RESOLVE

Serving Communities

The Serving Communities work group is focused on addressing local chemical exposure concerns to promote environmental justice and improve health. To review the group’s membership, charge, and past meeting summaries, visit the National Conversation work group page.

Next Steps
The National Conversation Council will consider public input received through web dialogues and public comment in revising the Action Agenda in the early spring 2011. Work group reports will be appended to the action agenda.

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14 Comments

  1. Ernest Grolimund

    Coalition Against Wood Burning, Residents Against Wood Smoke Emmissons of Particulates

    The CDC website on “DEBRIS SMOKE” says that “if you can see or smell smoke, there is a health problem and unhealthy conditions are not allowed under health nuisance laws. But wood smoke health nuisances including deaths and heart attacks and asthma attacks and numerous minor health symptoms are universally ignored!!! It is causing cities to be engulfed by wood smoke and its hundreds of toxic chemicals, as shown by photos and observations of the distinct wood smoke smell and scientific studies.

    The CDC statement above and the Surgeon Generals statement that second hand smoke is unhealthy could used to provide a simple, cost effective, monitoring system: our eyes and noses. This would make suppression and prevention of health problems much easier, and probably stop our cities from being photographed engulfed in wood smoke. The photographs are proof positive according to the CDC that we have a serious wood smoke toxic emergency on our hands. But if you require pm monitoring and certified smoke readers you may never get the information you need and the expense of government will go up needlessly. A little common sense is what is needed.

    Requiring monitoring and expensive environmental personnel to do health assessments is dangerous because it is too slow and expensive and hard to do. A much more cost effective way to deal with the wood smoke issue is to do computer estimating or modeling of the pm from classes of equipment. Then, you get data from computer for 10 types of equipment say, instead of requiring monitoring for every individual stove or outdoor wood boiler or what have you. Maine did this for outdoor wood boilers, as did NESCAUM, but the ATSDR refused to do modeling for stoves and fireplaces that I requested as a victim and engineer. This is preventing the inexpensive gathering of data you say you desperately need and preventing action on a gross and dangerous toxic emergency occuring all over the country. The modeling can be combined with existing census data to show that millions of pm hotspots exist with pm violations up to 80 mcg/m3, 24 hr ave. The combination of this information can allow the calculation of an average pm design level in our cities from a background level of 30 mcg/m3 and 10% ofthe houses at 80 mcg/m3 and 20% of the houses at 50 mcg/m3. The weighted average is about 45 mcg/m3 and this is about what the ave U.S. design level is. Note that the pm std is 35 mcg/m3 and there are apparent commonplace violations. They are predicted by estimates and confirmed by EPA monitoring and photos of cities engulfed in wood smoke. Advanced portable monitoring checks the pm violations but nothing is being done.

    The problem is that the government is not listening to the victims like me, and only listening to the federal government and the state and local governments are supressing the science and evidence which is a type of fraud liken to tampering with evidence. It is gross negligance really, and it has to stop. People with science backgrounds and leadership qualities like me spoke up loudly about this in the national conversation but we were ignored.

    We agree totally that there should be a simple way for victims and individuals to complain and thereby help the counrty improve but we are not seeing that yet, although we are heartened to see that someone on the policy levels seems to agree that people like us need to be listened to. The problem seems to be that the ATSDR and government in general responds to other gov entities as authorities but this does not work when the authorities are the problem. It does not happen often but it is now. It is like Obama describes for global warming. He says congress is negligant in not recognizing global warming and he is right. The same thing happened with the BP oil spill and with gross pollution from stoves and wood smoke. Non scientific politicians are dominating and preventing action by the scientists in all arenas of society today and corruption in the form of political contributions to politicians is apparently involved. Both Obama and NcCain talked openly about money in politics causing problems like this all through government. Look at unregulated mortages causing a stock market collapse and recession to unregulated oil speculation driving up energy costs to unregulated global warming destroying the planet illustrated by melted glaciers and ice caps.

