Abstract
The Environmental Protection Agency measures the success or failure of Superfund site remediation efforts against remedial action objectives (RAOs).
RAOs are frequently based on environmental contaminant concentrations, but with lead exposure, blood lead levels from the population at risk are often used. Although childhood lead screening is an important public health tool, an RAO based on child blood lead levels raises ethical concerns: public health efforts that are more reactive than preventive, a blood lead standard (10 μg/dL) that may not be fully protective, the use of a measure whose validity and reliability may be easily compromised, and exacerbation of environmental injustice and systematic disadvantages.
The example of Bunker Hill mine, Kellogg, Idaho, allowed an examination of these ethical concerns.
EFFORTS TO CLEAN UP CON-taminated mine sites present a number of ethical and policy challenges. Defining remediation objectives and selecting and implementing the methods needed to achieve them require careful consideration of immediate and long-term health risks, long-standing social and environmental injustices, resource constraints, and political pressures. Although efforts to deal with actively producing mines are subject to many of the same problems, this discussion focuses on issues arising from the remediation of abandoned mines.
The Environmental Protection Agency (EPA) measures the success or failure of remediation efforts at Superfund mine sites against a set of remedial action objectives (RAOs), which might include, for example, soil, house dust, and surface water and drinking water lead contaminant levels. In the case of the Bunker Hill mine examined in this study, an RAO was set for blood lead levels in children. In 1991, when the initial Bunker Hill Record of Decision (ROD) was developed, the US Centers for Disease Control and Prevention (CDC) 1985 health advisory for child blood lead was in effect; the limit was set at 25 micrograms per deciliter. However, the EPA acted on research indicating adverse health effects at lower lead levels, defining the RAO at 10–15 micrograms per deciliter.
Still, as discussed in the following, even these levels cannot be considered protective of child health and must be lowered if they are to be used as an RAO. Although blood lead screening for children is an important public health tool, its use as an RAO may be ethically problematic. In addition to setting a blood lead level that continues to allow harmful exposures to occur in a vulnerable population, such an RAO may lead to public health efforts that are more reactive than preventive, the use of a measure whose validity and reliability may be easily compromised, and exacerbation of environmental injustice and systematic disadvantages.
The concept of systematic disadvantage is particularly important in understanding what is ethically problematic about the use of child blood lead levels as an RAO in the remediation of contaminated mine sites. Powers and Faden used the term systematic disadvantage to describe those situations in which “inequalities beget inequalities,” resulting in “systematic patterns of disadvantage that profoundly and pervasively undermine the prospects for well-being.”1 Because remediation efforts in mining communities often occur against a background of poverty, low educational achievement, and poor health outcomes, the risks associated with exposure to contaminants are amplified by inequalities in the social context. As discussed in the following, an RAO based on child blood levels may further increase these risks.
This study examined the Bunker Hill Superfund Site in Kellogg, Idaho. In 1983, several investigations by the CDC and others highlighted the high blood lead levels among children living near the former Bunker Hill lead mine and smelter.2 This led the EPA to place the mine on the National Priorities List and to classify it as a Superfund site.2 Remediation has been ongoing since that time. The Bunker Hill case provides an opportunity to examine ethically problematic aspects associated with the use of child blood lead levels as an RAO.
BLOOD LEAD SCREENING AND REMEDIAL ACTION OBJECTIVES
In the Superfund site clean-up process, RAOs are set in the process of the ROD; they are used as criteria to determine when the site has been satisfactorily remediated. Generally, environmental criteria, such as soil, dust, and water contaminant levels, are selected as RAOs and can be used to set remediation priorities. For example, more heavily contaminated areas or areas where children are more likely to be exposed receive higher priority. The use of child blood lead levels as an RAO—an endpoint strongly associated with actual exposure and adverse health outcomes rather than potential exposure—is altogether different and raises a number of ethical issues, including the ways in which the guideline is defined, implemented, and monitored. This will be discussed in more detail in the context of the Bunker Hill case study.
