplicity of the trees' water producing function is as
follows: In following with the perfection of its own natural design, the large stature of the tree allows its
leaves to collect rainwater and moisture from the air in general. This water, collected by the leaves, is
transported through the tree's vascular system o its trunk.. From this depository, the water reaches the
ground, where it is stored in its roots. Through osmosis, the water found in the tree's roots is absorbed
into the surrounding ground. This ground water, originally sourced from the tree, provides for the
double terrestrial benefit, of preventing land erosion. The additional positive aspects of using trees, as a
water-producing instrument, Is that their maintenance is extremely low cost, which is beneficial to low
income communities. Also, in being a natural, organic element, and resource, their usage to such an
end, leaves no toxic chemical residues. In order to take full advantage of the trees' water producing
ability, a cultivation and planting of this natural organism must be done on a systematic, as well as on
both a very extensive and intensive basis.. Planting must be done in strategic areas, such as along
roadsides, where contaminants occur from the fuel of passing vehicles, as well as from the
concentration of rubber particles released by the friction of the automobile tires moving on the
pavement. Also, an intensive and extensive planting of trees must be realized in urban centers, with
special attention devoted to their industrial nuclei. THE OXYGEN PRODUCING ACTION OF THE TREE:
The tree produces oxygen much in the same mechanical way, as it produces water. Thus, it does so,
through its same vascular system. The organic beauty of the divine design of the much under
appreciated tree, expressed in its towering stature, and also, through its elevated and densified network
of leaves and branches, allow for the process of osmosis to occur, much in the same way as the tree's
alternately, as well as equally important, water producing function, However, there is a difference in the
formal mechanics of these two functions. That is to say, whereas the water producing function of the
tree is more static, in that, it is an accumulation of this vital liquid, which takes place at the base of the
trunk, and in the surrounding ground of the same. On the other hand, in the display of the tree's critical
oxygen producing function, a clearly dynamic process is observed, which involves the rhythmic,
continuous, and most dynamic respiration of the tree as a most living and vibrant entity. In this sense,
the essential and kinetic, inhalation and exhalation of gases, occurs principally, at the tree's upper level
network of branches and leaves. The true magic of the tree's oxygen producing process manifests itself
on various levels. To begin with, the tree reveals itself, and most surprisingly so, probably to many, as a
true living organism, in that it breathes—inhaling and exhaling—as every other vital creation on earth,
be they part of either the kingdoms of the flora, or that of the fauna. The magical beauty, of the
orchestral silence of the breath of the tree, increases in crescendo, upon defining the content of its
continuous suppression and release of sacred gases. This statement is made without hyperbole, upon
the discovery of the nature of the gas. This gas, which is released by the tree into the environment, is
identified as oxygen. By the same token, the gases inhaled by this natural purifying instrument of nature
are the toxic components, which are responsible for the "Greenhouse Effect", the main culprit
responsible for global warming. These gases can be defined as the freons, methanes, and carbon
monoxides, which accumulate, as an aura around the earth's surface, creating an impenetrable
atmospheric layer, which prevents the normal transpiration, that is, the exit and exchange of hot air
within the planet's environment into outer space. These gaseous substances are currently thought to be
the product of human activity, here on our planet's surface. Also, the entrance of cooler air into the
earth's gaseous environment, from this same exterior space, is prevented due to the accumulation of
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these same toxic gases, creators of this same "Green House" effect, on the most exterior layer of the
Earth's atmosphere. In effect, and to this end, what can be witnessed, in both the water producing
function, but especially in the trees' expression of the much needed oxygen supply in our planetary
environment, is, perhaps, the most direct and complementary, relationship in the satisfaction of human
needs, ever to exist between humanity, and another living organism on the earth's surface. Yes, and
undoubyably so, the most essential and purest form of the dynamic action, between the "ying" and the
"yang" could not be spoken in any louder of a voice than that existing, in the present, the past, and
hopefully forever more, between the social network of human beings, and the soulful natural society of
trees. Why then, has this infinite and auxiliary resource found in the natural bounty of the king of the
flora kingdom, the beautiful and blessed tree, never been tapped into as a solution for global warming?
