Although ATSDR funding for state health departments has provided impetus for studies of exposed populations, the most compelling pressure has been the continuous public demand for health studies of specific sites. Politically, such studies are an appealing way to cope with frightened and outraged communities, particularly when cleanup is far in the future. In many states, these demands for health studies are focused on reported clusters of cancer or other illnesses. The states with the largest programs, California, New York, New Jersey, and Minnesota, have developed triage systems that sort out the scientific plausibility and methodologic feasibility of responding to the increasing stream of requests (R.R. Neutra, California State Department of Health Services, personal communication, 1990). These programs also have led to extensive discussions within the field of epidemiology about the methodologic issues associated with the study of reported clusters (American Journal of Epidemiology, 1990). Relatively few of the environmental epidemiology studies conducted by the states make their way into the published literature. Directly published state reports often serve the agencies better, and many investigations are not designed or completed in a form that is appropriate for publication in the regular scientific literature.

A REVISED FORM OF INITIAL SITE ASSESSMENT

Congress has charged the federal government—EPA, along with ATSDR and NIEHS—with the job of protecting the health of the public from hazardous-waste sites. Three components of this responsibility are also among the critical tasks of environmental epidemiology: characterizing current and potential human exposures; evaluating the potential harm to human health of these exposures; and investigating the actual health effects associated with the exposures.

As our review of federal programs concludes, there is no comprehensive national inventory of hazardous-waste sites, no site discovery program, no minimum data set on potential human exposures, no adequate system for the early identification of sites for which immediate action to protect public health or continued surveillance of health effects could be necessary, and no validation or evaluation of the component parts of the site assessment process. EPA and ATSDR are instituting some improvements in each of these areas, but these improvements are largely limited to sites that are proposed for or already listed on the NPL.

During the past 10 years, of the estimated $4.2 billion spent each year on hazardous-waste sites in the U.S. (OTA, 1989), less than 1 percent has been devoted to the study of health risks at these sites.



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