Health authorities consider blood lead screening critical for identifying children at risk for lead exposure and initiating early intervention, namely, mitigation of exposure sources and provision of remedial education and resources to reduce long-term neurocognitive deficits.3,4 Chelation therapy is recommended to lower blood lead levels in children who have been acutely exposed (greater than 45 μg/dL) to reduce further harm to their health. However, chelation has not been shown to reverse adverse effects for children exposed at lower levels.5–8 Preventing lead exposure is therefore critical for ensuring the protection of child health. Insofar as the EPA is committed to environmental justice, the agency requires that no group should bear a disproportionate share of negative environmental consequences.9
Current CDC guidelines hold that to protect child health, blood lead levels should not exceed 10 micrograms per deciliter. However, more recent studies reported adverse effects in children at much lower levels.10 Children with blood lead levels greater than 1.5 micrograms per deciliter were more than 8 times as likely to be diagnosed with conduct disorder compared with children with blood lead levels less than 0.7 micrograms per deciliter.11 Prenatal and early life exposure to lead were associated with the potential for increased risks of adolescent neurobehavioral and mental disorders (e.g., conduct disorder,11 attention deficit and hyperactivity disorder,12 schizophrenia13,14), persistent decrements in school performance and tests of cognitive ability,15–17 and increased odds of violent behavior and criminal arrests.18–21 This research called attention to the fact that the effects of lead exposure extend beyond previously assessed biological effects.
Moreover, the neurocognitive and behavioral effects of lead persist in impacted children, resulting in life-long repercussions. Child development studies documented that early life difficulties in school continue throughout the exposed individual's life time.22 It was shown that among exposed children, early childhood blood lead levels as low as 2 micrograms per deciliter negatively impacted future school grades.23 Because academic success is a predictor of improved health, social, and economic outcomes later in life,24,25 disproportionate exposure to lead experienced by long-term residents of contaminated mining communities might compromise the ability of community members to lead healthy, full lives.
Given the evidence supporting the adverse effects of lead at levels much lower than the current 10 micrograms per deciliter guideline and the lack of effective medical treatment of children who are exposed at these levels, preventing adverse health and social outcomes requires reducing exposure to lead (measures supported by CDC). Although screening blood lead levels is an appropriate public health tool, using children to measure progress in reducing or preventing this exposure—the proverbial “canaries in the coal mine”—is ethically problematic as the children have already been exposed to harmful levels of lead.
Although it is recognized that complete removal of lead is not practical or feasible, especially in mining contexts, the Bunker Hill case study illustrated the adverse health and social consequences that arose as a result of using child blood levels as an RAO.
BUNKER HILL CASE STUDY
The Bunker Hill mining site is located adjacent to the northern Idaho community of Kellogg, a region with a long and rich mining history.26 Lead mining began in 1884, with the addition of a smelter that operated from 1917 to 1981.26 At its peak, Bunker Hill was the largest lead smelter in the United States. The owners of the mine declared bankruptcy in 1981, leaving behind a toxic legacy of unattended mine waste and residual metal contamination. The work force was laid off without severance pay, and the company subsequently defaulted on the pension fund, severely impacting the community economy and morale.
The mine's damage to the health of the surrounding community was most apparent in the high blood lead levels of children living in Kellogg. In 1976, 78% of Kellogg children screened had blood lead levels greater than 40 micrograms per deciliter,27,28 which, at the time, was the guideline below which exposure was considered safe. Among children living within 1.6 kilometers of the smelter, 99% of those screened had blood lead levels greater than 40 micrograms per deciliter.29 These levels decreased when the mine stopped production but remained high. In 1983, the Agency for Toxic Substances and Disease Registry conducted a survey that showed 19% of Kellogg children had blood lead levels greater than 30 micrograms per deciliter (the revised US guidance level at that time).30
When the Bunker Hill mine was first declared a Superfund site, there was a concerted effort by the EPA and Idaho Health Department to promote and support blood lead screening for children in Kellogg. The Lead Health Intervention Program was initiated in 1985 by Panhandle Health to increase lead screening in the area by offering free blood lead testing for children up to the age of 9 years, $20 incentives for testing, and door-to-door solicitation for child blood lead testing.31
The 1991 ROD for the Bunker Hill mine defined the EPA RAOs for child blood lead levels and stipulated the following criteria measures: (1) less than 5% of tested children should have blood lead levels greater than 10 micrograms per deciliter and (2) less than 1% of tested children should have blood lead levels greater than 15 micrograms per deciliter.2 Given the adverse health outcomes associated with these levels of lead exposure, it is ethically problematic that the RAO accepts a certain percentage of children over guideline recommendations when declaring the site remediated. Further, as previously discussed, increasing evidence indicates that blood lead levels well below 10 micrograms per deciliter are harmful and should be monitored and reported as discrete values rather than being written off as below the threshold of concern.
