Overview

On June 22-23, 2010, in New Orleans, Louisiana, the Institute of Medicine (IOM) convened a workshop, Assessing the Human Health Effects of the Gulf of Mexico Oil Spill. The workshop brought together more than 350 federal, state, and local government officials, expert scientists, academic leaders, policy experts, health care providers, public health advocates, community representatives and residents, and other participants from diverse disciplines to examine options for measuring the Gulf oil spill’s potential health effects on different human populations. This publication summarizes the background, presentations, discussions, and public comments that occurred during the workshop.

INTRODUCTION

On April 20, 2010, the Deepwater Horizon offshore drilling rig in the Gulf of Mexico exploded, causing a sea-floor oil leak 1 mile beneath the ocean’s surface. The explosion killed 11 workers and unleashed one of the largest offshore oil spills in U.S. history, threatening the entire Gulf and Atlantic coastline. The depth of the oil source has made it difficult to accurately measure how much oil is being discharged. At the time of this workshop,1 official estimates of the amount of oil released daily into the Gulf of Mexico ranged drastically (MacDonald et al., 2010). The effects of this much oil on a community so dependent on the Gulf waters will be

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This report summarizes a workshop that took place on June 22-23, 2010. All the information presented, including estimated flow rates, is stated as of those approximate dates.



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Overview On June 22-23, 2010, in New Orleans, Louisiana, the Institute of Medicine (IOM) convened a workshop, Assessing the Human Health Effects of the Gulf of Mexico Oil Spill. The workshop brought together more than 350 federal, state, and local government officials, expert scientists, academic leaders, policy experts, health care providers, public health advocates, community representatives and residents, and other participants from diverse disciplines to examine options for measuring the Gulf oil spill’s potential health effects on different human popula- tions. This publication summarizes the background, presentations, discussions, and public comments that occurred during the workshop. INTRODUCTION On April 20, 2010, the Deepwater Horizon offshore drilling rig in the Gulf of Mexico exploded, causing a sea-floor oil leak 1 mile beneath the ocean’s surface. The explosion killed 11 workers and unleashed one of the largest offshore oil spills in U.S. history, threatening the entire Gulf and Atlantic coastline. The depth of the oil source has made it difficult to accurately measure how much oil is being discharged. At the time of this workshop, 1 official estimates of the amount of oil released daily into the Gulf of Mexico ranged drastically (MacDonald et al., 2010). The effects of this much oil on a community so dependent on the Gulf waters will be 1 This report summarizes a workshop that took place on June 22-23, 2010. All the information presented, including estimated flow rates, is stated as of those approximate dates. 1

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2 ASSESSING THE HUMAN HEALTH EFFECTS OF THE GULF OIL SPILL far-reaching and pronounced, leading many to describe the situation in the Gulf of Mexico as an oil disaster rather than an oil spill. From the leak’s origin, to the amount of oil released into the envi- ronment, to the duration and ongoing nature of the spill, the Gulf oil spill has presented many unique challenges. The clean-up efforts have been the most demanding on-water response in U.S. history, involving the use of more than 1 million gallons of oil spill dispersants (Judson et al., 2010) and the deployment of thousands of skimming vessels (Deepwater Horizon Response, 2010), including local boat operators who assist with containment and response activities using their “vessels of opportunity.” Many on- and offshore commercial workers, clean-up workers, and volunteers have subjected themselves to numerous physical hazards (such as chemical exposures, heat stress, and injury) through response activities involving chemical dispersants, booms, and skimmers. Long work days and weeks are common as workers and volunteers combat waves and plumes of oil that continue to threaten their communities, livelihoods, and ways of life. In addition to the physical stressors, the Deepwater Horizon oil dis- aster has disrupted delicate social, economic, and psychological balances in communities across the Gulf region. Local fishermen and -women in the region are grappling with possibly permanent disruptions to their long-standing livelihoods. Fears associated with contaminated beaches and food continue to dissuade tourists from visiting an area still recover- ing from the devastation of hurricanes such as Katrina, Rita, and Gustav. Communities question the safety of their most vulnerable populations and worry about the effects that the Gulf oil disaster will have on their immediate and long-term health. The resulting uncertainty about physi- cal, social, and economic health has profound implications for the psychological well-being of individuals in affected communities. Despite information available through studies of past oil spills and other disaster responses, uncertainty continues to mount in the absence of reliable and trustworthy information about the hazards posed by the Gulf oil spill and its related clean-up activities. A number of federal, state, academic, private-industry, and community efforts are already under way to help generate data that can answer some of the most pressing ques- tions. However, more information is needed to best protect the health of affected populations in the contexts of the Deepwater Horizon oil spill and future public health disasters.

