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Protocol and Recommendations for the Belledune Area Health Study

 

April 26, 2004

Protocol for Health Study Assessment
 Belledune and Area
Presentation by Brenda Kelley of BSD and BDSD
 
To The Minister of Health and Wellness and Goss Gilroy Consulting,
Please accept this notification and presentation from Belledune Sustainable Development and Bathurst Sustainable Development that we are requestingto participate in the development of the Terms of Reference, all meetings, allowed to have appropriate time and funds for peer review and comments for all stages of the Belledune and Area Health Assessment and to sit on the new Community Health Assessment Steering Committee that we hope will be formed with the cooperation and participation of our two groups, you and other citizens.

The purpose of the community-wide human health assessment/ study we feel should be, to provided a comprehensive assessment of the current health conditions of and life time exposure impacts on the individual citizens living within the study area which is and has been the area that receives the peek exposure to heavy metals and industrial pollutants for the past 40 year and to determine how their health conditions may be related to their life time exposure to these environmental contaminants.
 
In order to obtain a true representation of the facts of the existing health status and impacts on the citizens in the study area, this health study cannot be rushed, it must be provided the necessary time, in-depth assessments and funding required for each stage.

The results would then be assessed for their levels of risk to human health and disease, with a particular focus on adverse reproductive outcomes, cancer incidence, fetal exposure, childhood illnesses, asthma rates, developmental delays, thyroid diseases, industrial disease and documented symptoms of exposure to elevated levels of lead, cadmium, zinc and arsenic which are the main CoC (Chemicals of concern).

It can be a challenge to generalize the findings from such studies to current  residents for several reasons. First, the sample size of many similar studies is fairly small and, therefore, may provide limited power to detect associations between CoC exposure and the occurrence of disease. Second, the design of these studies has often precluded an evaluation of cause and effect relationships. Third, retrospective determination of CoC exposures is difficult. Fourth, and perhaps most important, the studies conducted to date have focused on either obtaining suitable measures of CoC exposure, or disease, but not both. Because of these challenges, the current study we are considering must be very well designed.

Two occupational Health Studies conducted in the past , one by Mazerolle in the early 1970’s and one by Dr. Marchon in 1990 both identified major health impacts from elevated exposure to lead, zinc, cadmium and arsenic in the workers in the Belledune smelter. However, to the best of our knowledge, no such in-depth health study of the impact of these chemicals of concern on the residential citizens and children in the area has been done for at least 15 years. The March 2003, New Brunswick Epidemiological Report raises a “red flag”  to support the need for further investigation of the health of the people in the area.  

The following documents also support the need to study the “life time” and current exposure to heavy metals on the people living in the study area:
 
 
1966                 NB Department of Agriculture: Belledune Soil Sampling Program
1975                 Brunswick Smelting: Belledune Soil Sampling Program
1984                 An Assessment of Environmental Quality in the Baie Des Chaleurs:
                                   Surveillance Report EPS: Lawrence Hildebrand
1986                 Ecobichon & Hicks- Heavy Metal Content in Food, Belledune
1989                 EIA Belledune Thermal Generating Station
1995                 Lead, Cadmium, Arsenic and Zinc- Belledune Smelter
2000                 Ray Cranston, Metal Accumulation in Sediments in Belledune
2002                 TOXIC Contamination in Soil in Belledune- CCNB
2002                 Toxic Contaminates in Soil in Belledune
2003                 NB Epidemiological Report Vol. 11, No.1
2003                 Table 1- Summary of lead, arsenic in soils, CCNB
2003                 Lead, Zinc, Arsenic in Belledune, Jacquet River, Point Verte, Petit Rocher
2003                 Dr. Harrold Hoffman- Comments on Soil Sampling Results
2003                 Lead and Arsenic in School Yards, ballfields, CCNB
 
Port Colborne Community Health Assessment
We are familiar with the problems encountered in Port Colborne, in 2001, in trying to conduct a health assessment,  when the Department of Health, attempted to get public support to conduct a health study, in which it was proposed to reach conclusions on biological testing conducted in the winter months, when peek exposure levels are at their lowest instead of recommending to do the testing during the summer months when the exposure is at its peek and more appropriate for addressing long term exposure to peek levels of exposure to heavy metals and chemicals of concern. The idea of doing biological testing first and the proposed timing of the sampling were rejected by the citizens. Our presentation to you to today is an attempt to provide the necessary protocols for our study so that it is accepted and supported by the population and thus can both move forward and be successful in its purpose.

