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Implementation of the Minamata Treaty on Mercury in the U.S. Implications for Public Policy, Environmental Justice, and Public Health Education -By Mark Mitchell M.D., MPH

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Page 1: Implications for Public Policy, Environmental Justice, and Public Health Education -By Mark Mitchell M.D., MPH

Implementation of the Minamata Treaty on Mercury in the U.S.

Implications for Public Policy, Environmental Justice, and Public Health Education

-By Mark Mitchell M.D., MPH

Page 2: Implications for Public Policy, Environmental Justice, and Public Health Education -By Mark Mitchell M.D., MPH
Page 3: Implications for Public Policy, Environmental Justice, and Public Health Education -By Mark Mitchell M.D., MPH

1. Minamata Treaty Goal2. Why is Mercury Exposure a Problem?3. Minamata Treaty Requirements4. Sources of Mercury in the U.S.5. Why Focus on Mercury Products?6. Exposures in Vulnerable Populations7. Policies Needed to Reduce Mercury

Exposure

Overview

Page 4: Implications for Public Policy, Environmental Justice, and Public Health Education -By Mark Mitchell M.D., MPH

Minamata Convention on Mercury

Mercury Treaty Negotiations

Objective:

“…to protect the human health and the environmental from anthropogenic emissions and releases of mercury and mercury compounds.”

Page 5: Implications for Public Policy, Environmental Justice, and Public Health Education -By Mark Mitchell M.D., MPH

Mercury is an element◦ Cannot be created or destroyed by humans◦ Can change in form to become more or less

Toxic Biologically available

Mercury is persistent, bioaccumulative and toxic

Why is Mercury a Problem?

Page 6: Implications for Public Policy, Environmental Justice, and Public Health Education -By Mark Mitchell M.D., MPH

Fish consumption is largest source◦ Fish consumption advisories in all 50 states ◦ Mercury in commercial fish varies considerably◦ High mercury commercial fish:

Swordfish King Mackerel (not canned, Atlantic, or Pacific Mackerel) Shark Tilefish Tuna (especially albacore [white] tuna)

Mercury amalgam tooth fillings◦ Have not been shown to cause direct harm in adults

Some medications and multi-dose vaccines◦ Particularly eye, ear, and nose antibiotics◦ Have not been shown to cause direct harm to humans

Human Exposure to Mercury

Page 7: Implications for Public Policy, Environmental Justice, and Public Health Education -By Mark Mitchell M.D., MPH

To protect public health we must reverse the bioaccumulation in fish

To reverse bioaccumulation of mercury in fish, we must eliminate as much mercury released into air and water as possible on a global scale

The Minamata Convention on Mercury attempts to do this

Reversing Bioaccumulation in Fish

Page 8: Implications for Public Policy, Environmental Justice, and Public Health Education -By Mark Mitchell M.D., MPH

Reduce or eliminate mercury from artisanal and small-scale gold mining.

Control mercury air emissions from ◦ coal-fired power plants, ◦ coal-fired industrial boilers, ◦ certain non-ferrous metals production operations, ◦ waste incineration and ◦ cement production.

Phase out or reduce mercury in manufacturing processes

◦ chlor-alkali production, ◦ vinyl chloride monomer production, and ◦ acetaldehyde production.

Source: www.epa.gov/mercury

Minamata Convention on Mercury Requirements

Page 9: Implications for Public Policy, Environmental Justice, and Public Health Education -By Mark Mitchell M.D., MPH

Phase-out or reduce mercury use in mercury containing products ◦ batteries, switches, lights, ◦ cosmetics, ◦ pesticides and ◦ measuring devices, ◦ reduce the use of (phase down) mercury in dental

amalgam

In addition, the Convention addresses the supply and trade of mercury; safer storage and disposal, and strategies to address contaminated sites.

Minamata Convention on Mercury Requirements (cont’d)

Page 10: Implications for Public Policy, Environmental Justice, and Public Health Education -By Mark Mitchell M.D., MPH

Mercury Releases in the United States—2000

(tons)*

 Releases

to AirReleases to

WaterReleases to

LandIntentional Use in Products 41 0.8 106Combustion of Coal and Other Fuels 60 0.2 33Mining (mercury in ore) 15 45 2585Other 10 0.1 2Total 126 46.1 2726       

* Source: Cain, et al, Substance Flow Analysis of Mercury Intentionally Used in Products in the United States. Journal of Industrial Ecology 2007 Vol: 11(3):61-75. DOI: 10.1162/jiec.2007.1214

Page 11: Implications for Public Policy, Environmental Justice, and Public Health Education -By Mark Mitchell M.D., MPH

Mercury in products is (arguable) easiest source to eliminate in the U.S.

