Society
for EnvironmentalSEGH Newsletters
Archive Issues: June 2007 European Conference | December 2007 | March 2007 | April 2006 (pdf) | September 2004 | November 2003 | June 2003 | November 2002 | August 2002 | December 2001 | June 2001
SEGH MULTITUDE workshop* 4-7th June 2007, Liverpool UKEmerging Findings and Next Steps
The SEGH MULTITUDE workshop held in Liverpool, jointly with the 25th European
meeting of SEGH, provided a forum for around 50 delegates (including public
health doctors, epidemiologists, environmental geochemists, mathematical
geologists, chemists and social scientists) from a wide range of organisations
(academia, consultancy, industry, regulators [national and local], governmental
organisations [Primary Care Trusts, Health Protection Agency, British
Geological Survey, Environment Agency, Scottish Environment Protection
Agency English Partnership] to discuss the gaps in our understanding and
key opportunities for future research. Supported by several keynote review
papers, focussed sessions addressed the five priority themes (below).
Participants in each session, from across environment and human health
(E&HH) disciplines, generated lively discussion and raised a number
of issues in response to directed questions from workshop leaders.
A full discussion of the findings, and how they could be achieved, will
be given several scientific papers in a special issue of journal Environmental
Geochemistry and Health (EG&H). A brief summary of the issues emerging
from these discussions are presented below:
1. Transport and dynamics of toxic pollutants in the natural environment and their effect on human health.
Questions: What are the main drivers supplying toxic pollutants to and controlling transportation within the external environment? How sensitive are they to changing macro and global environmental conditions? What do we need to know more about to improve our understanding of how contaminants in soil, once they arrive at the human receptor, can affect human health?
Issues raised by participants, in response, included the need for research to validate the risk assessment process in the context of changing environmental scenarios and incorporate the impact of climate change on both pollutant dynamics and human behaviour.
The Risk Assessment approach used needs to be more realistic with standardisation of data sets and refined test methods, raising questions about the effects of extreme exposures on assessments and the improvement in pathway delineation for exposure. The opportunity was given to consider the use of models of in vivo transport of toxic substances as part of a tiered strategy for risk assessment. In addition work towards improving our understanding of the impact of indoor versus outdoor exposure, focussing particularly on child (and maternal) health, as well as the elderly, and assessing effect of gender on exposure.
2. Uncertainty in risk assessment, epidemiology and regulation.
Two case studies were used to stimulate discussion and identify; sources
and levels of uncertainty, how uncertainties can be reduced if necessary,
the gaps in understanding, and the new initiative that are required to
fill these gaps.
The first study was a local, individual-level monitoring of lead in soils
and children’s blood at Lavrion, Greece (Fig 1). The second was a large,
semi-individual distance-based exposure assessment study, of birth defects
around landfill sites in the UK. The sources of uncertainty were both
conceptual (‘wrong question’) and analytical (‘wrong answer’) in both
case studies. Types of uncertainty considered ranged from the quantitative
‘statistical’ type, through scenario uncertainty, to identified ignorance
and total ignorance. The levels of uncertainty were generally higher for
the landfill study, but could be reduced to some extent in the scoping
of such studies. Gaps in understanding that were identified, in one or
both studies, included:-
· Data on environmental concentrations (including background levels)
· Processes (chemistry) of release, mobilisation and environmental fate
· Combined and synergistic effects of exposure cocktails
· Mechanisms by which exposures translate into health effects
· Costs/benefits of risks, including burden of disease and economic factors
Some of these gaps can be filled simply by a transfer of knowledge between scientific disciplines, by building multi-disciplinary research teams to tackle these issues, for example. Other gaps will require new research, such as the need to improved statistical method to deal with heterogeneity. A full discussion of the findings, and how they could be achieved, will be given in the scientific paper in EGH.
3. Social, economic and behavioural factors in the genesis and health impact of environmental hazards.
The underlying rationale for this workshop was that social, economic
and behavioural factors are responsible for the creation of environmental
hazards and benefits that, in turn, can affect human health with concomitant
effects on future social well-being
A case study was discussed which centred on the investigations, public
engagement, and partnership work that had been undertaken following the
death of two neighbouring children in Cheshire.
