Analyzing the Effectiveness of Fish Consumption Advisories in Immigrant Populations Dan Endreson...

Analyzing the Analyzing the Effectiveness of Fish Effectiveness of Fish

Consumption Advisories Consumption Advisories in Immigrant in Immigrant PopulationsPopulations

Dan EndresonDan Endreson

November 27, 2007November 27, 2007

Problem Introduction and Problem Introduction and AnalysisAnalysis

Hmong populations in the Twin Cities are adversely exposed to methylmercury

contamination due to greater fish consumption.

Problem Introduction and Problem Introduction and AnalysisAnalysis

► Problem BackgroundProblem Background Mercury in the environmentMercury in the environment Public health concernsPublic health concerns Hmong population and cultureHmong population and culture

► Evaluation CriteriaEvaluation Criteria► AlternativesAlternatives► Alternative EvaluationAlternative Evaluation► RecommendationsRecommendations

Hmong populations in the Twin Cities are adversely exposed to methylmercury

contamination due to greater fish consumption.

Mercury SourcesMercury Sources

► Natural (30%)Natural (30%) Volcanic activityVolcanic activity

► Anthropogenic (70%)Anthropogenic (70%) Product useProduct use

► PesticidesPesticides► PaintsPaints► Medical and dental useMedical and dental use

By-productsBy-products► Waste incinerationWaste incineration► Coal combustionCoal combustion► Metal mining and Metal mining and

processingprocessing

Sources: Mercury Fact Sheet, EPA, June 2001; Mercury Emissions Report, MPCA, March 2004

Mercury SourcesMercury Sources

► Natural (30%)Natural (30%) Volcanic activityVolcanic activity

► Anthropogenic (70%)Anthropogenic (70%) Product useProduct use

► PesticidesPesticides► PaintsPaints► Medical and dental useMedical and dental use

By-productsBy-products► Waste incinerationWaste incineration► Coal combustionCoal combustion► Metal mining and Metal mining and

processingprocessing

87% from coal 87% from coal combustion and combustion and waste incinerationwaste incineration

Sources: Mercury Fact Sheet, EPA, June 2001; Mercury Emissions Report, MPCA, March 2004

Human Exposure and Health Human Exposure and Health EffectsEffects

► Fish consumption is primary human exposure routeFish consumption is primary human exposure route Methylmercury accumulates in the fat and muscle of fishMethylmercury accumulates in the fat and muscle of fish Trimming and cooking fish Trimming and cooking fish does notdoes not significantly reduce significantly reduce

methylmercury concentrationmethylmercury concentration

► Easily passes through digestive system due to lipophilic propertiesEasily passes through digestive system due to lipophilic properties

► Half life in body of 44-80 daysHalf life in body of 44-80 days

► Chronic ToxicityChronic Toxicity Central nervous systemCentral nervous system Cardiovascular and immune systemsCardiovascular and immune systems KidneysKidneys ReproductionReproduction Possible carcinogenPossible carcinogen

► Especially harmful to fetuses, infants, and childrenEspecially harmful to fetuses, infants, and children Is passed through breast milkIs passed through breast milk

Public Health ExtentPublic Health Extent

► 66% of Minnesota waters impaired due to 66% of Minnesota waters impaired due to mercurymercury

► No danger for typical consumer No danger for typical consumer

(10g/day ~ ¼ cup/day)(10g/day ~ ¼ cup/day)

► Increased dangerIncreased danger Consuming large fishConsuming large fish Pregnant womenPregnant women Subsistence anglersSubsistence anglers

Source: TMDL Pollutant Reduction Plan, MPCA, 2004

Hmong PopulationHmong Population

► Non-state culture originating in Southeast AsiaNon-state culture originating in Southeast Asia► 750 immigrants arrived in 1976 through the U.S. 750 immigrants arrived in 1976 through the U.S.