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3 OVERVIEW ASSESSING THE EFFECTS OF THE GULF OF MEXICO OIL SPILL ON HUMAN HEALTH: AN INSTITUTE OF MEDICINE WORKSHOP To explore the need for appropriate surveillance systems to monitor the spill’s potential short- and long-term health effects on affected com- munities and individuals, Secretary Kathleen Sebelius of the U.S. Department of Health and Human Services (HHS) contracted with the IOM to convene the public workshop Assessing the Human Health Effects of the Gulf of Mexico Oil Spill in the Gulf region. Nancy Adler chaired a six-member planning committee. 2 The workshop explored available scientific evidence about oil spills’ effects on human health to guide the development of appropriate surveillance systems and to estab- lish possible directions for additional research. Specifically, HHS asked the IOM to: (1) identify and discuss the populations most vulnerable to or at increased risk for adverse health effects, including worker sub- populations; (2) review current knowledge and identify knowledge gaps regarding the human health effects of exposure to oil, weathered oil products, dispersants, and environmental conditions such as heat; (3) consider effective communication strategies to convey information about health risks to at-risk populations, accounting for cultural, health literacy, linguistic, technological, and geographical barriers; (4) explore research methodologies and appropriate data collection to further our understand- ing of the risks to human health; and (5) review and assess components of a framework for short-term and long-term surveillance to monitor the spill’s potential adverse health effects. The 2-day workshop included expert presentations, six panel discus- sions, and an open-microphone dialogue with the audience. Sessions were designed to focus mainly on one of the five charges described above, but some overlap occurred. An additional goal of the workshop was to afford substantial opportunity to hear from members of the public. To accomplish this goal, the planning committee designed four methods for members of the public to submit their questions and comments to the workshop: (1) submitting electronic comments through the IOM website; (2) submitting a written comment sheet during the workshop; (3) com- pleting question cards for individual panels; and (4) speaking during the workshop’s public comment session. Appendix D includes a brief 2 The planning committee’s role was limited to planning and preparing the workshop. This document was prepared by rapporteurs as a factual summary of the workshop’s presentations and discussions.

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4 ASSESSING THE HUMAN HEALTH EFFECTS OF THE GULF OIL SPILL summary of the public comments and questions submitted to the IOM through all four methods. WORKSHOP THEMES The workshop provided the opportunity for all attendees to hear and to provide a rich array of experiences, diverse perspectives, and fresh ideas. Over the course of the workshop, certain ideas were often repeated in different ways. Box S-1 summarizes the emerging themes. These themes capture some of the overarching ideas and considerations that could inform the development of a successful surveillance and monitor- ing system. BOX S-1 Emerging Workshop Themes Complexity. Assessing the effects on human health of oil spills and response activities is complex. Multiple dimensions. Human health is multidimensional and includes physi- cal, psychological, and socioeconomic dimensions. Uncertainty. Information about the specific hazards related to the Gulf oil spill and the range of potential acute and long-term effects of oil spills on human health is incomplete and leads to uncertainty. Immediacy. Understanding the current state of knowledge can guide immedi- ate actions to mitigate known risks and to fill existing knowledge gaps. Community engagement. Community involvement and collaboration are es- sential when designing surveillance systems, related research activities, and effective risk communication strategies. Coordination. Coordination can strengthen existing and developing surveil- lance and monitoring systems. Commitment. Long-term surveillance and related research activities are criti- cal to identifying acute, chronic, and long-term health effects of oil spills.

