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- Exposed: BPA science
- Agents of Change
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- Cancer risk in Pittsburgh
- PFAS contamination
- Breathless: Childhood asthma
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The report recommends that the Centers for Disease and Control and Prevention advise clinicians to offer PFAS blood testing to their patients who are likely to have a history of elevated exposure to the toxins. Those test results should be reported to state public health authorities to improve PFAS exposure surveillance, according to the report, issued by the National Academies of Sciences, Engineering, and Medicine, or NASEM.
The testing should be done for people with occupational exposure, as well as those who have lived in communities with documented contamination, and those who have lived where contamination may have occurred — such as near commercial airports, military bases, wastewater treatment plants, farms where sewage sludge may have been used, or landfills or incinerators that have received waste containing PFAS, according to the report.
“Our report shows that we are going to need robust and effective collaboration between local communities, states, and federal agencies in order to respond to the challenge of PFAS exposure,” Ned Calonge, chair of the NASEM committee that authored the report, said in a statement.
'Make PFAS testing available'
“We need to continue to identify communities with elevated PFAS exposure, learn more about specific health impacts, make testing available to patients, and give clinicians more strategies for counseling patients and providing preventive medical care,” Calonge added in the press statement. Calonge is associate professor of family medicine at the University of Colorado, Denver and associate professor of epidemiology at the Colorado School of Public Health.
NASEM acts as the collective scientific national academy of the United States and its recommendations typically are highly regarded. It was created to provide independent and objective guidance that informs American policy.
The report released today is sponsored by US Department of Health and Human Services.
PFAS, the 'forever chemical'
PFAS is an acronym for a class of chemicals known as per- and polyfluoroalkyl substances. PFAS are also often referred to as “forever chemicals” because they do not break down in the environment and bioaccumulate, persisting in the bodies of humans and animals. There are more than 4,000 man-made PFAS compounds used by a variety of industries for such things as electronics manufacturing, oil recovery, paints, fire-fighting foams, cleaning products and non-stick cookware.
People can be exposed through contaminated drinking water, food and air, as well as contact with commercial products made with PFAS. Some PFAS have been linked to cancer, immune deficiencies, thyroid disease, and other health problems.
How PFAS enters the environment
How PFAS enters the environment
Credit: Evich et al., 2022
Last year, the US Environmental Protection Agency identified more than 120,000 locations around the United States where the agency believed people may be exposed types of PFAS. The scope of the list underscored that virtually no part of America appears free from the potential risk of air and water contamination with PFAS.
The Biden Administration has announced a series of steps to try to restrict PFAS from contaminating water, air, land, and food as well as to clean up PFAS pollution and speed up research on other PFAS issues.
Last month, the administration started the process of designating two types of PFAS – PFOA and PFOS – as hazardous substances under the law, which would allow the EPA to deploy recover clean-up costs from companies responsible for contamination and take other steps to address contamination.
NASEM said a large body of scientific literature on PFAS shows there is “sufficient evidence” of association between exposure to PFAS and increased risk of decreased antibody response in adults and children, abnormally high cholesterol in adults and children, decreased infant and fetal growth, and kidney cancer in adults.
The report found there was “limited or suggestive evidence” of increased risk of breast cancer in adults, liver enzyme alterations in adults and children, pregnancy-induced hypertension, increased risk of testicular cancer in adults, thyroid disease and dysfunction in adults, and increased risk of ulcerative colitis in adults.
The NASEM report warned that people with PFAS in their blood above 2 nanograms per milliliter (ng/mL) but below 20 ng/ml may face the potential for adverse effects, especially “sensitive populations,” such as pregnant women. Clinicians should encourage reduction of PFAS exposure for these patients and prioritize screening for a range of health problems that include hypertensive disorders of pregnancy, breast cancer, signs of kidney and testicular cancer and of ulcerative colitis, according to NASEM.
People found with PFAS in their blood at levels higher than 20 ng/ml potentially face a higher risk, the report states.
The report noted that more information is needed on how PFAS affects children and pregnant women, and recommends the gathering of data to address those groups.
Environmental justice and systemic racism
The report notes that systemic racism and issues of environmental justice could compound the “challenge of responding clinically" to PFAS contamination.
The report notes: “While environmental justice research specific to PFAS contaminants has been limited, place-based factors that may put individuals at greater risk of exposure (siting of chemical companies, refineries, and industrial sites), coupled with insufficient access to environmental screening, information, and adequate health care, have disproportionate impacts on Black, Hispanic, and Indigenous communities, as well as low-income populations.”