Refugee ProgramRefugee Program 60 in Minnesota60 in Minnesota

► Continual increase in populationContinual increase in population 41,800 in Minnesota; 50% increase from 199041,800 in Minnesota; 50% increase from 1990 May be as high as 70,000May be as high as 70,000 97% live in the Twin Cities97% live in the Twin Cities

► EconomicEconomic 33% below the poverty line (Average rate is 8%)33% below the poverty line (Average rate is 8%) Median Family Income = $35,864Median Family Income = $35,864 Per Capita Income = $7,210Per Capita Income = $7,210

Source: 2002 U.S. Census

A Culture of FishingA Culture of Fishing

►Deep cultural ties to fishingDeep cultural ties to fishing Used to supplement dietUsed to supplement diet

►Tradition continues after immigrationTradition continues after immigration Eases transition after immigrationEases transition after immigration Recreational and consumptive anglingRecreational and consumptive angling Fish for bass, perch, and troutFish for bass, perch, and trout 90% consumption90% consumption

Source: Hutchinson and Kraft, 2004

Evaluation CriteriaEvaluation Criteria

►Administrative OperabilityAdministrative Operability

►Effectiveness - HealthEffectiveness - Health

►CostCost

►Social AcceptabilitySocial Acceptability

Alternative #1Alternative #1

Continue the current practice Continue the current practice of fish consumption advisoriesof fish consumption advisories

Alternative #1: Fish Consumption Alternative #1: Fish Consumption AdvisoriesAdvisories

Administrative OperabilityAdministrative Operability► Pollution Control Agency (PCA)Pollution Control Agency (PCA)

Developing state water standardsDeveloping state water standards Statewide water quality planning and monitoringStatewide water quality planning and monitoring

► Department of Natural Resources (DNR)Department of Natural Resources (DNR) Enforce fishing regulationsEnforce fishing regulations Analyze fish for contaminantsAnalyze fish for contaminants

► Department of Health (MDH)Department of Health (MDH) Develop guidelines for safe fish consumptionDevelop guidelines for safe fish consumption Publishes data and educates the publicPublishes data and educates the public


Effectiveness - HealthEffectiveness - Health► Declining fertility ratesDeclining fertility rates

1995: 96.3 per 1,0001995: 96.3 per 1,000 1998: 96.4 per 1,0001998: 96.4 per 1,000 2000: 81.1 per 1,0002000: 81.1 per 1,000

► Increased rate of:Increased rate of: low birth weight rates low birth weight rates kidney stoneskidney stones incidence of cancerincidence of cancer

► Comparative pilot study Comparative pilot study in Wisconsinin Wisconsin Deficits in spatial Deficits in spatial

learning and memorylearning and memory

► Decrease in infant Decrease in infant mortalitymortality 1995-99: 7.1 per 1,0001995-99: 7.1 per 1,000 2000-04: 5.0 per 1,0002000-04: 5.0 per 1,000

Sources: MDH, 2004, MPR, 2005; Children’s Environmental Health Center, Univ. of Illinois-Champaign, 2007


CostCost► PCAPCA

Water quality - $52.7 millionWater quality - $52.7 million

► DNRDNR Fisheries = $82.9 millionFisheries = $82.9 million Game and Fish Protection = $38.7 millionGame and Fish Protection = $38.7 million

► MDHMDH Staff support = $33.9 millionStaff support = $33.9 million Printing and mailing = $25,000Printing and mailing = $25,000

Sources: Department of Finance, 2007; DNR FY2006-07 Operating Budget

Total = $208 millionTotal = $208 million

Alternative #1: Fish Consumption Alternative #1: Fish Consumption AdvisoriesAdvisories Social AcceptabilitySocial Acceptability

► 2003 - Michael Joseph, Brown University2003 - Michael Joseph, Brown University Interviewed 15 anglers of Southeast Asian descent in Interviewed 15 anglers of Southeast Asian descent in

