Public Health Assessment Process

Jack Hanley, M.P.H.

Environmental Health Scientist

Agency for Toxic Substances and Disease Registry

Superfund Amendments and Reauthorization Act - 1986

• ATSDR mandated to perform a public health assessment for each facility listed on the Environmental Protection Agency’s National Priorities List

• An analysis and statement of the public health implications posed by the release of hazardous substances

Public Health Assessment

Purpose of a Public Health Assessment

• Identify the public health impact on off-site populations from releases of hazardous substances

• Determine the need for follow-up public health actions or studies

Possible Recommendations

Public Health Assessment Process

Step 1: Evaluate site informationStep 2: Identify health concernsStep 3: Determine contaminants of concernStep 4: Identify and evaluate exposure pathwaysStep 5: Determine public health implicationsStep 6: Determine conclusions and

recommendationsStep 7: Develop a public health action plan

Evaluate Site Information

• Background information• Community health concerns• Demographics• Land use and natural resources use• Environmental data• Environmental pathways

Identify Community Health Concerns

• Identify involved community members• Involve the community in the public health

assessment process• Maintain communication with the community

and other involved parties throughout the process

Determine Contaminants of Concern

• Identify significant releases of contaminants

• Determine which contaminants may have contributed significantly to the off-site health hazard posed by the site

• Identify contaminants used at the facilities

Identify and Evaluate Exposure Pathways

• Identify each of the five elements of an exposure pathway

• Categorize an exposure pathway as completed or a potential

• Determine whether these elements form a past, present, or future exposure pathway

• Determine whether the exposure pathway should be eliminated

Elements of an Exposure Pathway

• Contaminant Source

• Environmental media

• Exposure Point

• Exposure Route

• Receptor population

Exposure Pathway Potential Pathway

Contaminant Source

Environmental Media

Exposure Point

Exposure Route

Receptor Population

Contaminant Source

Environmental Media

Exposure Point

Exposure Route

Receptor Population

Completed Pathway

Importance of Exposure Pathway Analysis

• Enables the health assessor to focus on completed pathways

• Provides a systematic methodology for identifying receptors

• Lays the foundation for evaluating the public health implications

Determine Public Health Implications

Evaluation Occurs in Three Areas:

• Toxicological• Health outcome data • Community health concerns

Toxicological Evaluation

• Estimate media-specific exposures• Compare exposure estimates with health

guidelines• Determine exposure-related health effects• Evaluate other factors that influence

adverse health outcomes

Health Outcome Data Evaluation

• Evaluate available health outcome data for all identified plausible health outcomes associated with contaminants determined to be of public health concern

Community Health Concerns Evaluation

• Address site-related health concerns expressed by the community using environmental data, exposure pathways analysis, toxicological evaluation, and health outcome data evaluation

Community Health Concerns Evaluation

• Determine whether the outcome is plausible

• If the outcome is not plausible, identify other data and information to explain the likelihood of the outcome

• Address other issues related to environmental and other concerns

Determine Conclusions

• Assign a public health hazard category to the site

• Identify health implications from completed exposure pathways

• Identify plausible community health concerns

• Identify insufficient information

ATSDR Hazard Categories

A. Urgent public health hazard

B. Public health hazard

C. Indeterminate public health hazard

D. No apparent public health hazard

E. No public health hazard

Determine Recommendations

ATSDR makes recommendations for:

• Protecting public health • Follow-up public health actions• Additional environmental information

Develop Public Health Action Plan

• Identify actions undertaken or planned

• Identify the agencies that conduct the actions

Oak Ridge Reservation Public Health Assessment

• ATSDR, with the assistance of the Subcommittee, will analyze and evaluate the information, data, and findings from previous studies and investigations on the radiological and chemical contaminants released from the Oak Ridge Reservation

Oak Ridge Reservation Public Health Assessment

• Identify and characterize exposures of off-site populations

• Identify populations exposed at levels of health concern• Evaluate health outcome data associated with

exposures of concern• Address community health concerns• Recommend follow-up public health actions or studies