Introduction

According to the World Health Organization, "...environmental health comprises those aspects of human health, diseases, and injury that are determined or influenced by factors in the environment. This includes the study of both the direct pathological effects of various chemical, physical, and biological agents, as well as the effects on health of the broad physical and social environment, which includes housing, urban development, land-use and transportation, industry and agriculture."

This is an extremely broad definition, and many health goals and objectives that it could encompass are covered in other priority areas, such as cancers caused by tobacco, or vaccine-preventable diseases. In this priority area, the focus is in the areas of reducing occupational injury and disease, reducing exposure of school children to asbestos, and evaluating sites that might have the potential for human exposure to hazardous waste. Goals in these areas were selected because of the potential severity and magnitude of health consequences due to what are largely preventable causes, in the case of occupational health, or due to environmental conditions which can be controlled, such as asbestos exposure.

Outlook for Reaching Specific Objectives:
	Achieve target:	Likely	Unlikely	Uncertain
10A.	Reduction in construction- related deaths
10B.	Reduction in workers with high lead levels
10C.	Reduction in work-related hospitalizations for acute lung diseases
10D.	Increase the number of hazardous waste sites evaluated
10Ei.	Increase the number of schools that have approved asbestos plans
10Eii.	Increase in removal projects passing first inspection

Data Update

10A. Reduce work-related injury deaths per 100,000 construction workers to:

8.5

Achieve target:	Likely	Unlikely	Uncertain

Construction workers are defined as individuals who work in the construction industry, i.e. job classifications which are included in Standard Industrial Classifications (SIC) 15 - 17. In 1991, New Jersey began participating in the U.S. Department of Labor's Bureau of Labor Statistics Census of Fatal Occupational Injuries, a program to collect detailed information on every occupational fatality to ensure an accurate count of such injuries and to facilitate development of appropriate prevention strategies. At that time the definition of work-related fatal injuries was also broadened, to include homicides and suicides and to add more reporting sources. Data from 1983 through 1990 shown above were revised under the new protocol.

The work-related injury death rate for construction workers has fallen considerably during the past decade. If this trend continues, it is likely the year 2000 objective will be met.

10B. Reduce the number of workers with occupational exposure causing blood lead concentrations >25 µg/dL of whole blood to:

0

Achieve target:	Likely	Unlikely	Uncertain

The number of workers with elevated blood-lead levels has decreased in New Jersey in recent years. This decrease may be due to companies' better controlling exposure to lead during production or a reduction of the number of companies in the state which use lead in their production processes. Despite this improvement, it does not appear likely that the year 2000 target will be achieved.

10C. Reduce the number of adults with occupational or environmental exposures leading to a hospitalization for acute lung disease to:

90 per year

Achieve target:	Likely	Unlikely	Uncertain

It is estimated that 5 to 15 percent of all hospital cases of acute lung diseases such as adult asthma are related to occupational exposures. After several years of decline, hospitalizations for acute lung conditions increased substantially in 1996; however, data for the first three quarters of 1997 show a marked decrease (to 70 cases). At this point it is uncertain whether or not the year 2000 goal will be met.

10D. Increase the number of sites evaluated for potential human exposure pathways to hazardous waste to:

275 sites

Achieve target:	Likely	Unlikely	Uncertain

Hazardous waste sites in New Jersey are designated by the federal Environmental Protection Agency for inclusion on the National Priority List (NPL) and evaluation for potential human exposure pathways. From year to year, the number of sites on the list can change, as remediated sites are removed and newly designated sites are added. As of 1997, health assessments had been completed for 174 sites. Even though there has been a substantial increase in the number of NPL sites evaluated in recent years, there may not be sufficient time to complete the remaining sites currently on the NPL list by the year 2000.

10Ei. Increase K-12 schools which have NJDOH-approved management plans and have begun to implement these plans to control asbestos hazards, including identification, abatement and reinspection to:

100 percent

Achieve target:	Likely	Unlikely	Uncertain

Since about 1993 the more than 4,000 public and private New Jersey schools, grades K-12, have been in compliance with the federal mandate to inspect for asbestos-containing material and submit management plans describing how this material will be handled. Schools are required to conduct surveillance activities every six months to detect any changes in the asbestos-containing material identified in the management plan. At least once every 3 years, schools must conduct a reinspection and submit any changes to the management plan to the Department for review and approval. This ongoing activity is monitored closely, and year 2000 objectives should be met.

