Environmental Health Perspectives Volume
103, Supplement 6, September 1995
[Citation
in PubMed]
Environmental Health and Hispanic Children
Raphael Metzger, Jane L. Delgado, and Robert Herrell
National Coalition of Hispanic Health and Human Services Organizations,
Washington, DC
Abstract
There are numerous indicators that Hispanics face a disproportionate
risk of exposure to environmental hazards. Ambient air pollution, worker
exposure to chemicals, indoor air pollution, and drinking water quality
are among the top four threats to human health and are all areas in which
indicators point to elevated risk for Hispanic populations. These data,
juxtaposed with data on the health status of Hispanics, tell us that the
environmental health status of Hispanics and their children is poor. At
the same time, significant inadequacies in the collection of data on Hispanics
make it difficult to make improving Hispanic environmental health status
a priority. These inadequacies include the failure to use Hispanic identifiers
in data collection and failure to collect sample sizes large enough to allow
for breakouts of data by Hispanic subgroup. In addressing environmental
justice issues, the U. S. Environmental Protection Agency (U.S. EPA) and
the Department of Health and Human Services (HHS) should prioritize improving
the quantifiability of environmental exposures and risk based on race or
ethnicity. However, improving data should not be the prerequisite to significant,
affirmative steps by HHS and EPA to address environmental and environmental
health problems facing Hispanic communities. In particular, a health-based
approach to environmental justice should be the priority. -- Environ
Health Perspect 103(Suppl 6):25-32 (1995)
Key words: Hispanic, health, environment, children, data collection,
environmental justice, minority, ambient air, water quality, indoor air,
pesticides
This paper was presented at the symposium on Preventing
Child Exposures to Environmental Hazards: Research and Policy Issues held
18-19 March 1994 in Washington, DC.
The National Coalition of Hispanic Health and Human Services
Organizations (COSSMHO) is a private, nonprofit, membership organization
dedicated to improving the health and well-being of the nation's Hispanic
population. Founded in 1973, COSSMHO is the only national Hispanic organization
focused on health. COSSMHO pursues its mission through policy and research
activities and programing in partnership with community-based member organizations.
COSSMHO does not accept funds from alcohol or tobacco companies or their
subsidiaries or parent companies.
Address correspondence to Raphael Metzger, National Coalition
of Hispanic Health and Human Services Organizations (COSSMHO), 1501 Sixteenth
Street, NW, Washington, DC 20036. Telephone (202) 797-4338. Fax (202) 265-8027.
Introduction
The Children's Environmental Health Network (CEHN) Symposium, Preventing
Child Exposures to Environmental Hazards was a public health milestone because
it recognized that for purposes of environmental health the issues of children
are different. This is the starting point for CEHN's development of a research
and policy agenda to address hazardous environmental exposures to children.
The National Coalition of Hispanic Health and Human Services Organization's
(COSSMHO) objective in helping to provide an environmental justice context
for this landmark symposium is to ensure that the research and policy agenda
that results is meaningful for all children, including Hispanic children.
A persistent theme underlying most discussions of environmental health
is the issue of causation. The difficulty of establishing causation is rooted
in the fact that
...the amount of exposure sustained by study subjects and the conditions
under which that exposure occurs generally are beyond the direct control
of the investigator. Human populations are exposed to multiple pollutants
whose individual, let alone joint, effects are not known. Under these conditions,
inaccurate measurement of exposure and the effects of extraneous factors
on disease occurrence often present major threats to study validity. (1)
Further, such research may set inappropriate toxicity levels for Hispanics
and Asians, given recent data that show significantly different pharmacokinetic
responses to drugs in drug trials compared to responses in non-Hispanic
whites (2). These can be taken as an indication of variable responses
to substances in the environment based on ethnicity. Thus, although causality
is an important issue, complete research in this area must account for variation
in response based on ethnicity and other biologic factors.
The extreme difficulty of not only establishing causation but also accounting
for variable responses based on ethnicity underscores the futility and impracticality
of approaches to environmental health that are predicated on proof of harm.
While research into causation is critical, preservation and improvement
of public health necessarily requires a protective approach to environmental
regulation--one that seeks to prevent exposure to potentially harmful substances
even without certainty of cause. Further, there are data available from
which sound indications of risk can be determined for various populations.
These indicators should be the basis for federal, state, and private efforts
to achieve more equitable environmental protection for all people living
in the United States, including Hispanics who constitute a major segment
of the population.