    If you do the modeling for old stoves and fireplaces and wood boilers you will see common violations of pm standards all over. I worked with Maine and the EPA to do this modeling. I know. But Maine and the EPA and the ATSDR and CPSC and other government agancies are suppressing the science and an obvious problem.

    To make matters worse, the consensus in the scientific community is that there is a seperate dose for safe woodsmoke pm at 108 mcg,hr/m3 pm2.5 instead of the accepted dose of ambiant pm2.5 at 35 mcg/m3 x 24 hours or 840 mcg,hr/m3. In other words, wood smoke toxics make wood smoke far more dangerous. But the ATSDR says it cannot do a million dollar study on wood smoke pm toxicity to save an estimated $ 150 billion/year from health costs due to woodburning alone. Now this is penny wise but dollar stupid especially when you consider that the peer reviewed study has already been done and it leads to action like the second hand smoke laws advocated by the Surgeon General. Judges say err on the side of safety, so if you can’t do the study, accept the science community opinion and give the hearth industry the opporunity to try to prove the medical commiunity wrong. This would follow the precedant for building permits and furnace installations. Only allow proven safe heating equipment to be used. When this whole subject is adequately studied you will find that all the grandfather rules for wood burning equipment are dangerous and need to be taken off the books.

    You have no choice but to do this according to the constitution which does not allow threats to life and health and policy from the DHHS which says all threats to life and health must be investigated and innovative research be done. Sorry to say the current Deputy Director of the ATSDR would not obey the law in my opinion due to ignorance and bad judgement. I am talking about Tom Sinks, but he may have been prevented from doing the right thing by superiors.

    For your information, I have a BS in Civil Engineering and a genius IQ and a history of accomplishments. I am also a victim of extreme wood smoke air pollution which has led me to become a leader in this area out of neccesity to protect my life, health, safety, and welfare. I helped get a wood boiler law passed and a changeout law passed but both pieces of legislation are woefully inadequate and negligant. It can be traced all the way back to congressman who are notoriously hard to reach. I have welcomed the opportunity to try to be a part of the national conversation as it is a good idea, but so far the ATSDR is ignoring individuals and giving undue preferance to ignorant congress people and government groups. Only goverment groups appear to be given a chance to get things done and this is wrong.

    Please call.

    The subject of toxic chemicals should not be confined to chemicals from industry especially when hundreds of chemicals from wood smoke are vastly outnumbering the toxic chemicals from industry. .

  2. Frederic Pfaender

    UNC Chapel Hill SRP

    Well done report on a very important topic.

    Comments;

    1 Although not mentioned there are many of their recommendations that while appropriate may run into issues around responsibilities of state and local government relative to the federal government.

    2. Most of the recommendations ask for new legislation or executive orders from the federal government. In the current climate this is probably unlikely. Are there recommendations that can be implemented within existing legislative authority and funding? An enhanced and expanded EPA TAG grant mechanism comes to mind as a way to address recommendation 4 soon.

    3. Recommendation 3 is good and echos recommendations of several other working groups. Coordination across agencies and levels of government is necessary to efficeintly address most Environmental Public Health issues.

    4. The training recommendations in Rec 5 need to be tailored to each community rather than using the one-size-fits-all approach common to federal agencies.

    5. Rec 7 should be at least partially covered by the health care reform program.

    6. For the conversations recommended to be most helpful the industry or government entities causing the pollution need to be made a more specific part of the process. This document sees community/goverment as one side and industry on the other. If advisary positions can be minimized much more can be accomplished. They seem to have missed this.