We have made ourselves familiar with the new and current being conducted Community Health Assessment Project, being conducted in Port Colborne, which is a comprehensive clinical study. The study is being conducted by Ventana and partially funded by the nickel smelter in that community owned and operated by Inco.  We have introduced ourselves and been in contact with Dr. Harrold Hoffman, who is assisting with the Port Colborne assessment and who has reviewed and commented for us on the soil sampling results taken this past fall by the Conservation Council of NB, in this area. Dr. Hoffman is an associate of Dr. Irena Buka, who specialize in Pediatric Health and has also participated by providing technical expertise to the Port Colborne health assessment. We are pleased with the methodologies being used in that study, support and respect them, and wish to have them used as the model for our health assessment. We believe that with our support and participation, the citizens of this region will also support a health study conducted in this credible manner.
In Port Colborne, they began phase one of the health assessment by collecting and evaluating the data from four main sources:


Phase 1 Health Assessment
  • A Comprehensive Health Questionnaire/Survey- Port Colborne used an excellent in-depth questionnaire sent to each home. We have obtained a copy of the Adult, Child and Adolescent questionnaire used in the Port Colborne assessment which was publicly distributed to the 18,000 health study participants.  Since Bathurst Sustainable Development sits on the National Mining Committee of the Mining Association of Canada-TSM Committee,  along with Peter Jones, from Inco and Elizabeth Mae of the Sierra Club of Canada., and since we know well the community group in Port Colborne,  Chaired by Dianna Wiggins, who is  involved in the study, and since Inco is financially supporting the Port Colborne health study, I feel very confident that both Inco and Ventana will agree to allow us to use the same questionnaires here as well as the hospital discharge form for our study. Port Colborne had close to a 50% return on the survey- that is significant and an excellent participation rate. Their survey was completed last spring- 2003- and the data was released to Ventana and a report is pending within a few weeks. If you have the full support of both Sustainable Development groups and our 24 Directors, and if we together with you, agree to the full participation of our groups in this assessment using our recommended methodologies, then we are on the right track to conducting a valid study which will be accepted by the local population involved. If this agreement becomes the case, then we are willing to send a letter of support to all households in the study area notifying them of our complete support and asking them to fully participate in the study.  The results of the questionnaire will identify if there are any symptoms or diagnosed disease levels of concern that raise a “red flag”. The benefit of the survey is that it gives you the history of symptoms of the years of exposure. The questionnaires are designed in two categories- Adults and Child/Adolescent. Each member of each household in the study area fills in their appropriate questionnaire for their age range.
 
  • A Hospital Discharge Study- We have obtained a copy of this study form that they used in Port Colborne. Statistics Canada breaks the Census reports down into blocks of approximately 2000 population or less. Since our study area overlaps the NB Health Regions of both Region 5 and 6, we will need to access the Census blocks to break out the hospital discharge rates to the specific study area for our assessment.

  • The Epidemiological Report: As with the Hospital Discharge Rates, we will again need to access existing available Provincial data. We have a copy of the 2003 reports here. You will however, need to use the census block of 2000 population or less area to assess the data from our study area. This will allow us to break up Belledune into more distinct areas such as Upper, Central and Lower Belledune. The same can be done with Pointe Verte.
     
  • Cancer Rate Study- Cancer Care Ontario and the Government of Canada have cancer stats that can be used and related to the census blocks.

  • Comparison to Other Communities without Industrial Exposure: The previous four sets of data will allow us to compare our study area to several areas with similar populations and demographics, but areas without exposure to any industrial chemicals and pollutants- for example, a rural community in the Annapolis Valley, would make an excellent comparison area. If the comparison communities have the same number of cases of symptoms, hospital discharge rates for example, then we will know for sure that it is not the industries and chemicals being released causing the high levels and incidents of these items in our study area. If these communities have much lower incidences of diseases, hospital discharge rates etc… then we can conclude that the industries may be negatively contributing to the heath of the citizens living within our study area.
     
  • Child Development School Records should be used to assess developmental delays.
  • With these four assessment tools, the Questionnaire, the Hospital Discharge Rates the Cancer Rate Study and the Epidemiological Reports, we will be able to see if any of the compiled information triggers “red flags” such as high numbers of specific symptoms, diseases, incidents of cancer, and chemicals of concern. If we do identify a red flag, or flags,  then, we have the baseline information and supporting facts to warrant conducting the next level of assessment;
Phase II
The Biological Control Case Studies
The Biological Control Case Studies would be conducted only if the first phase of the study results in “red flags” of concern being identified. These studies would involve selecting citizens from the surveys for control case studies, and sampling their biology over several months- blood and urine analysis, recording symptoms and hair analysis. These must be done from late spring to early fall, which are the peek exposure months. It would not be acceptable to do the biological control sampling in the winter months. Biological results can have significant fluctuations, in their readings particularly in children, but this is where the questionnaire/survey comes in – the survey gives the symptoms over the years of exposure and the biological study gives you the exposure currently through inhalation, absorption and uptake through the food chain from locally grown and ingested agricultural products and home gardens.

