Mapping Mortality in Western Pennsylvania – Part 2

The Pittsburgh Post-Gazette recently completed an amazing series of reports on the cancer clusters in Western Pennsylvania. Here is a sample from Day 2 of their 8-day series.

In many places around Western Pennsylvania residents see clusters of death and clusters of people sickened by cancer or heart and lung diseases.

And, like Lee Lasich, a Clairton resident, they’re frustrated that government health and environmental agencies don’t see them too, don’t do something about the problems and don’t take a tougher stance on enforcement of air pollution regulations.

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The Pittsburgh Post-Gazette’s analysis of Pennsylvania Department of Health mortality data from 2000 through 2008 found that 14,636 more people died from heart and respiratory disease and lung cancer in 14 Western Pennsylvania counties than national rates would predict, or 12,833 after adjusting for excess smoking in the region. And the yearlong investigation found numerous people throughout the region who talked about what seemed like unnatural and unexplained clusters of illnesses and death in their communities.

This overlap of high mortality rates and pollution raises questions about whether there is a causal relationship. The question has not been definitively answered, but for the people who live among these clusters, the connection seems clear.

More . . .

When it comes to particulate pollution, what you can’t see can hurt you.

“The stuff now is more insidious but much harder to perceive,” said Lester B. Lave, the Carnegie Mellon University economics professor who pioneered pollution mortality research in the 1970s. “There is no rotten egg smell. There is no dirt. It is less easily perceived. People are usually astonished that Pittsburgh still is one of the worst, but air pollution is continuing.”

Studies estimate that pollution kills 20,000 to 60,000 each year in the United States. Even at the lower range, pollution deaths would equal the nation’s annual rate of homicides.

The upper range would equal traffic fatalities and suicides combined and rank pollution as the nation’s eighth leading cause of death, just behind diabetes — another disease pollution has been linked with — and just ahead of the combined category of influenza and pneumonia.

And what’s true about pollution deaths holds true about particulate pollution: Both remain largely imperceptible to the general public.

Science to the rescue

For the past 40 years, science time and again has implicated particle pollution as a major killer.

In 1970, Dr. Lave and Eugene B. Seskin for the first time calculated health damage from pollution. Their subsequent book, “Air Pollution and Human Health,” published in 1977, found not only “a close association between air pollution and mortality,” but determined the relationship to be substantial.

Drs. Lave and Seskin’s work stirred such controversy that it prompted an effort to get Dr. Lave fired from his teaching position. But their science stood the test of time and helped inspire major epidemiological studies in subsequent decades.

More . . .

• A PG multimedia display tells the human side of the effects of air pollution
• PG interactive maps show disease rates and major pollution sources
• See an index to the series

Mapping Mortality in Western Pennsylvania – Part 1

The Pittsburgh Post-Gazette has just completed an amazing series of reports on the cancer clusters in Western Pennsylvania.  Here is a sample from Day 1 of their 8-day series.

Numerous studies show that southwestern Pennsylvania has poor air quality and a yearlong Pittsburgh Post-Gazette investigation has found that those pollution problems remain far from solved in communities such as Shippingport and Monaca, Bellevue and Sewickley, Masontown and Clearfield, Cranberry and Bridgeville, Pittsburgh and hundreds of others.

At the same time, the Post-Gazette’s review and analysis of state Department of Health mortality statistics shows that 14,636 more people died from heart disease, respiratory disease and lung cancer in the region from 2000 through 2008 than national mortality rates for those diseases would predict.

Those diseases have been linked to air pollution exposure.

After adjusting for slightly higher smoking rates in Pennsylvania, the total number of excess deaths from those three diseases is 12,833. That’s still a more than 10 percent higher mortality rate overall than would be expected in the population of approximately 3 million people in 14 counties, based on national risk rates for those three diseases.

More . . .

The Post-Gazette mapped the mortality rates for heart and lung disease and lung cancer for each of 746 municipalities in the 14-county region and found higher rates around many of the region’s 16 coal-fired power plants and 150 other companies considered by the EPA as major stationary sources of pollution emissions. High mortality rates also turned up irregularly in the “plume shadows” of the utilities and industrial sources, that is the downwind area where their emissions can be transported.

The mortality mapping, while not establishing any direct cause-and-effect link to any single or specific pollution source, shows associations that are consistent with accepted scientific health risk models and formulas used by the EPA and other pollution research scientists. It indicates that pollution may play as big a role in the region’s high mortality rates for those three diseases as Pall Malls, pilsners and pierogies.

“The maps do actually form some evidence that reinforces the literature that coal burning does have those effects,” said Conrad Dan Volz, director of the University of Pittsburgh’s Center for Healthy Environments and Communities and an assistant professor of environmental and occupational health.

