Educate, Empower, Protect: Our Health and Environment
April 27, 2019, 9 am – 3 pm, Harpers Ferry West Virginia
Educate, Empower, Protect: Our Health and Environment
April 27, 2019, 9 am – 3 pm, Harpers Ferry West Virginia
This symposium was sponsored by RAD (Rural Agricultural Defenders) and the West Virginia Public Health Association. The aim of the symposium was to bring together national and several local experts to talk about the health impact of air pollution and how to monitor levels of air pollution to protect the public’s health. It was 100% crowd funded. This report is a synopsis of the presentations. A link to a video of the full day along with the powerpoint presentations may be found at www.RADWV.org.
Michael McCawley, PhD, Clinical Associate Professor
West Virginia University, School of Public Health, Dept. of Occupational and Environmental Health
Air Pollution 101: What is it? How does it affect the human body? How is it regulated? Are regulations strong enough to protect the public’s health?
Michael McCawley from West Virginia University, an expert on harmful effects of air pollution on human health, defined harmful as including not only human health but also includes human wealth in the form of property values and agriculture products. No one wants to live next to a dirty, smelly factory. The human health costs of air pollution include increased rates of asthma, bronchitis, chronic obstructive pulmonary disease (COPD), cardiovascular disease and cancer. Dr McCawley emphasized the harmful effects of particulate matter (PM) especially those particles those smaller than 2.5 micrometers in diameter and even more important ultrafine particles (less than 0.1 micrometers). The ultrafines are the most dangerous but are not regulated because they are hard to measure, so setting limits is difficult. In order to regulate something, you have to be able to set a limit.
The smaller the particles the further they penetrate into the lungs and the more severe the damage to the lungs. However, particulate matter taken into the body through the lungs can be picked up in the blood stream and travel to other organ systems causing inflammation which in turn leads to adverse health outcomes and even death.
As a West Virginian, Dr McCawley pointed out that we have temperature inversions on a regular basis, we see them as ground fog. When there is fog, the pollution emitted into the air is trapped, thus increasing the concentration, prolonging the exposure, and increasing the harmful effects. These temperature inversions are best known as smog. Smog has been demonstrated to have many negative effects on human health and the health of livestock including death.
Dr McCawley was careful to point out that the Environmental Protection Agency (EPA) and the West Virginia Department of Environmental Protection (WVDEP) regulate the smokestack emissions, but do not include the additional pollution generated by all of the trucks delivering raw material and hauling away finished product even though the air pollution generated by the trucks is likely to be more than that generated by the factory. The pollution adds up. Repeated and prolonged exposure to air pollution from factories and traffic is harmful.
Jaime Hart, ScD, Epidemiologist, Assistant Professor
Harvard University Medical School
Harvard University TH Chan School of Public Health
Brigham and Women’s Hospital
The impacts of air pollution across the lifespan
Jaime Hart, from the Brigham and Women’s Hospital, Harvard Medical School and the Harvard T.H. Chan School of Public Health spoke about the health risks associated with air pollution. Dr Hart noted that it is important to remember that the risks of air pollution are measured at the level of populations. That is, while one person may be unaffected, many other individuals are affected and thus assessing the rates of death and disease in a group of people is essential. Some groups of people are more susceptible to air pollution than others: people who already have health problems like asthma and COPD, children and older individuals, those who spend more time outside, and those who breathe through their mouths like children and athletes are the most susceptible.
Air pollution harms the human body in multiple ways. Air pollution causes inflammation, oxidative stress, endocrine disruption, immune disruption and nervous system dysfunction. Different types of air pollution have been consistently associated with increased risk of mortality, hospitalizations, and cardiovascular events (heart attacks and stroke). Particulate matter less than 2.5 micrometers is considered a type 1 carcinogen.
Dr Hart described studies in the Utah Valley where a single polluting factory is a major source of air pollution in an area with frequent temperature inversions. On days when the factory is in operation there are more admissions to the emergency department and more admissions to the hospital for asthma and other lung diseases and more deaths. Thus air pollution unambiguously is affecting the population in the valley.
Panel: A deeper dive: Air pollution impacts on fetal development and the health of infants and children
Katie Huffling RN, CNM, Director
Alliance of Nurses for a Healthy Environment
Known and suspected impacts on pregnancy, fetal development and women’s health
Katie Huffling, a certified nurse-midwife, described how air pollution effects human from preconception to death. The number of oocytes or a woman’s eggs are reduced by air pollution as is men’s semen quality. The mother is the baby’s first environment. Everything to which the mother is exposed, penetrates into the womb and across the placenta and exposes the fetus to that substance. The babies grow more poorly and the outcome is more preterm and low birthweight babies. Maternal asthma increases the chances the child has asthma. Children exposed to air pollution have more asthma, more problems with lung development, increased rates of autism and ADHD.
