The Environmental Health Matters Initiative (EHMI) held a workshop on identifying opportunities to understand, control, and prevent exposure to per- and polyfluoroalkyl substances (PFAS) on September 26–27, 2019, at the National Academies of Sciences, Engineering, and Medicine in Washington, DC. The National Environmental Health Association (NEHA) serves as a liaison to the initiative, and Dr. Natasha DeJarnett is NEHA’s representative. Environmental health leaders, scientists, physicians, and community members banded together to discuss innovative approaches for preventing PFAS exposures. As the first of its kind, this workshop helped to advance the understanding around PFAS and human exposures. While this robust discussion focused on routes of and methods to limit exposure, the long-term adverse health effects of PFAS were outside the scope of the workshop, an area that remains relatively unknown. Environmental health professionals can, however, benefit from having a comprehensive understanding of PFAS, its persistence, and approaches they can take to mitigate exposure, and inform and protect the public’s air, water, and consumer products.
The Environmental Health Matters Initiative workshop explored how to understand, control, and prevent PFAS exposure.
Understanding PFAS Can Inform Decision Making
PFAS are a group of human-made chemicals that include perfluorooctanoic acid (PFOA), perfluorooctane sulfonate (PFOS), and many other materials (Food and Drug Administration [FDA], 2019; U.S. Environmental Protection Agency, 2018). PFAS contents are used in consumer products such as stain repellants, pizza boxes, carpeting, cleaning products, and cookware. PFAS have been manufactured in the U.S. since the 1940s. Unfortunately, the unregulated contaminant is rarely monitored long-term, is persistent, and can bioaccumulate (i.e., a gradual amassing or concentration of contaminants or chemicals in both humans and animals). For example, PFAS can pollute surface waters and bioaccumulate in fish, of which humans can consume and therefore, directly expose humans. Though PFOA and PFOS no longer manufactured in the U.S., other members of the class are and these chemicals are still imported internationally in consumer goods. Aside from consumer products, including cosmetics, PFAS have been found in the air we breathe, water we drink, wastewater treatment plants, and landfill leachate. PFAS have been found in drinking water and military sites across the U.S. Scientific studies indicate that PFAS can cause reproductive, developmental, immunological, liver, and kidney effects in laboratory animals. With over 5,000 different types of PFAS (FDA, 2019), the potential threat these chemicals could pose to human health is a growing concern.
PFAS use and exposure also imposes economic concerns. According to Dr. Holly Davies of the Washington Department of Health, the estimated health cost of exposure is $37–$59 billion and $12.1 billion in environmental damages. Some uses of PFAS, however, are both essential and suitable for use. Both Dr. Davies and Dr. Carla Ng of the University of Pittsburgh explained the essential uses for PFAS and the use of alternative assessments to identify, compare, and select safer alternatives to reduce the risk of PFAS exposure. It is a challenge to prioritize the uses of PFAS due to their high functionality. For example, there are both essential and nonessential uses of PFAS in aircrafts. PFAS is essential to design and construct the motor and other interior parts of the plane unexposed to passengers. PFAS are water and oil repellent, temperature resistant, and reduce friction. The chemicals help prevent corrosion, provide insulation, and prevent fires. PFAS are also used as coatings for leather seats, carpets, and plastics on aircrafts. Coating textiles and leather in PFAS, such as carpets, clothing, and protective clothing, are nonessential uses of the chemicals and can unnecessarily expose the public.
Moreover, industry and tariff engineering are drivers to PFAS use in manufacturing and consumer behavior. While some experts believed that consumers would be more or less likely to purchase a product if made aware of their exposure to PFAS, others argued against the responsibility of the consumer to understand this chemical, stating, “Consumers have no idea they are being exposed. They did not sign up for exposure to these contaminated products.” PFAS are mostly used in industrial and consumer products. While there is much for scientists, physicians, and health professionals to understand about these chemicals, consumers are also learning how to identify major sources of PFAS and are seeking to understand the potential adverse health effects of its use.
PFAS Exposure Occurs Through Multiple Pathways
Dr. Thomas Webster of Boston University and Dr. Antonia Calafat of the Centers for Disease Control and Prevention (CDC) shared some of the many challenges to understanding these elusive and slow degrading chemicals, such as 1) time of exposure, 2) lack of information on the chemicals, 3) limited surveillance, and 4) unregulated contamination. Additionally, scientists face challenges to understanding the multiple pathways of exposure to PFAS. Potential sources and routes of exposure of PFAS to the general population include:
- Ingestion: Including drinking water, food sources, food processing, and food contact materials (e.g., cardboard boxes and Teflon pans).
- Inhalation: Breathing volatile precursor compounds or dust, respiration of indoor air and other contaminated media.
- Dermal: Skin contact, including personal skincare products, hair care products, or cosmetics.
Dietary intake may be an important pathway of PFAS exposure in adults, and bioaccumulation and food packaging are the two main contributors. Currently, there is very little research on PFAS and food processing and indoor and dermal exposure (the least attributing route of exposure). Since drinking water is a common route of exposure, there is a critical research need in PFAS contamination in private drinking water.
Dr. Jennifer Field of Oregon State University expanded on the exposure pathways through the goods that we purchase and the connectivity of these different pathways. Manufacturing is the largest polluter of PFAS. Manufacturing wastes emit into the air and are dispersed and disposed of into landfills and wastewater treatment plants (WWTPs). Additionally, aqueous film-forming foams (AFFFs) or firefighting foams contain PFAS and have been used since the 1960s. Runoff from consumer goods, landfill leachate, AFFFs, and WWTPs discharge into the soil and water, which can contaminate the drinking water and food humans consume. The cycling of these persistent compounds maximizes exposure. There are several methods, however, to identify and reduce the source of exposure to PFAS.
