Date: March 31, 2000
National Economic Council
David Michaels, PhD, MPH
Assistant Secretary for Environment, Safety and Health
Subject: Work Products from Inter-Agency Working Groups
Attached are work products from two Inter-Agency Working Groups formed by the National Economic Council in response to President Clinton's direction for a study of occupational disease among the Department of Energy (DOE) contractor workers.
As you know, on July 15, 1999, Secretary Richardson announced that the Administration would propose legislation to establish a new program to compensate victims of beryllium disease. At the same time, the President tasked the National Economic Council to coordinate an interagency process to examine whether other illnesses would warrant inclusion in such a program and how this should be accomplished. Experts in the fields of occupational medicine, public health, and social insurance were assembled to examine these issues. Staff from the Departments of Health and Human Services, Labor, Justice and Defense joined DOE in these efforts; the results do not therefore reflect the views of any particular agency.
The first paper examines the link between exposure to occupational hazards and illnesses in the DOE contractor workforce. The second reviews benefits available to DOE contractor personnel from state workers' compensation programs. The efforts of these two groups provide important input that will be useful in crafting a sound, science-based approach to the issues raised by the President: whether there are other occupational illnesses in DOE nuclear weapons complex, and, if so, how workers with these conditions should be compensated. If you need additional information, please do not hesitate to contact me.
The Link Between Exposure to Occupational Hazards and Illnesses In the Department of Energy Contractor Workforce
This memo examines whether there is evidence of occupational illness in current and former contract workers at the US Department of Energy (DOE) from exposures to occupational hazards in nuclear weapons production and evaluates the strength of that evidence. To accomplish this task, an interagency panel of experts in the fields of public and occupational health reviewed the following sources of information related to the DOE workforce: 1) epidemiological studies completed and published either in the peer-reviewed literature as well as in technical reports; 2) information on the types and levels of exposures to workplace hazards; 3) special medical monitoring programs for workers with the highest exposures to ionizing radiation; 4) medical screening programs for former DOE contractor workers exposed to radiation as well as physical and chemical hazards; and 5) reports of illnesses presented to the DOE in public meetings or reported in the press.
The DOE and its predecessor agencies, principally the Manhattan Engineering District and the Atomic Energy Commission, consist of a nationwide network of 40 contractor-operated industrial sites and research laboratories that historically have employed over 600,000 workers in the production and testing of nuclear weapons. Because of this weapons production mission, health studies of DOE workers have focused primarily on the adverse health effects of exposure to ionizing radiation. Other non-radiation hazards have been studied at DOE sites only to a limited extent.
As a particular health outcome of concern associated with exposure to ionizing radiation is cancer, the panel also consulted the scientific literature in this regard. The 1994 United Nations Scientific Committee on the Effects of Atomic Radiation noted that cancers for which statistically significant excess risks have been determined from the Life Span Study mortality data are leukemia, breast, bladder, colon, liver, lung, esophagus, ovary, multiple myeloma and stomach. In addition, significant excess risk has been determined for the incidence of thyroid and skin cancers. The known and possible associations between radiation exposure and the above cancers tend to be based on populations exposed to relatively high levels of ionizing radiation (e.g., Japanese atomic bomb survivors, and recipients of selected diagnostic or therapeutic medical procedures). The question of cancer risk for chronic low dose levels or periodic higher levels of ionizing radiation exposure (e.g., such as may occur in certain occupational settings at DOE facilities) has not yet been completely studied. Other Health and Human Services literature suggests a possible association between ionizing radiation exposure and cancers of the prostate, nasal cavity/sinuses, pharynx/larynx, and pancreas. However, other National Cancer Institute literature indicates that other chemical and physical hazards and lifestyle factors (to include smoking, alcohol consumption, diet) contribute to many of these same diseases.
The panel examined all studies related to hazards and adverse health outcomes related to DOE's nuclear weapons production activities. The panel did not evaluate information on non- DOE populations, such as atomic bomb survivors or populations with occupational radiation exposures such as shipyard workers and medical personnel. Determining the causal links between an exposure and an illness was not considered to be within the mandate of this panel
There is evidence from health studies of DOE workers that suggests that some current and former contractor workers at DOE nuclear weapons production facilities may be at increased risk of illness from occupational exposures to ionizing radiation and other chemical and physical hazards associated with the production of nuclear weapons. For certain facilities and for certain subgroups of workers within these facilities, some evidence suggests a strong association between employment and adverse health outcomes. Some studies indicate an increased risk of adverse health outcomes with increased levels of exposure to ionizing radiation.
Most DOE studies concerning the health status of its workers have been mortality studies. Evidence of health problems potentially related to exposures based on mortality studies is limited to specific facilities and causes of death. The identification of excesses of some types of cancers at some facilities and other types of cancers at other facilities is not surprising given the differences in past and present production processes, levels of exposure, and types of radiation and chemical hazards at these DOE facilities. Results from epidemiological studies must be interpreted with caution since a finding of a statistically significant elevation of disease does not alone imply causality. Conversely, the lack of a finding of excess disease in study does not imply that occupationally-related disease is absent in the study population. In addition, based on the studies reviewed, it is not possible to answer questions about the relationship between an individual's illness and that worker's occupational exposures.