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5 OVERVIEW Complexity Assessing the effects on human health of oil spills and response ac- tivities is complex. Factors such as oil composition and weathering, a diverse range of exposures and potential adverse health effects, the unique characteristics of affected populations, and the ongoing nature of the oil spill, can increase the assessment complexity. Multiple Dimensions Human health is multidimensional and includes physical, psycho- logical, and socioeconomic dimensions. These dimensions are not inde- pendent and can influence the overall well-being of individuals and communities. A number of workshop participants predicted that the Deepwater Horizon disaster will likely have an even greater effect on the psychological health of affected communities because of serious and pro- longed disruptions to the social environment and local economies. Uncertainty Information about the specific hazards related to the Gulf oil spill and the range of potential acute and long-term effects of oil spills on hu- man health is incomplete and leads to uncertainty. Only a handful of studies have explored the potential short-term and especially long-term health consequences of oil spills, and the exact nature and extent of haz- ards, risks, and vulnerable populations contribute to the uncertainty. Some workshop participants suggested that this uncertainty could make effective risk communication with the public and surveillance-strategy development difficult. Immediacy Understanding the current state of knowledge can guide immediate actions to mitigate known risks and to fill existing knowledge gaps. Al- though many aspects of the Deepwater Horizon disaster remain uncer- tain, information exists that can help prevent and mitigate harm from recognized hazards, as a number of speakers explained. Increasing awareness of hazards and risks associated with adverse health outcomes can help prevent such outcomes, alleviate unnecessary anxieties, and in-

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6 ASSESSING THE HUMAN HEALTH EFFECTS OF THE GULF OIL SPILL form the policies and procedures that shape responses to the Gulf oil spill and future disasters. Community Engagement Community involvement and collaboration are essential when designing surveillance systems, related research activities, and effective risk communication strategies. Local residents and communities have unique experience and expertise that can improve surveillance-related activities, especially if community engagement begins early. A number of participants suggested that community engagement can also strengthen surveillance activities by increasing community participation, encouraging surveillance activities that target “actionable” information, and improving the message and manner of risk communications. Coordination Coordination can strengthen existing and developing surveillance and monitoring systems. In light of limited resources and the oil spill’s scope and magnitude, many speakers described the need for coordination between and among all interested parties, which may speed surveillance implementation and improve the overall impact of surveillance systems. Additionally, coordination and consultation between interested parties could result in shared platforms and standardization, which could strengthen the system as a whole. Commitment Long-term surveillance and related research activities are critical to identifying acute, chronic, and long-term health effects of oil spills. To support ongoing activities, a range of speakers stated that sustained commitments at the federal, state, and local levels are necessary. Invest- ments in public health infrastructures can also play a significant role in the success of long-term surveillance activities. Finally, one speaker noted that if one of the goals of surveillance and related research is to drive action, then long-term strategies are needed to turn surveillance results into practice. In addition to these recurring themes, participants offered a number of suggestions throughout the workshop on data collection, research methods, and components of an effective surveillance system. For exam-

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7 OVERVIEW ple, Nancy Adler proposed six possible dimensions to consider when designing a framework to guide development of a surveillance system and related research activities: Key Characteristics. A surveillance framework must be long- term, flexible, multilayered, and integrated. Population(s). A surveillance system needs to monitor all popu- lations in order to establish a baseline for comparison, but must also focus on particularly vulnerable or at-risk populations. Content. Outcomes and measurement methods should be selected to best capture exposures and the effects of those exposures. Processes. A successful public health surveillance system will require public input from a wide variety of stakeholders, includ- ing communities and government agencies. Use of Existing Data Sources. A framework for surveillance can build on existing data sets or data-collection activities. Unanswered Questions. Identifying knowledge gaps and perti- nent questions can be as informative to developing a framework for surveillance systems identifying what is known. WORKSHOP IN BRIEF Workshop Introduction (Chapter 1) The oil spill in the Gulf of Mexico and related response activities are unprecedented in the United States. Chapter 1 outlines the events leading up to the IOM’s June 22-23 workshop, explains the workshop’s over- arching goals, and describes themes that emerged during the course of the workshop. Presentations in this chapter focused on the compelling need to understand the potential effects of oil spills on human health and set the stage for later panel discussions. Specifically, expert speakers discussed the current level of scientific understanding about the effects of oil spills on human health and described the chemical composition of oils and oil dispersants, explaining what happens when oil spills into the environment.

