Public health and the environment

By Erin Bills explorebigsky.com health columnist

Montana is known for breathtaking
natural beauty and a presumably
pristine environment. Our natural
resources have helped sustain our
state’s economy for generations.
However, this has come at a high cost
to the health of our environment and
communities.
Evidence of increased health concerns
related to environmental hazards are
abundant in Montana: the ongoing
tragedy of Libby, the proposed Coal
Bed Methane project in Eastern Montana,
and pesticide use on agricultural
land near Great Falls.
The environment and our health are
intimately connected. As defined by
the World Health Organization, environmental
health is the assessment
and control of all physical, chemical
and biological factors external to
a person including related factors
impacting behavior. Considering that
environmental health hazards make
up a significant portion of the noncommunicable
disease burden in our
state and worldwide, attention must
be directed to this issue.
The incidence of non-communicable
diseases such as cardiovascular
disease and cancer has increased in
the past 30 years. In Montana, cancer
rates are higher in rural counties
compared to more developed counties
such as Gallatin or Missoula county.* Many environmental factors may be
causing or exacerbating these conditions,
including decreased air quality,
access to clean water, and increased
exposure to
toxins.
Major air pollutants
common in
Montana include
lead, sulfur
dioxide, carbon
monoxide, particulate
matter,
nitrogen oxides,
tropospheric
ozone, and toxic
pollutants such
as dioxins and
asbestos. The
source varies
by process and/
or reaction, but
predominant sources of air and water
pollution in rural Montana are a
result of pesticide use in agriculture,
wildfires and byproducts of the mining
and oil industries. The Environmental
Protection Agency recently
reported that 80 of the 177 common
air pollutants—specifically formaldehyde,
benzene, and polycyclic
aromatic hydrocarbons —have been
linked to cancer. These pollutants do
not remain in the air and routinely
end up in the soil and water, creating
numerous exposure routes.
Based on the bioaccumulant nature
of these toxins, investigating disease
mechanism of cardiovascular disease,
cancer, developmental
defects,
neurodegenerative
diseases,
and genetic susceptibility
(just
to name a few) is
of essence. Although
epidemiological
data
has suggested
an increased
incidence of
disease rate,
there are many
confounding
factors such as
study design,
race, age, smoking
status, and other lifestyle choices
that must be considered.
This does not mean we should ignore
the surmounting evidence.
Consider Libby, Montana, where
over the past decade, many cases of
asbestos related disease (ARD) have
been documented. The Agency for
Toxic Substances and Disease Registry
has confirmed contamination
of the town and surrounding area.
Mortality studies conducted by this
agency concluded that deaths due
to ARD were 40 to 60 times higher
in Libby than the expected national
average. The true disease toll may not
be known for decades because of the
long latency period for ARD.
This high death rate in Libby, plus
rural factors such as access to care, a
lack of primary care providers, and
economic forces, spurred regulatory
action. In June of 2009, the EPA
declared Libby a Public Health Emergency,
the first in United States history.
This declaration, under the 2009
Patient Protection Affordable Care
Act, extended Medicare coverage to
Libby residents afflicted with ARD.
While this may sound like a health
policy success story, it may not have
been necessary if we knew then what
we know now about environmental
health.
*National Cancer Institute, State
Cancer Profiles
Erin A. Bills, MPH, is a public health
consultant living in Big Sky. She has
worked extensively with the community
of Libby, Mont., and is dedicated
to improving the health of Montana’s
rural populations.