Information evaluated by the panel from morbidity studies and medical surveillance programs for current and former DOE contract workers also provide evidence that these workers have suffered material impairment of health as a result of performing their jobs. However, before attempting to draw conclusions as to the health status of the overall population of former workers using this information, a number of factors must be considered. For example, the former worker medical surveillance program is in its initial phase with only preliminary results available. Further, participants in this program are selected from potential high-risk job categories and thus their health status may not be representative of the workforce as a whole.
Nevertheless, the results from this program provide strong evidence that participating former workers at some facilities have experienced adverse health outcomes, particularly in the form of nonmalignant lung diseases. Mortality studies have also shown evidence that workers at several facilities have experienced excesses of nonmalignant lung diseases.
While the panel found credible evidence of occupational illness in current and former workers at DOE facilities, linking these illnesses to workplace exposures is limited by several factors: 1) there may have been inaccuracy and inconsistency in the radiation dosimetry monitoring program at certain facilities and during certain time periods; 2) there is a general lack of industrial hygiene monitoring data for chemical and physical hazards as well as other important non-occupational exposures such as smoking history; 3) not all workers at a given facility (such as female and minority workers) nor all facilities were included in the studies; 4) in some studies there may be a insufficient length of follow-up for some health outcomes (with long latencies) and for some worker cohorts (where they are not reaching the age where certain diseases such as cancers more commonly occur); 5) the potential that a healthy worker effect may obscure associations in some studies; 6) there was a tendency in these studies to focus on mortality, an extreme manifestation of injury or illness, yet most health conditions do not tend to be immediately fatal; and 7) often the size of a study population at a given facility decreases the ability to detect a health problem (a problem that cannot be overcome by grouping various cohorts together from different facilities due to the substantial variation in work tasks, processes and exposures from site to site)
The Link Between Exposure to Occupational Hazards and Illnesses
In the Department of Energy Contractor Workforce
On July 15, 1999, President Clinton issued a Memorandum to the Secretaries of Defense, Labor, and Energy, the Attorney General, the Director of the Office of Management and Budget, and the Assistant to the President for Economic Policy regarding occupational illness compensation for DOE contractor personnel. The Memorandum indicated the Administration's intent to submit legislation to create a program to give DOE contractor employees with chronic beryllium disease (CBD) and beryllium sensitivity compensation benefits similar to those available to Federal employees. Such legislation was submitted to Congress on November 17, 1999. In addition, the July 15 the memorandum established an interagency review coordinated by the National Economic Council (NEC) to assess, by March 31, 2000, whether there are other illnesses that warrant inclusion in this program and how this should be accomplished. In determining whether and how other illnesses should be included in this program, three tasks were designated. The first task is the subject of this memo. From October 1999, through January 2000, a panel of experts from a wide spectrum of federal agencies (Appendix 12) met to address the following questions:
1. What is the evidence that current and former contractor workers at DOE facilities are at increased risk of illness resulting from exposures to occupational hazards uniquely associated with nuclear weapons production?
2. How strong is this evidence? To answer these questions, they examined and evaluated information and data from a variety of sources including current and historical exposure hazards at DOE facilities related to nuclear weapons production, as well as epidemiologic, other health studies and surveillance activities conducted among DOE contractor workers. In evaluating these data, the panel considered reviews of DOE's epidemiologic research program that have been conducted by different groups.
- Geiger HJ, Rush D, Michaels D. Dead Reckoning: A Critical Review of the Department of Energy's Epidemiologic Research. Physicians for Social Responsibility. Washington, DC.
- Report to the Secretary. The Secretarial Panel for the Evaluation of Epidemiologic Research Activities for the US Department of Energy. March 1990.
- US General Accounting Office. Problems in assessing the cancer risks of low-level ionizing radiation exposure (2 volumes). Washington DC: GPO, January 2, 1981.
Although data from other radiation exposed cohorts, most notably nuclear shipyard workers, were discussed by the panel members, the results of these studies are not included in this report due primarily to the limited focus and charge of this panel.
The findings expressed in this document represent the views of the technical experts who were members of the panel and not the individual agencies that provided the panel members.
II. Nuclear Weapons Production & DOE Operations
The Department of Energy and its predecessor agencies, principally the Manhattan Engineering District and the Atomic Energy Commission, have been engaged primarily in an extensive industrial enterprise to build and test nuclear weapons.
For more than half a century, DOE has owned and its contractors have operated a nationwide network of heavy industrial sites as well as research laboratories involved in every aspect of weapons production from the refining of raw materials to the eventual testing of the bombs, and ultimately to the management of the weapons stockpile and the environmental consequences of nuclear production and testing.
It has been estimated that 5.5 trillion dollars (in 1996 dollars) have been spent since 1940 on U.S. nuclear weapons and weapons-related programs and that upwards of 600,000 workers were involved in the construction, maintenance, operations, and scientific activities at DOE owned facilities.
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