  3. Ernest Grolimund

    Coalition Against Wood Burning, Residents Against Wood Smoke Emmissons of Particulates

    Serving communities is a very good idea. It is a basic function of government. But I see a problem with how the ATSDR is serving communities because it seems to require working with a local or state government health dept. The gov health dept is not necessarily serving the people in many cases and is serving the Mayor or Governor and sometimes the actual community is at odds with the government representatives who represent the democratic or republican point of view. The government often gets tyranical when it is not responsive to all the public and working for the good of a constituency, or stakeholders group. People with an economic stake are almost always sought for example, but the public gets left un represented believe it or not on narrow issues. For example a paper company in Maine where I live paysa lot of money to the state in taxes and this revenue is protected even when cancer hot spots are spotted by local hospitals. The paper companies burn wood as biomass in huge controlled boilers but the control largely goes towards pm reductions and the pm reductions allow the burning to be ramped up to huge fires which increases chemical toxics released, from acrolein to volatile aromatic hydrocarbons. The cancer victims are brushed off and not served because they can’t pay to play and have no organized commercial lobbying effort or group.

    When an individual has a problem with wood smoke of any kind, small source or large source, and he approaches the ATSDR he is usually brushed off because he is alone and powerless even though in theory he has rights and should be listened to. He has to go through the health dept or CDC-DHHS and if he does not have that, forget it. He is not served. The DHHS is seving the Governor trying not to be fired for disloyalty and the Governor is serving the industry to protect tax revenues.

    The ATSDR started in response to an individual heroic house wife and support group at Love Canal and the gov was totally unresponsive to that person and group, till an extraordinary event forced prseidential involvement which is almost unheard of. But when you read the ATSDR history account , the heroic house wife is not mentioned and credit is given to the EPA when they were really the problem. So the public is not necesarily being served and the public or the people are the community.

    Here is another example. Congress acts to have regulation of chemicals from chemical plants. A good cause. But it is so big, that there is no money to handle anything else. Then at the same time an energy crisis occurs, and more people burn wood and expose 30% or more of the population to extreme amounts of chemical toxics in the pm. The wood smoke problem is the larger problem affecting more people and releasing more chemicals but it gets ignored and the smaller chemical problem from industry gets all the money. 86,000 chemicals is no small problem but the mass of it is less and the number of chemical sites is small compared to hundreds of millions of stoves. Congress is served but not the public or the majority of the people or victims. Debatable but true from my perspective.

    Having a national conversation where people can speak their minds helps tremendously, at least on paper, but I see no sign that I have been taken seriously at all and I feel like I am talking to a cold and uncaring bueauacracy, terribly negligant. Hundreds of people or thousands have asked me to try to speak out, on victims websites. But because I belong to two fledgling groups I do not rate like the Am Lung Assn or Env Def Fund even tjough I have helped lead these two great groups on the small issue of woodburning and wood smoke. And we see millions of victims from DEP census data combined with DEP-EPA modeling.

    Something is obviouisly not right when cities like Denver and Salt Lake City and other cities are being photogrsaphed engulfed in wood smoke and 180 toxic chemicals and the EPA, ATSDR, CDC, CPSC, and other gov agencies are doing nothing. To us that is obviously not serving the people. 30% or more of the people are not being served too. Just because the victims have not gotten a large group together does not mean we do not exist. But compare how we are served to the oil companies with politicians pandering to them right and left for the tax revenues, economic benefits and yes some political contributions.

    We all think this group is not being listened to because the victims are all struggling on their own as individuals. But there are many scientists on our side working individualy too it seems and being ignored. The problem is a lot like global warming. 99% of the scientists agree it is real but the tiny minority of politicians, especially republicans, stops the community from being served. They stop the government from working for the good of all and get it to work for business or corporations or the party in power.

    The same thing is happening with woodsmoke. It is a terrible toxic problem being ignored and even ties in with warming through the soot issue. But the hearth industry or stakeholder group is called to discuss problems and the pm and toxic gas problem is supressed and hushed up with bogus science that dilutes the pollution with time of all things by averaging out pollution problems over a 24 hr time period and not considering the total toxicological load from all 180 toxics and the pm together. Modeling could cheaply adress millions of units at the sam time and identify many unsafe consumer products and a nw toxicological dose for wood smoke pm has been identified by peer science reports quoted by the ATSDR andcalled good. So $150 billion in health costs is born by the community for lack of a $1-2 million study which really is not neccesary acording the EPA exposures Dept. They say the new peer reviewed dose is legally binding for courts and therefor everyone from my perspective.