10Eii. Increase the percentage of K-12 school asbestos removal projects scheduled for completion in a given year that, on first inspection, are found to have complied with federal and state regulations for asbestos removal to:

85.0 percent

Achieve target:	Likely	Unlikely	Uncertain

There has been major improvement in the percentage of completed school asbestos abatement projects which are found to be in compliance on their initial inspection with federal and state regulations. It appears likely that this objective can be achieved prior to the year 2000, if the current trend continues.

Discussion

Fatal occupational injuries among construction workers account for approximately 15 percent of all work-related fatal injuries. Each of these deaths contributes on average 26 potential years of work life lost. The Department investigates work-related deaths from falls, electrocutions and machine-related injuries, all of which are common in the construction industry, through the Fatality Assessment and Control Evaluation (FACE) Project. FACE investigation reports, which contain recommendations on ways to prevent similar fatal injuries, are distributed to employers, unions and workplace health and safety personnel. Information bulletins on selected injuries, FACE Facts and Hazard Alerts, are also distributed to employers and employees as preventive measures. These efforts may have contributed to the reduction in the fatal occupational injury rate in the construction industry during this decade.

In order to lower blood-lead level concentrations in workers, several programs have been initiated. The Department has participated in a collaborative effort with the state Department of Treasury to prevent lead poisoning of workers who are repainting bridges. Contracts for bridge construction and repair projects involving potential lead exposure now contain mandatory health and safety language. The Department analyzes and disseminates its occupational lead toxicity surveillance data, and is actively involved in counseling workers, their employers and their physicians about prevention and control of lead exposure. The number of workers reported with occupational lead exposure has declined in recent years, but some workers are reported year after year with persistent lead toxicity due to on-going overexposure. This persistence in some individual cases, despite the availability of effective prevention measures, is particularly challenging. The Department does not have authority to enforce health standards for lead at private sector work sites; this is an area under federal Occupational Safety and Health Administration jurisdiction. The Department is committed to continued surveillance and education to improve the control of lead exposure in New Jersey work sites.

Acute lung diseases, such as occupational asthma, that are due to occupational exposures are estimated to comprise 5 to 15 percent of all adult asthma cases, making this a public health problem of considerable concern in New Jersey. However there are no national data systems designed to measure the true magnitude of this problem. New Jersey is one of a few states that systematically collects data on occupational asthma, including data from hospitals. The Department also provides education and consultation on ways to prevent occupation- related acute lung conditions.

Health assessments at hazardous waste sites that are on the National Priority List (NPL) are conducted to evaluate the potential risk to human health posed by these sites. These sites are distributed throughout this densely populated state and many are known to contain heavy metals, industrial solvents, cancer causing compounds and other chemical wastes. Assessments are funded by the federal government and performed by either the U.S. Agency for Toxic Substance and Disease Registry (ATSDR) or the Department.

A Health Assessment is an evaluation of the public health implications posed by a hazardous waste site. Environmental data, health outcome data, and community health concerns are examined in order to: 1) identify human exposures and hazardous conditions associated with a site; 2) assess past, current or future impact on public health; 3) develop health advisories or other health-protective recommendations; or 4) identify populations living or working near the sites for further health studies or educational programs.

In some cases, a Health Assessment may recommend further health study. Health studies may consist of medical and exposure screening, collection and analysis of environmental or biological samples, reviews of disease surveillance data, and epidemiological studies. The objectives of these studies are to increase understanding of the relationship among site contamination levels, actual human exposure to hazardous substances, and adverse human health effects.

As part of a site-related activity, the Department may also develop and disseminate to physicians and other health care providers informational materials on the health effects of toxic substances, specific hazardous waste sites in New Jersey, and resources for additional detailed information. The Department may also carry out community health education programs related to specific site-related concerns.

The Department intends to continue health assessments at the NPL sites until all have been completed. There are additional hazardous waste sites that have been identified by the New Jersey Department of Environmental Protection that do not appear on the NPL, for which federal funding to conduct health assessments is not available. Within the resources available, the Department intends to prioritize non-NPL hazardous waste sites for possible assessment.

Due to state oversight and education of the private contractors doing asbestos removal in New Jersey schools, major improvement in the number of projects passing an initial inspection has occurred since 1988, when only 10 percent of inspected "completed" projects were properly completed. The Department coordinates the statewide asbestos quality assurance program in New Jersey schools, which succeeded in raising the first-time inspection pass rate for completed projects to 77 percent in 1997.