At this juncture, it must, also be emphasized, that the current cause of all the climatic upsets
experimented by our Mother Earth, is not the cause of climate change, but instead climate change is a
consequence of global warming. The increase of temperatures on the Earth's surface, as well as in her
atmosphere, is the cause of climate change, and most definitely not vice-versa. There may be various
causes for this incomprehensibly neglectful phenomenon of the sacred gift presented to us by our trees
. To a certain extent it may be attributed to the very important, as well as apropos adage referring to
the so typical behavior of human "nature", in that, "one finds oneself so lost in the trees, that one
forgets all about the forest". Perhaps a more inverted, side of that coin, might be represented in the
saying, that, "The devil is in the detail." Details, which we, especially, as destracted modern day
inhabitants of our planet Earth, tend to overlook. However, it is inevitable not to return to the
conditioning monetary factor of economic determinism. That is to say, there is no real profit factor, in
both the costly extensive, as well as intensive planting of trees, which to be authentically and genuinely
effective must be accomplished both simultaneously and systematically across the surface of the globe.
This feat can only be accomplished, by some stretch of the imagination, by one or various extremely
large multinational corporations, whose functions are strongly dictated by strong ideals of philanthropy.
However, a more pragmatic vision of this extensive, and intensive, as well as simultaneous global tree-
planting operation, might be done with greater success if handled at a supra-national level. That is, to
be organized and institutionalized, in some form, of bio/polictical entity such as that of the United
Nations, the European Union, or the World Bank,, though, with the purposeful difference of having the
objective of performing a herculean, as well as macro mission of planetary agricultural gardening for
humanity's own salvation, in its sights. However, if such daunting tasks, as putting men on Mars, are
being financed and explored, which arguably might be of less value to the members of the human race,
who will be left behind, while others, set off to colonize that vacant, and airless red planet. Thus leaving
our perfectly, and uniquely beautiful green and blue planetary home, of which, with certainty, there is
no comparable other, only as a fleeting vision, in the rear view mirror, of definitively departing space
ships and satellites, from our Mother Earth's blue skies, into the infinite and blackened darkness of the
foreboding outer space. Certainly then, given, what should be, a terrifying and extremely expensive
alternative step into the most impractical unknown, more practical credence and care, could be placed
on our already existing and most supreme planetary home, by exercising some basic housekeeping
chores, in order to benefit it. For example, and for the welfare of all inhabitants on the globe, our
oceans, and waterways should be properly mapped out, a task, which has already been completed with
such intricacy and perfection for the empty, and to date uninhabitable surface of the planet Mars; and
at such an unimaginable expense. Then, in conjunction, with the caring for our planet's oceans, seas as
well as waterways, as purposefully, yet humbly outlined in this paper, our lands must be carpeted with
the magnificence of the greenery of our gifted trees, which in all their miraculous organic simplicity,
serve as the best, yet most overlooked tool, truly capable of saving our planet Earth from its demise, by
producing, adding to, and purifying its much deteriorated water supply. At the same time terrestrial
forests, have the ability, as well as the need, in and of themselves, to absorb the emission of toxic gases,
A4 p.1011
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which so greatly contaminate the Earth's atmosphere. In that same perfection of the breath of a forest,
a rainbow of the purest air, may be found rising from within its living and beating heart, perpetuating
the exhalation of oxygen from its most flawless system of pulmonary perfection...All to benefit so
organically, and in stellar, yet strident silence the survival of humanity in the ever lasting and never
ending beautiful bounty of our green and blue home...Mother Earth.
What do you want the WHEJAC to advise the White House Council on Environmental Quality to do?:
I would urge the White House to systematically, intensively, as well as extensively, unite with other
world powers, in order to plant trees at a global level. This is urgently recommended as the tree is the
most viable solution to solve and correct the problem of global warming, which is currently, and so
gravely affecting our planet Earth, even to its demise.
Full Name (First and Last): Paul Bernstein
Name of Organization or Community: Self
City and State: Honolulu, HI
Brief description about the concern: Between the deterioration and operational errors, fuel from the
Red Hill tanks has gotten into aquifers on Oahu that supply water for about half the population on the
island. The current spills have led to dislocation of a number of families, and a larger spill could mean no
potable water for several hundred thousand people. These tanks must be relocated before such a
disaster occurs.
What do you want the WHEJAC to advise the White House Council on Environmental Quality to do?:
Please drain and relocate the fuel tanks at Red Hill to a location in which a spill or leak would not pollute
Oahu's drinking water. Our experience with the Navy's stewardship of the bulk fuel storage facility at
Red Hill is that: not only is the facility out of date and corroding literally everywhere, but the Navy has
not kept up with very long-standing recommendations. You can't expect to throw money at it and
expect the job to get done right. It's time for different parties to get involved, demonstrate state-of-the-
art knowledge, and most likely go elsewhere. The aquifer is one of a kind and cannot be replaced.
