ASSESSING THE EFFECTS OF THE GULF OF MEXICO OIL SPILL ON HUMAN HEALTH

A Summary of the June 2010 Workshop

Margaret A. McCoy and Judith A. Salerno, Rapporteurs

INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

Washington, D.C.
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ASSESSING THE EFFECTS OF THE GULF OF MEXICO OIL SPILL ON HUMAN HEALTH A Summary of the June 2010 Workshop Margaret A. McCoy and Judith A. Salerno, Rapporteurs

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THE NATIONAL ACADEMIES PRESS • 500 Fifth Street, N.W. • Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. This study was supported by Contract No. HHSOl00201000001E between the National Academy of Sciences and the Office of the Assistant Secretary for Preparedness and Response, Biomedical Advanced Research and Development Authority. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project. International Standard Book Number-13: 978-0-309-15781-0 International Standard Book Number-10: 0-309-15781-1 Additional copies of this report are available from the National Academies Press, 500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624- 6242 or (202) 334-3313 (in the Washington metropolitan area); Internet, http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2010 by the National Academy of Sciences. All rights reserved. Printed in the United States of America The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin. Cover credit: Reprinted with permission from AP/Wide World Photos. Suggested citation: IOM (Institute of Medicine). 2010. Assessing the effects of the Gulf of Mexico oil spill on human health: A summary of the June 2010 workshop. Washington, DC: The National Academies Press.

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The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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PLANNING COMMITTEE ON ASSESSING THE EFFECTS OF THE GULF OF MEXICO OIL SPILL ON HUMAN HEALTH: AN INSTITUTE OF MEDICINE WORKSHOP 1 NANCY E. ADLER (Chair), Director, Center for Health and Community and Professor of Medical Psychology, Departments of Psychiatry and Pediatrics, University of California, San Francisco JOHN C. BAILAR III, Professor Emeritus, Department of Health Studies, University of Chicago MAUREEN Y. LICHTVELD, Professor and Freeport McMoRan Chair of Epidemiology and Associate Director of Population Sciences, Department of Environmental Health Sciences, Tulane University School of Public Health and Tropical Medicine LINDA A. MCCAULEY, Dean, Nell Hodgson Woodruff School of Nursing, Emory University KENNETH OLDEN, Founding Dean at the Proposed CUNY School of Public Health and Acting Dean, School of the Health Professions, Hunter College of the City University of New York LINDA ROSENSTOCK, Dean, School of Public Health, University of California, Los Angeles DAVID A. SAVITZ, Professor, Department of Community and Preventative Medicine, Mount Sinai School of Medicine Study Staff JUDITH A. SALERNO, Executive Officer MARGARET A. MCCOY, Associate Program Officer ANDREW M. POPE, Director of the Board on Health Sciences Policy CHRISTINE M. COUSSENS, Senior Program Officer BRUCE M. ALTEVOGT, Senior Program Officer KATHARINE BOTHNER, Research Associate SHELLY COOKE, Senior Financial Administrative Assistant PAMELA A. LIGHTER, Senior Program Assistant TREVONNE WALFORD, Program Assistant JUDY ESTEP, Program Associate 1 The role of the planning committee was limited to planning and preparation of the workshop. This document was prepared by rapporteurs as a factual summary of what was presented and discussed at the workshop. v

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Reviewers This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s (NRC’s) Re- port Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and respon- siveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We wish to thank the following individuals for their review of this report: Georges C. Benjamin, American Public Health Association Joan D. Flocks, Levin College of Law, University of Florida Bernard D. Goldstein, University of Pittsburgh Roger O. McClellan, Independent Advisor on Toxicology and Human Health Risk Analysis David A. Savitz, Mount Sinai School of Medicine Robert J. Ursano, Uniformed Services University of the Health Sciences Although the reviewers listed above have provided many construc- tive comments and suggestions, they were not asked to endorse the final draft of the report before its release. The review of this report was over- seen by Robert B. Wallace, Irene Ensminger Stecher Professor of Epi- demiology and Internal Medicine in the College of Public Health at the vii

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viii REVIEWERS University of Iowa. Appointed by the NRC and the Institute of Medicine, he was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the rapporteurs and the institution.