Demographics: Hispanic Children
Hispanics constitute a significant portion of the American population--about
22.4 million persons in the United States (3), and an additional
3.5 million persons in Puerto Rico (3). Hispanics are also a youthful
population, with a median age of only 26.1 years compared to 27.7 for blacks
and 33.6 for whites (4). High birth and fertility rates characterize
Hispanics in the United States; they had a birth rate of 26.2 per 1000 persons
in 1989, compared to an overall birth rate of 16.3 per 1000 for the United
States in general (5). Additionally, the "estimated fertility
rate for U.S. Hispanic women aged 15 to 44 years was 104.9, 60% above the
rate of 65.7 for non-Hispanic women" (5). These high rates,
together with the relative youth of the Hispanic population, have led to
projections that by 2010 Hispanics will number 31 million persons (6).
Additionally, the 1990 Census of Population and Housing reveals that 29.5%
of the Hispanic population was 14 years of age and under, compared to 20.8%
of the non-Hispanic population (3). Indeed, in the same year, "63%
of Hispanic families had children under 18 living with the family, compared
to 47% for non-Hispanic families" (3). The characteristics of
high birth and fertility rates together with youthfulness result in a substantial
proportion of the Hispanic population being composed of children. Unfortunately,
relatively little is specifically known about the environmental health status
of Hispanic children because of a lack of data.
Key Overall Findings
Inadequate Data Collection Systems
Overall, since the direction of policy efforts and programs to address
serious problems are at least in part driven by data, the lack of data that
would be useful in assessing with specificity the environmental health status
of Hispanic children remains an important issue for Hispanic communities.
The Clinton Administration's 11 February 1994 Executive Order on environmental
justice may prove useful in helping to address the issue of data collection
on Hispanics. While the provisions of the executive order are peppered throughout
the text with the caveat "whenever practicable and appropriate,"
a notable exception is the provision that requires federal agencies to "provide
minority populations and low-income populations the opportunity to comment
on the development and design of research strategies undertaken pursuant
to this order" (7). At present it is still unclear which studies
will be designated as undertaken pursuant to the executive order, and therefore
fall under this definition. Nevertheless, this is a potentially important
precedent, particularly so for Hispanic communities. To date, Hispanics
continue to be regularly excluded from important federal research and data
collection activities through methodologies that fail to require ethnic
identifiers, do not oversample, do not collect samples of a size sufficient
to allow break out by Hispanic subgroup, or rely on interviews conducted
by field researchers without the appropriate linguistic competence.
These data collection issues are well documented. The most recent General
Accounting Office study on Hispanic access to health care reports that while
there are "sources of data that do provide some useful information
on the health status of the Hispanic population...no existing database currently
provides accurate, complete, and available data on the entire Hispanic population,
including subgroups, residing in the United States" (8). Delgado
and Estrada state the problem more specifically, noting that the U.S. Department
of Health and Human Services (HHS) has 21 national health data collection
systems which:
largely form the basis of our quantitative knowledge of public health
in the United States.... Of the 21 systems, 6 do not collect Hispanic population
data, including the Medicare statistical system. Furthermore, of these data
systems, only the National Vital Statistics System collects data for all
Hispanic subpopulation groups. Seventeen of the 21 data systems do not collect
samples of a size adequate for analysis for any of the four major Hispanic
subpopulation groups. (9)
While the Office of Management and Budget has provided the appropriate
standards for Federal data collection efforts encompassing race and ethnicity
in its Directive No. 15 (10), the exclusion of Hispanics from critical
national data systems has persisted. Until changes occur in Federal data
collection and reporting, the information needed to determine the environmental
health status of Hispanic children with specificity will continue to elude
policy makers, and Hispanic children will continue to be the victims of
inequitable Federal responses to health and environmental health problems.
An excellent case study of the importance of sound data to establishing
risk is provided by the recent attention focused on siting of hazardous
waste treatment, storage, and disposal facilities (TSDFs).
Unfair Siting and Unequal Enforcement
Various studies have sought to document that TSDFs are disproportionately
located in black and Hispanic communities. Research conducted by Public
Data Access, Inc. for the United Church of Christ Commission on Racial Justice
(UCCCRJ), which used ZIP code areas as the primary geographic unit, found
that race and ethnicity are the strongest predictors of commercial hazardous
waste activity (11). While this study would benefit from analysis
that breaks out the specific figures for Hispanics and blacks and has been
criticized for using a too large primary geographic area for its computations,
it is the first widely recognized attempt to document that a disproportionate
number of TSDFs are located in Hispanic and black communities. Further,
substantial anecdotal evidence from COSSMHO member agencies and others in
the southwestern United States supports the notion that TSDFs and other
sources of risk such as chemical plants, refineries, and other industrial
operations pose threats to the health and well-being of Hispanics living
near them.
