A MULTIMEDIA HEALTH RISK ASSESSMENT FOR THE POPULATION DWELLING IN INDUSTRIALLY POLLUTED AREAS (EXPERIENCE OF THE SVERDLOVSK REGION)

S.V. Kuzmin1, L.I. Privalova2, B.A. Katsnelson1, V.B. Gurvich3, E.A. Kuzmina1, A.S. Kornilkov1, S.A. Voronin4, S.V. Yarushin1

1 Ekaterinburg Medical Research Center for Prophylaxis and Health Protection in Industrial Workers of Rospotrebnadzor 2 Ural Regional Center for Environmental Epidemiology 3 Sverdlovsk Regional Agency of the Federal Service for Surveillance in the Sphere of Consumer Rights Protection and Human Welfare 4 Center for Hygiene and Epidemiology in the Sverdlovsk Region, Ekaterinburg,

The Sverdlovsk Region is a highly industrialized region with intensively developing metallurgical, machine building and chemical industries. Thirteen regional towns are noted for high environmental pollution. One of the mechanisms of solving the task of securing environmental safety of the population is health risk assessment, management and communication, all widely used in the international practice. The methodology of risk assessment in all developed countries and international organizations is considered to be one of the most effective instruments of substantiation of managerial decisions in the sphere of environmental and public health management. To set priorities in environmental and public health management it is necessary to compare contributions from different sources of contamination by different pollutants, routes and pathways of exposure to the development of adverse health outcomes and to rank areas by health risks. Such a comparison of risks helps determine the main directions of preventive actions and predict their relative effectiveness. In Russia the use of the health risk assessment methodology has been officially introduced since 1997. The Ural Regional Center for Environmental Epidemiology, Ekaterinburg, was the first to receive the Certificate of Accreditation (the Sverdlovsk Region). Today two more organizations of the Sverdlovsk Region are accredited to perform health risk assessment – Ekaterinburg Medical Research Center for Disease Prevention and Health Protection in Industrial Workers of Rospotrebnadzor and the Center for Hygiene and Epidemiology in the Sverdlovsk Region. The staff of these organizations developed the first Russian official method document on health risk assessment, published a monograph about risk assessment as an instrument of the socio-hygienic monitoring, and implemented a health risk assessment project within the framework of the whole town (1997), which was not only the first in Russia but also a rare event in the world practice. In the following years the staff developed the scientific and method basis supplementing and deepening the risk assessment based on recent published data, own accumulated experience, and results of own environmental epidemiology studies. Important distinctive features of risk assessment projects in the Sverdlovsk Region include the developed criteria of setting priority environmental pollutants, a predominant use of “exposure – response” relationships substantiated by environmental epidemiology studies, and original approaches to ranking risks. In order to justify priority measures of environmental health and public health management in 2004-2008 we performed a multimedia health risk assessment in 12 most polluted areas: , Verkhnyaya , Ekaterinburg, Kamensk-Uralsky, , , , Nizhni Tagil, , , Revda, and within the framework of the Regional Program “Ecology and Natural Resources in the Sverdlovsk Region” adopted and funded by the Government of the Sverdlovsk Region. The urban population of the Sverdlovsk Region lives in conditions of an intensive chemical contamination of all environmental media. To specify levels and pathways of exposure a supplementary annual monitoring of environmental media is conducted. To assess airborne exposure of the population we apply a mathematical modeling of dispersion of emissions from stationary and mobile sources along with data of stationary and mobile monitoring sites. In accordance with the applied criteria we established priority chemical pollutants of the environment with account for their multimedia effects. In each town under study the list of priorities contains chemicals, inhalation and multimedia exposure to which may increase the probability of malignancy (carcinogenic factors). If a chemical is a priority in more than two towns, this shows the regional character of its priority. From this point of view the regional priorities include TSP, benzo(a)pyrene, arsenic, cadmium, manganese, copper, nickel, lead, fluoride, chromium (VI), zinc, benzene, formaldehyde, sulfur dioxide, nitrogen dioxide, and chloroform. Based on ranking predicted health risks in 12 towns of the Sverdlovsk Region the most important risks are: - the risk of pre-term death related to acute and chronic effects of exposure to PM10 and PM2.5; - the cumulative carcinogenic risk with a predominant contribution of oral exposure to arsenic; - the risk of mental retardation in children and pre-term death in adults related to a multimedia lead exposure; - the lifetime risk of nephropathies related to a multimedia cadmium exposure.