Screening inadequate numbers of children also compromised the validity and reliability of child blood lead levels as an RAO. Blood lead screening in Kellogg has declined; 195 children aged 0–9 years were tested in 200232 compared with only 8 tested in 2007 (in 2000, the US Census Bureau reported that there were 164 children in Kellogg younger than 5 years).33 In 2003, of 8 children tested by Panhandle Health, 2 had blood lead levels greater than 10 micrograms per deciliter.31 Such a small sample cannot accurately reflect population exposures; determining whether the RAO has been met requires a larger and more representative sample. Given the long term and widespread exposure to lead in Kellogg, the insufficient numbers of children screened highlights the inadequacy of current monitoring efforts to generate sufficient data to make scientifically and ethically sound decisions about the effectiveness of the remediation efforts.34
In 2000, the average child blood lead levels in Kellogg dropped below the guideline criterion of 10 micrograms per deciliter blood lead, but the levels remained significantly above the national average. The average blood lead level for children aged 0–9 years in Kellogg was 3.2 micrograms per deciliter.32 It should be noted that children younger than 5 years generally have a higher risk for lead exposure. The 6–9-year-old children in the Kellogg sample might have resulted in an artificially low average, masking the extent and severity of the risks to that population.
Moreover, infrequent blood lead screening is ineffective for capturing the full extent of intermittent or seasonal lead exposures because the measure only provides a 30-day window on exposure time. It was common practice in Kellogg to screen children during their peak lead exposure, in late summer when they were playing outdoors and exposed to blowing dust or contaminated soils. It was recommended that children with elevated blood lead levels be retested in a few months time. However, this would give a false representation of decreased blood lead levels because it would be taken at a time when children's outdoor activities, and consequently their exposures, would be lower. This decrease would not reflect improvements in contaminant levels, but rather the seasonal differences of child behavior and the snow cover over the contaminants. Without consistent follow up at times of peak lead exposure annually, it is difficult to rely on the data for decision-making purposes.
The EPA considered the RAO for child blood lead levels as met in 2002, and the community was informed that blood lead levels were in an acceptable range.31 Given the subsequent low screening rates, it was unethical to interpret ongoing monitoring results as indicative of actual lower exposure levels. The EPA's decision, not supported by valid and reliable data, conveyed an unfounded message that the site was sufficiently remediated and that children had an acceptable environment in which to reside. These actions had the unfortunate result of damaging relationships with community members, whose trust and cooperation is essential to any successful assessment and remediation effort.35
In the case of communities negatively impacted by mining operations, fair treatment requires that the community be actively engaged in decisions regarding remediation and afforded adequate protection from contaminant exposures. Unfortunately, this did not occur in the Bunker Hill case. Although there was a 9 member Silver Valley Task force appointed in 1987 to act as a liaison between the EPA and the community, it generally only provided information in the form of fact sheets and public information sessions rather than soliciting input from the community. The Citizen's Coordinating Council (CCC) was established in 2002 as part of the Basin Environmental Improvement Project Commission (BEIPC). Originally 50–60 community members participated on the CCC; however, low attendance was consistently reported in minutes since then with only 10 participants (including EPA, BEIPC, and other government staff) listed in the latest minutes available from October 2010.36 Although there are a range of reasons for low participation rates, this lack of adequate community engagement in decision making might have resulted in outcomes that failed to reflect community interests and priorities, including the use and inadequate monitoring of child blood lead levels as an RAO.