The issues of the disproportionate siting of TSDFs and other operations
in Hispanic and black communities is of particular concern because of potential
effects on health to those living in the areas surrounding such facilities.
For example, various studies have documented serious negative health effects
among workers at hazardous waste incinerators (12), which suggests
the possibility of similar effects on persons living in the surrounding
area. Further, there is compelling evidence that regulatory agencies such
as the U.S. Environmental Protection Agency (U.S. EPA), whether intentionally
or unintentionally, enforce environmental law differently in Hispanic and
black communities. The strongest analysis of this to date was offered by
The National Law Journal, a Washington-based weekly periodical. Among
its findings were that penalties issued pursuant to U.S. hazardous waste
laws at sites "having the greatest white population were about 500%
higher than penalties at sites with the greatest minority population"
(13). The study also found numerous other disparities that suggest
unequal protection for Hispanics and blacks under the various environmental
statutes. Environmental justice advocates have found this evidence to be
less than compelling among those who argue that, with regard to the siting
process, economics is the principle determinant of likelihood to live near
a TSDF. The argument over economics and market forces does not answer the
issue of differential enforcement, however. Rather than becoming entangled
in formalistic arguments regarding the role of economics in propensity to
live near a TSDF, it is important to remember that the principle reason
siting is of concern is because of potentially deleterious effects on health.
To this end, the broader categories of concern articulated by this article
provide a health-based approach to environmental justice that relies on
scientifically established areas of top concern for public health.
Top High Risk Human Exposures: Threats to Hispanic Health
In 1987 and again in 1990, the U.S. EPA convened its Science Advisory
Board (SAB) to determine the top environmental threats to human health.
The 1987 U. S. EPA SAB considered four major types of risk--cancer risks,
noncancer health risks, ecological effects, and welfare effects--in an evaluation
of 31 environmental problems based on both quantitative data and expert
judgment (14). The results of the evaluation included an U.S. EPA
ranking of environmental hazards on the basis of cancer risk, as follows:
a) radon/worker exposure to chemicals; b) pesticide residue
on food; c) indoor air pollutants other than radon/ consumer exposure
to chemicals; d) hazardous/toxic air pollutants; e) depletion
of stratospheric ozone; f) hazardous waste sites--inactive; g)
drinking water; and h) application of pesticides (14). More
recently, in 1990 the U.S. EPA SAB's Relative Risk Reduction Strategies
Committee released a report which, while not ranking risk from highest to
lowest, identified more generally the highest-risk environmental exposures
for humans. This listing substantially overlapped with the ranking of risk
developed by U.S. EPA in 1987. The top four high-risk human exposures are:
* ambient air pollutions
* worker exposure to chemicals in industry and agriculture
* pollution indoors
* pollutants in drinking water (15).
These two separate determinations by the U.S. EPA of the top threats
to human health are important because they provide expert criteria by which
to set environmental policy-making priorities to protect the public health,
including the environmental justice issues that are part of these critical
public health questions. Further examination of each of the high-risk exposure
areas reveals that, in terms of risk, Hispanics either fare the worst or
face significant threats to health for every area identified by the U.S.
EPA as a top threat to human health.
U. S. EPA High Risk Human Exposure: Air Pollutions. Acute
effects of air pollution on the respiratory system include "triggering
or aggravating of asthmatic attacks, exacerbation of symptoms of chronic
obstructive disease, increased upper or lower respiratory infections, transient
changes in pulmonary function, increased respiratory symptom reporting,
increased respiratory hospital admissions or doctor visits, and increased
daily mortality" (16). Chronic effects of air pollution on the
respiratory system include "promotion of the development of asthma,
increase in non-specific airway responsiveness, reduced level of lung function,
increased rate of lung function decline, decreased rate of lung growth,
development of chronic obstructive pulmonary diseases, increased reporting
of persistent respiratory symptoms, lung cancer, and increased mortality"
(16).
The chronic and acute health effects of exposure to air pollution are
in large part responsible for introduction of air pollution control laws
in the United States. The Clean Air Act (CAA) (18), which "establishes
comprehensive sets of measures to control outdoor air pollution throughout
the nation" (17), is the modern mechanism for national regulation
of air quality by the U.S. EPA. To control the amount of pollution in the
air, the U.S. EPA sets National Ambient Air Quality Standards (NAAQS)--uniform,
national air quality standards that restrict ambient levels of certain pollutants
to protect the public health (17). According to §108(a)(2) of
the CAA (18), these NAAQS must "accurately reflect the latest
scientific knowledge useful in indicating the kind and extent of all identifiable
effects on public health or welfare which may be expected from the presence
of such pollutant in the ambient air." NAAQS exist for particulate
matter (which includes emissions from sources such as incinerators), lead,
ozone, carbon monoxide, nitrogen oxide, and sulfur dioxide (17).