The total number of predicted pre-term deaths related to acute and chronic effects of PM10 and PM2.5 in 12 towns of the Sverdlovsk Region is 2,941 per year (1.31 per 1,000). The worst situation by indices of health risk from exposure to fine particles was observed in Ekaterinburg (the risk of population mortality) and Nizhni Tagil (the risk of population mortality and the mortality rate per 1,000). Due to the multimedia risk exposure in the study areas we predicted 654 (5.8 per 1,000) cases of mental retardation in preschool children. The total number of predicted cases of preterm death among adults was 1,258 (0.56 per 1,000) every two years. Based on indices of health risk the worst situation was observed in the towns of Kamensk-Uralsky, Ekaterinburg, Kirovgrad, Asbest, and Krasnouralsk. In the study areas 142,015 nephropathy cases from a lifetime multimedia exposure to cadmium were predicted. The highest number of such cases was expected in the towns of Kamensk-Uralsky, Ekaterinburg, and Nizhni Tagil (by the risk of population mortality) and also in Kirovgrad and Asbest (by the mortality rate per 1,000). As a result of a cumulative effect of priority chemicals (carcinogens) in 12 towns of the Sverdlovsk Region there exists the lifetime risk of over 7,000 cancer cases among the exposed population. The highest personal cancer risk was noted in Kamensk-Uralsky and Kirovgrad, the highest population one – in Kamensk-Uralsky and Ekaterinburg. According to the Guidelines for Health Risk Assessment R 2.1.10.1920-04 the cumulative personal cancer risk from a multimedia exposure to carcinogens in the study areas is in the 4th range (with the exception of Nizhni Tagil and Serov). The fourth range (personal lifetime risk ≥ 10-3) is inacceptable for the population as a whole. Such a risk requires the development and implementation of planned sanitary measures. The results of the multimedia risk assessment, regardless of all the uncertainties, provided important information about risk sources and factors, areas and groups at risk, priority pollutants and pathways of exposure. They helped establish high-priority directions of prevention of negative health effects of industrial contamination of the environment in various aspects (both in the evaluation of town-planning decisions, development of technological, sanitary technical and other measures and in the public health risk management). In particular, results of the multimedia risk assessment were used for substantiation of town-planning decisions for the general plan of development of Ekaterinburg until 2025, development and implementation of the program of improving health of the population of industrially polluted areas of the Sverdlovsk Region, for substantiation of the status of industrially polluted areas. The accumulated experience gives evidence of some methodological problems (e.g., inconsistencies between the lists of carcinogens in different official documents, ambiguity of approaches to the hygienic evaluation of dust and suspended particles, the absence of a common approach to selecting reference concentrations provided in the Guidelines and official standards) that significantly impede implementation of specific tasks of risk assessment. Thus, there exists an urgent necessity in improving normative and method documents at the federal level including the development of a revised edition of the Guidelines for Health Risk Assessment by leading Russian scientists (in process).

S.V. Kuzmin, L.I. Privalova, B.A. Katsnelson, V.B. Gurvich, E.A. Kuzmina, A.S. Kornilkov, S.A. Voronin, S.V. Yarushin. A multimedia health risk assessment for the population dwelling in industrially polluted areas (experience of the Sverdlovsk Region). In: Health protection in the population of industrial regions: the strategy of development, innovative approaches and perspectives. Proceedings of the Russian scientific and practical conference with international participation, Ekaterinburg, 28-30 October 2009. Pp. 83-87.