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Environmental health gaps


Yet environmental health didn’t get the respect, and resources, it needed, Leighton feels. Many other officials agree that the environmental health implications of the disasters weren’t accorded enough attention at the time.


As the EPA Inspector General’s report concluded, the crucial role for environmental and health expertise was deliberately removed, as the White House downplayed any perception of a health crisis.


Before that, however, EPA concluded in its first “Lessons Learned” report, that the agency was hamstrung by the perception that it wasn’t a public health agency. “Many federal, state and local entities, however, failed to sufficiently recognize and understand EPA’s role, mission and capability as part of an emergency response with environmental and human health consequences,” the report stated.


At the World Trade Center, according to this report, New York City directed the response, and EPA was responsible for the health and safety of site workers. Many non-EPA responders did not recognize EPA’s authority in decisions involved protective equipment.” And at the Pentagon, the FBI excluded EPA’s On-Scene Coordinators from being fully brought into the emergency response.


Perhaps that is a symptom of an uneasiness between public health and environmental professionals and the military. (27) Dr. Patrick Meehan, Director, Division of Emergency and Environmental Health Services at the National Center for Environmental Health at CDC, says that working with enforcement agencies like the FBI, as it did during the anthrax incidents, was a new experience for many in the public health establishment.


“One of the lessons learned from the World Trade Center,” Meehan told NEHA, “is that local Health departments need a lot more robust capability, to provide trusted health based interpretations of hazards to the public.” Although the New York city Health department took many responsibilities upon itself – everything from managing traditional public health to tackling occupational health with respirators – “the dilemma,” says Meehan, “was enforcement.”


All this may have led to a vacuum in environmental health leadership. Not everyone blames EPA or the city exclusively.


“I wish that the public health leadership had stepped up and added some health perspective during the first few months, when there was so much uncertainty about the dangers in the dust,” says Dr. Steven Markowitz, a professor of Community Health and Social Medicine at the City University of New York Medical School, in Flushing, N.Y. “It should not have just been left to the environmental experts to communicate the need for precautions.”


Markowitz helped fill that vacuum by providing free respiratory screenings to more than 400 undocumented immigrant workers at Ground Zero who were not otherwise being checked by local unions or other agencies. The physician and epidemiologist, joined with the New York Committee for Occupational Safety and Health (NYCOSH) and the Latin American Workers Project to give out free respiratory screenings, with an $80,000 grant from the United Way's September 11th Fund.


Officials of the fund were looking for causes to support, so getting the money was not difficult. Money was used to rent a van that was already equipped to perform occupational screenings and hire a staff of seven.


The difficulty was trying to reach the largely immigrant workers, thousands of whom did piece work for the big office building companies, cleaning near Ground Zero, but lacked health insurance or even access to a doctor.


Markowitz supervised the medical monitoring van near Ground Zero for two months, from January through March 2002, offering free health exams, which included breath tests, collection of urine and blood and interviews about their work history. Workers told the medical workers that they were given mops and rags and told to remove inches of dust coating floors, walls and furniture in office buildings.



"Few of these people we saw were given respirators or taught how to use them," Markowitz says.” In fact, some workers cleaning dusty offices were even told not to wear their own respirators for fear that this might deter them from taking these jobs, he says. Many of these cleaners proved to have symptoms four to six weeks after they stopped working, says Markowitz.



“Someone in the public health leadership should have said, ‘let’s err on the side of caution.’”



It’s understandable, Markowitz says, that the firefighters were overcome by grief and might have been less inclined to comply with the need to wear their respirators, but there should have been some third party agency or official looking at preventable errors in those workers, in residents, and among anyone who came in touch with the dust.


“Given the health risks here, someone in the public health leadership should have said, ‘let’s err on the side of caution,’” he adds.

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