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Children’s Environmental Health Issues in IndianaMarch 2005 Edition
IKE Seeks New Executive Director
IKE’s Executive Director, Tom Neltner, has decided to leave IKE and take on new challenges in Washington, DC. On March 5, IKE’s Board of Directors began to search for a new executive director. Applications are due by March 30. The Board anticipates making a decision by late April to ensure a three- or four-month transition time. Go to www.ikecoalition.org for more information.
Indiana Legislature – So Far So Good Last November, Indiana elected Republican Mitch Daniels to be Governor. It also gave the Senate a Republican supermajority and the House went from a slight Democrat majority to a slight Republican majority. While children’s environmental health issues had strong bipartisan support in the Indiana General Assembly, IKE was concerned that open discussion and deliberation would be lost under one-party control. IKE’s Tom Neltner decided to spend more time attending the committee meetings and engaging in the discussion than in years past.
While controversy has swirled around other aspects of the General Assembly’s bills and process, Tom Neltner is pleased to report that the discussion in both the House Environmental Affairs Committee and the Senate Energy and Environmental Affairs Committee has been excellent. Senator Gard and Representative Wolkins have worked hard to solicit input and respond constructively to ideas. There has been less posturing and more discussion, especially in the House where proxy voting was stopped. The House Environmental Affairs Committee even proposed tax increases on tires and diesel fuel to address funding needs.
IKE’s interaction with other committees also has been good. While the agencies are still struggling to find their voice during the major leadership transition, the key legislative committees related to children’s environmental health are doing well. While the last weeks in the session are usually the most telling – and trying – so far, so good!
Asthma
Burden of Asthma in Indiana – Daviess County has Highest Rate The Data and Surveillance Workgroup of the Indiana Joint Asthma Council (INJAC) published its report on “The Burden of Asthma in Indiana” in December 2004. The report is 73 pages long and a 0.86 MB download. Dr. Stephen Downs of Indiana University’s School of Medicine chaired the workgroup.
The report is loaded with statistics and charts to help you understand the magnitude of the asthma problem in Indiana. The information is drawn from four Indiana-specific databases. The bottom line is that Indiana is close to national averages. For children, boys are more likely than girls to have asthma.
Statewide, 10.4% of children on Medicaid had asthma. Daviess County had the highest rate with 17.2%. Huntington, Jefferson, Lawrence, Monroe, Montgomery, and Tipton counties had a rate greater than 15%. Elkhart and Crawford Counties had the lowest rates with 5.8% and 5.9% respectively. LaGrange, Newton, and Spencer had rates below 7%. Of the five largest counties, Marion (Indy) had the lowest rate. Please note that estimates for the large counties may be artificially low because they have a larger percentage of children in managed care. Managed care organizations are less likely to submit specific claims for asthma because of their reimbursement structure.
Of children on Medicaid, 18% had an emergency room visit with diagnosis of asthma. 6% were hospitalized.
INJAC Publishes Five-Year Strategy INJAC, IDEM and ISDH published “A Strategic Plan for Addressing Asthma in Indiana” in December 2004 (104 pages / 3.8 MB). The plan is an initial five-year action plan to begin to deal with the burden of asthma in the state. The plan consists of goals, objectives, strategies, and action steps over a real timeline with specific deadlines. The plan has five major areas: data/surveillance, children & youth, public education, healthcare, and environment. To reduce environmental hazards associated with asthma attacks, the plan’s only efforts that do not consist solely of research and outreach will be to: § By 2006, propose revisions to the Indiana Sanitary Schoolhouse Rule; § By 2009, recommend revisions to voluntary and regulatory codes that affect schools and regulated early care settings; and § By 2010 or in advance of federal deadlines, attain ozone and fine particulate matter health standards in 24 counties designated in whole or in part as non-attainment areas in 2004.
IKE believes that the plan is a great start. IKE remains concerned that the plan’s objectives to reduce environmental triggers will not be effective at helping the low income, multi-racial, and African-American communities that struggle with the disproportionate impact of asthma. IKE will stay involved in the effort to impact state policies and strategies that reduce asthma attacks in children.
For more information on Indiana’s asthma efforts, check out www.in.gov/isdh/programs/asthma/index.htm.