    Perhaps all the agencies have to get together and decide who should serve the community of victims and handle the problem or all depts should collaberate to check the others work.

    The community is not being well seved by the way wood smoke is being ignored for the most part by the ATSDR. It says the problem is the jurisdiction of the EPA and the EPA says it has no jurisdiction to regulate air inside homes. Everyone tries to pass the buck and two great organizations that could accomplish tremendous things accomplish nothing and the criminal negligance should be investigated and dealt with.

    Ernest Grolimund, retired engineer, smoke victim and activist by necessity, trying to protect his asthmatic daughters health.

  4. Donna Donna Mirynowski

    Concerned Citizens

    To Whom it May Concern,

    For the past few years my community has been supporting the removal of a concrete recycling facility in the state of Pennsylvania. During this process Laura Werner and Robert Helverson (CDC/ATSDR) have been very supportive in our endeavor.. Although it has been difficult on a local level we have now gone to the state due to the fact there are approximately 100 of these facilities in the Commonwealth of Pennsylvania.

    Laura and Robert have been very supportive and I believe we would not have been able to accomplish what we have to date without their support. When we have questions or need additional help they are there for us. Their performance goes above and beyond the call of duty and we are very fortunate to have their continued support.

    Sincerely,
    Donna Mirynowski

  5. Michael Duenas, OD

    American Optometric Association/ AD Health Sciences and Policy

    The American Optometric Association (AOA) submits these timely comments to the Serving Communities Work Group of the National Conversation on Public Health and Chemical Exposure, a collaborative project of the Centers for Disease Control and Prevention (CDC) and the Agency for Toxic Substances and Disease Registry (ATSDR).

    AOA’s 36,000 members have a long history of servicing the health care needs of vulnerable populations, including, people of all life stages, races and ethnicities, the economically disenfranchised and those disproportionally burdened by disease and by harmful chemical exposures. Doctors of optometry, as independent physician providers, work in concert with a host of other disciplines to give surety to the full range of essential primary health care services necessary to assure optimum health and quality of life. Optometrists serve patients in nearly 6,500 communities across the country, including, many environmental justice communities.

    The AOA specifically supports and is encouraged by action recommendation, #2) Congress should amend ATSDR‘s mandate and mission to ensure it serves public health more efficiently. The AOA believes there is much synergy regarding the underlying causes of disease disparities and the unique intersections between the health care community, broader public health community, governmental and environmental concerns. Currently these are not well coordinated and silos between agencies/organizations must be dissolved and become integrated to better address the important health issues that face our nation. Doing so will serve to close health care gaps, reduce disease disparity and promote and protect community health. As an example, environmental pollutants have been associated with two of the top four major causes of adult vision loss. Together these two serious diseases account for a significant portion of the $51.4 billion annual cost associated with adult eye disease in the U.S.

    Heavy metals such as lead have been with associated with increased prevalence of cataracts. Although treatment for a cataract, a clouding of the eye’s lens, is available, access barriers such as insurance coverage, treatment costs and patient perceptions or awareness prevent many people from receiving proper treatment thereby adding to disease disparity. Secondly, dioxins and dioxin- like compounds and other endocrine disruptors have been associated with increased prevalence of diabetes and its resulting common ocular complication of diabetic retinopathy, the leading cause of blindness among working-age adults in the U.S. ages 20-74. Individuals of Hispanic descent have a vision impairment prevalence rate of 7.3% due to diabetic retinopathy compared with Whites at 4.7%. Especially noteworthy to this conversation is that individuals of Hispanic descent are 2.3 times more likely than whites to reside in a neighborhood that hosts a commercial hazardous waste facility.

