In 1972, the US-Canada Great Lakes Water Quality Agreement (GLWQA, 1972; amended 1978) committed the United States and Canada to restoring and maintaining the chemical, physical, and biological integrity of the Great Lakes Basin Ecosystem. The agreement reaffirmed the rights and obligations of Canada and the United States under the Boundary Waters Treaty of 1909. The International Joint Commission (IJC)1 monitors and assesses the progress under the agreement, including the protection of human health. The committee believes that investigating whether there is a relationship between contaminants and health outcomes is important for areas around the Great Lakes.

In a 2001 letter (IJC, 2001; see Appendix B), the IJC requested ATSDR’s2 assistance in “evaluating the public health implications of the presence of hazardous materials in Great Lakes Areas of Concern (AOC’s) by providing information on ATSDR's public health assessments of hazardous waste sites within these AOC’s.” An AOC is “a geographic area that fails to meet the General or Specific Objectives of the Agreement where such failure has caused or is likely to cause impairment of beneficial use or of the area’s ability to support aquatic life” (Great Lakes Water Quality Agreement, Annex 2; 1978). The letter further specified that it “would be most helpful if ATSDR could identify evaluated sites within each AOC, the Hazard Category assigned to each site, any relevant demographic information available to ATSDR concerning the populations at risk, completed exposure pathways identified, and the priority substances following these pathways.” The IJC had previously worked with Health Canada to produce a report for each of the AOCs in Canada (including the Canadian side of binational AOCs) outlining particular health outcomes in the AOCs. Those reports were summarized in a journal article (Elliott et al., 2001) and were available to the committee.

In April 2004, ATSDR prepared a draft report related to the IJC request (ATSDR, 2004).3 In that report draft, information from ATSDR’s health-evaluation documents, including the documents termed Public Health Assessments (PHAs),4 on sites both within and close to the AOCs, data from 2001 on contaminants from a national database (the Toxic Release Inventory, TRI), and summary county-level health data from the Community Health Status Reports (CHSRs) produced in 2000 by the Health Resources and Services Administration (HRSA) were compiled for each of the AOCs. The contaminant data focused on the pollutants that have been


The IJC is an independent binational organization established by the Boundary Waters Treaty of 1909. Its purpose is to help prevent and resolve disputes related to the use and quality of boundary waters and to advise Canada and the United States on related questions (IJC, 2008).


ATSDR’s mission is to serve the public by using the best science, taking responsive public health actions, and providing trusted health information to prevent harmful exposures and disease related exposures to toxic substances (


The title of the 2004 draft was Public Health Implications of Hazardous Substances in the Twenty-Six U.S. Great Lakes Areas of Concern.


Since 1986, ATSDR has been required by law to conduct a PHA at each of the sites on the Environmental Protection Agency’s National Priorities List. The aim of these evaluations is to find out whether people are being exposed to hazardous substances and, if so, whether the exposure is harmful and should be stopped or reduced. If it is appropriate, ATSDR also conducts PHAs when petitioned by concerned individuals. PHAs are carried out by environmental and health scientists from ATSDR and from the states with which ATSDR has cooperative agreements.

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