SOCIAL AND ENVIRONMENTAL JUSTICE CONCERNS
The public health objectives in contaminated site remediation are to research and determine the practicality and feasibility of carrying out remedial work to reduce, limit, or eliminate exposures harmful to the public.37 Identifying exposure sources and practical means for remediation interventions can be challenging in complex and massive sites such as Bunker Hill. Current sources of lead pollution in Kellogg are a combination of long-term deposition from smelter emissions, blowing dust from mine waste (tailings), periodic flooding of contaminated river sediments into the town, and contaminated soils washing down from the mountain.38–43
The use of other RAOs (e.g., soil, dust, or water lead levels) in conjunction with blood lead levels present additional ethical concerns. In 1986, selected contaminated areas of Kellogg (e.g., city parks, school playgrounds) were remediated by soil removal and replacement to achieve RAO defined soil levels of 1000 milligrams lead per kilogram.44 This RAO has not been revised, although it is a level more than double the EPA soil standards for play areas set in 2001 (400 mg/kg) as a revision to the US Toxic Substances and Control Act (Section 403). In addition to raising concerns about environmental injustice, this RAO violates the EPA's own requirement that there should be no disproportionate burden of exposure9; by its very definition, it considers higher levels of lead exposure acceptable. In 1999, the soil lead concentrations of Kellogg yards ranged from 20 to 126,000 milligrams per kilogram with a geometric mean of 220 milligrams per kilogram.45 The geometric mean lead level in house dust in 1999 was 600 milligrams per kilogram (maximum 26,780 mg/kg).45 Exposure to 1000 milligrams per kilogram of lead in house dust was estimated to cause a 0.2–7.2 micrograms per deciliter increase in blood lead levels.46 Although remediation efforts were extensive, lead levels remain high in Kellogg. A 2007 study comparing Kellogg to 5 demographically similar nonmining towns in northern Idaho found that the nonmining towns had significantly lower soil and house dust lead levels than Kellogg.47
The Kellogg exposure scenario resulted in an unjust distribution of environmental hazards, exacerbating problems of systematic disadvantage. In Kellogg, patterns of systematic disadvantage are evident in the low educational achievement, poverty, poor health outcomes, generations of inequitable power distribution, social disruption. and lack of respect for community well-being. The Community Health Status Indicators database, which provides reports on summary health status measures for Shoshone County, which includes Kellogg and other communities in relatively close proximity to the Superfund site, illustrated these disparities. Compared with the 2005 US national mean, residents of Shoshone County had a lower average life expectancy (75 vs 76.5 years), higher all-cause mortality (1000 per 100 000 vs 900 per 100 000), higher adult self-reported poor or fair health (23% vs 16%), and a higher number of unhealthy days in the past month (7.6 vs 6 days).48 Rates of death were higher for breast cancer, coronary heart disease, lung cancer, motor vehicle accidents, stroke, and suicide compared with the US median.48 Given these statistics, and the high prevalence of residents who were unemployed or work disabled, lacked a high school diploma, experienced major depression, or had a history of recent drug use, the residents of Kellogg would be considered a vulnerable population.48 Widespread exposure to lead would have more of an adverse impact on the health of Kellogg residents compared with a community that was not plagued by poverty, low educational achievement, and a background of poor health outcomes.
Although these patterns of systematic disadvantage are not attributable to lead alone, lead exposure is an important contributing factor, and the health profile for Kellogg is consistent with the effects of lead. Exposure to lead is associated with adverse health, cognitive, and sociobehavioral outcomes, and these, in turn, adversely influence educational, economic, and social outcomes. Emblematic of these systematic disadvantages and their effect on personal well-being is the use of the term “leaded” by Kellogg residents to describe their experiences (e.g., difficulties with cognitive ability, mental health, memory).35 This term reflects the stigma felt by Kellogg residents, who are aware of their marginalized status on both individual and community levels.35
Strides have been made in cleaning up the Bunker Hill Superfund site to reduce harm to Kellogg residents, but widespread social and environmental injustices, including disproportionate exposure to lead and poor health outcomes, persist. Some might argue that the current state of remediation is sufficient, given what the exposure conditions in Kellogg would have been in absence of the remediation efforts. Although contaminant levels have been reduced as a result of the EPA's remediation efforts, it is not clear whether there has been a corresponding improvement in community health and well-being. Thus, for the residents of Kellogg, the prospects for living a healthy, full life remain poor.