“PFAS contamination did not just randomly occur in rural communities serviced by well water that happened to be near industrial sites. Rather, the locating of certain industrial sites and decisions to dispose of PFAS with limited regard for the surrounding community’s access to safe water are rooted in the relationship and history of these industries and communities.
The disposal of these chemicals did not occur as single events lacking context, but reflected a pattern of decisions made over time. Understanding the historical and social context influencing how and where PFAS are distributed is an essential part of identifying effective mitigation strategies.”
This story was originally published in The New Lede, a journalism project of the Environmental Working Group, and is republished here with permission.
What is environmental health?
Environmental health is a branch of public health that monitors the relationship between human health and the environment, examining aspects of both our natural and man-made environment and their effect on human wellbeing.
What is an example of environmental health?
Living near factories or heavy traffic worsens air quality and leads to health impacts on the lungs and heart.
Credit: Kouji Tsuru/Unsplash
Environmental health is a broad area of study — everything from the climate to the food we eat to the air we breathe plays into environmental health. A few specific examples include:
- Air pollution: Living near factories or heavy traffic worsens air quality and leads to health impacts on the lungs and heart such as asthma and increased risk of heart attacks or stroke.
- Water contamination: Drinking lead-contaminated water can cause IQ loss, behavioral issues, learning disabilities and more. Infants and young children are most at risk.
- Toxic chemicals in consumer products: Phthalates, a class of chemicals that are widely used in consumer products, are known endocrine-disruptors, meaning they hijack your body’s hormones and can cause a wide array of health impacts including increased risk of cancer and fertility issues.
What is the role of environmental health?
The role of environmental health research is to examine areas of the environment that impact our health so that we can make personal and policy changes to keep ourselves safe and improve human health and wellbeing.
Why is environmental health important?
Credit: Viki Mohamad/Unsplash
Environmental health impacts every one of us.
We reap the benefits of clean air, clean water, and healthy soil. If our environment is unhealthy, with toxic chemicals saturating our resources and pollution abundant, then our health also suffers.
It is also an important field of study because it looks at the “unseen” influences on your health.
Many individuals may not associate their health problems with air or water quality, or with what clothes they wear, makeup and household goods they use, or food they eat.
That’s because not every example of environmental health problems are obvious: some chemicals, for example, build up slowly over time in your body: a small dose may not seem to bring harm, but repeated small doses can lead to later impacts.
- BPA absorbed through plastic containers, cans, receipts, etc. lingers in the body and the build-up over time increases risk of cancer, diabetes, liver failure, and more.
- PFAS are known as ‘forever chemicals ’— they don’t break down and are widely used, so small exposures are frequent and contribute to immune system and reproductive damages, heightened cholesterol levels, and more.
- Mercury from eating seafood and shellfish can impact neurological development of fetuses in the womb, and populations that regularly consume mercury-heavy seafood have shown mild cognitive impairment.
Also, individual susceptibility can differ: for example, one member of a household can experience illness, asthma, migraines, etc. from chemicals found in their water supply while another member of the same household is just fine, such as the case in a young girl’s reaction to benzene in her water from living near fracking wells.
Certain variables play a role in susceptibility and level of adverse health effects such as age, gender, pregnancy, and underlying health conditions. Studies suggest fetuses, infants and children are much more at risk to experience lifelong health problems from toxic chemical exposure.
Rate, duration, and frequency of exposure to toxic chemicals and other influences from our environment all factor into our health.
Good environmental health = good human health.
What environmental health problems affect our health?
Two women extracting from a well in Senegal.
Credit: JordiRamisa
There are many environmental health issues that affect human health. These include:
Air pollution — nine out of 10 people currently breathe air that exceeds the World Health Organization’s guideline limits for air pollution worldwide. This mainly affects people in low and middle-income countries, but in the United States, people that live in cities, or near refineries or factories, are often affected as well.
Air pollution also ramps up during wildfire season.
Read more: Breathless: Pittsburgh's asthma epidemic and the fight to stop it
Water pollution — as of 2014, every year more people die from unsafe water than from all forms of violence, including war. Water is the ‘universal solvent’, meaning it can dissolve more substances than any other liquid on Earth. Thus, it is too easy for toxic chemicals to enter our water supply.