Air pollution is the new tobacco. Air pollution is responsible for 16,000 premature births in the United States per year and being born too soon or too small can have life-long health impacts. It costs an estimated Five Trillion dollars per year. The average child with asthma costs $2000 per year for basic treatment. Asthma related costs reached $2,000,000,000 (two billion) dollars in Maryland in a recent year. Medical care is expensive and air pollution drives up those costs significantly.
Laura Anderko PhD, RN
Director, Professor and Scanlon Endowed Chair
Mid-Atlantic Center for Children’s Health and the Environment, Region 3 PEHSU (MACCHE)
Georgetown University, School of Nursing and Health Studies
An overview –known and suspected impacts of air pollution on child health and development and factors that affect children’s vulnerability
Laura Anderko, a registered nurse and Professor at Georgetown’s School of nursing, focused on the negative effects of air pollution on children. Children are more susceptible to particulate matter, ozone, and volatile chemicals because they are growing. The negative effects increase with the length of exposure and the concentration or closeness of the exposure to the pollutant. Additionally, as the temperature rises, the quality of the air gets worse. Of course, different people will respond differently to the effects of any pollutant. Nevertheless, air pollution has been linked to lower IQ, memory loss, ADHD, anxiety, and depression.
While children are the most vulnerable, all members of the community are impacted negatively. Indeed, air pollution is the only environmental factor among the top ten causes of premature death. Currently air pollution is measured at sporadic sites around the US using land-based sampling sites. In the current networks, the distance between stations can be fairly large, many miles. Dr. Anderko identified several websites that are useful for monitoring air quality including airnow.gov and www.purpleair.com. Among the comments after Dr Anderko’s talk was that NASA is developing a satellite-based system for measuring air pollution.
Audrey Flak Pennington PhD, MPH, Epidemic Intelligence Service Officer
Centers for Disease Control and Prevention
Asthma and Community Health Branch
Division of Environmental Health Science and Practice
National Center for Environmental Health
Air pollution and childhood asthma
Dr. Audrey Pennington, an Epidemic Intelligence Service Officer from the Centers for Disease Control and Prevention in Atlanta whose work focuses on air pollution and asthma, discussed asthma and children. She noted that asthma is a chronic condition found among 1 in 12 children in the U.S.
Dr. Pennington explained that exposure to air pollution can make childhood asthma worse and that children are exposed to more air pollution than adults. This is due to a number of factors such as increased ventilation rates and more time spent outdoors. Importantly, children are exposed to air pollutants at the same time their respiratory and immune systems are developing. Moreover, some types of air pollution may cause childhood asthma.
Children with asthma need to limit their air pollution exposure, Dr. Pennington said, for example by playing or doing other outdoor activities when air pollution levels are low. Asthma can have a large impact on quality of life and management of childhood asthma also includes appropriate medical care, avoiding other asthma triggers, and developing and using an asthma action plan.
From https://www.cdc.gov/asthma/ : There is no cure for asthma. It is a disease that is managed. Children need an action plan on file with the school nurse and parents know and follow. Every plan includes trying to avoid triggers that initiate an attack and exacerbate the symptoms. Traffic is a major trigger, idling buses and trucks should have their engines turned off. Children should avoid outdoor activities when pollution levels are high. Increased physical activity and more breathing through the mouth increase the risk of an asthma attack in children. One in six children with asthma will visit the emergency room during the year. One in twenty will be hospitalized. Air pollution is causally related to asthma and exacerbates symptoms. Treating asthma is expensive and increase the burdens on our healthcare system.
Sacoby Wilson, MS, PhD, Associate Professor
Maryland Institute for Applied Environmental Health, Department of Epidemiology and Biostatistics
School of Public Health, University of Maryland, College Park
Strategies and Solutions: Environmental Justice
Sacoby Wilson, an Associate Professor in Applied Environmental Health at the University of Maryland spoke passionately about the need for environmental justice which he linked to economic justice. Dr Wilson pointed out that corporations often conned unsuspecting groups with the promise of jobs that came with enormous environmental and economic costs. Corporations have grabbed too much power, and to rein in that power, the power must be taken back. Dr Wilson spoke of the critical role that citizen scientists can play, if they produce high quality data that is both accurate and precise. Economic and environmental justice both require community organization, walking and talking involving the whole community. Environment and economic justice are not established by science, but rather by environment literacy and active responses.