These results, or the lack thereof, are not entirely unexpected. RAOs are blunt tools that lack the capacity to address long-standing social and environmental injustices. Even when direct health indicators, such as blood lead levels, are used, RAOs fail to reflect a broader sense of individual well-being and community health. A reduction in childhood lead levels, although important, does not rectify the broader adverse health and socioeconomic impacts of the mining site. Focusing on such discrete measures as RAOs, particularly ones that are as ethically problematic as child blood lead levels, conveys a false sense of improvement; lower child lead levels do not automatically result in a reduction in poverty or improved educational or social outcomes. Preventing lead exposure is necessary but not sufficient for addressing social and environmental injustices.
LOOKING AHEAD TO WHAT MUST BE DONE
The use of child blood lead levels as an RAO in the clean-up of Bunker Hill Superfund site remains ethically problematic and failed to protect the health of the community, particularly those who are most vulnerable—children. First, the use of child blood lead levels as an RAO promotes reactive rather than preventive public health responses; only after children are found to have unacceptable, biologically internalized levels of lead is action taken. In the case of lead, preventing exposure is the only method known to be effective in reducing the risk of adverse health outcomes. Second, the RAO guideline of 10 micrograms per deciliter blood lead level is still too high to ensure that children are sufficiently protected. In addition, the RAOs for soil lead levels have also not been revised to reflect either current knowledge of health effects nor changes to regulatory requirements in 2001. Third, the sample size of recent lead screening in Kellogg has been too low to be a valid and reliable measure of community exposures or useful as a monitoring tool for decision making.
Current environmental contaminant status indicators show that Kellogg residents continue to be disproportionately exposed to lead compared with nonmining communities. However, under the current RAO for soil lead levels, this is deemed acceptable, although the standard permits levels of exposure more than double those employed elsewhere. Yet the lack of adequate testing and monitoring prevents an accurate assessment of the situation. If blood lead levels are higher among Kellogg children, the current lack of public health action allows lead exposure and adverse effects to continue unabated, perpetuating environmental injustices and exacerbating systematic disadvantages.
In the case of the Bunker Hill Superfund Site, the use of child blood levels as an RAO should be reconsidered. Blood lead screening was primarily used as a reactive rather than preventive tool; despite the continued presence of lead contamination, child blood level screening has drastically declined.
Furthermore, the use of child blood lead levels as an RAO cannot capture the broader dimensions of health and well-being that should be taken into account in remediation efforts. To this end, it should be argued that remediation efforts should not only focus on harm reduction but also contribute to efforts to ameliorate environmental and social injustices. Securing a healthy future for the residents of contaminated mine sites, such as Kellogg, requires more than just reducing child blood lead levels; it requires attention to the complex set of factors underlying the pattern of systematic disadvantages that compromise the health and well-being of a postproduction mining community. Future assessments of remediation programs should define quality of life indicators to track progress made in the social health of the community in addition to reduced contamination exposures. Insofar as the EPA is committed to environmental justice, as stated in their 1998 guidance document for incorporating environmental justice concerns in EPA's National Environmental Policy Act (NEPA) compliance analysis,9 Superfund site remediation should be situated in a broader social context. Meeting these challenges requires resources and institutional support beyond the Superfund mandate, and government agencies must work in concert to see that the environmental and social injustices are adequately addressed.
Human Participant Protection
Institutional review board approval was not required for this analysis as there was no contact with human subjects for the ethics paper. However the authors did have IRB approval to investigate blood lead screening in Kellogg, Idaho, and this paper resulted from that research.
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