THE COST OF INACTION Riana Bornman Environmental Chemical Pollution amp Health UP Centre for Sustainable Malaria Control SHSPH Conflict of interest statement Opinions expressed and conclusions arrived at are those of ID: 1047034
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1. Environmental Chemical Pollution and Health:THE COST OF INACTIONRiana BornmanEnvironmental Chemical Pollution & Health; UP Centre for Sustainable Malaria Control, SHSPH
2. Conflict of interest statementOpinions expressed and conclusions arrived at are those of myself, and are not necessarily to be attributed to any funder. I declare I have no actual or potential competing financial interests.As scientist I declare that I am not bound by any Government, International Government Organization, Lobby Group, or NGO position or policy on chemicals.The papers I refer to here are published in international, peer reviewed journals.
3. Definition of EDCs (IPCS 2002)An endocrine disruptor is defined as, “…an exogenous substance or mixture that altersfunction(s) of the endocrine system and consequently causes adverse health effects in an intact organism, or its progeny, or (sub) populations.”3estrogen, androgen and thyroid hormone
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5. Characteristics of EDC: implications for developmental exposures hormone levels, receptors, physiological responses change intensely across the life cycleappropriate levels hormones during early development – fetus and infantdisorders of sexual development e.g. abnormal androgen or estrogen levels5
6. Characteristics of EDC: implications for developmental exposures Exposures exogenous compounds (EDCs) can mimic or antagonize hormonal systems and change the developmental trajectoryDepending on timing of exposure, nature of the EDC, and its levels, an adverse outcome may be evident at birth, or there may be a latent disease outcome Developmental Origins of Health and Disease (DOHaD): motivates latent effects of EDCs on every endocrine system studied to date6
7. Chemical environmental agents and the endocrine system7Heterogeneous group of moleculesindustrial solvents/lubricantsflame retardantsaluminum can liningsplasticizerspesticidesfungicidespharmaceutical agents
8. EDC-2: The Endocrine Society's Second Scientific Statementon Endocrine-disrupting Chemicalscomprehensive review literature on seven topics strong mechanistic, experimental animal, and epidemiological evidence for endocrine disruption8Andrea C Gore et al., 2015
9. EDC-2: Endocrine Society's Statementon Endocrine-disrupting ChemicalsSTRONG EVIDENCE OF ENDOCRINE DISRUPTIONobesity and diabetesfemale reproductionmale reproductionhormone-sensitive cancers in femalesprostatethyroidneurodevelopment and neuroendocrine systems9Andrea C Gore et al., 2015
10. EDC-2: Endocrine Society's Statementon Endocrine-disrupting ChemicalsCHEMICALS WITH INFORMATION AVAILABLEBisphenol APhthalatesPesticidesPersistent organic pollutants such as PCBs, PBDEs, and dioxins10Andrea C Gore et al., 2015
11. EDC-2: Endocrine Society's CONCLUSIONS Endocrine-disrupting Chemicalsthorough coverage studies developmental exposures EDCs, especially fetus and infantcritical life stages: perturbations of hormones can increase probability of disease or dysfunction later in lifefuller understanding of endocrine principles by which EDCs act:including non-monotonic dose-responseslow-dose effectsdevelopmental vulnerabilityhealthcare providers to translate the science of endocrine disruption to improve public health.11Andrea C Gore et al., 2015
12. Significance of policyCost of brominated flame retardants likely to be higher in the US, as use is more stringently limited in Europe.Levels of phthalates (DEHP) have decreased 17-37% in the US between 2001-10 and costs of attributable disease are likely to have decreased over that period.EDCs are used globally, and findings support careful regulation as part of the Strategic Approach to International Chemicals Management. 12
13. 13Quantifying EDC disease burden and costsFor EDCs, laboratory evidence is supplemented by varying levels of epidemiologic evidenceEach condition is clearly multifactorial.Absent estimates of the burden of disease and disability potentially produced by EDC exposures, high costs of alternatives are likely to outweigh concerns about the health consequences of using EDCs.Expert panels quantified EDC disease burden and costs
14. 14J Clin Endocrinol Metab 100: 1245–1255, 2015The objective was to quantify a range of health and economic costs that can be reasonably attributed to EDC exposures in the European Union (EU).
15. 15J Clin Endocrinol Metab 100: 1245–1255, 2015EDC exposures EU are likely contribute substantially to disease and dysfunction across the life course with costs in the hundreds of billions of Euros per year. These estimates represent only those EDCs with the highest probability of causation; a broader analysis would have produced greater estimates of burden of disease and costs.