Providence, RIProvidence, RI Not concerned or did not understand advisoriesNot concerned or did not understand advisories Most avoided fish for taste, not safetyMost avoided fish for taste, not safety Contamination associated with taste, smell, sightContamination associated with taste, smell, sight

► 2006 - Indigenous Women’s Mercury Investigation2006 - Indigenous Women’s Mercury Investigation Interviewed 11 families on native reservations in Northern Interviewed 11 families on native reservations in Northern

MinnesotaMinnesota 9 families consumed fish more than one meal per week9 families consumed fish more than one meal per week Many had minimal interaction with MDH literature and staffMany had minimal interaction with MDH literature and staff Consumption continued even with educationConsumption continued even with education


Shift public education of fish Shift public education of fish advisories to units of local advisories to units of local

government and organizationsgovernment and organizations

Alternative #2: Local InvolvementAlternative #2: Local InvolvementAdministrative OperabilityAdministrative Operability

►Local government unitsLocal government units Park and Recreation DepartmentsPark and Recreation Departments

►Enforcement and educationEnforcement and education

►Non-Profit OrganizationsNon-Profit Organizations Fox River Environment and Diet Study Fox River Environment and Diet Study

(FRIENDS)(FRIENDS)►Research and educationResearch and education

Alternative #2: Local Involvement Alternative #2: Local Involvement Effectiveness - HealthEffectiveness - Health

►Expect slow decrease in mercury-Expect slow decrease in mercury-related illnesses over timerelated illnesses over time Able to reach subpopulationsAble to reach subpopulations

►Should be more effective than MDH Should be more effective than MDH advisories aloneadvisories alone

Alternative #2: Local Involvement Alternative #2: Local Involvement CostCost

► Current Advisory CostsCurrent Advisory Costs $208 million$208 million

► Local GovernmentLocal Government Minneapolis Park and Recreation BoardMinneapolis Park and Recreation Board

► $346,921 for Public Information $346,921 for Public Information ► $163,905 Customer Service $163,905 Customer Service

St. Paul Parks and RecreationSt. Paul Parks and Recreation► $310,546 for Community Education $310,546 for Community Education

► Non-ProfitsNon-Profits


Sources: MPRB 2007 Annual Budget; SPPR 2005 Budget; DNR CO Program

Alternative #2: Local Involvement Alternative #2: Local Involvement Social AcceptabilitySocial Acceptability

►Tracey Nordstrom, MPRB Vice PresidentTracey Nordstrom, MPRB Vice President Local units have greater access to communitiesLocal units have greater access to communities Normally work with neighborhood associationsNormally work with neighborhood associations

►FRIENDSFRIENDS Greater knowledge of cultural barriersGreater knowledge of cultural barriers Can build trust within the communityCan build trust within the community Empower local activismEmpower local activism


Place a fish consumption ban Place a fish consumption ban on all contaminated waters in on all contaminated waters in

MinnesotaMinnesota

Alterative #3: Fish Consumption BanAlterative #3: Fish Consumption BanAdministrative OperabilityAdministrative Operability

►PCAPCA Developing state water standardsDeveloping state water standards Statewide water quality planning and Statewide water quality planning and

monitoringmonitoring

►DNRDNR Enforcement of consumption banEnforcement of consumption ban Analyze fish for contaminantsAnalyze fish for contaminants

Alterative #3: Fish Consumption BanAlterative #3: Fish Consumption BanEffectiveness - HealthEffectiveness - Health

►Reduction in mercury exposureReduction in mercury exposure No longer able to consume contaminated No longer able to consume contaminated

fishfish

►Lose benefits of eating fishLose benefits of eating fish Lean protein sourceLean protein source Omega-3 fatty acidsOmega-3 fatty acids

Alterative #3: Fish Consumption BanAlterative #3: Fish Consumption BanCostCost

►PCAPCA Water quality - $52.7 millionWater quality - $52.7 million

►Additional enforcement expenseAdditional enforcement expense DNRDNR

►Fish = $82.9 millionFish = $82.9 million►Game and Fish Protection = $77.4 million Game and Fish Protection = $77.4 million