Panel: The Citizen Scientist
Ana Maria Rule, PhD, Assistant Professor
The Johns Hopkins University Bloomberg School of Public Health, Department of Environmental Health and Engineering
Johns Hopkins Education and Research Center for Occupational Safety and Health
Particulate Matter Research Center
Methods, technologies and approaches to air quality monitoring for the Citizen Scientist
Ana Maria Rule emphasized the need to collect high-quality data. Dr Rule spoke of the need to collect data with a goal in mind. What are you trying to show? Where do you want to monitor? It is critical to have reproducible data from machines that have been calibrated before during and after the data are collected. The calibration can be done by placing commercially available monitors near a WVDEP monitor or other EPA-approved monitor to determine if results are comparable. The variability of measurements needs to be measured and any measurement bias needs to be evaluated. Dr Rule stated that the fundamentals of data collection are maintenance of records and machines, careful review of the data, and validation of the data.
Kelly Jones, RN, PhD
National Socio-Environmental Synthesis Center
So we’re collecting data. What’s next?
Kelly Jones is a registered nurse with an undergraduate degree in engineering and is currently a post-doctoral fellow at Georgetown. Dr Jones focused on what to do with the data collected and she presented several calendar methods of looking for patterns of events in the data vis-à-vis poor air quality days. Such calendars can be extremely useful for families to identify e.g. triggers for asthma or other health events. The data alone do not point to conclusions, but rather the analysis of the data permits testing hypotheses to reach a defensible conclusion. There is no magic in the data, but good data are essential.
Catherine Clark Feaga, DO
Core faculty, Meritus Family Medicine Residency
Clinical faculty, Mountain State OPTI
Board member, West Virginia Osteopathic Medical Association
Poor air quality days and the use of health services: What increased air pollution means for health care services in Jefferson County
Dr Catherine Clark Feaga, a family physician spoke about the status of healthcare in Jefferson County. The County is underserved. There are over 55,000 people and too few physicians. Our hospital and emergency room provide basic services, but more advanced care requires the patient be transported to Morgantown or Washington DC. The new factory will increase the number of cases of asthma, COPD, cancer, heart disease, preterm and low birthweight babies. All of these patients will need help, it will decrease access to healthcare and it will increase costs. This is a tax. We will pay more because of the new factory.
Joseph Bocchiaro III, PhD, Citizen of Jefferson County and Scientist
Dr. Bocchiaro described his journey to find a way to get help from a government agency to conduct a third party health assessment to determine how various communities within Jefferson County might be exposed to air pollution from new heavy industry. Attached is a list of resources he uncovered in his research. He noted that permit data and modeling data are seldom used to answer such questions. Government agencies such as the Centers for Disease Control and Prevention can help but only after the factory is in operation. He also noted the “catch 22” nature of the laws designed to protect citizens. Resources exist but may be called into action only after people are exposed to pollution. He suggested that a regional approach (Eastern Panhandle, Maryland, Virginia) to aligning development and public health goals would be far better than a single county trying to go it alone.
Resources for Health Assessment Assistance
- Air Quality Flag Program https://airnow.gov/index.cfm?action=flag_program.index
- Air Quality Index https://airnow.gov/index.cfm?action=airnow.local_city&mapcenter=0&cityid=161
- ATSDR: Agency for Toxic Substances and Disease Registry https://www.atsdr.cdc.gov
- Built Environment and Health Initiative https://www.cdc.gov/healthyplaces/hia.htm
- Community Benefits Agreements https://en.wikipedia.org/wiki/Community_Benefits_Agreement
- Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) https://www.epa.gov/laws-regulations/summary-comprehensive-environmental-response-compensation-and-liability-act
- EPA: United States Environmental Protection Agency https://www.epa.gov/enviro/about-data
- LFI: International Living Future Institute https://living-future.org
- NIOSH: The National Institute for Occupational Safety and Health https://www.cdc.gov/niosh/index.htm
- Pediatric Environmental Health Specialty Units (PEHSUs) https://www.pehsu.net
- Pew Trusts https://www.pewtrusts.org/en/research-and-analysis/data-visualizations/2015/hia-map?
- USGBC: U.S. Green Building Council https://www.usgbc.org
- West Virginia Department of Environmental Protection https://dep.wv.gov
- West Virginia Department of Health and Human Resources (DHHR) https://dhhr.wv.gov