    The AOA is encouraged by requirement #2c) that ATSDR identify and coordinate a community dialogue with other agencies/organizations to address health issues and health care gaps and recommendation #3) that Government agencies shall develop coordinating structures/mechanisms across agencies. The AOA would be glad to participate in such a dialogue with ATSDR and other agencies and organizations. The AOA recommends that essential additional agencies be specifically designated in the final report. For example, the AOA believes that enhanced ATSDR inter-agency efforts should include the National Institutes of Health (NIH)/ National Eye Institute (NEI) and the Health Resources and Services Administration (HRSA), both of whom appear absent from the agency examples given in the draft workgroup report.

    The AOA specifically supports and is encouraged by action recommendation, #4) Government agencies shall provide communities with funding, technical assistance and resources to build capacity to address environmental health problems. The AOA believes that Community Based Participatory Research (CBPR) is critical to help better identify problems and trends before government agencies have prioritized those concerns. The AOA would suggest that Practice Based Research Networks (PBRN’s) be added to this draft section and that the Agency for Health Care Research and Quality (AHRQ) also be named in this section of the final report.
    The AOA also recommends that “academic partners” be listed and that Schools of Optometry be specifically included. Such a listing of “academic partners” might read as follows: Schools of medicine, osteopathy, optometry, dentistry, nursing, pharmacy, chiropractic, public health, mental health professionals, social workers, pharmacists, physical and occupational therapists and physician assistants. These academics should also be encouraged to do work in environmental public health through access to competitive federal sponsored fellowships for training and loan repayment for young investigators.

    The AOA specifically supports and is encouraged by action recommendation, #6) CDC and/or ATSDR should establish a National Health Outcomes Database to be used to create a standard process for governmental agencies to assess community health and potential synergistic, cumulative and aggregate environmental factors. The AOA believes this is imperative to the improved understanding of important associations. Disease and environmental exposures data linked geo-specifically through a sentinel surveillance system as described in the draft is both workable and necessary. The AOA would suggest that medical data, contained in optometric records is important data to collect and that this should be made a part of any system designed to interface with electronic health records (EHR) systems accessible by a third party such as the CDC. As an example, a variety of endocrine disruptors and potentially pesticides and other organic compounds may play a role in vision and eye health and these data would be important in discovering important associations that may exist within environmental justice communities today and in the future. Additionally, smog and airborne chemical pollutants have adverse effects on the eye and surrounding tissues and have also recently been linked to diabetes.

    The AOA specifically supports and is encouraged by action recommendation, #7) Increase access to health and health care for populations experiencing environmental justice challenges. The AOA is in full support of and encouraged by the “community health access model” that is proposed in the draft report. The AOA is fully in support of the described holistic, integrated, comprehensive and sustainably-designed community health centers (CHCs). The “community health access model” takes into important consideration the fact that vulnerable environmental justice communities often bear a disproportionate burden of disease and are often the same communities that lack access to health care. These are the communities that would most benefit from Community Health Centers (CHCs) offering a full range of primary care services and a multi-disciplinary team approach to care and prevention that is most critical to serving the needs of these communities.

    In conclusion the AOA is in full support of the important work being done by the Serving Communities Work Group of the National Conversation on Public Health and Chemical Exposure as evidenced by this draft report.
    [file]http://resolv.org/site-nationalconversation/files/2011/02/AOA ATSDR Comments National Conversation 092410.pdf[/file]

  6. Jennifer McKinnis

    "MCS" Beacon of Hope Foundation

    Dear Work Group Members,

    We have attached our summary regarding the issues you proposed. Thank you so much for this opportunity to share the collaborative views of our particular community.