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Preface On April 20, 2010, 11 oil workers lost their lives when the Deepwa- ter Horizon, a semi-submersible offshore drilling rig in the Gulf of Mex- ico, exploded and created one of the largest environmental disasters in U.S. history. In the weeks and months that followed, hundreds of millions of liters of crude oil spewed into the Gulf of Mexico, threatening the waters and surrounding lands, marshes, and beaches; damaging fish and wildlife; and disrupting the lives of many residents and communities in the Gulf region. This is not the first oil spill disaster. Other oil spill catastrophes have occurred in the United States and around the world. But, the Gulf oil spill is distinctive in its magnitude, in its duration, and in the complexity of its assessment. Unlike most spills in which there is a single event and measurable release of oil, the Deepwater Horizon spill has been plagued not only by its resolution but also by its wide-reaching and likely prolonged impact on communities in the affected regions. The extensive, prolonged use of dispersants is also unprecedented, and the risks associ- ated with their use are unknown, as are risks associated with fumes from the oil and controlled burns. In fact, it may be the sheer level of uncer- tainty that best defines the Gulf of Mexico oil spill. Since the Gulf oil spill began, there have been concerns about the extent to which related hazards, such as physical and chemical exposures and social and economic disruptions, will impact human health. In addi- tion to concerns about the spill’s impact on the general population of the Gulf region, some populations are potentially at increased risk of short- and long-term physical and psychological health damage. The latter include clean-up workers and volunteers, who are exposed to extreme ix

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x PREFACE heat and fatigue, fishermen and -women, oil rig workers, and countless others, who wait to hear when and if they can go back to their livelihoods and their ways of life. While studies of previous oil spills provide some basis for identifying and mitigating the human health effects of these ex- posures, the existing data are insufficient to fully understand and predict the overall impact of hazards from the Deepwater Horizon oil spill on the health of individuals—including workers, volunteers, residents, visitors, and special populations. The Secretary of the U.S. Department of Health and Human Services, Kathleen Sebelius, asked the Institute of Medicine (IOM) to hold a workshop to inform efforts to monitor the health effects of the Gulf oil spill and to communicate information concerning these risks to the public. Reflecting the urgency of the issue and the dedication and hard work of the IOM staff, the workshop was held within 2 weeks of receiving the Secretary’s request. I was honored to chair the planning committee, which included distinguished colleagues with diverse backgrounds and expertise. With only 1 week’s notice, 37 experts and health officials and 4 community representatives participated in the workshop in New Orleans and gave excellent presentations. More than 300 other participants attended the workshop, and hundreds more have viewed the webcast. Public commentary was submitted via a specially developed portal on the World Wide Web. This publication captures many of the observations, ideas, and suggestions offered by participants. In 2 days, it was not possible to de- sign a surveillance system, but the discussion pointed to key considerations that should be used in designing such a system. By identifying what is already known and what is missing, policy makers, public health officials, academics, community advocates, scientists, and members of the public can work together to create a monitoring and surveillance system that results in “actionable” information that identifies emerging health risks in specific populations. Doing so can help target resources to high-risk populations for treatment and foster new approaches for the prevention of adverse health effects. Workshop participants from the local area poignantly described the frustration and struggle faced by Gulf residents and reminded us of the importance of incorporating the concerns and expertise of community members. Surveillance activities will need to be coordinated and should involve federal, state, and local governments; academic institutions; advocacy groups; private industry; and community networks. By includ- ing all the relevant parties, we can develop more comprehensive and

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xi PREFACE effective surveillance systems to inform decision makers and the public about the physical and psychological health issues related to the Deepwa- ter Horizon oil spill and other environmental disasters in the future. Nancy E. Adler, Chair Planning Committee on Assessing the Effects of the Gulf of Mexico Oil Spill on Human Health: An Institute of Medicine Workshop