Mercury in non-dental products has dropped 97% since 1980 (Source: EPA Strategy to Address Mercury Containing Products, Sept. 2014)

Why Focus on Mercury Products?

Page 12: Implications for Public Policy, Environmental Justice, and Public Health Education -By Mark Mitchell M.D., MPH

Mercury in ProductsTons Released Per Year

1990 2000 20050

20

40

60

80

100

120

Dental Amalgam

Flourescent Lamps

HID and Other Lamps

Bulk Liquid Mercury

Switches and Relays

Measurment and Control Devices

Batteries

Paint

Page 13: Implications for Public Policy, Environmental Justice, and Public Health Education -By Mark Mitchell M.D., MPH

Mercury Use in Dentistry is Declining

Eleven Low Amalgam Countries

Use of mercury in dentistry is declining more slowly than in other products in U.S.

There are safe substitutes Even though only about 48-68%

of dentists in the U.S. use dental amalgam,[1] dental amalgam still represents one of the leading uses of mercury in the United States at about 18 to 30 tons annually (35 to 57% of use in products).[2][3]

Many other countries have virtually eliminated dental amalgam

Page 14: Implications for Public Policy, Environmental Justice, and Public Health Education -By Mark Mitchell M.D., MPH

Pregnant women and developing fetus Women who might become pregnant Nursing mothers Young children Subsistence fishers who fish from local waters People who engage in cultural practices using

azogue Those who eat more than one or two tuna meals

per week Those from developing countries who live near

mining or mercury storage or disposal sites

Vulnerable Populations for Mercury Poisoning

Page 15: Implications for Public Policy, Environmental Justice, and Public Health Education -By Mark Mitchell M.D., MPH

People of Color are more likely to have high mercury levels (Source: Schober, S et al: JAMA. 2003;289(13):1667-1674)

◦ From subsistence fishing or eating more local fish◦ From eating more canned tuna◦ From cultural practices using azogue

Low Income people get amalgam fillings placed more often◦ Amalgam is more likely to be used for American Indians, Alaska

Native, Asians, and Pacific Islander patients while composite is more likely to be used in other patients.[4]

◦ Medicaid often only covers cost of amalgam fillings◦ Patients often are not given a choice of fillings◦ Dental students are often required to place amalgam fillings in

dental clinics

Environmental Justice Concerns

Page 16: Implications for Public Policy, Environmental Justice, and Public Health Education -By Mark Mitchell M.D., MPH

INCREASE fish consumption in pregnant women and children while REDUCING canned tuna and other higher mercury fish

Eliminate added mercury from products, as much as possible

Increase public awareness of mercury in foods and products, and the availability of low mercury alternatives Research alternatives to mercury in products where no good alternative currently exists Modify insurance to cover non-mercury dental products

Mercury Policies Needed in U.S.

Page 17: Implications for Public Policy, Environmental Justice, and Public Health Education -By Mark Mitchell M.D., MPH

[1]Haj-Ali R, Walker MP, Williams K., Survey of general dentists regarding posterior restorations, selection criteria, and associated clinical problems, Gen Dent. 2005 Sep-Oct;53(5):369-75 (“A total of 714 dentists (26.3%) responded. Direct composite was the material used most commonly for posterior intracoronal restorations. Dentists in amalgam-free practices (31.6%) were significantly more likely (p = 0.001) to use direct composite than dentists whose practices used amalgam.”); U.S. EPA, Health services industry detailed study (August 2008), http://water.epa.gov/scitech/wastetech/guide/304m/upload/2008_09_08_guide_304m_2008_hsi-dental-200809.pdf, p.3-1 (“The survey found that 52 percent of dentists do not place amalgam fillings”).

[2] U.S. Geological Survey, Changing Patterns in the Use, Recycling, and Material Substitution of Mercury in the United States(2013), p.26 (“Dental amalgam represents one of the leading uses of mercury in the United States at about 18 to 30 t annually and constitutes the largest amount of mercury in use in the United States.”)

[3]U.S. Geological Survey, Changing Patterns in the Use, Recycling, and Material Substitution of Mercury in the United States(2013), http://pubs.usgs.gov/sir/2013/5137/pdf/sir2013-5137.pdf , p.1

[4] Sonia K. Makhija, Valeria V. Gordan, Gregg H. Gilbert, Mark S. Litaker, D. Brad Rindal, Daniel J. Pihlstrom and Vibeke Qvist,Practitioner, patient and carious lesion characteristics associated with type ofrestorative material : Findings from The Dental Practice-Based Research Network, J AM DENT ASSOC2011;142;622-632, http://jada.ada.org/content/142/6/622.long

References

Page 18: Implications for Public Policy, Environmental Justice, and Public Health Education -By Mark Mitchell M.D., MPH

Thank YouQuestions?

[email protected]