    Sincerely, your friends in Hope & Health,
    Peggy, Julia, and Jennifer

    toxicinjury.org

    “Applied Knowledge is Power ~ Prevention is Key. . .” Peggy Troiano
    [file]http://resolv.org/site-nationalconversation/files/2011/02/National Conversation on Public Health ~ 20101.pdf[/file]

  7. Michael E. Bailey

    People First, California, Orange County Chapter

    It is a trueism that some of the most polluting and dangerous facilities we have as far as chemical manufacturing, storing, use, and recycling are located in less affluent areas and that it is mostly minorities and disabled persons and seniors of all races that live in these areas and are exposed more than others are. It is also true that the ptro-chemical business has a major credibility problem with everyone.
    There should be stronger federal laws that will allow greater public input into the decision making processes of where chemical plants can be sited, what health and safety controls they must have, how they will handle their discharges, and guarantees of prompt public notification in an emergency. There should also be laws to increase the penalties for chemical discharge into the air, water, or soil.
    The idea of participatory research in chemical pollution issues–involving members of the community in the research–is also important. It is playing a key role now in the Pacific Institute’s investigation and research into nitrate contamination of the drinking water in a number of wells in the San Joaquin Valley. Some of the worst contamination is being found in low income areas with volunteer water boards.

    And it is also very important to give low income communities the tools they need to help make sure they will be protected from chemical accidents, which can be done by such means as increasing the level of U.S. EPA Environmental Justice Grants.

    Thank you.

    Michael E. Bailey, People First, California, Orange County Chapter, 25801 Marguerite Parkway, No. 103, Mission Viejo, CA. 92692.

  8. Stephanie Wozniak

    My general comment after briefly reviewing all of the draft reports and hearing that our nation has been officially declared the “fattest” nation on earth is this: clearly I believe the overwhelming presence of persistent, bio-accumulative, toxic, carcinogenic, mutagenic, reproductive system damaging and endocrine disruptive chemicals in our food supply, air, water and homes has made us not only the fattest, but also the most depressed, medicated, lethargic, apathetic and generally unhealthy people who are most likely to become extinct by our own actions and arrogance.

    I would like to say that without a doubt one of the most important decisions our nations leaders and scientists and industry leaders can make is to stop poisoning the population and the environment with wood preservatives and other known dangerous pesticides.

    Please see attachment for complete fax submission and work group specific comments.
    [file]http://resolv.org/site-nationalconversation/files/2011/02/Stephanie Wozniak – Serving Communities.pdf[/file]

  9. Maggie Byrne

    CDC

    This is a great report that highlights many important issues surrounding the importance of engaging communities in advancing environmental health. The report mentions building trust as an important component to keep in mind in striving to meet these goals. One tool that may be of interest to the workgroups is the Protocol for Assessing Community Excellence in Environmental Health (PACE EH). This tool was developed by CDC and NACCHO and has been used to foster partnership between communities in local governments in addressing environmental factors that affect residents’ quality of life and health. Communities have used the tool to increase leadership of local/state environmental health staff and also to engage communities characterized by poverty, negative health outcomes, adverse environmental health consequences, and perhaps no surprise, despair. Another meaningful aspect of the tool is that, while it is designed to be used by environmental health departments, it is not topic specific and rather encourages a broad definition of environmental health — broad enough to address community concerns that are tied to a specific topic area. In this way, it also fosters collaboration within various components of local governments — including crime/law enforcement, public works, environmental health, and others — whoever is needed to address the concern. Meaningfully engaging the community in prioritizing their concerns offers an opportunity to build trust. The state of Florida has done exemplary work using this tool and recently won an Innovation award from Harvard recognizing the tool as a promising government practice. Perhaps there are ways to incorporate this tool/approach into more of our work with communities to focus not only on past exposures but also creating a community vision for the future and partnering with them to achieve it. More information on Florida’s experience is available at: http://www.doh.state.fl.us/environment/programs/PACE-EH/pacepower/. More information on PACE EH is also available from NACCHO and CDC and the PACE EH guidebook in English is attached.

    In addition, the workgroup mentions the importance of federal collaboration to support community-based efforts. In 2007, CDC, EPA, and ATSDR signed a Memorandum of Understanding to support community-based environmental health activities. Lessons learned from this effort may be helpful to the workgroup as it considers recommendations surrounding federal collaboration.
    [file]http://resolv.org/site-nationalconversation/files/2011/02/PACE EH Guidebook English.pdf[/file]

  10. Nsedu Witherspoon

    Children's Environmental Health Network

    Serving Communities

    The Network strongly supports the vision statement offered in this report.