Unfortunately, Hispanics appear to face elevated risk for developing
acute and chronic responses to exposure to air pollution because a disproportionate
number of Hispanics live in areas failing to meet one or more NAAQS. Recent
research reveals that 80% of Hispanics live in an area failing to meet one
U.S. EPA air quality standard compared to 65% of blacks and 57% of whites
(19). Additionally, in areas failing to meet two NAAQS, three NAAQS,
and four or more NAAQS, Hispanics are consistently significantly worse off
as measured by percentage of the population living in these nonattainment
areas. Sixty percent of Hispanics, 50% of blacks, and 33% of whites live
in areas failing to meet two or more NAAQS; 31% of Hispanics, 20% of blacks,
and 12% of whites live in areas failing to meet three or more NAAQS; and
finally, 15% of Hispanics, 10% of blacks, and 5% of whites live in areas
failing to meet four or more NAAQS (19).
There are some specific data on health outcomes related to air pollution
that are consistent with the acute and chronic health effects from exposure
to air pollution. The American Lung Association reports that "63% of
preadolescent children reside in counties classified as nonattainment for
one or more NAAQS" (20). Further, "61% of pediatric asthma
cases (less than 18 years of age) are among children living in nonattainment
areas for one or more NAAQS" (20). With the exception of regional
data on asthma among Puerto Rican children, who are more than three times
as likely as non-Hispanic white children to suffer from active asthma (21),
specific quantitative knowledge on the environmental health status of Hispanic
children is virtually nonexistent. This is largely due to the failure to
collect Hispanic specific data in national data systems, also noted above.
Nevertheless, on a pollutant by pollutant basis, reviewing data that indicate
disproportionate risk for Hispanics provides an indication of the type of
health effects Hispanics must therefore be at some degree of elevated risk
of experiencing.
Particulate Matter. Hispanics are more than twice as likely
as either blacks or whites to live in areas with elevated levels of particulate
matter. Thirty-four percent of Hispanics, 16.5% of blacks and 14.7% of whites
live in a U. S. EPA non-attainment area for particulate matter (19).
Research into the effect of exposure to particulate matter on lung function
reveals that both forced vital capacity and forced expiratory volume are
consistently lower in urban children than in suburban children (22),
strongly suggesting that urban ambient air pollution exposure (particulate
matter, NO2, SO2, etc.) are responsible for the retardation
in growth of lung function in children. Research conducted by Joel Schwartz
of the Harvard School of Public Health reports an association between elevated
levels of PM and death rates for various conditions which have respiratory
factors as contributing to the underlying causes of death (23).
Lead. Hispanics are more than twice as likely as either
blacks or whites to live in areas with high levels of lead. About 18.5%
of Hispanics, 9.2% of blacks, and 6% of whites live in an U. S. EPA nonattainment
area for lead (19). The effects of lead on child development are
well documented and well known. Indeed, "chronic low-level exposure
to lead has been linked to damage to the central and peripheral nervous
system, low birth weight, learning disabilities, chronic anemia, shorter
stature, impaired hearing, and impaired formation and function of blood
cells in young children, infants, and fetuses" (24).
Ozone. Hispanics are most likely to live in a U.S. EPA
nonattainment area for ozone. Seventy-one percent of Hispanics, 62% of blacks,
and 52% of whites live in areas with high levels of ozone (19). "There
are some provocative indications that there may be substantial adverse effects
[to ozone exposure]. The indications include: greater rate of loss of lung
function in nonsmoking men and women..., reduced baseline lung function
when annual average O3 concentration is greater than 40 ppb,
based on a national population sample, and an unexpectedly high incidence
of centriacinar region disease in the lungs of adolescents and young adults
examined postmortem in Los Angeles County" (25). Additionally,
"acute reduction of pulmonary function performance following ozone
exposure has been documented in epidemiologic studies in which small groups
were followed over a short period" (26).
Carbon Monoxide. Eighty-eight percent of Hispanics and
85% of non-Hispanic blacks live in nonattainment areas for carbon monoxide,
compared to 50% of non-Hispanic whites (19).
Carbon monoxide binds with hemoglobin in the blood to form carboxyhemoglobin
(COHb), reducing oxygen transport to the tissues. The most common symptoms
of carbon monoxide poisoning are headache, dizziness, drowsiness, nausea,
and vomiting. But it can also lead to confusion, neurologic damage, cardiac
arrhythmias, coma, and death. Retinal hemorrhages are standard signs of
CO poisoning (19).