Read more: Sacred Water: Environmental justice in Indian Country
Lack of access to health care — yes, this is an environmental health issue! Having an accessible health care system is part of one’s environment. Difficulty getting health care can further impact one’s health.
Poor infrastructure — from “food deserts” to lack of transportation services, living in an area with poor infrastructure can impact your health.
Read more: Agents of Change: Amplifying neglected voices in environmental justice
Climate change — climate change-induced heat waves, increased frequency and severity of large storms, droughts, flooding, etc. have resulted in health problems and even death.
Chemical pollution — chemical pollution can be sneaky: the chemicals in your everyday products, from shampoo to deodorant to your clothing to the food you eat, can directly affect your health. These chemicals are often not on the label or regulated at all.
Read more: Exposed: How willful blindness keeps BPA on shelves and contaminating our bodies
How can we improve our environmental health?
Credit: instaphotos
Educate yourself. Environmental health is a broad topic, so this can seem overwhelming. Start by taking stock of your own personal environment. Look up air pollution monitoring in your area. Get your water tested to see its chemical makeup. Evaluate the products you use in your life — personal products like shampoo and deodorant, household cleaners, air fresheners, the foods that you eat — and see what you’re bringing into your home.
Explore the Environmental Working Group's guides to check your products for toxic chemicals.
We have additional guides to help you learn more about environmental health. Find guides to plastic pollution, environmental justice, glyphosate, BPA, PFAS and more in the Resources tab at the top of our website.
As individuals we have the power to improve some of our environmental health, but there is a pressing need for systemic change and regulation on a policy level.
We’re actively working with scientists to share their research and knowledge with politicians to advocate for science-backed policy change. But we need your help. Contact your representatives to let them know that environmental health is important to you — whether it’s air pollution in your area, contaminated water, plastic pollution, food deserts in your area, or chemicals in consumer products.
Subscribe to Above the Fold, our daily newsletter keeping you up-to-date on environmental health news.
Sargis, a practicing doctor and professor of medicine at the University of Illinois, is one of a number of doctors incorporating the science of obesogens — endocrine-disrupting chemicals that spur obesity — into their clinical practice.
Obesogens are a subset of endocrine-disrupting chemicals — man-made compounds that alter hormone activity. They are generally defined as any chemical that can cause the human body to produce more fat than it normally would, and can include substances we usually think of as fattening, like sugars or artificial sweeteners.
However, obesogens are not only found in food, rather entering the body through other consumer products, like makeup, shampoos, soaps, plastics, and food packaging. People are exposed through contact with the chemicals and through ingestion of contaminated foods. The chemicals are also shed from such products and can accumulate in household dust, which people breathe in. PFAS, or per- and polyfluoroalkyl substances (toxic chemicals used in many consumer and industrial products) are another example of obesogens, as is bisphenol- A (BPA).
By disrupting hormone activity, these chemicals can spur obesity in a number of ways. They can alter metabolism, cause the body to produce new fat cells, alter eating behavior, and even change the way food is digested.
To Sargis, incorporating an understanding of obesogens into clinical practice is part of the goal of medicine as a whole: to build a healthier society. Obesogenic chemicals have other harmful health impacts too — for example, PFAS and BPA are also linked to certain cancers and reproductive problems. Reducing obesogen exposure is beneficial across the health spectrum.
“What we’ve seen in medicine over the last few years is this shift from individual factors, like genetics, lifestyle and diet, to an embracing of the social determinants of health, including things like food, environment, exercise and education,” Sargis told EHN.
However, Sargis and other doctors interested in using the obesogen framework face barriers, such as difficulties gathering data on obesogens, a bias toward focusing on diet and exercise, and inadequate medical school training in environmental exposures.
In addition, a lack of regulation of obesogens makes it hard to reduce the exposures — even for patients who are aware of the risks. “The challenge is that there are systemic forces that you have to fight, and a lot of that's policy, and a lot of that policy is embedded in politics,” Sargis said.
Lack of data
Doctors are hesitant of incorporating obesogens in their clinical practice as there's no data showing that if a person reduces their obesogen exposure, they can lose more weight.
Credit: Pixabay
A major obstacle to incorporating an understanding of obesogens into clinical practice is that doctors are sometimes not convinced by the data available. While plenty of data exists to show a correlation between obesogen exposure and obesity, there is less data that shows that if a person reduces their obesogen exposure, they can lose more weight.