    The report cites statistics on childhood disparities to illustrate the challenges before us. However, there is no specific mention of children as a “vulnerable population” to be specifically considered. We urge the inclusion of this concept throughout the report.

    The concluding paragraph of the report does not specifically mention children:
    “Protection from harmful chemical exposures must include protection for those who are most vulnerable, including low-income communities, indigenous communities, and communities of color. The Serving Communities work group views the implementation of the recommendations in this report as an important step towards achieving this goal.”

    The Network urges the inclusion of children in this list.

  11. Mari Eggers

    Crow Environmental Health Steering Committee

    Please find attached comments from our Crow Environmental Health Steering Committee, composed of health, environmental and education professionals and cultural experts, all Tribal members, from the Crow Reservation in southcentral Montana. We had not realized the format for submission would be separated by work group, and hence compiled responses to several reports into one document. Page one lists who we are, and pages 5-6 are specific to your work group report. We also attached a recent article about our work. We thought your report was visionary and inspiring and spoke to our concerns and experiences as a Tribal community.

    We appreciate your hard work on behalf of all communities across the country.

    Thank you for the opportunity to comment.
    [file]http://resolv.org/site-nationalconversation/files/2011/02/Community conversation summary2.ppt[/file]
    File: CumminsEtAl_2010_CBPR_In_Indian_Country2.pdf

  12. Erin Byrne

    Diabetes Action Alliance (DAA)

    To Whom It May Concern:

    We, members of the Diabetes Action Alliance (DAA), submit these comments to the Serving Communities Work Group of the National Conversation on Public Health and Chemical Exposure.

    We, members of the DAA believe there is action needed regarding the underlying causes of disease disparities and intersections between the health care community, broader public health community, governmental and environmental concerns. Dioxins and dioxin-like compounds, and other endocrine disruptors, have been associated with diabetes and pre-diabetic disturbances. Further investigation is warranted to elucidate these potential associations and therefore we fully support the mandate to amend or expand the mission of ATSDR to accommodate this and other important investigations that may link chemical exposures to health.

    Additionally, we members of the DAA support CDC and/or ATSDR in the establishment of a National Health Outcomes Database to be used to create a standard process for governmental agencies to assess community health and potential synergistic, cumulative and aggregate environmental factors. We believe that improved data systems and sentinel surveillance will be important to indentifying many significant associations involving environmental exposures and human disease.

    Furthermore, we the members of the DAA support the “community health access model” which realizes that vulnerable environmental justice communities bear a disproportionate burden of environmental exposure and disease and are most often the same communities that lack access to health care. These are the communities that would most benefit from new or expanded Community Health Centers (CHC’s) offering a full range of primary care services and a multi-disciplinary team approach to care and prevention that is most critical to diabetes care and prevention.

    In conclusion, we the members of the DAA support the cross-cutting report of the Communities Work Group. Please feel free to contact DAA co-chair Tricia Brooks (TIIB@novonordisk.com ), Michael Duenas (MRDuenas@AOA.ORG), or Martha Rinker (MRinker@aadenet.org) with any questions or comments.

    Sincerely,

    American Optometric Association
    American Association of Diabetes Educators
    Novo Nordisk, Inc.
    VSP (Vision Service Plan)

  13. Miles Ballogg

    CardnoTBE

    I am in wholehearted support of improvements to Public Health in underserved and disadvantaged communities. I would like to bring to the attention of the working group that a primary strategy for improvements to Public Health in areas that have experience a disproportionate environmental impacts from Chemical Exposures and other negative economic and environmental factors is through the use of Brownfields redevelopment that in linked to reuses that result in Public Health and Health Related improvements in underserved communities. This strategy can not only result in the assessment and determination of risk to communities through the assessment of air, soil, and groundwater and other environmental impacts (through the use of environmental assessment) but can also result in the remediation of properties that are many times located within the heart of our communities and present potential environmental and health risk to residents that many times face the cumulative impacts form disproportionate contamination impacts and also suffer from lack of health care .

