Public Questions and Comments
As explained in Chapter 1 of this summary, communication with the public about risk and research strategies could strengthen existing and future surveillance and monitoring systems. The workshop included four methods by which the public could submit comments to the Institute of Medicine (IOM): (1) submitting electronic comments through the IOM website; (2) submitting a written comment sheet during the workshop; (3) completing question cards for individual panels; and (4) making a 3-minute statement during an open dialogue with the audience.
Between the four methods, the IOM received comments from more than 60 members of the public. The vast majority of questions and comments fell into one of eight categories (Box D-1). A majority of the comments described in this chapter are also described in the main body of the report in the summaries of the question-and-answer periods. However, this chapter includes additional comments, such as those submitted through the IOM’s website. Although this appendix does not describe each additional comment, it does provide a general overview of the types of questions and comments that are at the forefront of the public’s mind. This section also references specific data sources and references when possible.
Populations at Risk
On- and Offshore Workers
One comment stated that offshore workers are at greatest risk for exposure because they work directly with oil closest to the source. Proximity increases the risk of contact with the oil through multiple routes of exposure, including inhalation, dermal contact, and ingestion. Another comment also noted that the worker population also includes members of the military and volunteers.
General and Vulnerable Populations in Affected Areas
A number of comments noted the risk to the general population in affected areas and expressed concern that changing weather events could increase the number of people directly exposed to the oil and contaminants related to the oil response.
A number of comments cited particularly vulnerable populations, including women, children, persons with disabilities and preexisting conditions, fishermen and -women, low-income and medically under-served populations, disabled persons, and residents affected by previous disasters, including recent floods. A few comments specifically addressed mental health research. One comment cited an article by Kessler that found a correlation between five or more stress factors and an increased risk of serious emotional disturbance. Additionally, one comment suggested that mental health professionals may also be vulnerable to adverse health outcomes.
Contaminants and Contaminated Sources
A number of participants stated that exposure to all contaminants related to the oil spill and response activities were of concern. Specifically, public comments mentioned heavy metals and dispersants, and questioned whether the chemicals in the oil were yet known.
A couple of comments referenced oil in ocean sediment, one noting that oil on the ocean floor is the result of multiple spills and leaks over time. Another comment explained the potential for changing weather patterns to expand the scope of the problem from local to regional.
In addition to more familiar sources of exposure to contaminants, one person suggested that experts consider how the use of desalinization plants could affect exposure rates.
A number of physical health effects were mentioned, including respiratory, gastrointestinal, and cerebrovascular conditions. One comment suggested that infection rates, cardiac arrhythmias, and liver function may also be compromised as a result of oil spill exposures. A few comments highlighted the physical effects of heat stress, including fatigue, musculoskeletal issues, and premature aging. Two comments were concerned about cancer risk.
Psychological and Social
A number of psychological and social health effects were mentioned by members of the public, including domestic violence, drug and alcohol abuse, post-traumatic stress disorder, and stress. A few comments also mentioned that fear and “mass hysteria” could result from mixed messages to the public. One comment noted that stable income is important for maintaining the well-being of families and children. Food insecurity was also mentioned.
One specific comment explained that the Behavioral Risk Factor Surveillance System (coordinated by the Centers for Disease Control and Prevention) is conducted continuously with rolling probability samples in every state. The system tracks health-related quality-of-life measures by using a battery of five basic questions that investigate the presence and causes of, as well as the responses to, activity limitation. Some states include an additional five questions that target pain, depression, anxiety, sleeplessness, and vitality.
To measure occupational exposure, a few comments suggested using air and water sampling. Another comment listed individual medical histories as a source of information. At a local level, some private corporations have initiated data collection. For example, Cerner Corporation
established the HealthAware Coast Initiative, which used electronic health records to aggregate summary-level counts of adverse health effects across health care facilities. Another question from the audience suggested that health care providers could use standardized exam procedures, which would help establish baseline data. Finally, one comment specifically identified the National Library of Medicine Specialized Information Services Division’s website as a reliable source of information on crude oil spills and health.
One comment expressed concern that data and research results may not be made available to the public. Along these lines, another comment suggested that researchers publish both positive and negative research findings. Another comment suggested that a lack of worker training may affect surveillance and monitoring systems targeting workers.
Research and Analysis
A number of comments suggested specific endpoints to include in future surveillance systems, including cardiac arrhythmias, impaired liver function, infection rates, and depression. For women and children, one comment mentioned stillbirth, birth defects, low birth weight, preterm birth, and neonatal deaths. Another comment listed the following outcomes by type of physical health: respiratory (cough, asthma, respiratory infections); gastrointestinal (food poisoning, nausea, vomiting, and diarrhea); cerebrovascular (headache, dizziness, and confusion); infection rates (viral and bacterial). Finally, one member of the public suggested that both risk and protective factors (e.g., factors associated with resiliency) are important to track.
A number of comments were concerned with different aspects of biomonitoring and specimen banking, including what should be measured, how it would be used, whether it was necessary, and how to maintain specimens. To track worker health, one comment suggested the use of worker health surveys and follow-up surveillance. Finally, a comment recommended designing research to drive comprehensive outreach, education, and interventions. The effects of proximal and previous exposures were also of concern.
Ethics and Litigation
Although the IOM was not charged with examining ethical or legal considerations associated with developing surveillance systems, a number of comments pertained to this topic. One comment was concerned about litigation affecting long-term research, citing differences in mental and physical effects of disasters that do and do not encounter litigation. A number of individuals expressed concerned with the misuse of personal data. A few comments offered suggestions for improving research activities, including the use of Certificates of Confidentiality and the establishment of standing institutional review boards to speed the approval for baseline data collection.
A number of comments noted the need for assistance in navigating the information available about the oil spill. Suggested activities included holding organizations accountable for presenting clear and concise risk-mitigating information, using “gatekeepers” to screen for reliable and requested information, establishing a coordination care center, and holding town meetings. Other comments noted the absence of reliable information to inform day-to-day decisions.
Research Development and Communication
To improve public trust, one comment stated that stakeholders (including the workers and residents) should be engaged prior to conducting research, during research, and during follow-up. Another comment suggested that one organization be charged with reviewing data and releasing that information to the community.
Research and Response
A number of public comments expressed the need to coordinate across response and research activities related to the oil spill. Suggestions included establishing a National Disaster Research Coordinator. One comment noted that this type of approach could reduce confusion that will result if the community receives the same proposal from multiple entities.
A number of public comments focused on using surveillance systems to prevent future adverse health impacts. Suggestions included adopting regulations to limit day-to-day worker exposures, establishing best practices for both physical and mental prevention behaviors. A few comments wondered if more training for workers was warranted.
A number of comments noted the absence of adequate resources to address both physical and psychological health effects of the oil spill. For example, one comment noted that few mental health doctors or therapists are available in some of the affected communities.