U.S. EPA High-risk Human Exposure: Worker Exposure to Chemicals in
Industry and Agriculture
Environmental exposure of humans to agrichemicals is common and results
in both acute and chronic health effects, including acute and chronic neurotoxicity
(insecticides, fungicides, fumigants), lung damage (paraquat), chemical
burns (anhydrous ammonia), and infant methemoglobinemia (nitrate in groundwater).
A variety of cancers also have been linked to exposure to various pesticides,
particularly hematopoietic cancers. Immunologic abnormalities and adverse
reproductive and developmental effects due to pesticides have also been
reported (27).
The willingness to continue current pesticide use practice is astonishing
given the risk to farm workers and their children. Research reveals evidence
of a possible association between pesticide exposure and aplastic anemia
(28), while another study on couples seeking artificial insemination
with donor sperm because of poor sperm quality found a significant association
between male factor infertility and employment in agricultural occupations
(29). Still other research suggests elevated risks of Ewing's bone
sarcoma for children "whose fathers were engaged in agricultural occupations"
(30). Additionally, "[a]n increased risk for anencephaly has
been related to parental occupation of farmer and farm worker; neural tube
defects, and a combined category of neural tube defects, facial clefts,
and renal agenesis have been related to exposure to agricultural chemicals
during preconception" (30). There is also evidence to suggest
an association between spontaneous abortion and stillbirth and exposure
to pesticides (30).
The threat to health indicated by the studies cited above is borne out
by 1992 data from the Bureau of Labor Statistics, which indicate that farmworkers
account for 11% of all occupational fatalities--the second highest percentage
of work-related deaths in the United States after transportation occupations
(31). Other data indicate that prolonged exposure to pesticides causes
an estimated 313,000 illnesses and 1000 deaths annually among agricultural
workers (32). These findings are of particular concern to Hispanic
health advocates because Hispanics account for such an overwhelming percentage
of both seasonal agricultural workers and migrant workers, and because "[a]griculture
accounts for 80% of the 1 billion pounds of pesticides used annually in
the U.S." (33). Fully 71% of all seasonal agricultural workers
are Hispanic, compared to whites at 23% and blacks at 3% (34). The
proportion of Hispanics who are migrant agricultural workers is even higher
at 95% (35). Agricultural workers are thus particularly at risk of
exposure to pesticides. More specifically, workers who mix, load, and apply
pesticides, and workers who are in contact with crops or commodities sprayed
with pesticides have the greatest potential exposures (33). In addition,
many migrant farm workers live near the crops they service, and may be regularly
exposed to a great variety of pesticides due to pesticide drift and off-gassing
(36).
Although regular exposure is foreseeable, of the approximately 600 "active
pesticide ingredients" in use "adequate toxologic data are available"
for only about 100 of them (27). Thus even though, "...the effects
of acute exposure (usually a relatively large single exposure) are well
documented, the effects of chronic, low-level exposure...to pesticides is
unclear" (24). Research "is needed to better characterize
and quantitate the adverse effects of agrichemicals on human health"
(27), yet there is more than enough evidence to justify proactive
efforts to prevent harmful exposures to pesticides among farmworkers in
terms of which pesticides are registered for use and the aggressive promotion
of alternative pest-control technologies.
U.S. EPA High-risk Human Exposure: Pollution Indoors
At first glance pollution indoors appears to be an inconsequential threat
to health compared to other exposures, but it can be just as deadly. Among
the most serious indoor air quality issues are environmental tobacco smoke
and radon. The dangers to health posed by the indoor air pollutants envrionmental
tobacco smoke (ETS) and radon are distinct from many other environmental
threats to health in that they are most directly caused by preventable consumer
behavior, as in the case of ETS, or randomly occurring natural phenomenon,
as in the case of radon.
Environmental Tobacco Smoke. It is well established that
cigarette smoking is a major cause of death and disease. According to the
U.S. Department of Health and Human Services (HHS), "[t]obacco use
is responsible for more than one of every six deaths in the United States
and is the most important single preventable cause of death and disease
in our society. Cigarette smoking accounts for about 434,000 deaths yearly
including 21% of all coronary heart disease deaths, 87% of all lung cancer
deaths, and 82% of all deaths from chronic obstructive pulmonary disease"
(36).