Full Name (First and Last): Sherry Pollack
Name of Organization or Community: Ahuimanu, Oahu
City and State: Kaneohe, Hawaii
Brief description about the concern: Aloha members of the White House Environmental Justice
Advisory Council (WHEJAC) I am a resident of Oahu, Hawaii. I wish to report a major environmental
disaster and injustice that is being perpetrated by the Navy against the people of our island. Jet fuel
from the Navy's 80-year-old Red Hill Bulk Fuel Storage facility has made its way into our drinking water
on Oahu. In November 2021, the Red Hill tank system leaked jet fuel into the drinking water of more
than 90,000 residents currently residing around Pearl Harbor Navy Base and Hickam Air Force base. And
as I type this testimony, up to 187 million gallons of fuel continues to be stored a mere 100 feet above
our primary aquifer that serves over 400,000 Hawaii residents. Despite complaints from their own
military families of oily sheens in their tap water, overwhelming diesel-like fumes, and widespread
health problems, Navy leaders insisted for days that the water was not contaminated. In the weeks
following, the Navy's response continues to be lacking in urgency and now they are contesting the
emergency order calling for the defueling of the tanks for the safety of Oahu's people and environment.
In the course of all this, thousands of families have since been displaced, many were sickened, some
hospitalized, and some pets had to be put down. Two lawsuits filed on February 2, 2022 by the U.S.
Department of Justice on behalf of the Department of Defense and the Department of Navy challenge
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the State of Hawaii's emergency order to shut down and defuel the leaking 80-year-old jet fuel tanks. I
am outraged by this development and the Navy's total disregard for the health and safety of our
community and for their actions that continue to threaten our drinking water aquifer. The Honolulu
Board of Water Supply has had to shut down its nearby wells as a precaution and residents across the
island are asked to conserve water. Water shortages are already anticipated when summer arrives.
Our drinking water supply was already at risk due to the effects of climate change, including a significant
decline in rainfall across all the islands. We cannot afford to let this disaster worsen or for this to
happen again. The Red Hill tanks must be to defueled and decommissioned immediately. Please help us.
What do you want the WHEJAC to advise the White House Council on Environmental Quality to do?:
Please ensure the Navy defuels and decommissions the Red Hill tanks immediately. The President is
commander and chief and has the authority to order this. Mahalo.
Full Name (First and Last): Kelsey Amos
Name of Organization or Community: O'ahu community
City and State: Honolulu, HI
Brief description about the concern: I live on O'ahu and am concerned about the Red Hill Fuel Tank
facility, which has leaked multiple times in the past and sits only 100 feet above O'ahu's freshwater
aquifer that provides water to the most densely populated part of our island chain. Most recently a leak
poisoned, sickened, and disrupted the lives of dozens if not hundreds of military and civilian families
that had jet fuel in their house tap water. As long as these tanks are still in operation we run the risk of
harming more Hawai'i residents, permanently poisoning our freshwater supply on one of the most
isolated islands in the world, and harming our ocean ecosystems that contaminated fresh water washes
out into.
What do you want the WHEJAC to advise the White House Council on Environmental Quality to do?:
Please advise the White House Council on Environmental Quality to do everything they can to rapidly
de-fuel, decommission, and clean up / remediate the Red Hill Bulk Fuel Storage facility. As Commander-
in-Chief President Biden could order the Navy to make amends and clean up their mess.
Full Name (First and Last): Danielle Espiritu
Name of Organization or Community: O'ahu, Hawai'i
City and State: Aiea, Hawai'i
Brief description about the concern: Since 1943, over 180,000 gallons of fuel have leaked from the
facility, which was built just 100 feet above the underground aquifer that serves as O'ahu's main source
of drinking water. This includes the release of 27,000 gallons in 2014 and up to 19,000 gallons in 2021.
