First Superfund Health Impact Assessment in Nation

JHA collaborated with the University of Washington Department of Enviromental and Occupational Health Sciences and the Duwamish River Cleanup Coalition to conduct the first Health Impact Assessment (HIA) in the nation on a Superfund Site.  The Health Impact Assessment: Proposed Cleanup Plan for the Lower Duwamish Waterway Superfund Site focuses on health changes that may result from the proposed cleanup and makes recommendations about how to minimize health impacts, maximize health benefits, and reduce health disparities in three vulnerable populations: local residents, Tribes, and non-tribal subsistence fishers.

Health equity is an explicit principle in HIAs.  Equity is different from equality.  Equality provides each person with the same amount and type of resources.  In contrast, equity means that some communities may require different types and amounts of resources in order to reduce health disparities.   With respect to the Superfund cleanup, if there are impacts of the Environmental Protection Agency’s proposed plan that unfairly disadvantage some groups and those impacts are avoidable, they should be mitigated.   Achieving health equity also means that vulnerable populations should have a voice to meaningfully participate with decision makers to improve their health.

An example of how equity could be implemented in this Superfund HIA can be found in the Tribal recommendations part of the Report.  The Coast Salish Peoples lived in Seattle and along the Duwamish River since about 8000 BC.  The Europeans arrived and were befriended by Chief Sealth. But over the years, the Tribes were removed from their ancestral lands and deprived of their culture.  Since then they have suffered huge health disparities relative to the general population and still do to this day as shown in our HIA report.    Health disparities for American Indians and Alaska Natives in both King County and Washington State are extremely high.  They have high levels of poverty, unemployment, infant mortality, and high rates of smoking, obesity, diabetes, heart disease, cirrhosis, asthma, and mental distress relative to the general population.   The research tells us that these types of disparities makes the Tribes more vulnerable to the effects of toxic chemicals.  In terms of equity, the Tribal part of this HIA found that the Tribes are in a “no win” situation when it comes to the river cleanup plan because of remaining (residual) contamination after cleanup is finished. There are going to be fish advisories for 40 years to come and possibly in perpetuity for Tribes.  On one side of the coin, if the Tribes eat seafood from the Duwamish River, they have one set of health problems.  If they don’t eat seafood from the river, they have another set of health problems.  On both sides of the coin, treaty rights are not fully expressed which leads to disempowerment issues, a known determinant of health and this causes still, another set of health problems.  Tribal members often make a choice to sacrifice their physical health for their spiritual health as so adeptly said in the following quote by a Swinomish elder:

“Like we say, it’s our spiritual food so it feeds our soul; so it might poison our body, but then we’d rather nourish our soul”

The Tribal HIA recommendations are examples of how to promote health equity for the three affected Tribes (Duwamish, Muckleshoot, and Suquamish) with ancestral ties to the Duwamish River:

1. Collaborate with the Tribes to more fully address their health concerns about the river cleanup.

2. Restore Tribes’ traditional resource use in accordance with Treaty rights: Institutional Controls (fish advisories) need to be temporary, not permanent.

3. Establish a “Revitalization Fund” to enhance Tribal empowerment and health until Institutional Controls are removed.