He noted that the mortality rates from 2000 through 2008 are “lagging indicators” that could reflect past pollution exposure for the region’s population. But they might also show the health impacts of continuing exposure and that regulations aren’t as effective as they could be.

More . . .

On Sunday morning U.S. Steel finally shut down its Donora mills. By that afternoon, when a rainstorm blew into the valley ending the inversion and clearing the pollution, 22 people had died in Donora and the town of Webster, just across the Mon. Almost half of Donora’s 13,000 residents were sickened, and hundreds were evacuated or hospitalized.

“Dr. Clarence Mills, a researcher at the University of Cincinnati, said at the time that if the inversion had lasted another day, hundreds more would have died and life as we know it would not exist in Donora,” Dr. Stacey said.

In the months that followed, an additional 50 people died in Donora over the number that would normally be expected. And the town’s mortality rate remained significantly higher than that of neighboring towns in the Mon Valley for a decade.

U.S. Steel refused to accept blame at the time and still has not turned over to researchers its archival data related to the fatal smog.

Lawsuits totaling $4.5 million in claims were filed by more than 100 Donora residents against U. S. Steel. All were settled in 1951 for $256,000, according to a new book, “The Polluters,” written by Benjamin Ross and Steven Amter.

“No one got rich,” said Dr. Stacey. “After the lawyers were paid, most people had enough to buy a television set.”

More . . .

Although FirstEnergy sent workers through the affected communities to power-wash the ashy black residue from the exterior of homes, outdoor deck and lawn furniture and vehicles, and cleaned indoor carpeting — and did so at Gracie’s grandparents’ home in Raccoon Township — it did not remove the sand pile where she continued to play daily, and, as was her wont, put things in her mouth.

Then, the lawsuit states, on Aug. 7, 16 days after what had become known in the community as the “black rain event,” FirstEnergy notified local officials and made public announcements recommending that farmers not allow livestock to graze in fields carpeted with the soot and that residents not use or eat from their home gardens for a year. In the weeks that followed, while company workers mowed the affected hay and yards, and harvested and paid for backyard garden produce, Gracie’s long brown hair was falling out in big clumps.

More . . .

• A PG multimedia display here tells the human side of the effects of air pollution.
• PG interactive maps show disease rates and major pollution sources.

Upstream Sources of Health Inequeties

From St. Louis Beacon: Where we live can determine how long we live (by Robert Joiner).

* * *  Larry Chavis, George Banks, Tracy Blue and Carolyn Dickerson are among the St. Louisans featured in this Beacon series about how and why some health and social conditions afflict African Americans in certain zip codes at a much higher rate than whites. They are known as health disparities or inequities. And, for the most part, they have been accepted as perplexing but unsolvable facts of black and white life in St. Louis and the nation.Public health as prevention

Until now, that is. One aim of the new health-reform law is to reverse the notion that health disparities are inexplicable and inevitable. The new law is expected to address the issue in part by re-energizing the public health movement.

While medical doctors treat disease, public health workers identify trends, explain why people get sick and address conditions that trigger illnesses. Public health work includes screening children for lead poisoning, offering nutrition programs for diabetics, and setting up sex education classes to try to prevent the spread of sexually transmitted diseases, or STDs. Over the years, this work has faltered from a lack of manpower and money. That has allowed some diseases to move way beyond the prevention stage. Traditional medicine has been left to fill the void with a case-by-case approach to treating disease. It as if we had responded to the massive BP oil spill by dealing with one oil-soaked fish at a time.

Still, the news in some poor St. Louis neighborhoods isn’t all bad. Examples include the city Health Department’s sustained attack on lead poisoning and a similar effort planned for childhood asthma. Another is the Maternal and Child Health Coalition’s push to reduce infant mortality. These challenges have prompted providers to be more imaginative in the ways they view and tackle health problems.

Looking upstream

We can trace the roots of such efforts all the way back to the 19th century and the work of Dr. John Snow. He’s credited with looking beyond conventional thinking during a cholera outbreak in London. Snow eventually traced the epidemic to a contaminated public water pump. Removing the pump is said to have helped end an epidemic that claimed 600 lives. Fast forward to 2010, and the moral might be that high-tech medicine isn’t always the answer and certainly not the cheapest solution to some diseases in St. Louis.

“The public fails to realize that some illnesses have an environmental influence and are preventable,” says Dr. William Kincaid, former head of the St. Louis Health Department and now head of the local Asthma Coalition. “We develop systems to treat them after they happen, but we don’t look upstream to see why we are having these problems. And we lose an opportunity to make some of them go away. Lead is a classic example. So is asthma.”