    The assessment and remediation of the contaminated sites within underserved communities is merely the first part of the strategy to improve health care and heath within communities that suffer health disparities. The redevelopment of Brownfields sites that have many times have been left fallow for decades can be a huge positive step forward but the transformation of these sites into end uses that actually provide health care (free clinics, vision centers, community based health resource centers…..) And is a positive step to begin to address lack of access to health care and subsequent health disparities.

    Other potential end uses for Brownfields sites can continue health related improvements within communities including but not limited to:

    • Open Space /Green Space – Improving Access to physical activity and addressing issues like childhood obesity, diabetes …..
    • Development of Community Gardens, delivery of Grocery and other healthy food choices to communities (urban agriculture )
    • Development of Public Safety facilities to improve emergency response times –for police and fire and EMS services ……
    • Water Quality , Habitat and other Green Infrastructure improvements – improving the overall natural environment for underserved communities
    • Economic Development and educational facilities – both of these factors and play a major role in improvements to public health

    In closing, it is not good enough or effective enough to have a fragmented approach that does not integrate the necessarily tools and strategies that will ultimately result in the removal of environmental contamination from communities that for far too long have suffered the brunt of negative chemical exposures. And it is not good enough or effective enough to not replace contaminated facilities with development that will improve the health care and overall health of communities that have suffered health disparities for far too long.

    One does not need to look too far to see how many communities have used this strategy successfully. Be it the conversion of an old abandoned gas station in the heart of the Greenwood Community in Clearwater Florida into a free clinic by retired Nurse Ms. Willa Carson or the transformation of an old junk yard into a Fire Station and the transformation of an old car dealership into a grocery store within the same community. We have a unique opportunity to promote the successful use of Brownfields sites to improve public health through forums like the “Serving Communities Work Group” we have the resources and commitment to bring the appropriate Federal, State and Local Stakeholders together to truly make positive changes to reverse environmental injustice and replace it with healthy communities .

    Respectfully

    Miles G. Ballogg
    Co – Chair – Environmental Justice Committee – Florida Brownfields Association
    Board Member – Willa Carson Community Health Resource Center, Clearwater Florida
    Recipient of the SEPIA – Dr. Martin Luther King Brotherhood Award

  14. Kathy Curtis

    Oregon Toxics Alliance...

    Oregon Toxics Alliance, Northwest Indiana Toxics Action Project, Alliance of Nurses for Healthy Environments, Alaska Community Action on Toxics, University of Alabama Hospital Highlands, Oregon Environmental Council, Clean New York, Environmental Health Fund, Citizens’ Environmental Coalition

    Comments to the Centers for Disease Control & Prevention regarding National Conversation on Public Health and Chemical Exposures
    Workgroup Reports

    General Comments:

    The Massachusetts TURI program should be made into a federal program, using a similar structure. It is funded by a user fee that companies pay based on the amount of hazardous materials they use. The fees are used to support programs that work with companies to help them reduce their use of hazardous chemicals, which then reduces the fees they have to pay to the program. In addition, companies that reduce their hazardous chemicals also reduce costs to store, ship, and dispose of them, which usually saves them money overall.

    Children are generally not called out in any of the work group reports, yet they are a specific vulnerable population: they cannot identify risks, remove themselves from harm, or describe exposures or events. Neither CDC’s Environmental Public Health Tracking nor the National Children’s Study collect information regarding children’s exposures in schools or child care centers, but they should be. When those are mentioned in various work group reports, it would be prudent to add that EPHT and NCS need to swiftly address these well-known data gaps with revised work plans. Children have exposures “on the job” in schools and child care centers and outnumber adults by about ten to one (depending on age group and health status) in those settings, but children/families have no recourse and no public services to intervene or to track or research those exposures.

    Serving Communities Work Group:

    The recommendations in this report are generalized and vague. There’s good, protective prevention language up front but they are not well-translated in the recommendations.