Allowing 80 year old tanks, that can hold up to 250 million gallons of jet and diesel fuel to sit just 100
feet above the aquifer that supplies the water for the majority of our island is not only wreckless, its
genocide. Our Board of Health has already ordered the U.S. Navy to defuel the facility, and the
Department of Defense has instead chosen to legally appeal the order, refusing to defuel. As the Red Hill
facility continues to leak, which studies have already shown will happen, it poses a direct threat to the
drinking water for our entire island. Several nearby public board of water supply wells have already been
shut down for fear of contamination, and our board of water supply is monitoring salinity levels in our
drinking water to be sure we are not overtaxing other wells that are being tapped to compensate for the
wells that have been shut down. This affects our entire island.
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Since many of Hawai'i's streams are fed by springs that come from our aquifer, contaminated
groundwater will likely make its way into the ocean, affecting offshore fisheries. In addition, the most
recent projections show the ability of fuel that has already spilled to travel underground across valleys
and into an agricultural region where I personally am working to restore lo'i kalo, traditional taro fields.
What do you want the WHEJAC to advise the White House Council on Environmental Quality to do?:
I implore you to use your power to call for and allocate funds toward the defueling and permanent shut
down of the U.S. Navy's bulk fuel storage facility and underground storage tanks located at KapukakT or
"Red Hill." In addition, I ask that you create and enforce restrictions preventing the U.S. Department of
Defense from further polluting our islands. In addition, I ask for real accountability and action toward
the protection of our lands and waters. This begins with defueling and permanently shutting down the
U.S. Navy bulk fuel storage facility. Our urgent and collective action will determine whether or not our
children and grandchildren will be able to drink water from our island and engage in these critical land-
based cultural practices, which are protected by law. Mahalo nui, thank you so much for your time and
attention to this urgent issue.
Full Name (First and Last): Pete DOKTOR
Name of Organization or Community: Wai Ola Alliance and community of Moanalua, West Honolulu
City and State: Honolulu, HawaiM
Brief description about the concern: I'm a concerned veteran, parent, homeowner & community
organizer in Moanalua threatened by the "imminent peril" resulting from a catastrophic leak into our
sole-source aquifer by the US military, particularly the Naval Red Hill Underground Bulk Fuel Storage
facility that has poisoned thousands in the last few months (December 2021). However, our family has
been worried daily since a series of fuel leaks in 2014 just a mile from our home. This was not long after
what happened in Flint, Michigan and we have been worried if they would harm our then newborn
daughter's neurological development, given even military studies confirm will inevitably leak every year.
The dominant claim by militarists is Red Hill is critical for "national security." How can "national
security" trump the public health & safety of the people, as well as our livelihoods and the livability of
our community? Is the Executive Branch suggesting that protecting political and economic interests such
as markets or political projection are paramount to the people for whom the military purportedly
protects? As a parent and former medic & teacher, I would like to know how the Navy finds justified that
we live everyday concerned for our kids that today might be the day of a catastrophic leak, and that the
US military is currently our most direct, existential threat?
What do you want the WHEJAC to advise the White House Council on Environmental Quality to do?:
Please do everything within your power to convince President Biden to immediately defuel and
permanently decommission the Naval Red Hill fuel tanks, in a safe manner and fund that endeavor.
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Letters to the Editor
Mercury Use
in Espiritismo:
A Survey of Botanicas
Despilc the well-known hazards of
mercury exposure,1-5 practitioners of espir-
itismo, a spiritual belief system indigenous
to Puerto Rico and other Caribbean
islands,6 have been reported to use mer-
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cury.7-9 Wc surveyed New York City
stores selling mercury for spiritual prac-
tice to clarify misperceptions and alert
public health workers about possible
mercury presence in homes in which
espiritismo is practiced.
Mercury goes by the name of azogue
and is sold in botanicas, stores that
specialize in selling religious items used in
espiritismo, voodoo, and Santcria, a Cuban-
based religion that venerates both African
deities and Catholic saints. Botanicas also
sell herbs used in folk medicine and for
general health promotion.
Our interviewer visited 41 botanicas
in low-income New York City Hispanic
communities between March and May of
1995, asking store personnel about the
cost, sales, uses, and purchasers of mer-
cury. We found that nearly 93% of
botanicas sold about one to four capsules
(about 9.0 g9) of mercury daily at an
average cost of $1.50 (see Table 1).
Botanica personnel estimated that Puerto
Ricans, Dominicans, and "other Ilispan-
ics" make up about 90% of mercury
buyers and that more than two thirds of
buyers are women.
