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Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services Executive Summary In 2005, the National Academies convened an expert committee to conduct a review of the Worker and Public Health Activities Program, which is operated by the Department of Health and Human Services (HHS) at Department of Energy (DOE) nuclear facilities under a Memorandum of Understanding (MOU) with DOE. HHS Agencies participating in the MOU included the National Institute for Occupational Safety and Health (NIOSH) and the National Center for Environmental Health (NCEH), both organizational units of the Centers for Disease Control and Prevention (CDC), as well as the Agency for Toxic Substances and Disease Registry (ATSDR), whose administrator is also the CDC Director. The committee’s task included assessing and recommending ways to enhance the program’s scientific merit, focus, effectiveness, and overall quality; its impact on DOE’s policies and decisions; and other program benefits, including the relevance to DOE’s mission. The committee’s principal conclusions and recommendations are provided in this executive summary; a more detailed summary with findings and recommendations follows. The committee concluded that positive benefits have accrued to DOE by having occupational epidemiological studies performed through NIOSH by investigators outside its direct control. Research performed under the MOU has directly benefited DOE by providing important information to the Comprehensive Epidemiologic Data Resource, by contributing to the understanding of the risks of protracted low-dose radiation exposure for human health, and by providing advice to several of the worker surveillance activities, including the beryllium sensitization screening program. These activities have provided important scien-
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Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services tific support for DOE’s Former Worker Medical Surveillance Program. Although the current method to assess beryllium sensitization in workers needs substantial improvement, the committee concludes that the occupational beryllium studies completed by NIOSH have made a significant contribution to the scientific community in general, as well as to DOE’s understanding of the potential for beryllium exposure, sensitization, and progression of disease. The committee concluded that useful research methodologies were developed in the NIOSH program, and also that the work performed by NIOSH under the MOU has been sound. However, there have been serious and not fully explained delays in executing some studies. NIOSH extramural and intramural programs have not been highly productive in terms of contributions to the peer-reviewed literature. ATSDR has provided DOE-funded products that add value to the program conducted under the MOU and these products are generally of a high quality. The Public Health Assessments (PHAs) and Toxicological Profiles reviewed by the committee generally contribute to enhancing the public’s understanding of the potential risks posed to the surrounding communities by the activities at the DOE sites. However, while ATSDRstates that it embraces conservative assumptions concerning risks to the community, it is the committee’s view that ATSDR’s continued use of a threshold for radiation effects in the PHAs reduces both public trust and acceptance of the information provided. In addition, it should be noted that the committee did not review either the completeness or the scientific validity of the responses by ATSDR to the public comments that were included in the final PHAs reviewed. For many of the DOE facilities, NCEH conducted dose reconstruction studies of historical exposures of the public independent of DOE. NCEH has established a scientifically sound public record of the doses received by members of the communities surrounding these facilities that is of benefit to DOE. The NCEH dose reconstruction methods that have been developed, applied, and refined in the NCEH studies have been accepted widely and are being used in epidemiological studies worldwide. NCEH has made dose reconstruction project findings available on-line via the Radiation Studies Branch web site.1 In some cases, there are links to the studies from the individual DOE facility’s web site, which the committee considers appropriate, since a person seeking information about historical releases from a DOE facility and their potential health effects on the surrounding communities would not necessarily know which organizations would be responsible. The publication of dose reconstruction study findings in the open literature appears to depend on the initiative of the contractors who performed the research. 1 See http://www.cdc.gov/nceh/radiation/. Last accessed August 2006.
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Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services The dissemination of information about health risks to the public and workers from HHS agencies, which are more trusted than DOE, also has been of value in the program. The variety of HHS dissemination efforts benefited target audiences by providing them with information about scientific studies and health risk concerns, although the amount and quality of information disseminated varied among the agencies. However, a lack of concerted two-way communication efforts between the agencies and the public might have worked against public acceptance of various HSS messages. The paucity of HHS-sponsored systematic external evaluations of these efforts made it difficult for the committee to assess the impacts or benefits of these dissemination and communication activities. The majority of the studies conducted under the MOU followed sound research practices and provided results that should be useful for policy decisions. From this perspective the studies had value. The committee finds that the productivity could have been greater with respect to improved coordination between HHS and DOE in the identification and transfer of exposure and outcome records from DOE facilities, in the setting of research priorities, and in NIOSH’s peer-reviewed publication record. Additional gains in productivity are possible through completion of an ongoing NCEH dose reconstruction and of some ATSDR studies that remain unfinished because of inadequate funding. The dissemination of the results of these studies to workers and the public was extensive and generally made available. However, two-way communication was not common nor were there adequate evaluations of the effectiveness of the dissemination and communication efforts. Continuing and improved dissemination and communication efforts about health risk evaluations are considered by the committee as essential as long as cleanup and remediation activities continue at DOE sites. The committee concludes that DOE and HHS should sign and implement a new MOU enabling continued work on the Worker and Public Health Activities Research Program. A single advisory committee, with a charter issued jointly by DOE and HHS, should be established to review and comment on the research program. DOE and HHS should establish and maintain oversight and coordination of the program at the Assistant Secretary level in HHS and the equivalent level in DOE, and DOE and the relevant HHS agencies should collaborate to update the research agenda annually. Finally, to enhance communication, DOE and HHS should establish functional feedback mechanisms to each other for all aspects of the research program.
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