AAMR F.Y.I. Talks to Michele N. (Gagnon) Wagner, Director of the Environmental Health Initiative at AAMR
There is more we don't know about the environment and intellectual disabilities than we do know--about how chemicals and toxicants in the air we breathe and the food we eat contribute to the occurrence of disabilities. In 2004, with support from the John Merck Fund, AAMR launched an Environmental Health Initiative and chose Michele N. (Gagnon) Wagner, MPH, to head a concerted effort to raise awareness about the unnecessary occurrence of developmental disabilities caused by environmental toxicants and pollutants. For the past 2 years Michele has been involved in a variety of educational, policy, and research efforts on promoting good health and reducing toxic exposures for the developmental disabilities community. Read more...
AAMR F.Y.I.: Can you tell our readers a little bit about your initiative and how it came about?
Michele: The Environmental Health Initiative at AAMR has two main goals: To raise awareness about the association between neurotoxic exposures that may lead to or cause a developmental disability, and secondly, to raise awareness that those living with a developmental disability may be vulnerable to toxic exposure. The Initiative in general advocates for promoting good health by reducing toxic exposures.
The initiative was the brain child of the Executive Director of the American Association on Mental Retardation (AAMR), M. Doreen Croser. Doreen and others in the developmental disability and environmental health community collaborated to hold a groundbreaking Wingspread conference in 2004 to address how toxic exposures can lead to developmental disabilities and how toxic exposures affect this community. From this conference a report was developed titled Pollution, Toxic Chemicals, and Mental Retardation. This report is the guiding document for the Initiative. It is available free in hard copy from AAMR by emailing books@aamr.org.
AAMR F.Y.I.: Why would you say our readers should care about the environment in the context of intellectual disabilities?
Michele: In a simplified statement, some elements in the environment have the potential to adversely affect the intellectual capacity of individuals. Specifically, neurotoxicants such as lead, mercury and polychlorinated biphenyls (PCBs) can disrupt the developing brain in utero and during childhood. This disruption in normal brain development can result in a lower IQ. However, there are many factors that may influence brain development such as diet and socio-economic status. Many environmental professionals include these factors as part of the environment too, not just chemicals.AAMR F.Y.I.: At what level of knowledge are we now, with regards to our understanding of the interplay of the environment on intellectual disabilities?
Michele: We have only scratched the surface with regard to understanding all the complex ways the environment affects brain development. If you only consider particular chemical contaminants such as the neurotoxicants, we have a lot of information and research on a few substances and virtually no information on thousands of other toxicants in our environment that are classified as "suspected" neurotoxicants. For instance, there are approximately 80,000 chemicals in production in the United States that are registered with the U.S. Environmental Protection Agency (EPA). Of these 80,000 chemicals, approximately 20 have been fully studied for their potential toxicity to the brain.
AAMR F.Y.I.: Is your Initiative engaged in any educational efforts in this area?
Michele: The Initiative engages in a host of policy and legislative issues that work towards reducing toxic exposures or understanding how the thousands of chemicals in production are affecting our health. AAMR has joined policy letters with other environmental advocates urging the EPA to require more thorough testing of chemicals in production, especially for neurotoxicity testing.
AAMR F.Y.I.: How hard has it been for you to connect the developmental disability and the environment communities in collaborative efforts?
Michele: The environment community is eager to connect with the developmental disability community on collaborative projects. The disability community is becoming aware of environmental issues and I believe it's a growing area of concern. One of the primary goals of the Environmental Health Initiative is to raise awareness about how important environmental issues are for optimal health and wellness of persons with developmental disabilities.
AAMR F.Y.I.: How have you achieved this so far?
Michele: The entire AAMR Environmental Health Initiative is a collaborative effort among traditional environmental groups and developmental disability groups. I incorporate environmental health professionals and disability professionals on the advisory board, in presentations at national conferences, to lecture for the Research and Science teleconference series, and on the Initiative's Education and Outreach Workgroup. All these activities are represented by both environmental and disability professionals. It is the blending of expertise that allows for successful projects and programs.
In fact, the AAMR Environmental Health Initiative is not the only project connecting the two communities. For example, the Learning Disability Association of America and the Collaborative on Health and the Environment both have projects that include expertise from both disciplines.
AAMR F.Y.I.: We hear a lot about exposure to chemicals and harmful effects. In the context of prevention and developmental disabilities, does your research suggest reducing exposure, eliminating all together? What should we absolutely stay away from?
