remediation or closure. Use the inventory to ensure that sites are not deferred or placed in closure status without a revised preliminary assessment as described above.

  • Rigorously evaluate the data and methodologies used in site assessment, including the characterization of potential and actual releases to groundwater, surface water, air, and soil that result in human exposure; and the methodologies for estimating the size and make-up of populations exposed to hazardous-waste site emissions. Use this information in preliminary assessments and in deciding how to protect the public health. Evaluate compliance with public health recommendations for the protection of exposed populations and site remediation.

  • Improve and expand research to fill data gaps in environmental epidemiology to illuminate the distribution and severity of exposures, risks, and health effects associated with hazardous-waste sites. Establish an extensive program of applied research, including exposure registries linked to priority substances, and further the development of surveillance methods such as community health data bases, biologic monitoring, and sentinel events.

  • Direct ATSDR and other relevant agencies to expand cooperative agreements with states and develop a comprehensive program of technical assistance for state and local agencies. Federal and state agencies, such as ATSDR and the National Institute of Environmental Health Sciences, also should provide increased support for university-based research in environmental epidemiology.

The legislative mandates, policies, and programs of the federal and state agencies that currently manage hazardous-waste sites are inadequate to the task of protecting public health. Although evidence suggests that specific populations near specific hazardous-waste sites are exposed to substantial risks, the distribution and frequency of these exposures cannot be ascertained, because the needed data have not been gathered.

A decade after implementation of Superfund, and despite congressional efforts to redirect the program, substantial public health concerns remain, and critical information on the distribution of exposures and health effects associated with hazardous-waste sites is still lacking. Whether for the purposes of environmental epidemiology or for the protection of public health, the nation is failing to adequately identify, assess, or prioritize hazardous-waste-site exposures and their potential effects on public health. Our next report will contain a review of selected state health department reports on this subject and of case studies of legal decisions that have evaluated epidemiologic



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