• Improve and expand research in environmental epidemiology to illuminate the distribution and severity of exposures, risks, and health effects associated with hazardous-waste sites. Authorize ATSDR to direct responsible parties to conduct research to fill prioritized data gaps on critical substances. Expand the ATSDR mandate to 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. Regularly monitor the literature on health effects of toxic-waste sites and publish reviews when indicated. As appropriate, meta-analyses can be conducted of these studies, provided that the studies meet the criteria required for such aggregate analysis.

• Direct ATSDR to expand cooperative agreements with states and to develop a comprehensive program of technical assistance for state and local agencies. Provide increased funding for competitive grants in environmental epidemiology through ATSDR and NIEHS.

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.

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 the health of the public. Although extensive evidence suggests that specific populations near specific sites are exposed to substantial risks, the distribution and frequency of these exposures are impossible to ascertain. At sites where potentially critical exposures are detected, there is no regular application of an adequate system of early assessment of the health risks involved or of the need for interim action to protect the health of exposed populations. As a result of the failure to construct a system for managing hazardous-waste sites that incorporates these essential components, we find that the health of some members of the public is in danger, and that the conditions for development of environmental epidemiology are so adverse as to impede the development of useful scientific investigations of many important questions.