If you have a lot of children, for example, in the survey, with attention deficit disorder- you then do a properly designed case control study where you conduct biological sampling of those children over a number of times over a few months. A single sample data point tells you nothing- if you released a study of that type and tried to get it published by saying you tested the group of children on a single given day, the scientific peer reviewers would never publish it. If the biological sampling is warranted it must be done over several peek exposure months with several samples taken in order to obtain credible data.  

As described by the environmental justice movement, communities exposed to
environmental contamination are asserting themselves in the process of recognition and management of the environmental hazard (Elliott et al, 1999). This focus on both process and outcome requires risk assessments that are acceptable to both the ‘scientific’ and ‘lay’ communities (Kraus et al, 1992).

Community Health Study Steering Committee
To facilitate this process, we wish to see a Community Health Study Steering Committee formed, which would include one representative from Bathurst Sustainable Development, two from Belledune Sustainable Development, one from the NB Department of Health and Wellness,  a representative from Health Canada (who has a background in COPC hazard quotients (HQ) and intakes), a rep fro the NBDLG,  the consultant responsible for conducting the study, a medical practitioner who is a specialist in pediatrics or children’s exposure to toxins,  or an agreed upon alternate field, two additional citizen committee members with various backgrounds, a medical/ representative from Point Vert or Petit Rocher, and a local farmer.

There is a radius of 6- 9 klm around the industrial area of Belledune, where we know levels of arsenic and lead are elevated, we must focus our study area on this parameter. A map has been provided.
The Community Health Assessment Steering Committee must allocate, at each interim stage of the health study, budget for third part, independent, expert peer review and consultation should the NGO and local citizen representatives request it. The budget for this peer review is to be agreed upon by the Steering Committee as a whole and the choice of peer reviewer agreed upon by a consensus which is to include the representatives of the committee and must include the agreement of both Bathurst and Belledune Sustainable Development. It is recommended that the local industries be requested to assist in the over all cost of the independent expert peer review of the reports produced by the study.

When public information sessions, public meetings, open houses are being organized, proper and wide spread notification must be given to ensure that citizens are informed. A flyer, letter or handout should be published stating the purpose, date, time, format, location and agenda of the meeting. The notice for this weeks meeting was not adequate to inform the population of the communities of interest.

Lastly, the issue of Jurisdiction must be settled.

Bathurst and Belledune Sustainable Development have as their mandate adopted the United Nations definition of Sustainable Development. Jointly we are members of the Canadian Environmental Network and the NB Environmental Network. Bathurst Sustainable Development is a member of the Southern Gulf of St. Lawrence Coalition on Sustainability, members of Mining Watch Canada, the Green Communities Association, the Partners for Climate Change Program and part of the Sustainable Communities Initiative of Natural Resources Canada. We have many partners on activities throughout the region including the City of Bathurst, Transport Canada, Environment Canada, various conservation groups and the NB Community College Environment, Research and Engineering Departments.

 It is the jurisdiction of Bathurst and Belledune Sustainable Development to address issues pertaining to any substance being emitted or released into the air shed of this region; any substances that are being released into the waters and marine environments and thus draining into and impacting the Bay Chaleur and Southern Gulf of St. Lawrence, any consumption that impacts the quality and quantity of our surface and ground water,  any activity that impacts the quality of life of our citizens and communities and our species and eco systems from the area of Pokeshaw to Seaside and out over the Bay Chaleur.

Bathurst Sustainable is the senior organization of these two groups. We are the supervisors of the Belledune programs and projects; we provide mentorship, support and work hand in hand with the Director’s of Belledune Sustainable Development to foster integrated plans for the betterment of the quality of life and protection of our eco systems in this region. It is within our jurisdiction to be here and to participate in all aspects of this health study.

It is our sincere hope that our recommendations will be implemented and that we can begin to work cooperatively and effectively with you to produce a comprehensive and thorough health assessment based on credible data, supported science and mutual cooperation.
 
Yours sincerely,
Brenda Kelley, on behalf of:
 
Bathurst Sustainable Development                               Belledune Sustainable Development
285 St. Patrick Street                                                    237 Main Street,                                       
Bathurst, New Brunswick                                                Belledune, NB,                                
E2A 1C9                                                                        E8G 2H5                                                                                  
Tel: (506) 548-2106/ Fax: 545-7838                               Tel: (506) 522-2148/ 237-1112
www.bathurstsustainabledevelopment.ca                 Email:  junia@nb.sympatico.ca
Email: rosewood@nbnet.nb.ca                                    Email: bpgordon@nb.sympatico.ca   

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