Environmental Assessments Guide Controls of PFAS
The EHMI workshop provided a number of treatment technologies and methods to control PFAS, such as prioritizing essential and nonessential uses of PFAS. Alternatives assessments and life cycle assessments help identify, compare, and recommend safer alternatives to PFAS. Manufacturers can use life cycle assessments to identify the effects utilizing different inputs or processes. Exposure assessments were an example raised during the workshop to better understand and inform controls of PFAS exposures. The CDC and Agency for Toxic Substances and Disease Registration (ATSDR) conduct PFAS exposure assessments in communities with PFAS in the drinking water and near military sites. Risk assessments aid in the identification and communication of exposure risks and can be piloted within smaller subgroups.
Lastly, biomonitoring—the measurement of chemicals in human tissues and fluids— strengthens exposure assessments and helps to identify vulnerable communities. Several biomonitoring efforts are underway, including the National Health and Nutrition Examination Survey (NHANES) to detect PFAS in children and adults. Dr. Calafat presented some results from NHANES, a probability sample of the U.S. population and a biological collection of serum and urine from 1999–2018. The study acknowledges an 80% decrease in PFOS serum concentrations after manufacturing changes in the U.S. since 1999. PFAS was detected, however, in children who were born after manufacturing changes in the 2013–2014 NHANES. Though biomonitoring cannot tell us when and how we are exposed to a certain chemical, it can be used to target and screen. The choice of sample matrix, serum was mostly preferred in this study, influences the success of the biomonitoring exposure assessment as well, which might be unique to different locations across the U.S.
“I wanted to raise points about opportunities for control and prevention of PFAS contamination and exposure. I would encourage that we consider equity and ensure that those opportunities do not further burden populations that are already vulnerable and have high disparities and are already contaminated,” stated NEHA’s Dr. Natasha DeJarnett. Dr. DeJarnett also expressed the need to consider the cost impacts of phasing out the use of PFAS and the potential burden that might pose on low-income communities.
In conducting these assessments, equity should be at the forefront of efforts toward understanding PFAS exposure reduction. “In this PFAS world, it is critical to engage with the people in the community. If not for the community, we would not have some of these current PFAS health studies,” stated a community representative. Dr. DeJarnett also raised comments regarding health equity. As we increase funding for research and mitigate exposures, it is imperative to ensure all communities are fully represented and informed.
Environmental Health Professionals Can Act on PFAS
PFAS are everywhere! Understanding and controlling PFAS exposure requires time and resources; however, it can be done. I had the opportunity to pose several questions on how the environmental health workforce can play a role in PFAS prevention. How can the environmental health workforce assist in countering the challenges in identifying safer alternatives and what should we be telling our constituents about exposure? With regard to public health, it is essential to create an integrated picture and capture the life cycle of these chemicals. Environmental health professionals can contribute to PFAS prevention by educating their constituents about the uses of PFAS and their potential harms. Areas of opportunity to inform the public on PFAS include:
- food processing,
- indoor exposures,
- dermal exposure,
- occupational health,
- increased funding around PFAS and health research,
- public health guidelines and regulations, and
As the EHMI workshop concluded, Meredith Williams of the California Department of Toxic Substances Control, made a striking statement, “PFAS will keep coming around if we keep putting them in the environment.” As consumers, this step is the first to begin thinking about our exposure to PFAS. Dr. Linda Birnbaum, retired director of the National Institute for Environmental Health Sciences, validated this sentiment in her closing remarks asking why we would want something that will live in our environment forever. Environmental health was defined at the beginning of this workshop; however, health was beyond the scope of the meeting. Moving forward, it’s urgent to examine the potential harm PFAS pose on human health. The more we can inform the decision makers and the public of PFAS hazards, the more we can promote the decrease in its production and use in the U.S.
Ayana Jones posed questions to panelists on how the environmental health workforce can control and prevent PFAS exposure
In an effort to promote the protection of human health and the role of the environmental health workforce among policy makers, NEHA will be hosting an upcoming Hill briefing on PFAS exposure with the U.S. Senate on October 24, 2019. NEHA encourages its constituents and members to become familiar with PFAS. To learn more on the manufacturing history of PFAS, I recommend tuning into Dark Waters, an upcoming American film of the 20-year legal battle between environmental lawyer Robert Bilott and DuPont, the manufacturer of Teflon. The class action lawsuit ended with a $600 million payout to thousands of people who DuPont admittedly poisoned in West Virginia. The film is set to release on November 22, 2019. NEHA also asks its partners, EHMI, and environmental health agencies to prioritize human health in discussions on PFAS and advocate for additional funding for assessments, guidelines, research, or the elimination of PFAS use. The more we understand about the effects PFAS has on the environment and human health, the better prepared we will be to limit its use and create healthier environments.
Food and Drug Administration. (2019). Per and polyfluoroalkyl substances (PFAS). Retrieved from https://www.fda.gov/food/chemicals/and-polyfluoroalkyl-substances-pfas
U.S. Environmental Protection Agency. (2018). Basic information on PFAS. Retrieved from https://www.epa.gov/pfas/basic-information-pfas
Ayana Jones is a Project Coordinator in NEHA’s Program & Partnership Development department in Washington D.C.
She works on vector control and water-related projects at NEHA.