Some aspects of the case were only revealed as workshop delegates delved
deeper and new concerns were raised. Key issues raised during discussion
included;
· Who had decided what to look for and why?
· Should / could every case involve engagement on the scale seen in this
case?
· What would success look like?
· What constitutes a cluster?
Vocabulary needs to be free from jargon and acronyms. Differences between
different disciplines need to be better understood, this will help to
ensure that the way in which a problem is constructed depends less on
who constructs it and in turn will help to address it. The definition
of the ‘community’ is itself far from clear-cut, yet questions of how
to involve this community in intervention processes are important ones.
Similarly, responsibility for environmental damage to health is fraught
with difficulties and may often militates against an informed and open
debate among interested parties.
Some important gaps in our combined understanding of the issues were apparent,
for example; Who decides when a solution to the problem is satisfactory?
How much uncertainty is acceptable?
There is clearly a need for better, more considered forms of communication
with communities and the public if fears are to be allayed. The question
then arises of cost-effectiveness!
4. Strategies for improving health in contaminated situations.
This Workshop session reviewed:
· the success (and failure) of some past strategies in various contaminated
situations at global, international and national levels before considering
a case study of local chromium contamination in Glasgow and the extent
to which measures to alleviate contamination should include direct measurement
of human exposure and health effects and outcomes.
· the public health approach to understanding health in local populations,
including burden of disease and its relationship to deprivation, alleged
clusters of ill health, and biological sampling requirements, as well
as wider considerations of risk assessment, stakeholder analysis and situational
analysis, including their role in the management of incidents.
The session recommended that:
· Research needs to recognise the complexity of issues, different situational
analyses, and the interaction of ecological and social systems with geochemistry
to produce unexpected situations.
· Inclusion of risk perception, assessment, communication and management
is crucial.
· Inclusion of both health impact assessment and environmental impact
assessment is necessary.
· Health, planning, environmental science and regulation need to be integrated
against a background of sustainability.
· With respect to biomarkers, there should be population-level acquisition
of biological data, including generic information sets (baseline, screening,
blood levels, genomics, mapping links with environmental data etc).
· There should be associated research council support of blue sky and
directed, site-specific and generic, modelling and direct measurement,
and planned and unplanned experimental research, with further development
of understanding of established areas as well as of emergent topics.
· Retrospective analysis of environment and health should be undertaken
where possible.
5. The effects of multiple toxic pollutants on health.
The questions posed included
· How do we more fully recognise the extent of the complexities and uncertainties
inherent in studies into the effects of multiple toxic pollutants on health?
· How do we develop truer interdisciplinarity in studies and higher education?
· How do we improve communication across disciplines?
· How do we develop interdisciplinary studies into mixtures?
The issues raised were:
· Mixtures are complex and require more than just a joint approach from
various disciplines: multidisciplinary studies need more integration in
organisation, including steering group meetings that are frequent and
face to face,
· A scenario based approach is needed for easier integration of diverse
sciences
· A suggested scenario could include the following:
o A location where the disease pattern suggests the effect of an airborne
mixture
o Emission data and modelling of spread
o Air concentrations
o House dust and soil concentrations
o Exposure estimations
o Lab based toxicology of identified mixtures, including bioaccessability
experiments [lung and gastro-intestinal]
o Biomonitoring of exposed and unexposed populations
o Genomic studies
o Historical distribution of pollutants in bogs and sediments
o Social science assessment of professional and population attitudes and
perceptions, including risk understanding
o Remediation assessment to including basic and social sciences
· Other considerations in such a scenario would be ethics, statistics
and epidemiology, the extent of stakeholder involvement and the need of
children.
· A joint environment and health leadership would be needed – and such
a leadership mixture would be of interest in itself!
The overall picture is somewhat like a layer cake [the disciplines] with slices and borings being taken through the layers [the multidisciplinary steering group interactions/meetings].