Mercury is usually recommended by
family members, spiritualists, card read-
ers, and santcros (practitioners of Sante-
ria). The two primary reasons given for
mercury use arc for good luck and
protection from evil and the envy of
others. Through anecdotes, we learned
that because mercury "(lows smoothly," it
provides good luck and, as a result of its
slippery nature, prevents evil from stick-
ing to the person. The most often recom-
mended manner of using mercury is
carrying it on one's person in a scaled
pouch that should be prepared by some-
one with spiritual "powers." Sprinkling
mercury in the home is another common
form of use.
Yearly sales in Bronx 25,000 to 155,000
(median 47,000) 9 gram capsules per year.
Equals 506 lbs. - 3,080 Ibs/yr. Between 8,000
and 51,000 (median 13,000) homes per year
contaminated in the Bronx.
Our survey shows that mercury is
quite easy to purchase, and the manner of
use may create situations of constant
exposure to potentially high levels of
mercury vapors in the immediate atmo-
sphere. Of course, more research is
needed. In particular, explorations of
mercury levels in inner-city communities
should include adherents of spiritualism
as well as nonadherents since the latter
may be exposed unwittingly to mercury
poisoning by residing in apartments and
homes previously inhabited by mercury-
sprinkling tenants. Also, because of mer-
cury's neurobchavioral effects, pediatri-
cians, psychiatrists, and learning specialists
should be alert to its potential presence in
children.2'4'5'10
As providers of community health
and mental health services in underserved
areas, we recognize the public health
threat of dispensing mercury. However,
wc recommend also that the dangers of
mercury be sensitively separated from the
social-psychological benefits of spiritual-
ism. In inner-city Hispanic communities,
espiritismo is an indigenous source of
community socialization and support.
Spiritualists frequently represent the first
line of extrafamilial mental health inter-
vention. Since botanicas also sell medici-
nal plants and herbal remedies, they offer
some basic health care familiar to the
cultures of Latin America. Therefore,
public health interventions must be aimed
at helping spiritualists lind safe alterna-
tives to mercury. ~
Luis H. Zayas, PhD
References Philip o. Ozuah, md
1. Agocs MM, Etzel AE, Parrisli GR, et al.
Mercury exposure from interior latex paint.
N Engl J Med. 1990;323:1096-1101.
2. Campbell SS. Acute mercurial poisoning
by inhalation of metallic vapor in an infant.
Can Med Assoc J. 1948;58:72-75.
3. Curtis HA, Ferguson SD, Kell RL, Samuel
All. Mercury as a health hazard. Arch Dis
Child. 1987;62:293-295.
4. Davis LE, Kornfield M, Mooney MS, el al.
Methylinercury poisoning: long-term clini-
cal, radiological, toxicological, and patho-
logical studies of an affected family. Ann
NcutvL 1994;35:680-688.
5. Yeates KO, Mortensen ME. Acute and
chronic neuropsychological consequences
of mercury vapor poisoning in two early
adolescents. J Clin Exp Neurupsychol. 1994;
16:209-222.
6. Bird HR, Canino I. The sociopsychiatry of
"espiritismo": findings of a study of psychi-
atric populations of Puerto Rican and
oilier Hispanic children. J Am Acad Child
Psychiatry. 1981;20:725-740.
7. Peyser A. Ritualistic poison. New York
Post. September 12,1991:5.
Ranch KD. The spiritual use of poisonous
mercury. Washington Post. August 13,
1991:7.
Wendroir AP. Domestic mercury pollu-
tion. Nature. 1990;347:623.
Fagala GE, Wigg CL. Psychiatric manifes-
tation of mercury poisoning. J Am Acad
Child Adolesc Psychiatry. 1992;31:306-311.
8,
10.
TABLE 1—Reports by Botanica
Personnel of Mercury
Sale and Use for
Spiritual Practices,
New York City
Botanicas
Mercury Sale
Reporting
and Use Data (n
= 41), No. (%)
Sale
Sell mercury
38 (92.7)
Do not sell
3 (7.3)
Volume of daily sales3
1-4 capsules
20 (48.7)
5-10 capsules
12 (29.2)
11 or more capsules
3(7.3)
Dispensing forms
Capsules
33 (80.5)
Larger quantities
2(4.8)
Both forms
3 (7.3)
Source of recommen-
dation for mercury
useb
Family member
16(39.0)
Spiritualist
16(39.0)
Friends
15(36.5)
Card reader
14(34.1)
Self
9(21.9)
Santero
4(9.7)
Books
1 (2.4)
Condition for which
recommended13
Luck in love, money,
32 (78.0)
work, health
Protection against
23 (56.0)
evil
Protection from envy
1 (2.4)
Method of useb
Carried in sealed
20 (40.8)
pouch
Sprinkled in home
12(29.3)
Carried in pocket
13(31.7)
Sprinkled in car
1 (2.4)
Consumed in small
1 (2.4)
quantities
"Only 35 botanicas provided information
on daily or weekly sales.