Minneapolis Park and Recreation BoardMinneapolis Park and Recreation Board►Park Police = $9.6 millionPark Police = $9.6 million

Total = $222.6 millionTotal = $222.6 million

Sources: Department of Finance, 2007; DNR FY2006-07 Operating Budget

Alterative #3: Fish Consumption BanAlterative #3: Fish Consumption BanSocial AcceptabilitySocial Acceptability

►Would not be accepted by the publicWould not be accepted by the public

►Too many groups tied to fish Too many groups tied to fish consumptionconsumption

►Fish consumption would occur Fish consumption would occur regardless of banregardless of ban


Provide more Asian-specific Provide more Asian-specific items at food shelves for low-items at food shelves for low-

income segments of the income segments of the populationpopulation

Alternative #4: Modify Food ShelvesAlternative #4: Modify Food ShelvesAdministrative OperabilityAdministrative Operability

►Second Harvest Second Harvest Provides food to local shelters and food Provides food to local shelters and food

shelvesshelves Refrigerated and non-refrigerated itemsRefrigerated and non-refrigerated items Serves entire metro areaServes entire metro area

►Center for Asian & Pacific Islanders (CAPI)Center for Asian & Pacific Islanders (CAPI) Asian-specific food shelfAsian-specific food shelf

Alternative #4: Modify Food ShelvesAlternative #4: Modify Food ShelvesEffectiveness - HealthEffectiveness - Health

►Fish is complemented with other food Fish is complemented with other food itemsitems

►Better overall nutritionBetter overall nutrition

Alternative #4: Modify Food ShelvesAlternative #4: Modify Food ShelvesCostCost

►Second HarvestSecond Harvest $47 million annual$47 million annual

►CAPICAPI


Source: Second Harvest Annual Report, 2007

Alternative #4: Modify Food ShelvesAlternative #4: Modify Food ShelvesSocial AcceptabilitySocial Acceptability

►Provides culturally familiar foodProvides culturally familiar food

► Increases chance of consumer using Increases chance of consumer using food shelf food shelf

Alternative EvaluationAlternative Evaluation

► Administrative OperabilityAdministrative Operability Mechanisms in place for all 4 alternativesMechanisms in place for all 4 alternatives

► Greatest Effectiveness – HealthGreatest Effectiveness – Health Consumption banConsumption ban Food shelfFood shelf

► Least CostlyLeast Costly Fish Consumption AdvisoriesFish Consumption Advisories Food shelfFood shelf

► High Degree of Social AcceptabilityHigh Degree of Social Acceptability Local educationLocal education Food shelf Food shelf

RecommendationsRecommendations

► Use a strategy of multiple alternativesUse a strategy of multiple alternatives Continue Fish Consumption AdvisoriesContinue Fish Consumption Advisories Move public education to the local levelMove public education to the local level Provide culturally familiar options for low-income Provide culturally familiar options for low-income

segmentssegments

RecommendationsRecommendations

► Use a strategy of multiple alternativesUse a strategy of multiple alternatives Continue Fish Consumption AdvisoriesContinue Fish Consumption Advisories Move public education to the local levelMove public education to the local level Provide culturally familiar options for low-income Provide culturally familiar options for low-income

segmentssegments

► Compliance failures are due to cultural barriersCompliance failures are due to cultural barriers Distrust of the unknownDistrust of the unknown Misunderstanding of dangerMisunderstanding of danger Decision between culture and healthDecision between culture and health Cheap food sourceCheap food source

Analyzing the Effectiveness of Fish Consumption Advisories in Immigrant Populations Dan Endreson...

Documents

Transcript of Analyzing the Effectiveness of Fish Consumption Advisories in Immigrant Populations Dan Endreson...