Special Feature: What a New Report on 
Environmental Neurotoxicants Means for Health Care

Autism, attention deficit hyperactivity disorder, intellectual disabilities, and other neuro-developmental disorders are growing at an alarming rate in the United States. Nationwide, 1 in 6 children have a developmental disability, a 17% increase from a decade ago. Despite clear evidence linking chemical exposure to neuro-developmental disorders, our inability to make effective protective regulations about these chemicals is cause for concern, according to a recent consensus statement by an alliance of top scientists, health advocates, and health care providers. 
In their July 2016 statement on neurotoxicants, participants in Project TENDR: Targeting Environmental Neuro-Developmental Risks say starkly, “Our system for evaluating scientific evidence and making decisions about environmental chemicals is broken. We cannot continue to gamble with our children’s health. We call for action now to prevent exposures to chemicals and pollutants that can contribute to the prevalence of neuro-developmental disabilities in America’s children.”

Over many months, Ted Schettler, MD, MPH, the Science Director of the Science and Environmental Health Network and science advisor to Health Care Without Harm, was part of the Project TENDR process to evaluate neurotoxicants. According to Dr. Schettler, the group used a systematic set of criteria to review literature and find the candidate chemicals where the evidence of a causal neurodevelopmental toxic effect, not only in animals but also in humans, was strongest. “We know about these chemicals quite confidently and this is probably just the tip of the iceberg,” said Schettler.

The final list of neurotoxicant chemicals includes organophosphate pesticides, PBDE flame retardants, phthalates, combustion-related air pollution, lead, mercury, and PCBs. These chemicals are commonly found in our environment as well as in the bodies of pregnant women, where many can cross the placenta and are often found in cord blood or other fetal tissue.

Schettler said it became clear to the researchers that we are facing a crisis, and that decades of scientific research has not lead to much significant progress on a policy level. Of the thousands of chemicals on the U.S. market today, few have been tested for their safety and even fewer have been tested with the vulnerability of children in mind.

Although people are exposed to dozens of chemicals at any given time, the cumulative impact of chemical mixtures is rarely studied or evaluated by regulatory bodies.

Communities of color and lower income populations are also more vulnerable to certain chemical exposures due to additional social stressors and limited access to ways of reducing exposures including alternative products and materials. Our current system allows products on the market before thoroughly proving that they are safe, leaving the burden of proof on the general population and advocates that they are in fact causing harm.

Given the consensus that neurodevelopmental toxicants pose a hazard, Schettler pointed to language in the statement urging action, including by the healthcare sector: “Businesses need to eliminate neuro-developmental toxicants from their supply chains and products, and health professionals must integrate knowledge about environmental toxicants into patient care and public health practice,” according to the consensus statement.

For the health care industry, Project TENDR poses a challenge — just how can hospitals and healthcare facilities ensure that their purchases do not add to harmful chemical exposure? In the face of the broken system, what is healthcare’s role? How can the healthcare sector adopt a broader approach that asks more challenging questions and looks beyond the information that is provided in the supplier’s catalog?

According to Schettler, purchasing power is a critical tool that healthcare can use to help reduce exposures to harmful chemicals. Aggregating demand for healthier affordable products through initiatives such as Healthier Hospitals, or the recently launched Greenhealth Exchange, can help move markets and accelerate the move to safer products. Greenhealth Exchange and Healthier Hospitals seek out and consolidate reliable information on product content and greener alternatives to make it easier for both purchasers and suppliers to purchase green products.

Common chemicals and their possible clinical effects. View the entire chart. Credit Centers for Disease Control and Prevention and Project Tendr.

Removing flame retardants and other hazardous chemicals from heath care furnishings is one such area that Schettler sees as having great potential for success in helping to build demand and encourage a larger supply of healthy and affordable flame retardant free products, similarly to the successful campaign started by Health Care Without Harm to remove mercury from medical equipment.

Larger institutions such as Kaiser Permanente, Advocate, Partners, and Dignity Health have been leaders in looking closely as the environmental impacts of the materials they purchase, and developing policies and practices that have demonstrably improved the availability of sustainable products on the market. However, change does not need to come only from larger leadership systems — it can also look like one champion nurse in a smaller hospital who successfully removed harmful materials from the NICU, notes Schettler. Initiative can come from anywhere in a facility — all it takes is for someone to be motivated enough to act.

Because they are anchor institutions in their communities, Schettler emphasizes that some hospitals have turned into strong advocates of improved community health and health equity. “The healthcare sector has found a role for itself in trying to influence public policy and direct the market towards safer materials in a variety of ways over the years. Being advocates for public and environmental health interventions is typically not something that they have been involved in historically. To actually come out and become advocates is somewhat new over the past twenty years… It is a very important voice to hear,” he says.

Coincidentally, the Project TENDR consensus statement was released just as the Toxic Substances Control Act reform was passed. Schettler, cautiously optimistic, hopes that this new development will improve the assessment of chemicals in terms of their impact on the developing child, with regulatory agencies taking a closer look at brain development. “While there are opportunities for that to happen within the new TSCA we do not know what impact it will have… there is oftentimes resistance within the agencies to carry out additional testing,” Schettler said. “We will need to advocate strongly to encourage the agencies to use the new authorities TSCA provides.”

In the meantime, as the statement emphasizes, “we as a society should be able to take protective action when scientific evidence indicates a chemical is of concern, and not wait for unequivocal proof that a chemical is causing harm to our children.” And because we have the proof in hand for so many chemicals, the time to act is now.

Helaine Alon provides communications support for the Health Care Without Harm Safer Chemicals team.

Health Care Without Harm seeks to transform the health sector worldwide, without compromising patient safety or care, so that it becomes ecologically sustainable and a leading advocate for environmental health and justice.