Gathering that data is difficult, but possible, said Sargis. However, the ubiquity of obesogens in everyday products, as well as the lack of transparency from companies about the chemicals in their products, makes designing such a study difficult. The sheer number of chemicals that would need to be tested — there are more than 9,000 types of PFAS, for example — also adds to the challenge.
Jerry Heindel, a biochemist and founder and director of HEEDS*, a coalition of researchers advocating for better regulation of chemicals, told EHN that doctors and patients could benefit from an accessible and cheap way to measure exposure to obesogens. That way, patients could hypothetically see if their exposure levels drop over time as they worked to eliminate obesogens from their daily life. For now, he said, patients would need to pay for the tests themselves, but he hopes insurances would cover the tests in the future.
Jenna Hua, a doctor-turned-CEO of medical testing company Million Marker, thinks her company’s product could play a role. Million Marker offers at-home test kits that measure the levels of 13 common endocrine-disruptors, some of which also act as obesogens, in a person’s urine. The tests are able to detect BPA, two BPA alternatives, five types of phthalates, four types of parabens, and oxybenzone. It’s “quite empowering,” Hua told EHN, when someone using the tests can see their exposure levels drop as they swap out products they’re using that include obesogens.
The type of testing that Million Marker offers would be another tool in managing weight loss. “It would not be possible to tease out what part of weight gain is due to obesogens,” Heindel said. “The doctor would have to explain to the patient all the possibilities and how to address each of them to reduce their weight.”
As more patients recognize that obesogen exposure is a threat to their health, Hua said, the public may be more inclined to pressure governments to regulate endocrine-disrupting chemicals. Most obesogens are not currently regulated in the U.S., for example, the Food and Drug Administration does not restrict the use of BPA in food packaging, and there are no federal standards limiting PFAS discharges in drinking water.
Bias toward individual factors
One of the reasons that obesogens have been overlooked, Sargis said, is that treatment of obesity is biased toward individual factors like diet and exercise. “There’s an inherent bias that this is somehow a personal failing,” he said.
That kind of thinking, he said, might be rooted in conventional beauty standards and the idea that obesity is an aesthetic problem more than a health problem. Research has shown that in the U.S., obese individuals are often highly stigmatized and labeled as lazy, unmotivated, and lacking in self discipline. Medical students themselves can perpetuate these stigmas — one study of third-year medical students at Wake Forest University found that more than one-third of the future doctors associated obesity with negative attributes, with the majority of students, 72%, reporting that they preferred “thin” people to “fat” people.
Enhancing education, growing awareness
A lack of training in environmental exposures in medical schools is a major obstacle.
Credit: National Cancer Institute/Unsplash
There is still a huge gap in medical school training when it comes to obesogens, Sargis said. The sheer volume of knowledge medical students are required to learn leaves little room for discussions about environmental exposures. The end result is that doctors often leave environmental exposures out of their practice — for example, a 2015 study of maternal and child physicians found that environmental health assessments were “infrequently” part of routine counseling of patients.
Dr. Jamaji Nwanaji-Enwerem, a 2021 graduate of Harvard Medical School and current resident at the Emory University School of Medicine, said he got very little training in environmental exposures in medical school. “Medical students across the nation are not being extensively exposed or trained formally on the effects of the environment on a patient's health,” he said. Rather, Nwanaji-Enwerem, who is also an assistant professor of environmental health at Emory, gained his expertise in learned about environmental exposures through classes outside of the medical school and through his own practice.
One patient suffering from hypertension and respiratory problems inspired Nwanaji-Enwerem to write a paper about the importance of considering environmental risks. In the paper, Nwanaji-Enwerem writes that other doctors should ask their patients about the chemicals they come into contact with at work, and whether they wear proper personal protective equipment to protect them from chemical exposures.
To supplement medical school training about obesogens, Heindel said, professional societies, like the Endocrine Society, Obesity Society and Pediatric Society, could be a good starting point to help young doctors learn about obesogens. For example, East Carolina University professor and pediatrician David Collier first learned about environmental exposures at a conference for academic practicing pediatricians. According to Collier, there need to be “many touch points” where researchers and doctors can have such conversations.
Additionally, Sargis said, doctors get very little time with patients. It’s difficult to squeeze in a conversation about the risks obesogens pose during a 20-minute consultation. To help, he said he’d like to see more educational materials available to patients after their visit, such as short videos explaining obesogen exposure.