The threat to health from tobacco use is not limited to the user of the
tobacco product. Others who are near a smoker can be exposed to passive
smoke, ETS (37). ETS is "composed of exhaled mainstream smoke
(MS) from the smoker, sidestream smoke (SS) emitted from the smoldering
tobacco between puffs, contaminants emitted into the air during the puff,
and contaminants that diffuse through the cigarette paper and mouth between
puffs" (37). While ETS is dilute compared to MS it is similar
in composition (37). Compounds present in ETS include: 1,3 butadiene,
acetic acid, acetone, ammonia, benzene, carbon monoxide, carbon dioxide,
formaldehyde, formic acid, hydrogen cyanide, toluene, and various types
of particulate matter, including di- and polycyclic aromatic hydrocarbons
(37). ETS contains "many of the same carcinogenic and toxic
agents" (37) present in MS, and as such ETS poses a significant
threat to the health of nonsmokers occupying the same environment.
Consistent with this threat to health the U.S. EPA in 1992 designated
ETS as a known human lung carcinogen, or "Group A" carcinogen
under U. S. EPA's carcinogen classification system (37). The Group
A designation is used "when there is sufficient evidence from epidemiologic
studies to support a causal association between exposure to the agents and
cancer (37). The application of stringent criteria led to conservative
estimates by U.S. EPA that ETS causes approximately 53,000 deaths annually
among nonsmokers in the United States, including 3000 lung cancer deaths
(38).
The U.S. EPA's designation of ETS as a Group A carcinogen is amplified
by the noncancer health effects of exposure to ETS. A positive link has
been established between ETS and respiratory illness in children (37),
with numerous epidemiological studies demonstrating a causal association
between ETS and
* bronchial hyperresponsiveness
* "additional episodes and increased severity of asthma in children
who already have the disease"
* reduced lung function as measured by various airflow parameters such
as forced expiratory volume
* cough, phlegm, and wheezing (37).
Other studies on the noncancer health effects of ETS on children show
evidence of an association between ETS and
* acute lower respiratory tract illnesses such as bronchitis and pneumonia
(occurring up to twice as often during the first 2 years of life in the
children of smokers)
* acute upper respiratory tract illnesses, acute middle ear infections,
and acute middle ear effusion ("the most common reason for hospitalization
of young children for an operation")
* sudden infant death syndrome (SIDS) (37).
Hispanic children are regularly exposed to ETS. According to the National
Center for Health Statistics, 44.3% of Hispanic preschool children have
been exposed to tobacco smoke compared to 50.8% of non-Hispanic white children
(21). Of this substantial number, Hispanic children are more likely
to be exposed to tobacco smoke postnatally rather than prenatally. Of all
Hispanic children exposed to tobacco smoke, 23.5% have been exposed postnatally
compared to 20.9% of non-Hispanics (21). This distinction is important
because it indicates a significant deterioration in the quality of Hispanic
children's environment once they are born, and points to a need for postnatal
health education and intervention in Hispanic households with children.
Radon
Radon gas is derived from the radioactive decay of radium, a ubiquitous
element found in rock and soil. The decay series begins with uranium-238
and goes through four intermediates to form radium-226.... Radium-226 then
decays to form radon-222 gas. Radon's half-life, 3.8 days, provides sufficient
time for it to diffuse through soil and into homes, where further disintegration
produces more chemically and radiologically active radon progeny ('radon
daughters'). These radon progeny, which include four isotopes with half-lives
of less than 30 minutes, are the major source of human exposure to alpha
radiation. This alpha radiation is responsible for cellular transformation
in the respiratory tract, which results in radon-induced lung cancer (39).
While the probability that radon will be a problem is essentially random,
public awareness is largely the result of purposive public health education
campaigns. Difficulties in raising public awareness about the seriousness
of the threat to health posed by radon are centered largely on the fact
that radon is colorless, odorless, and tasteless and causes no immediate
symptoms. Further, where federal efforts at public education have succeeded
for non-Hispanic whites, this is far less true for Hispanics. HHS's National
Center for Health Statistics reports that 61.2% of Hispanics have never
heard of radon compared to 21.5% of whites (40). Public education
materials and programs targeting Hispanic communities are critical to reducing
this knowledge gap.
U.S. EPA High-risk Human Exposure: Pollutants in Drinking Water.
The importance of safe drinking water cannot be overemphasized,
particularly for children. In a recent poll of public health officials,
82% responded that safe drinking water was the most important or a very
important factor in increasing life expectancy and quality of life (41).
Hispanic children nevertheless face significant threats to their well-being
from tainted water.
Lead. In urban areas, drinking water treatment and delivery
systems (pipes) can be a source of contamination of water with lead, disinfectants
and their byproducts, and fluoride (42). Lead in particular may be
problematic for urban Hispanic communities as lower income Hispanics are
more likely to rent older homes or apartments, which may contain antiquated
lead plumbing. This is particularly a source of concern regarding the health
of Hispanic infants, as "U.S. EPA found that more than 85% of the blood
lead in bottle-fed infants may derive from drinking baby formula made with
lead-contaminated water" (43). Further, this concern is corroborated
by findings regarding lead-based paint and higher prevalence of elevated
blood-lead levels among inner-city children living in deteriorating pre-1970s
housing (44). Chronic low-level exposure to lead has been linked
to damage to the central and peripheral nervous system, low-birth weight,
learning disabilities, chronic anemia, shorter stature, impaired hearing,
and impaired formation and function of blood cells in young children, infants,
and fetuses (24).