"Often, more than one source, condition,
or method was reported; therefore, per-
centages exceed 100%.
The authors are with the Department of
Family Medicine, Albert Einstein College of
Medicine and Montefiore Medical Center,
Bronx, NY; Dr Zayas is also with the Graduate
School of Social Service, Fordhain University,
Tarrytown, NY.
Requests for reprints should be sent to
Luis H. Zayas, PhD, Graduate School of Sochi
Service, Fordham University, Tarrytown, NY
10591.
American Journal of Public Health
January 1996, Vol. 86, No. I
lllA4"p.%15
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REPORTS BY BOTANICA PERSONNEL OF MERCURY SALE AND USE FOR SPIRITUAL
PRACTICES, BRONX, NEW YORK CITY, 1995
After: Zayas & Ozuah AJPH 1/96:112-113
Mercury Sale
and Use Data
Botanica mercury sales
Sell mercury
Do not sell
Volume of daily mercury salesa
1-4 capsules
5-10 capsules
11 or more capsules
Mercury dispensing forms
Capsules
Larger qualities
Both forms
Source of recommendation for mercury use
Family member
Spiritualist
Friends
Card Reader
Self
Santero
Books
Condition for which mercury was recommended
Luck in love, money, work, health
Protection against evil
Protection from envy
Method of mercury useb
Carried in sealed pouch
Sprinkled in home
Carried in pocket
Sprinkled in car
Consumed in small quantities
Botanicas
Reporting
(n = 41)
No. (%)
38
3
20
12
3
33
2
3
16
16
15
14
9
4
1
32
23
1
20
12
13
1
1
(92.7)
( 7.3)
(48.7)
(29.2)
( 7.3)
(80.5)
( 4.8)
( 7.3)
(39.0)
(39.0)
(36.5)
(34.1)
(21.9)
( 9.7)
( 2.4)
(78 .0)
(56.0)
( 2.4)
(48.8)
(29 .3)
(31.7)
( 2.4)
( 2.4:
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Only 35 botanicas provided information on daily or weekly sales.
b0ften, more than one source, condition, or method was reported;
therefore, percentages exceed 100%.
ESTIMATE OF TOTAL YEARLY MERCURY SALES, NUMBER OF DWELLINGS POLLUTED,
AND NUMBER OF INDIVIDUALS EXPOSED TO MERCURY (Based on above data.)
"Volume of daily mercury sales"
# Botanicas
selling
mercury
Range in
Table
# caps/day
Midpoint of
daily sales
(conservative]
Calculated #
capsules sold
per day
20
12
3
Totals:
35
1 - 4
5-10
11 - ?
2
7
11
20x2
12 X 7
3 x 11
40
84
33
157
Thus, 157 capsules sold per day, multiplied by 300 days per
retail year, equals some 47,000 capsules sold per year. Of these,
29.3%, or 13,800 dwellings per year will be sprinkled with mercury.
If there are but 2 inhabitants per dwelling, there will be 27,600
individuals exposed to toxic mercury levels per year in this area.
A4 p.1016
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Appendix 5. Draft Letter to CEQ Under Discussion
WHITE HOUSE ENVIRONMENTAL JUSTICE
ADVISORY COUNCIL
Rdiard Moore,
Go-Charr
ftajgy Shepard,
Co-Charr
Catherine Coleman
fkimxs,
Vfee Chair
Carkitta Trtoua,
Vkb Chair
LaTricea Adams
Susarta Aim an/a
.fade Begay
M ana Helen Power
Dr Robert Bullaid
Tom Goirnons
Jerome Foster II
Kim l-lavey
Angelo Logan
M aria Lopez-Nitiez
Harold M itdhell
Dr. Rachel Morelto-
Frosch
Ffenas
M ichele Roberts
Ruth Santiago
Dr.Nicky9ie^:s
Viola Waghiyi
Dr. Kyle Whyte
Dr. Beveily Wiight
IlliXyooj
M iya Yo^iataii
February 24, 2022
The Honorable Ms. Brenda Mai lory. Chair
The Council on Environmental Quality
Executive Office of the President
Washington, DC 20500
Re: Resources for (he White House Environmental Justice Advisory Council;
Request for Timelines for Key Deliverables;
Recommendation for Increase in CEQ Budget and Staff
Dear Chair Mai lory:
Members of the White House Environmmtal Justice Advisory Council (WHEJAC)
Scorecard Workgroup have been working to fulfill its mandate from the Council on
Environmental Quality (CEQ) to draft recommendations on a Scorecard that will
evaluate the Biden Administration's progress on implementing JusticcIO and
advancing environmental justice in all government policies, programs, functions, and
activities.
