Analyzing the Effectiveness of Fish Consumption Advisories in Immigrant PopulationsDan EndresonNovember 27, 2007

Problem Introduction and AnalysisHmong populations in the Twin Cities are adversely exposed to methylmercury contamination due to greater fish consumption.

Problem Introduction and AnalysisProblem BackgroundMercury in the environmentPublic health concernsHmong population and cultureEvaluation CriteriaAlternativesAlternative EvaluationRecommendationsHmong populations in the Twin Cities are adversely exposed to methylmercury contamination due to greater fish consumption.

Mercury SourcesNatural (30%)Volcanic activityAnthropogenic (70%)Product usePesticidesPaintsMedical and dental useBy-productsWaste incinerationCoal combustionMetal mining and processing

Sources: Mercury Fact Sheet, EPA, June 2001; Mercury Emissions Report, MPCA, March 2004

Mercury SourcesNatural (30%)Volcanic activityAnthropogenic (70%)Product usePesticidesPaintsMedical and dental useBy-productsWaste incinerationCoal combustionMetal mining and processing

87% from coal combustion and waste incineration

Sources: Mercury Fact Sheet, EPA, June 2001; Mercury Emissions Report, MPCA, March 2004

Human Exposure and Health EffectsFish consumption is primary human exposure routeMethylmercury accumulates in the fat and muscle of fishTrimming and cooking fish does not significantly reduce methylmercury concentration

Easily passes through digestive system due to lipophilic properties

Half life in body of 44-80 days

Chronic ToxicityCentral nervous systemCardiovascular and immune systemsKidneysReproductionPossible carcinogen

Especially harmful to fetuses, infants, and childrenIs passed through breast milk

Public Health Extent66% of Minnesota waters impaired due to mercury

No danger for typical consumer (10g/day ~ cup/day)

Increased dangerConsuming large fishPregnant womenSubsistence anglersSource: TMDL Pollutant Reduction Plan, MPCA, 2004

Hmong PopulationNon-state culture originating in Southeast Asia750 immigrants arrived in 1976 through the U.S. Refugee Program60 in MinnesotaContinual increase in population41,800 in Minnesota; 50% increase from 1990May be as high as 70,00097% live in the Twin CitiesEconomic33% below the poverty line (Average rate is 8%)Median Family Income = $35,864Per Capita Income = $7,210

Source: 2002 U.S. Census

A Culture of FishingDeep cultural ties to fishingUsed to supplement diet

Tradition continues after immigrationEases transition after immigrationRecreational and consumptive anglingFish for bass, perch, and trout90% consumptionSource: Hutchinson and Kraft, 2004

Evaluation CriteriaAdministrative Operability

Effectiveness - Health

Cost

Social Acceptability

Alternative #1Continue the current practice of fish consumption advisories

Alternative #1: Fish Consumption AdvisoriesAdministrative OperabilityPollution Control Agency (PCA)Developing state water standardsStatewide water quality planning and monitoring

Department of Natural Resources (DNR)Enforce fishing regulationsAnalyze fish for contaminants

Department of Health (MDH)Develop guidelines for safe fish consumptionPublishes data and educates the public

Alternative #1: Fish Consumption AdvisoriesEffectiveness - HealthDeclining fertility rates1995: 96.3 per 1,0001998: 96.4 per 1,0002000: 81.1 per 1,000Increased rate of:low birth weight rates kidney stonesincidence of cancerComparative pilot study in WisconsinDeficits in spatial learning and memoryDecrease in infant mortality1995-99: 7.1 per 1,0002000-04: 5.0 per 1,000

Sources: MDH, 2004, MPR, 2005; Childrens Environmental Health Center, Univ. of Illinois-Champaign, 2007

Alternative #1: Fish Consumption AdvisoriesCostPCAWater quality - $52.7 millionDNRFisheries = $82.9 millionGame and Fish Protection = $38.7 millionMDHStaff support = $33.9 millionPrinting and mailing = $25,000Sources: Department of Finance, 2007; DNR FY2006-07 Operating BudgetTotal = $208 million

Alternative #1: Fish Consumption Advisories Social Acceptability2003 - Michael Joseph, Brown UniversityInterviewed 15 anglers of Southeast Asian descent in Providence, RINot concerned or did not understand advisoriesMost avoided fish for taste, not safetyContamination associated with taste, smell, sight

2006 - Indigenous Womens Mercury InvestigationInterviewed 11 families on native reservations in Northern Minnesota9 families consumed fish more than one meal per weekMany had minimal interaction with MDH literature and staffConsumption continued even with education

Alternative #2Shift public education of fish advisories to units of local government and organizations

Alternative #2: Local InvolvementAdministrative OperabilityLocal government unitsPark and Recreation DepartmentsEnforcement and education

Non-Profit OrganizationsFox River Environment and Diet Study (FRIENDS)Research and education

Alternative #2: Local Involvement Effectiveness - HealthExpect slow decrease in mercury-related illnesses over timeAble to reach subpopulations