Part of the solution, too, could be getting doctors to care more about the environmental health of the neighborhoods where their patients live, Sargis said. While doctors might not want to engage in political discussions, they might play a key role in decreasing the chemical exposure of their patients. Getting doctors involved in discussions about housing, city planning, building codes, policing, water use, and environmental policy could make a difference for the health of people living in those communities, he said.
“When you have physicians that aren’t willing to step out of the clinic and into these discussions, it becomes difficult,” he said. “We really need physicians, scientists, and health policy experts at the table.”
*HEEDS is a program of Environmental Health Sciences, which publishes EHN.org.
*Editor's note: An earlier version of this article quoted Bruce Blumberg, professor of Developmental and Cell Biology, and Pharmaceutical Sciences at the University of California Irvine, asserting there is no evidence that lowering obesogen exposure reduces weight. Blumberg has published multiple scientific papers and a book, The Obesogen Effect, consistent with the role of obesogens in controlling weight.
Dioxins and dioxin-like polychlorinated biphenyls, commonly known as PCBs, are persistent organic pollutants, or POPs, that spread easily in the environment, accumulate in the food chain, and take years to biodegrade. They are linked to health effects such as cancer, hormone disruption, and alterations on brain development. While the global Stockholm Convention has regulated these kinds of chemicals since 2004, this study illustrates that dioxins and PCBs still pose major health threats to children and families around the world. The new study comes on the heels of a report that found most countries are failing to manage PCBs, and are far from achieving the Stockholm Convention goal of safe PCB management by 2028.
Food is the most common exposure pathway for POPs to humans. People are often exposed through fatty foods such as poultry, seafood, meat, milk, and eggs. Being the cheapest animal protein source with the lowest environmental impact, eggs are an important source of nutrition for poor people around the world. Yet, at the same time, the researchers describe them as the most sensitive exposure pathway because chickens feed on contaminated soil and ash every day, and transfer POPs to their eggs. People, especially children, eating just one egg a day, can easily exceed health-based values set by the World Health Organization and the EU.
For the study, researchers analyzed 113 groups of egg samples from free range chickens living near commercial and dump sites in developing countries, using sampling data from the International Pollutants Elimination Network and Arnika, a Czech environmental non-profit. “We have been collecting egg samples and mapping hotspots for almost 20 years with the International Pollutants Elimination Network, a network of more than 120 countries around the world,” Jindrich Petrlik, the lead author and director of Arnika, told EHN.
About 88% of sampled eggs exceeded the EU regulatory limit for dioxins and PCBs. In addition, 14% of egg samples exceeded the EU food limits by more than 10 times. The sample with the highest contamination came from eggs produced near an e-waste site in Ghana, at 264-times the EU food limit for dioxins. A child eating one egg from this site is exposed to more dioxins than the tolerable limit for five years.
Plastic fuels the fire
Contaminated ash in Kendalsari.
Credit: Jindrich Petrlik (Arnika & IPEN)
The researchers found extremely high egg contamination at sites that burned plastic. For example, the e-waste site in Kenya with the overall highest contaminated egg samples openly burns plastic. Samples from a tofu factory in Indonesia that uses plastic as fuel for burners yielded very high contamination levels as well. There were also two sites in Java with high levels, in all of these cases,e chickens consumed ash from the burning plastic waste.
When burned, plastics release a large amount of dioxins because they have chlorinated compounds, like PVC, which is used to insulate copper cables. Burning PVC with copper and other metals speeds up the reaction and releases a large amount of these toxins. Furthermore, burning plastic can release more than 2,400 other hazardous chemicals, as well as greenhouse gasses that contribute to climate change.
The Stockholm Convention suggests substituting PCV in plastic to prevent creation of dioxins. However, after 20 years of the treaty, no major replacements have been introduced. According to Petrlik, this is because the chlorine industry is powerful enough to influence policy and avoid PVC substitutions.
“This needs to be an important part of the new treaty on plastics,” Petrlik told EHN, “if we forget to talk about contamination from plastic disposal, then the treaty definitely won’t address the whole problem.”Suggested solutions to reduce contaminated eggs
The authors also offer several solutions including:
- Reducing overall plastic use and placing export restrictions on plastic waste and e-waste.
- Compensating farmers and affected populations by applying the “polluter pays” principle.
- Strengthening soil contamination limits, as the analysis found highly contaminated eggs even in soils under regulatory contamination limits.
- Building capacity for developing countries to control industrial releases and monitor human exposures from contaminated areas.
- Improved management and tracking of POPs waste and pollution.