health environments for the next generation: before, during & after pregnancy collaborative on...

Health Environments for the Next Generation: Before, During & after

Pregnancy

Collaborative on Health and the Environment

MissionTo work collaboratively with diverse groups

to eliminate harmful environmental exposure effecting children during their most critical development years: pre-

conception to age eight.

JoinWebsite: http://www.chenw.org

Listserve: Northwest Kids Environmental Health Groupwww.ecy.wa.gov/maillist.html

Meeting:Second Thursday of the month, 9:30 – 11:30Location rotatesIn-person or call-in options

Children’s Environmental Health 101

Nicole Thomsen, REHS, HHSPublic Health – Seattle & King CountyEnvironmental Public Health Planner

Nicole.thomsen@kingcounty.gov206-263-8516

“Social Justice is a matter of life and death. It affects the way people live, their consequent chance of illness, and their risk of premature death.”

WHO Commission on Social Determinants of Health

Source: New England Journal of Medicine, Sept. 2007

Where People Live 60%

Health Care10%

Genetics30%

What We Know About Health

“Children's environmental

health" focuses on

environmental exposures

before, during and after birth,

and the resulting health effects.

Schettler, T., Reproductive Health – NW Children’s Environmental Health Forum. 2013. Available at http://washington.chenw.org/CEHforum2013.html.

Developmental windows of

susceptibilities

Physiological differences

Behavioral differences

Children’s increased vulnerability

Increased speed of….

MyelinationCell divisionDifferentiationSynapse development

TEDX – The Endocrine Disruption Exchange.http://endocrinedisruption.org/prenatal-origins-of-endocrine-disruption/critical-windows-of-development/timeline-test/

Children’s physiology, compared to an adult

Breathing:

Drinking:

Surface Area:

Children’s behavior, compared to an adult

Mouthing:

Time on ground:

Playing:

Chemical Contaminants

Lead

Mercury

Environmental tobacco smoke

Formaldehyde

Polybrominated diphenyl ether

(PBDE)

Bisphenol A (BPA)

Pesticides

Birth defects

Reproductive capacity – age of menarche, semen quality, menstrual irregularities

Infant mortality, pre-term birth

Obesity

Neurological disorders

Endocrine disorders

Cancers

Health Outcomes

Cost to children in King County, per birth cohort

$177 million

172,000 healthy life-years

Live

Learn

Play

Cumulative Exposures

Steve Gilbert, PhD, DABTInstitute of Neurotoxicology and Neurological Disorders

Director & Foundersgilbert@innd.org

206-527-0926

Global Warming

Burning Coal

Coal Waste

Mercury from Coal to Fish

Nuclear waste

Chemical body burden

Chemical use

Sustainability

Inheriting The Future

Implications for Future Generations

Cumulative exposuresFood, chemical/contaminant, built, social environments; multi-level

Cumulative effectsHealth outcomes: increased risk of various adverse pregnancy outcomes; increased risk of chronic diseases; co-morbidities

From Ted Schettler

Cumulative exposures vs. Cumulative effects

Risk =

Hazard X Exposure

Dose / Response

Individual Sensitivity

78.2% no data

21.4% some data12 or 0.4% good data

U.S. Environmental Protection Agency. TSCA Chemical Substance Inventory. 2012. http://www.epa.gov/oppt/existingchemicals/pubs/tscainventory/index.html

Vogel. S.A. and J.A. Roberts, Why the Toxic Substances Control Act Needs An Overhaul, And How To Strengthen Oversight of Chemicals In The Interim. Health Affairs, 2011. 30(5): 898-905

The Chemical Data Vacuum

Developmental disabilities: one in six, or about 15%, of children aged 3 through 17 years have a one or more developmental

disabilities

Consequences

Learning disabilities: 5-10% of kids in public school

ADHD: 5% of all school kids, maybe higher. Approximately 11% of children 4-17 years of age (6.4 million) have been diagnosed with ADHD

as of 2011.

• Boyle CA, Boulet S, Schieve L, Cohen RA, Blumberg SJ, Yeargin-Allsopp M, Visser S, Kogan MD. Trends in the Prevalence of Developmental Disabilities in US Children, 1997–2008. Pediatrics. 2011; 27: 1034-1042

• http://www.cdc.gov/ncbddd/adhd/

“Conditions that ensure that all living things have the best

opportunity to reach and maintain

their full genetic potential.”

Steven G. Gilbert, 1999

Gilbert SG. Ethical, legal, and social issues: our children's future. Neurotoxicology. 2005;26:521-30

"A thing is right when it tends to preserve the integrity, stability, and

beauty of the biotic community. It is wrong

when it tends otherwise."

1887 - 1948

Aldo Leopold1949, A Sand County Almanac

Violent Crime and Blood Lead Levels

CDC 1960 CDC 1973 CDC 1975 CDC 1985 WHO 1986 EPA 1986 CDC 1990 CDC 2012 CDC 20??0

10

20

30

40

50

60

60

40

30

25

20

15

10

52

Agency and Year

Blo

od

Le

ad

(u

g/d

l)

Acceptable Childhood Lead Levels

O

BrxBry

PolyBrominated Diphenyl Ether

Environmental Working Group. In the Dust: Toxic Fire Retardants in American Homes. 2004. http://www.ewg.org/research/pbdes-fire-retardants-dust

PBDE’s in House Dust (ppb)

PBDE’s in Breast Milk (ppb, lipid)

Environmental Working Group. Mother's Milk. 2003. http://www.ewg.org/research/mothers-milk-0

“When an activity raises threats of harm to human health or the

environment, precautionary measures should be take even if some cause

and effect relationships are not fully established scientifically.”