With Changes at ISDH and IDEM, Will the Plan Have an Impact? ISDH Commissioner Dr. Wilson was the driving force behind Indiana’s renewed energy in reducing the burden of asthma on Hoosiers, especially children. His leadership engaged IDEM as a strong partner, led to the creation of the Indiana Joint Asthma Coalition (INJAC), got agency staff to step up, secured funding from CDC, integrated the medical research community into the effort, and made primary prevention a priority. He brought the parties to the table and gave INJAC’s chair, Dr. Leickly, the support he needed to get the strategic plan written.
Unfortunately, Dr. Wilson left ISDH on January 27, 2004 with the change of Governor. On March 7, 2005, Governor Daniel’s appointed Dr. Judith Monroe to be the new ISDH Commissioner and to serve as Medicaid’s Medical Director. All reports are that she will be an excellent commissioner but it is too early to tell what her priorities will be. In addition, Governor Daniel’s choice for Commissioner of IDEM, Tom Easterly, dismissed or transferred the key leadership on asthma at IDEM. And a recent speech indicated that he did not see a role for IDEM inside buildings – where asthma triggers dominate.
The foundation has been laid. Time will tell if the structure needed to reduce the burden of asthma on kids and communities is reduced.
Anticipating changes at IDEM and ISDH, INJAC’s leadership took the precautionary step of establishing the Indiana Joint Asthma Coalition as a separate non-profit corporation. This option does not foreclose any other structure but allows INJAC to ensure that Indiana stays on track in implementing the Strategic Plan for Addressing Asthma in Indiana. At its January 27 meeting, INJAC devoted significant time to discussing the options and formed a by-laws task force to make recommendations. IKE serves on that task force.
Before Assistant Commissioner Cheryl Reed left IDEM, she implemented one of her major projects. BreatheasyVille is on-line at www.in.gov/idem/breatheasyville/city.html. Check out the site. Click on the buildings to get basic guidance to reduce lead hazards. Thanks also to Tami Johnson for getting the project done.
An Inner City Asthma Study funded by the National Institutes of Health reinforced and expanded on earlier research regarding the causes of asthma attacks in inner city youth. The study was published in the March issue of the Journal of Allergy and Clinical Immunology.
The study concluded that children who were both sensitive and exposed to cockroach allergens in the home had significantly more asthma symptom days, more caretaker interrupted sleep, and more school days missed than children who were not sensitive or exposed. The study found that 69% of the inner city children were sensitive to cockroach allergens – more than dust mites and molds. It also found that a majority of homes in Chicago had significant levels of cockroach allergens. The good news for Indiana was that cockroach allergens were highest in high-rise apartments. Indiana does not have as many high-rise apartments.
Indiana Sues to Stop Fine Particulate Matter Designations Fine particulate matter penetrates deep into the lungs and can trigger asthma attacks. For that reason, EPA and IDEM regulate the fine particulate matter referring to it as PM2.5 – particulate matter smaller than 2.5 microns in size. If EPA determines that counties or parts of counties exceed a specific standard set for PM2.5, EPA will designate the area as non-attainment. IDEM would need to develop a plan to bring the area into attainment and stricter standards for new operations would be imposed.
In December 2004, EPA designated 14 counties and parts of five more counties as non-attainment. On March 7, 2005, Indiana Attorney General Steve Carter sued EPA on behalf of IDEM challenging EPA’s designation of 16 of the 19 counties as nonattainment. See www.in.gov/idem/air/pm25standard/index.html for IDEM’s presentation of the timeline and copies of key documents. While several counties with monitors such as Elkhart and Vigo indicated they were in attainment, 16 of the 19 counties designated as nonattainment relied on modeling not actual monitoring information.
The state seeks to have the 16 counties without actual monitoring data dropped from the list and designated as attainment. According to the press release, only Marion, Dubois and Clark counties should be non-attainment for PM2.5. While IKE will leave it to the lawyers to argue over the nuances of the designation, an overriding message seems to be that it is better not to have a monitor if there is a chance of having a problem. The reasoning that IDEM lacks the resources to monitor the air in all 16 of the counties at issue raises questions about the investment of resources into gaining the knowledge to get the right answers versus using resources for litigation.
Streamlined Mercury Variances for NPDES Permits On January 12, 2005, the Indiana Water Pollution Control Board unanimously adopted 327 IAC 5-3.5 establishing a streamlined mercury variance program. This rule would simplify the procedures for wastewater discharge permit holders to apply for and receive a variance from the water quality based effluent limitations for mercury in their National Pollutant Discharge Elimination System (NPDES) permit. The variance from the mercury permit limits lasts the duration of the five-year permit. Because of limits in state law, the variance could only be renewed once. The rule and supporting documentation is at www.in.gov/idem/rules/#new.