United States-Mexico Border. Contamination of the air and
water has also been a persistent problem along the United States-Mexico
border, leading many public health professionals and others who live and
work in the region to believe that contaminated air and water are responsible
for a cluster of neural tube defects (NTDs) discovered in 1989 by the Brownsville,
Texas, Community Health Center. While the results of a Texas Department
of Health study on the cause of NTDs in Cameron County pointed to folic
acid supplements for the diets of expectant mothers as a critical prevention
measure, the report was inconclusive as to whether or not environmental
factors are responsible for the high incidence of NTDs (45). Thus,
"it is important to realize that although there are no overwhelming
data to support a role for environmental agents in the etiology of NTDs,
there are data that suggest that extrinsic agents need to be evaluated further"
(LE Sever, unpublished data). Unfortunately, "[e]nvironmental data
collection, particularly on a county-wide level, are not designed to address
specialized public health issues such as the elevated rates of NTDs in Cameron
County" (45). In addition, data on surface water quality of
the Rio Grande are limited, although it is known that mercury concentrations
exceeded state standards and guidelines (45), and polychlorinated
biphenyls were detected above recommended guidelines in a fish tissue sample
collected from the Rio Grande River in Cameron County (45).
Another serious problem for Hispanic children in the United States-Mexico
border area is persistent biological contamination of water supplies for
residents of United States colonias. Most colonias originated
in the early 1950s when developers began creating subdivisions outside city
boundaries. These subdivisions were not incorporated or part of the cities
near which they were located (46), and those who moved into them,
mostly Mexican-Americans, have lived there since the subdivisions were created
(46). Additionally, most colonias exist in Texas, although
some can be found in New Mexico and Arizona with a substantial number of
people (46). In six Texas counties there are about 842 separate colonias
with over 200,000 persons living in them. Of this only three, or less
than 1%, have public sewage disposal systems (46). Without sewage
treatment facilities, water supplies often become contaminated with bacteria
and viruses (22), which in turn indicate the possible presence of
organisms that cause typhoid, cholera, infectious hepatitis, and dysentery
(47). Indeed, the EPA Journal has reported that "[o]utbreaks
of dysentery and hepatitis A are commonplace in the colonias, even
though in the rest of the United States these severe water-borne afflictions
are considered Third World diseases" (47).
Migrant Labor Camps. Many of the same Hispanics who face
threats to their health such as those described above must also contend
with biological and chemical contamination of water supplies at migrant
labor camps. Again, specific quantitative measures of this problem are generally
unavailable. There are, however, examples that can be considered reflective
of the situation in other sites. For example, a 1992 Pullman Health Systems
study found that 43% of water supplies at state-licensed migrant worker
camps in nine Michigan counties contained nitrates. In some wells, the levels
were so high that federally mandated warnings had to be posted.... (48).
Similarly, "[m]igrant labor camps in California covered by the Clean
Water Act have been cited by EPA for failure to sufficiently sample water
provided to laborers for contaminants. Some were exceeding limits for coliform
bacteria and some for high levels of nitrates in the water" (49).
Based on verifiable anecdotal accounts and other evidence it is anticipated
that serious drinking water quality problems are a persistent aspect of
migrant labor life.
Recommendations
Overall, the U.S. EPA needs to make itself accountable to the communities
it ultimately serves by improving its responsiveness to community concerns
and its accessibility to those concerned about environmental health. For
example, for Hispanics, one part of making U.S. EPA accountable must mean
increasing the diversity of its staff. Hispanics are severely underrepresented
at U.S. EPA, accounting for only 4% of the total U.S. EPA workforce. This
underrepresentation exacerbates the inaccessibility of the agency and its
information to interested individuals, community-based organizations (CBOs),
and national organizations who represent CBOs and Hispanic communities.
Effectively addressing the underrepresentation of Hispanics at the U.S.
EPA will involve improved agency responsiveness to Hispanic concerns through
immediate, more aggressive efforts to recruit Hispanics for professional
positions at U.S. EPA. In addition, it will also require the implementation
of long-term strategies to increase the accessibility of the U.S. EPA to
Hispanics and to increase the pool of qualified Hispanics from which the
U.S. EPA and other federal entities may draw. To this end, U.S. EPA, foundations,
and corporations should fund community-based programming that targets Hispanic
youth and seeks to cultivate interest in the environment and environmental
protection.