Location influences wellness

Hope and despair run on parallel tracks in some of the worst neighborhoods on the north side. Hope surfaces unexpectedly as a motorist takes in street after street of gloomy sights, then turns a corner and finds a suburban-like setting of a block or two of stately, market-rate brick homes, trimmed lawns, fenced-in backyards and newly poured concrete sidewalks out front. These neighborhoods still include many working-class and middle-class families, some of who can’t afford to leave. Others stay out of a sense of pride in a part of town that is rich in black history.

But the north side’s decay is never far away. Some neighborhoods have been reduced to a treeless landscape with crumbling houses, weedy sidewalks, cracked storefront windows and closed factories. The higher than average concentration of health problems in this part of town mirrors the conditions of many of its residents. You find many here with stooping bodies, burned out by cancer and respiratory conditions, heart disease and other illnesses that are the results of inhaling too much nicotine and bad air and consuming food high in fat and low in fiber.

The stress of living in what amounts to a racially isolated, crime-ridden wasteland also takes its toll. Many residents have no choice except to settle for substandard housing, unreliable public transportation, limited access to grocery stores and the trauma of hearing gunshots and witnessing occasional fights and other forms of violence. It is a community where Larry Chavis’ mom might be more likely to happen upon a crack house than a store that sells WIC-approved fresh fruits and vegetables essential to the health of her lead-poisoned son.Just as location affects the value of property, it influences wellness. In other words, where people live and how they live matter. Last February, that point was brought into sharp focus with a study from the University of Wisconsin’s Population Institute. The institute ranked the quality of life of communities within states, the first such study of its kind.

Stable St. Charles County ranked at the top. St. Louis, despite its world-class health facilities and providers, ranked at or near the bottom for most indicators, ranging from smoking to STDs. The survey showed that where people live, rather than access to clinical care, can make a big difference in health outcomes, according to Julie Willems Van Dijk, an associate scientist at the University of Wisconsin’s Population Institute.

“St. Louis is a perfect example of what we’re trying to show,” she says. “You have very good access to care and pretty good quality of care for those who get the care. But that alone is not enough to produce good health. It’s not just having a doctor. We’re saying it’s all of those factors working together to determine health outcomes.”

More.

Black Carbon a Major Force in Climate Change

From: The New York Times:

The tiny black particles released into the atmosphere by burning fuels are far more powerful agents of global warming than had previously been estimated, some of the world’s most prominent atmospheric scientists reported in a study issued on Tuesday.

These particles, which are known as black carbon and are the major component of soot, are the second most important contributor to global warming, behind only carbon dioxide, wrote the 31 authors of the study, published online by The Journal of Geophysical Research-Atmospheres.

The new estimate of black carbon’s heat-trapping power is about double the one made in the last major report by the United Nations’ Intergovernmental Panel on Climate Change, in 2007. And the researchers said that if indirect warming effects of the particles are factored in, they may be trapping heat at almost three times the previously estimated rate.

The new calculation adds urgency to efforts to curb the production of black carbon, which is released primarily by diesel engines in the industrialized world and by primitive cook stoves and kerosene lamps in poorer nations. Natural phenomena like forest fires also produce it.

Read entire article here.

“Phthalates: Are They Safe?” 60 Minutes on CBS – Shanna H Swan

Vodpod videos no longer available.

“Phthalates: Are They Safe?” 60 Minutes on CBS …, posted with vodpod

Erin Clayton on BPA’s Effect on Immune Syste

Erin Clayton at the University of Michigan’s School of Public Health wasrecently interviewed about her leading-edge research on the effect of BPA and other chemicals on people’s immune systems.

You can link to the podcast here.

The CHAMACOS Study

Professor Brenda Eskenazi discusses the “Environmental Chemical Influences on Neurobehavioral Development of Children: The CHAMACOS Study.”

Battling Drug Resistance

From Harvard Gazette:

In 2002, a new kind of bacterial infection was detected in the United States. It was caused by a common bug, Staphylococcus aureus, but with a troubling new twist. It was resistant to the drug that typically offered the last line of treatment, when other remedies failed.

The appearance of vancomycin-resistant Staphylococcus aureus, dubbed VRSA, sent shock waves through the medical and public health communities. For years, vancomycin was the physicians’ ace in the hole, used to treat infections that didn’t respond to other drugs, in particular methicillin-resistant Staphylococcus aureus, known as MRSA.

In 2009, Harvard scientists teamed up to tackle the challenge posed by growing antibiotic resistance, creating a program bringing together researchers to examine the problem of antibiotic resistance, with a specific focus on VRSA, MRSA, and vancomycin-resistant enterococcus, or VRE.