IKE supported the final rule and was an active participant in the two years of workgroup meetings that drafted and revised the rule. The rule is limited to dischargers that have less than 30 parts per trillion (ppt) of mercury in the wastewater. This limit is necessary to protect bald eagles (but not humans) from harm from eating fish contaminated with mercury. Facilities would be required to develop a pollution minimization plan to identify and eliminate or reduce sources of mercury in the wastewater. The rule establishes additional responsibilities on municipalities to work with indirect dischargers of mercury to their sewer systems.
IKE believes that the rule will give permit holders the confidence they felt they needed before starting aggressive mercury reduction efforts. Many permit holders used the lack of a simplified and clear process as a reason not to act aggressively to reduce mercury discharges. In response, IDEM delayed permits and when forced to issue permits, extending the compliance date out as long as possible. A few leaders such as Ispat Inland Steel, Bethlehem Steel, and U.S. Steel began an aggressive program years ago. They have developed a model that works. Unfortunately, even when the variance conditions are fully implemented and the dischargers reduce as much mercury as possible from known sources in their discharges, trace levels of methyl mercury in wastewater makes it unlikely that the permit holders will consistently meet the water-quality based effluent limits.
Linking Mercury Variances and Mercury Air Emissions Rep. Dennis Avery of Evansville introduced HB-1698 to establish in state law Indiana’s responsibility to reduce mercury contamination of water, wastewater and fish. HB-1698 would have required the Indiana Air Pollution Control Board to adopt strict limits on mercury emissions from coal-fired power plants. If the Board did not fulfill its mandate, IDEM would not be allowed to issue the streamlined mercury variances described above. The bill also directed the Board to adopt rules to protect the water from materials that persist or bioaccumulate in the environment and contribute to violations of water quality standards. This bill would have begun to breakdown the “silos” that have plagued Indiana’s environmental programs. Many programs fail to deal with pollutants moving between the air, water and land. One surprise came from Rep. Tim Brown of Crawfordsville was an excellent proposal to require that mercury switches be removed from vehicles before recycling at steel mills. A representative of the steel industry called for an amendment to establish the requirement. Thanks to House Environmental Affairs Committee Chair Rep. David Wolkins of Winona Lake for giving the bill a hearing. The bills opponents called for a national solution to the problem since a significant portion of the mercury travels long distances. The bill did not get a vote, but it was a significant step forward in dealing with the policy issues regarding mercury. Hopefully, the mercury switch issue and possibly signs to help people fishing know the fish consumption advisory for a lake or stream will be added to another bill.
Second-hand or environmental tobacco smoke is the most significant environmental threat to children’s health, especially children with asthma. IKE strongly supports efforts to reduce children’s exposure to tobacco smoke.
IKE has traditionally not had special efforts to restrict this exposure. Advocates at the state level and in Indiana’s communities such as SmokeFree Indy had more resources and capability to have an impact than a small organization like IKE. IKE has focused on filling the gaps in advocacy.
Progressive Indiana cities such as Bloomington have already adopted an ordinance to protect people from environmental tobacco smoke. In 2003, Indianapolis’ Councilor Beulah Coughenour proposed an ordinance but it died in committee. Indianapolis is considering a proposal again. Under the leadership of Councilor Angela Mansfield and the strong support of Councilor Greg Bowes, her Children’s Health and Environment Committee is in the midst of conducting six public meetings to discuss the issue in depth. Council President Steve Talley and Councilor Keller are co-sponsors of the proposal. A formal proposal should be considered in May, 2005. Thanks to Councilors Mansfield and Bowes for their approach and effort.
Even the Indiana General Assembly has begun to heed the call for action. The House Public Health Committee considered HB-1202 authored by Rep. Vernon Smith of Gary and coauthored by Rep. Orentlicher of Indy and committee chair Rep. Becker of Evansville. The bill was dramatically softened in the committee to only require designation of no smoking areas in restaurants that allow children. Studies have shown that this approach is ineffective at protecting children since smoke will spread. Amendments to strengthen it on the House floor were rejected. The bill died with many others when the House Democrats walked out to protest other bills. This important issue will not go away for those worried about children’s environmental health.
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