early in the assessment process. State health departments have been assisted by ATSDR funding through cooperative agreements, representing $5.2 million of the total $15.8 million ATSDR budget for health assessments in FY90 (J. Andrews, ATSDR, personal communication, 1990). ATSDR also has provided support for private sector organizations, such as the Association of State and Territorial Health Officers, the Association of State and Territorial Risk Assessors, and the National Governors' Association, to establish programs within state health departments and to provide policy leadership within professional organizations.

States have taken independent action to close or restrict access to more than 1705 sites because of contamination with toxic substances, as reported in a 1989 survey conducted by the National Governors ' Association with ATSDR support. The most common reason for site restrictions is groundwater contamination (69 percent of sites), because this affects drinking-water supplies (7479 groundwater wells were closed at these sites) (Wells, 1990). In the same survey, state environmental (and combined environmental and health) agencies reported having the most extensive authority to identify, restrict, and remediate contaminated sites. Mirroring the distinction between EPA and ATSDR, most state health agencies have primary responsibility for assessing human exposures and for epidemiologic studies of associated health effects (Wells, 1990).

The major source of funding for state programs for the evaluation and cleanup of hazardous-waste sites is that provided by the Superfund program under cooperative agreements. EPA does not allow states to use cooperative agreement funds for site discovery. Some states have invested additional funds in site discovery, in more complete initial assessments, and in outreach programs to work with groups of citizens who are concerned about waste sites in their communities. The most recent survey of state expenditures estimates that about $500 million is spent on hazardous-waste-site cleanups each year; no similar information is available for the health assessment aspect of these activities alone (OTA, 1989).

Most environmental epidemiology studies of health effects associated with hazardous wastes are conducted by state health departments, even in states that have separate departments for environmental management. State capacity in environmental epidemiology varies greatly. Some have several doctoral-level epidemiologists who conduct environmental epidemiology studies full time; in others, communicable disease or chronic disease epidemiologists also respond to environmental concerns when necessary; other states simply refer these issues to ATSDR or the Centers for Disease Control.

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