Should be more effective than MDH advisories alone

Alternative #2: Local Involvement CostCurrent Advisory Costs$208 millionLocal GovernmentMinneapolis Park and Recreation Board$346,921 for Public Information $163,905 Customer Service St. Paul Parks and Recreation$310,546 for Community Education Non-ProfitsTotal = $211 millionSources: MPRB 2007 Annual Budget; SPPR 2005 Budget; DNR CO Program

Alternative #2: Local Involvement Social AcceptabilityTracey Nordstrom, MPRB Vice PresidentLocal units have greater access to communitiesNormally work with neighborhood associations

FRIENDSGreater knowledge of cultural barriersCan build trust within the communityEmpower local activism

Alternative #3Place a fish consumption ban on all contaminated waters in Minnesota

Alterative #3: Fish Consumption BanAdministrative OperabilityPCADeveloping state water standardsStatewide water quality planning and monitoringDNREnforcement of consumption banAnalyze fish for contaminants

Alterative #3: Fish Consumption BanEffectiveness - Health

Reduction in mercury exposureNo longer able to consume contaminated fish

Lose benefits of eating fishLean protein sourceOmega-3 fatty acids

Alterative #3: Fish Consumption BanCostPCAWater quality - $52.7 millionAdditional enforcement expenseDNRFish = $82.9 millionGame and Fish Protection = $77.4 million Minneapolis Park and Recreation BoardPark Police = $9.6 millionTotal = $222.6 millionSources: Department of Finance, 2007; DNR FY2006-07 Operating Budget

Alterative #3: Fish Consumption BanSocial AcceptabilityWould not be accepted by the public

Too many groups tied to fish consumption

Fish consumption would occur regardless of ban

Alternative #4Provide more Asian-specific items at food shelves for low-income segments of the population

Alternative #4: Modify Food ShelvesAdministrative OperabilitySecond Harvest Provides food to local shelters and food shelvesRefrigerated and non-refrigerated itemsServes entire metro area

Center for Asian & Pacific Islanders (CAPI)Asian-specific food shelf

Alternative #4: Modify Food ShelvesEffectiveness - HealthFish is complemented with other food items

Better overall nutrition

Alternative #4: Modify Food ShelvesCostSecond Harvest$47 million annual

CAPITotal = $47 millionSource: Second Harvest Annual Report, 2007

Alternative #4: Modify Food ShelvesSocial AcceptabilityProvides culturally familiar food

Increases chance of consumer using food shelf

Alternative EvaluationAdministrative OperabilityMechanisms in place for all 4 alternatives

Greatest Effectiveness HealthConsumption banFood shelf

Least CostlyFish Consumption AdvisoriesFood shelf

High Degree of Social AcceptabilityLocal educationFood shelf

RecommendationsUse a strategy of multiple alternativesContinue Fish Consumption AdvisoriesMove public education to the local levelProvide culturally familiar options for low-income segments

RecommendationsUse a strategy of multiple alternativesContinue Fish Consumption AdvisoriesMove public education to the local levelProvide culturally familiar options for low-income segmentsCompliance failures are due to cultural barriersDistrust of the unknownMisunderstanding of dangerDecision between culture and healthCheap food source

EPA fact sheet (pdf)MPCA, March 2004 (pdf)

EPA fact sheet (pdf)MPCA, March 2004 (pdf)

EPA fact sheet (pdf)

EPA fact sheet (pdf)

http://www.hmong.org/displaycontent.asp?id=172000HmongCensusPublication.pdfDourson pdfhttp://www.metrocouncil.org/Environment/water/planning/who_water.htm

Published first advisory booklet in 1983Goal is not to reduce fish consumption educate of which fish to eat and how muchProvides general and site-specific adviceInformation distributed in print, media and onlineAvailable in English and SpanishPresentations made upon request

http://www.health.state.mn.us/ommh/asian.htmlhttp://news.minnesota.publicradio.org/features/2005/08/04_bensonl_kidnseystone/http://www3.interscience.wiley.com/cgi-bin/abstract/104535519/ABSTRACThttp://es.epa.gov/ncer/childrenscenters/illinois.html

http://www.budget.state.mn.us/budget/operating/200809/sup1/index.shtml

http://www.dnr.state.mn.us/aboutdnr/budget/budgetplan/index.html

IWMIhttp://www.friendscenter.uiuc.edu/about_us.html

http://www.minneapolisparks.org/documents/about/2007_annual_budget.pdf

http://www.ci.stpaul.mn.us/mayor/05budget/ParksOverview.pdfhttp://www.dnr.state.mn.us/aboutdnr/budget/budgetplan/index.html

http://www.dnr.state.mn.us/radiobite/script_096.html

http://www.dnr.state.mn.us/jobs/careerinfo/co.html

http://files.dnr.state.mn.us/enforcement/phonedirectory.pdf

http://www.2harvest.org/about/financial/downloads/2006%20Annual%20Report.pdf

http://www.2harvest.org/about/financial/downloads/2006%20Annual%20Report.pdf