Michael Gilmore, who organized the Harvard-wide Program on Antibiotic Resistance and whose lab in May announced it had decoded the genome of the 12 known VRSA strains in the United States, said the group is taking a diversified approach to meet the challenge of antibiotic resistance.

The group has seven main investigators who communicate and meet regularly, sharing notes and brainstorming fresh approaches to combat antibiotic-resistant bacteria.

Members of the group include Gilmore, the Sir William Osler Professor of Ophthalmology at Harvard Medical School (HMS) and Harvard-affiliated Massachusetts Eye and Ear Infirmary; Richard Losick, the Maria Moors Cabot Professor of Biology in the Faculty of Arts and Sciences (FAS); Fred Ausubel, professor of genetics at HMS and Harvard-affiliated Massachusetts General Hospital (MGH); Eleftherios Mylonakis, formerly at MGH and now contributing from Brown University; Suzanne Walker, professor of microbiology and immunobiology at HMS and an affiliate of the FAS Department of Chemistry and Chemical Biology; Roberto Kolter, professor of microbiology and immunobiology at HMS; and David Hooper, professor of medicine at HMS and MGH.

Of the three bacteria types the group is studying, MRSA is the most widespread, making up 30 percent of bacterial infections contracted outside of hospitals. It is deadly, having killed 18,000 per year since 2005, and is resistant to all of the commonly used antibiotics, including penicillin, amoxicillin, and methicillin. Vancomycin is typically reserved to fight MRSA and has to be carefully administered in a hospital, Gilmore said.

One difficulty in fighting antibiotic resistance is that the pace of new drug discovery has slowed, and so new drugs to which bacteria could not yet be resistant are few, Gilmore said. Antibiotics are often isolated from new strains of bacteria taken from the environment. The problem, Gilmore said, is that pharmaceutical companies have already scoured the easily accessible locations and are now extending into extreme environments in search of novel compounds.

These compounds are often the result of the chemical warfare that bacteria wage on each other. But only about 1 percent of bacteria found in the wild can be grown in the lab, Gilmore said, making the other 99 percent too difficult to use as sources of new medicines. Though efforts are under way to create strains that can live in the lab — or to transplant their DNA into bacteria like E. coli that grow readily in laboratory conditions — the process remains slow and difficult, Gilmore said.

The problems in dealing with drug-resistant bacterial strains aren’t just biological, however. Economics also comes into play, Gilmore said.

Drug companies have slowed their own research into new antibiotics because it is more economical to focus efforts on drugs for long-term conditions, Gilmore said. Compared with statins, used for a lifetime by patients to control high cholesterol, a new antibiotic makes less economic sense. Such a drug has similar development costs but will be used just for a few weeks until a patient is cured. A replacement for last-line drugs like VRSA, used only in the most intractable cases, would bring in even less money.

That’s why, Gilmore said, it’s important that academic scientists do a lot of the groundwork and initial discovery no longer being done by pharmaceutical companies.

For Losick, that means collaborating with Kolter in working on biofilms to find new ways to fight a physical structure that appears to protect the bacteria from antibiotics. When bacteria form biofilms, Losick said, they become more resistant to antibiotics, so research into how to prevent biofilms from forming or how to disperse them can provide an alternative way to fight bacteria. Today, Losick said, if a biofilm forms on an implant, like a hip replacement, there are few good ways to fight it, and the implant often has to come out.

“Staphylococcus aureus is an important public health threat. The idea is to develop fresh strategies for controlling it,” Losick said. “I think we all feel very pleased on how the program is progressing.”

Yale’s John Wargo on Environmental Toxins

John Wargo is a Professor of Risk Analysis, Environmental Policy, and Political Science, and Chair of the Yale College Environmental Studies Major and Program. He has been a professor at Yale since 1985 and has lectured extensively on the limits and potential of environmental law, with a focus on human health.

His latest book, Green Intelligence Creating Environments that Protect Human Health, winner of several prestigious awards, compares the history of five environmental threats to children’s health over the twentieth century: nuclear weapons testing, pesticides, hazardous sites, vehicle particulate emissions, and hormonally active ingredients in plastics.  Below is a video of  the introductory portion of a public-radio interview he gave about the book.

From wnycradio:

Yale University professor John Wargo discusses the impact of chemical exposures on women and children, and how, although people are growing more environmentally aware, there are still more than 80,000 synthetic compounds whose effects on human health havent been sufficiently studied. In his book, Green Intelligence: Creating Environments that Protect Human Health, he explains our misunderstanding of everyday chemical hazards and offers a plan for improving our awareness.

Listen to the entire interview here.

Click here to listen to John Wargo interviewed on NPR’s Living on Earth.