Wingspread Conference, 1998

Precautionary Principle

3 days

32 attendees

1 statement

• Setting goals (Health indicators)

• Taking preventive action in the face of uncertainty

• Shifting the burden of responsibility to the proponents of an activity (Who benefits?)

• Exploring a wide range of alternatives to possibly harmful actions (Is it necessary?)

• Increasing public participation in decision making (transparency of information & environmental justice)

Consensus Statement

Epi, means “upon”, "above", "in addition to"

Epigenetics is the study of changes in gene expression caused by mechanisms other than changes in the genetic (DNA) code

Epigenetics

Epigenetics

Environmental hazards

Epigenetics

Cigarette smoke

Arsenic

Alcohol

Phthalates

Bisphenol A (BPA)

Nutiriton

Mercury

Social and maternal behavior toward

child

• Moving “above” or “beyond” precautionary approach

• Doing good

• Loving & supportive environment

• Doing no Harm is not doing enough

• Ensure children can reach and maintain their full potential

• Biological support epigenetics

Epiprecaution

Holly Davies, PhDWashington State Department of Ecology

Senior ScientistHolly.davies@ecy.wa.gov

360-407-7398

Effective Actions

The American College of Obstetricians and Gynecologists

• Evidence is sufficiently robust linking toxic environmental agents to reproductive and developmental health outcomes.

• Reducing exposures is critical.

• Pre-conception & pre-natal

• Profound and lasting effects

• Healthcare providers should provide guidance

American College of Obstetricians and Gynecologists. Committee of Health Care for Underserved Women Opinion No. 575. Exposures to Toxic Environmental Agents. Obstetrics & Gynecology, 2013. 122(4): 931-5

Susan Buchanan, MD, MPHUniversity of Illinois at Chicago

School of Public Health

http://prhe.ucsf.edu/prhe/pdfs/CREM%20Prenatal%20Environmental%20Exposure%20History.pdf

Lead

Mercury in fish

Pesticide use

Endocrine disruptors

10 4 + =RiskTopicsMinutes

Am J Obstet Gynecol. 2012 Dec;207(6):463-70. doi: 10.1016/j.ajog.2012.02.004. Epub 2012 Feb 14.Environmental exposures: how to counsel preconception and prenatal patients in the clinical setting.Sathyanarayana S1, Focareta J, Dailey T, Buchanan S.

Benign design

Kids & environment

protected

Manufacturers share the

responsibility

Safer Alternatives

Green Chemistry

Phase out PBTs

Averting toxic exposures and avoiding future costs is the smartest, cheapest and healthiest approach.

Identify Chemicals of Concern

Gather dataBans, Limits,

Reporting

>>>BANS

>>> DATA COLLECTION

>>> STAKEHOLDER PROCESSES

Bisphenol A in children’s bottles/cups, sports bottles

Copper in brake pads, boat paint

Toxics in packaging Coal tar sealants

PBDEs, including deca-BDE in certain products

Chemical Action Plans for Persistent, Bioaccumulative Toxics

Children’s Safe Product Act reporting rule

Product testing

Alternatives assessment guidance

Green Chemistry Center

Brake pad law

Lead in wheel weights

Ecology’s Efforts

Flame Retardants

• PBDEs (polybrominated diphenyl ethers) – PBTs– Neurodevelopment and behavior effects,

cancer– Endocrine disruptor (thyroid hormone)– High levels in foam, plastics, textiles– House dust and environmental media

• Advice– Reduce exposure to dust- cleaning– Purchasing– Fish advisory

• PBDEs– Voluntary phase out with EPA (2004-2013)– 2006, PBDE chemical action plan (CAP) recommended ban – In 2007, Washington passed a law (RCW 70.76) banning the

manufacture, distribution, and sale of certain products with PBDEs

• Exemptions • Deca-BDE was prohibited after an alternatives assessment• Good compliance

– Other states also have bans• Other flame retardants

– Sleepwear in the 1970s – California TB117 update (2014)– Current bill in WA legislature– Other state laws (bans, labeling, disclosure) and bills

• Safer alternatives– What are they using instead?

Flame Retardants - Regulation

• Chlorinated Tris– TCEP, TDCPP, TDPP, TCPP, V6

• Firemaster 550

• HBCD

• Tetrabromobisphenol A (TBBPA)

• Polybrominated diphenyl ethanes– Other brominated compounds

• TPP

Alternatives Assessments and Green Chemistry

Flame Retardants - Alternatives

• 1976 Toxics Control Substances Act (TSCA)• Frank R. Laugtenberg Chemical Safety for the

21st Century Act• Senate and House bills• Chemical review by EPA

• High and low• State pre-emption

50

Federal Chemical Reform

– Water Quality rule updating Human Health Criteria

– Budget Package– Toxics Reduction Act

• Expand the use of CAPs for priority chemicals, including emerging contaminants

• Prevention of distributed sources• Alternatives assessments to avoid regrettable

substitutions• State purchasing

Governor’s Toxics Reduction Package

MissionTo work collaboratively with diverse groups

to eliminate harmful environmental exposure effecting children during their most critical development years: pre-

conception to age eight.

JoinWebsite: http://www.chenw.org

Listserve: Northwest Kids Environmental Health Groupwww.ecy.wa.gov/maillist.html

Meeting:Second Thursday of the month, 9:30 – 11:30Location rotatesIn-person or call-in options

Nicole Thomsen, REHS, HHSPublic Health – Seattle & King CountyEnvironmental Public Health Planner

Nicole.thomsen@kingcounty.gov206-263-8516

Steve Gilbert, PhD, DABTInstitute of Neurotoxicology and Neurological Disorders

Director & Foundersgilbert@innd.org

206-527-0926

Holly Davies, PhDWashington State Department of Ecology

Senior ScientistHolly.davies@ecy.wa.gov

360-407-7398