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8 ASSESSING THE HUMAN HEALTH EFFECTS OF THE GULF OIL SPILL At-Risk Populations and Routes of Exposure (Chapter 2) Effective surveillance systems require a basic understanding of ex- posure pathways, which includes identifying the contaminant source, available environmental media, exposure points, exposure routes, and the at-risk population. To better identify the most salient hazards when de- veloping a framework for surveillance and monitoring activities, this chapter focuses on different hazards, routes of exposure, and at-risk populations. Panelists discussed not only how different populations (e.g., fishermen and -women, clean-up workers, and residents of the affected communities) are exposed to different hazards related to the oil spill, but also the particular population vulnerabilities and available preventive steps that can affect the likelihood of experiencing adverse health effects. Short- and Long-Term Effects on Human Health (Chapter 3) This chapter covers discussions about the current state of knowledge and knowledge gaps regarding a wide range of effects on human health as a result of exposure to oil, weathered-oil products, dispersants, and environmental conditions such as heat. Panelists considered short-term and long-term outcomes; physical and psychological effects of exposure; physical stressors (e.g., heat stress and fatigue) and chemical stressors (e.g., the oil and dispersants); and potential health effects in both the general population and among children and pregnant women, specifi- cally. The panel’s goal was to consider which potential adverse effects to include in surveillance and to identify gaps in knowledge that could in- fluence future surveillance programs. Communicating with the Public (Chapter 4) One purpose of a surveillance system is to generate information to better protect the health of all affected populations by improving the or- ganization and delivery of health care services (see Chapter 6 for a more detailed discussion of this issue). Timely and reliable data collection and analysis is only one measure of an effective surveillance system. This chapter explores strategies for engaging the public in risk communica- tion, such as identifying the most critical needs of affected populations, engaging the public in surveillance-system and research development,

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9 OVERVIEW and establishing mechanisms to communicate credible, reliable, and ac- tionable data. This chapter also includes invited remarks from commu- nity representatives and audience members. Overview of Health-Monitoring Activities: State and Federal Perspectives (Chapter 5) The state- and federal-level governmental responses to medical and health-related issues around the Deepwater Horizon disaster are dedi- cated to developing surveillance approaches based on the best available science, to providing needed health services to affected communities as part of surveillance, and to collecting the necessary data to ensure that responses to future disasters are based on an even stronger evidence base. In this chapter, state health officials from Alabama, Florida, Louisiana, Mississippi, and Texas describe the oil spill response from their respec- tive states. Federal representatives from the Office of the U.S. Surgeon General, the Department of Health and Human Services, the Department of Homeland Security, and the Environmental Protection Agency also discuss current response activities. Data-Collection, Surveillance, and Research Methodologies (Chapter 6) There is an important distinction but critical connection between the goals of surveillance and the goals of research. This chapter explores research methodologies and available data sources (including ongoing health surveillance and surveys) that could be used to monitor effects of the Gulf oil spill. Panelists discussed characteristics of a surveillance framework that can efficiently and effectively identify and monitor po- tential short- and long-term health effects and help ensure the establish- ment of an integrated and coordinated health-monitoring system.

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10 ASSESSING THE HUMAN HEALTH EFFECTS OF THE GULF OIL SPILL Developing Effective Surveillance and Monitoring Systems: Future Directions and Resource Needs (Chapter 7) One of the workshop’s main objectives was to examine options for a surveillance-system framework to monitor the Gulf oil spill’s short- and long-term effects on human health. This final session was designed to integrate the many perspectives and themes that emerged throughout the workshop, including opportunities to build on what is already known and what has yet to be discovered. Considering the broad range of scientific evidence and suggestions presented throughout the course of the work- shop, panelists discussed possible components and suggestions to de- velop a framework for effective surveillance systems and monitoring activities.