The following, more specific recommendations are similar, made with an
eye toward making the federal government accountable to the communities
it ultimately serves.
Data Collection
As the U.S. EPA begins to collect exposure and other population data,
it should require methodologies that include ethnic identifiers, conduct
oversampling, collect samples of a size sufficient to allow break-out by
Hispanic subgroup, and require linguistic competence for interviewers. At
minimum both U.S. EPA and HHS should adhere to OMB Directive No. 15, which
sets forth the minimum standards on data collection activity at federal
agencies.
The U.S. EPA should improve the coordinating of its information for public
use by identifying and describing all current and proposed data and information
collection activities to be funded or to be conducted by the agency. In
addition, U. S. EPA should aggressively pursue policies that promote data
sharing and integration.
The U.S. EPA, HHS, and the Department of Labor should specifically identify
which studies each entity will be conducting pursuant to President Clinton's
Executive Order on Environmental Justice of 11 February 1994.
Unfair Siting and Unequal Enforcement
U.S. EPA should fully and completely assess the extent to which particular
racial and ethnic groups are more likely to live in proximity to TSDFs,
chemical plants, refineries, and other such facilities. This should be done
without determining risk or causation.
The U.S. EPA should develop a mechanism for review of local siting processes
to ensure full opportunity for participation by local residents and equal
protection under U.S. environmental law.
EPA should conduct an internal audit of its enforcement activities to
determine the extent to which non-Hispanic white communities benefit from
more punitive enforcement as compared to Hispanic and black communities.
Top High Risk Human Exposures: Threats to Hispanic Health
Ambient Air Pollutions. Existing NAAQS should be reviewed
and modified as needed in light of new research indicating more serious
health effects from exposure to ozone and other criteria pollutants. Existing
NAAQS may be too lax.
The U.S. EPA should require adherence to state implementation plans under
the Clean Air Act with renewed vigor. Noncompliance with NAAQS results in
unacceptable health costs for affected communities and places a particularly
onerous burden on children and their development.
Programs targeting Hispanic community-based organizations and individuals
for training on how to use the Toxic Release Inventory (TRI) should be a
priority to empower Hispanic communities in the monitoring and influence
local industry. While the TRI has been a particularly effective tool for
non-Hispanic white communities, it remains largely inaccessible to Hispanic
communities.
Worker Exposure to Chemicals in Agriculture
Improving safety of agricultural workers must involve a significant increase
in the threshold, which must be met before a pesticide can be registered
for use under the Federal Insecticide, Fungicide, and Rodenticide Act (FIFRA).
Administrator Carol Browner recently proposed the addition of 313 new chemicals
to the Toxic Release Inventory, over 170 of which are currently used and
registered as pesticides. That these substances are considered hazardous
enough to add to the TRI but at the same time continue to be used for pest
control is indicative of a pesticide registration process that does not
give appropriate weight to the health impact on agricultural workers and
their children.
The federal government must also improve access to health care for agricultural
workers through health reform, and improve monitoring of growers for compliance
with farmworker safety standards.
Indoor Air Pollutants
A tobacco tax should be imposed to reduce smoking behavior while at the
same time raising revenue for critical national efforts such as health reform
and environmental justice.
Increased public education is necessary, targeted to the specific groups
that need to be reached with messages on prevention or mitigation, recognizing
that simple translation of materials intended for mainstream, non-Hispanic
white audiences or other communities is not effective.
We also need to encourage development of creative programming targeted
to Hispanics, which focuses not only on raising awareness and eliciting
testing, but also seeks to provide low-cost options for mitigation.
Drinking Water Quality
The U.S. EPA, OSHA, and relevant state entities must vigorously pursue
enforcement of existing regulations relevant to the working conditions of
migrant farmworkers, including availability of clean drinking water. Where
gaps exist, new regulations should be initiated through the public review
and comment procedure.
The U.S. EPA and HHS should continue lead abatement programs targeting
urban areas, but should improve them by including linguistic and cultural
competence as critical elements of program implementation.
The U.S. Trade Representative and the U.S. EPA should undertake a public
education campaign targeted to the residents of the United States-Mexico
border area to inform them about the public participation provisions of
the environmental side accord to the North American Free Trade Agreement
(NAFTA). Public participation should be facilitated in all NAFTA related
environmental activities.
U.S. EPA, HUD, HHS, and other relevant governmental entities should make
bringing modern water treatment and delivery systems to the colonias
a priority and they should act on that priority with appropriate funding.
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