16. Pesticides used in agricultural and homes13 million lost IQ points in each EU country €124 billion lost earning potential59,300 born each year with intellectual disability = additional €21.4 billion1,555 obese 10 year olds = €24.6 million28,200 50–64 year olds with diabetes = €835 million16Bellanger et al, Legler et al J Clin Endo Metab epub Mar 5 2015
17. Phthalates used in food wraps, cosmetics, shampoos, vinyl flooring 24,800 additional deaths 55 – 64 year old men = €7.96 billion lost economic productivity618,000 additional assisted reproductive technology procedures costing €4.71 billion53,900 50-64 year old women obese = €15.6B20,500 50-64 year old women diabetic = €607M17Hauser et al, Legler et al J Clin Endo Metab epub Mar 5 2015
18. Flame retardants used in electronics, furniture, mattresses873,000 lost IQ points €8.4B lost earning potential3,290 intellectually disabled children = additional €1.9 billion6,830 new cases of testicular cancer = €850 million4,615 children born with undescended testis = €130 million18Bellanger et al, Hauser et al J Clin Endo Metab epub Mar 5 2015
19. Other estimates of burden and disease and costs19316 autistic 8 year olds each year (multiple EDCs) = €199 million31,200 10 year olds with ADHD (multiple EDCs) = €1.7 billionBisphenol A (used in aluminum can linings, thermal paper receipts): 42,400 obese 4 year olds each year = €1.54 billion
20. 20polybrominated diphenyl ether organophosphate exposures intellectual disability and lost IQ points autism spectrum disorder attention-deficit hyperactivity disorderEDC exposures Europe contribute substantially to neurobehavioral deficits and disease, with a high probability of €150 billion costs/year. J Clin Endocrinol Metab 100: 1256–1266, 2015
21. 21male infertility and phthalate exposure probability of 618 000 additional ART per year costing €4.71 billion annuallycryptorchidism due to prenatal polybrominated diphenyl ether exposure probability of 4615 cases costing €130 million testicular cancer by polybrominated diphenyl ethers costs of €848 million annually lower T concentrations 55- to 64-year-old men due to phthalate exposure, with 24 800 associated deaths annually and lost economic productivity of €7.96 billion.J Clin Endocrinol Metab 100: 1267–1277, 2015
22. 22J Clin Endocrinol Metab 100: 1278–1288, 2015dichlorodiphenyldichloroethylene (DDE) causing 1555 cases of overweight at age with associated costs of €24.6 millionDDE causing 28 200 cases of adult diabetes costs of €835 million phthalate exposure causing 53 900 cases of obesity in older women and €15.6 billion in associated costsphthalate exposure 20 500 new-onset cases of diabetes in older women with €607 million in associated costsprenatal bisphenol A exposure 42 400 cases of childhood obesity, with lifetime costs of €1.54 billion
23. SAICM-ICCM4 Emerging Policy Issuesappropriate action & priorities cooperative actionResolutions adopted:Lead in paintChemicals in ProductsLife cycle electrical and electronic productsNanotechnology & manufactured nanomaterialsEndocrine disrupting chemicalsPerfluorinated chemicals & safer alternativesHHPsEPPPs
24. 24INACTION: lack of action where some is expected or appropriate
25. CONFIDENTIAL25Much higher developing countries and countries with economies in transition
26. STATUS QUO: EDCs IN AFRICALack of awareness and knowledge amongst government officials & general public Competition national resources/priorities Lack of easily accessible, user-friendly informationMost countries no monitoring chemical movementNo information of chemicals in products - industry not expected to divulge information; no tracking chemicals from production or import to secondary use and final disposal.26
27. Industry often not required to do rigorous risk assessment on chemicals as a prerequisite before introducing them into the marketFragmented policy approach to dealing with chemicals management in generalExcept in RSA, no research or activities are known to have been undertaken on EDCs in Africa.27STATUS QUO: EDCs IN AFRICA
28. Environmental challenges mining, dumping, E-waste28
29. UNEP Report 5 Sep 2012Chemical 'Intensification' of Economies in Developing Countries Means Greater Risk of Exposure to Hazardous Substances.
30. Global chemical production
31. Chemical intensificationeconomic gains poor individuals particularly vulnerableexposures may be highpoor nutrition other risk factors can increase susceptibility
32. Challenge in AfricaHIV/AIDSMalariaTBacute respiratory infectionsdiarrhoeal disease vaccine-preventable diseasesInfectious killers ~2020 NCD (ie. DM, HT) cause 7/10 deaths Brundtland, 2002; Boutayeb, 2006malnutrition common contributor
33. Responsibility to our children6 October 201533
34. In any examination of the challenges of Africa, one natural resource often goes unnoticed: Africans themselvesKenyan Winner Nobel Peace Prize
35. Ro livhuwa!