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Acknowledgments This publication is the product of a small army of dedicated indi- viduals, and the Institute of Medicine (IOM) is grateful to all for their commitment, patience, and professionalism in developing and executing this workshop within a 2-week timeframe. Substantial recognition must be extended to the Secretary of the U.S. Department of Health and Human Services, Kathleen Sebelius; to Nicole Lurie, Assistant Secretary for Preparedness and Response (ASPR); and the ASPR staff for their vision and generous support for this workshop. This workshop would not have been possible without the expertise of the planning committee members and their skilled navigation of the questions and challenges. Under Nancy Adler’s adept direction, the planning committee assembled an impressive agenda of distinguished speakers, whose presentations both informed and provoked thoughtful discussions during the course of the workshop. Many devoted IOM staff members supported the planning and exe- cution of the summit. Bruce Altevogt, Christine Coussens, Meg McCoy, and Kathleen Stratton provided steadfast support to the planning commit- tee and project, while Clyde Behney, Cathy Liverman, Andy Pope, and Judith Salerno offered their guidance and leadership. Thanks go to Shelly Cooke, Pam Lighter, Janet Stoll, and Trevonne Walford for their assistance at the workshop; to Jill Grady and Hope Hare for their administrative support; to Marton Cavani, Lauren Tobias, and Jordan Wyndelts for their communications and technological expertise; and to Christine Stencel for her work with the media. The IOM extends special thanks to Katharine Bothner and Judy Estep for their initiative and management skills, and to Abbey Meltzer for her dedication xiii

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xiv ACKNOWLEDGMENTS throughout the project. Additional recognition goes to IOM staff members who contributed to the development of the workshop and to the production and dissemination of this publication: Christie Bell, Jody Evans, Linda Kilroy, Bill McLeod, Donna Randall, and Vilija Teel. The workshop was webcast by Digitell and transcribed by Debra Gilliam. The IOM is grateful to the staff of the Hotel Monteleone for their generosity and flexibility while hosting the workshop. Thanks go to Leslie Pray for her rapid writing; to Mark Goodin for copyediting the summary; and to Francesca Moghari for designing the cover. Finally, the IOM would like to express its appreciation to each work- shop speaker and participant for enriching the workshop discussions by sharing their diverse perspectives and experiences.

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Contents OVERVIEW 1 1 INTRODUCTION 11 Workshop Background, 11 The Compelling Need to Understand the Potential Effects of Oil Spills on Human Health, 19 2 AT-RISK POPULATIONS AND ROUTES OF EXPOSURE 29 Populations of Concern: Different Exposures, Different Risks, 30 Occupational Risks and Health Hazards: Workers and Volunteers, 32 Assessing and Preventing Exposure Across Populations, 35 Of People and Pelicans: A Local Perspective on the Gulf of Mexico Oil Spill, 36 Questions and Comments from the Audience, 38 3 SHORT- AND LONG-TERM EFFECTS ON HUMAN HEALTH 43 Potential Short- and Long-Term Physical Effects, 44 Potential Short- and Long-Term Psychological Effects, 60 Questions and Comments from the Audience, 68 4 COMMUNICATING WITH THE PUBLIC 75 Engaging the Public, Protecting the Health, 76 Community Perspectives, 80 Open Dialogue with the Audience, 83 xv

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xvi CONTENTS 5 OVERVIEW OF HEALTH-MONITORING ACTIVITIES: STATE AND FEDERAL PERSPECTIVES 87 State Responses, 87 Panel Discussion, 96 Federal Response, 97 6 DATA-COLLECTION, SURVEILLANCE, AND RESEARCH METHODOLOGIES 105 Public Health Surveillance in Emergency Response Settings: Lessons Learned from 9/11 and Other Disasters, 107 An Overview of Methodologies and Data Sources for Use in Health Surveillance and Environmental Monitoring Activities, 110 Assessing the Health Effects of the Gulf Oil Spill: Data Sources, 112 Mental Health Research and Screening Methodologies, 113 Information Infrastructure for Detecting and Managing Health Effects of the Oil Spill: Learning from the Past, Planning for the Future, 115 Reflections on Surveillance, 118 Questions and Comments from the Audience, 119 7 DEVELOPING EFFECTIVE SURVEILLANCE AND MONITORING SYSTEMS: FUTURE DIRECTIONS AND RESOURCE NEEDS 123 Suggested Dimensions and Components of a Surveillance Framework, 124 Major Overarching Themes of Workshop Discussions: Principles of a Framework for Surveillance, 126 APPENDIXES A References 137 B Bibliography of Related National Academies Press Reports 143 C Workshop Agenda 149 D Public Questions and Comments 157 E Speaker Biographies 165