Resources for the White House Environmental Justice Advisory Council
As the workgroup strives to meet the requested deadlines, we have reached
consensus that the workgroup cannot fulfill its mandate without bang assigned
sufficient resource, personnel, and consultation capacities that are normally made
available to federal advisory committees (F ACs) to achieve expected outputs. We are
referencing the Scorecard Workgroup, but this lack of sufficient support applies to
all the workgroups associated with the WI1EJAC.
We appreciate the dedicated work of the Designated federal Officer and relevant
staff of the Environmental Protection Agency (EPA) who work to ensure that
protocols and norms are followed, assist in meeting facilitation, development of
public meeting agendas, communication ofFAC requests, and ensure that meeting
notes are compiled and dissaninated for all the FAC meetings
However, the members are used to generating sophisticated and well documented
repjorts, recommendations, and other outputs. The Scorecard Workgroup realizes that
WHEJAC Public Meeting February 24,2022, Summary | 48
-------
a high-quality document thai reflects a scorecaid for each agency subject to the
Executive Order requires:
~ Advisors or advi sory bodies front each agency;
~ Experts to help develop indicators and metrics that are speci fic to each agency's
program areas;
~ Graphic designers, writers, and editors
~ Personnel support for holding public meetings and for managing review and
revision processes involving public comments, agency comments and other
comments
Many WHEJAC msnbers have saved on the National Ijivironmental Justice
Advisory Council, Clean Air Federal Advisory Committee, National Children's
Study and others where it is a matter of course for such expertise, resources, and
personnel be provided to ensure that volunteer members have the resources and
assistance to succeed and address their mandate effectively.
Request for Timelines for Key Deliverables
The WHEJAC requests CEQ to provide timelines for key outputs that are crucial to
the WHEJAC's considerations The members need to know:
~ Wheat will the Interim Guidance on the Scorecard be finalized?
~ When will the final Climate and Economic Screening Tool be released to the
public?
~ When will the revisions to the E.O.12898 be finalized?
~ When will we receive an organization chart for both the CEQ and the White
House Environmental Justice Interagency Council (I AC); a list of I AC
representatives; an update on the number of IAC meetings to date; and the plan
for the IAC to engage with the WHEJAC?
Recommendation for Increase in CEQ Bndget and Staff
~ Ihe WI II'JAC will prepare a letter to the White I louse to recommend an increase
in CEQ's budget and staff in order for it to be effective in implementing
Juslice4() in all-of-govemmait policies.
WHEJAC Public Meeting February 24,2022, Summary | 49
-------
We will appreciate your expeditious consideration and action on this request.
Sincerely,
Richard Moore, WHEJAC Co-diair
Peggy M. Shepard, WHEJAC Co-chair
cc: Members of the WHEJAC
Michael S. Regan, EPA Administrator
Matthew Tejada, Director Office of Environmental Justice, EPA
Corey Solow, Deputy Director for Environmental Justice, CEQ
White House Environmental Justice Interagency Council
Karen L. Martin, Designated Federal Officer,
WHEJAC Public Meeting February 24,2022, Summary | 50
-------
I, Richard Moore, Co-Chair of the White House Environmental Justice Advisory Council, certify
that this is the final meeting summary for the public meeting held on February 24, 2022, and it
accurately reflects the discussions and decisions of the meeting.
Richard Moore
I, Peggy Shepard, Co-Chair of the White House Environmental Justice Advisory Council, certify
that this is the final meeting summary for the public meeting held on February 24, 2022, and it
accurately reflects the discussions and decisions of the meeting.
WHEJAC Public Meeting February 24,2022, Summary | 51
------- |