Michele: There has been a shift in the environmental community from the notion of "controlling and reducing" harmful exposures to "elimination and prevention" in the first place. This is driven by the concept of the Precautionary Principle, which advocates that if a substance has the potential to cause harm we should use an alternative that we know is safer. This has come as a result of the thousands of neurotoxic and suspected neurotoxicants in production today. Some argue that we do not need to expend millions of dollars on research to fully "incriminate" a chemical when its structure or toxicological data indicate it is likely to cause harm. However, some chemicals are so persistent and obsequious in the environment that prevention of exposure is virtually impossible. For instance, we no longer think so much about if you have been exposed but rather how much exposure. Biomonitoring efforts by the Centers for Disease Control more often ask what level of a particular contaminant is found in a blood or urine sample, not if the contaminant exists in the blood or urine.
AAMR F.Y.I.: Talking about contaminants, we all know about the connection between lead and developmental disabilities. Apart from this, can you talk about other environmental factors known to directly cause a developmental disability?
Michele: Well, two well-researched examples are mercury and polychlorinated biphenyls (PCBs). There are likely thousands of others. It is important to keep in mind that it is very difficult to associate an environmental exposure as directly causing any one particular developmental disability. When you are talking about the toxicology of these substances, a lot of the effects will depend on the actual "dose" and "timing" and even the health status of the individual. Environmental influences are single factors in a multifactorial exposure scenario. It is hard to determine the exact effects of one independent exposure when exposure to many toxicants happens all at once and you need to account for the possibility of interaction between compounds.
AAMR F.Y.I.: What about the much-debated fish and mercury correlation? Any final word from the developmental disability community?
Michele: The form of mercury we are talking about here is methylmercury and there is no doubt that methylmercury exposure to the fetus at a high enough level causes mental retardation as well as host of other developmental disabilities along the spectrum. The key to this sentence is "dose" or amount of exposure. The amount of exposure you get from eating fish once or twice a week will most likely not result in a developmental disability because the dose is too low. Again, I qualify that answer because it depends on the "timing" of the exposure or what developmental stage the person is in and many other factors. The omega three fatty acids found in fish are actually very beneficial to brain development and should be a part of everyone's diet. Just not an excessive part of the diet.
AAMR F.Y.I.: Part of your efforts focus on the interaction of the environment on the lives of persons actually living with an intellectual disability. What activities or programs do you have in that area?
Michele: One of the goals of the Environmental Health Initiative is to raise awareness and develop a framework that illustrates how those already living with an intellectual or developmental disability are at a greater risk from toxic exposures than those without a disability. This does not hold true on the individual level but if you look at the unique population level characteristics of the developmental disability community, you can see how they should be considered a vulnerable population.
The Environmental Initiative's Outreach Workgroup developed an article for the Journal of Pediatric Nursing that outlines, perhaps for the first time in a peer-reviewed journal, the special concerns of the developmental disability community with regard to toxic exposures encountered at home. It's an exciting piece of work and will be published in the November/December issue of the journal.
AAMR F.Y.I.: By the way, any other particular resources on the environment for persons living with an intellectual and developmental disability?
Michele: For persons living with a disability there is not as much out there. The AAMR website's section on Environmental Health is a place to start. Most environmental websites that are related to disabilities focus their efforts on prevention in the first place and do not address the special concerns of persons living with a developmental disability. Approaching the developmental disability community as an Environmental Justice community or "vulnerable population" is really a novel idea and materials and information specifically tailored for them are still under development or emerging. However, for information on children's environmental health that focuses on disability issues you can go to the Learning Disabilities Association of America's Healthy Children Project website www.healthychildrenproject.org and to the Collaborative on Environmental Health's Learning and Developmental Disabilities Initiative website at www.healthandenvironment.org/working_groups/learning. Both of these websites focus on toxic exposures that may lead to, cause, or exacerbate optimal brain development.
AAMR F.Y.I.: And what about resources for women of childbearing age that want to be more informed about toxic exposures?
Michele: You know, that is a great question! I couldn't think of one off the top of my head so I did some searching on the Internet. To my surprise, I could not find a group dedicated to environmental health and pregnancy issues! This is one of the most critical periods of development when environmental exposures can make a big difference in optimal brain development and overall health. However, there are some resources that contain some environmental health information on preconception and pregnancy. Healthy Mothers Healthy Babies at www.hmhb.org is one such group. Also, the March of Dimes website at www.marchofdimes.com is a great resource for preconception and pregnancy concerns.
AAMR F.Y.I.: What do you make of the increasing incidents of learning disabilities in the United States?
Michele: That statement is up for debate! There is controversy whether rates of learning and developmental disabilities are actually on the rise and also controversy about the rate in which they are rising--if they are indeed. Some point to changes in diagnostic criteria and better detection to explain the increases. Others argue there is an undeniable increase as documented by state spending on special education services for children. It's a heated debate. However, I believe the growing consensus among "experts" is that they are on the rise but how much is hotly contested.
AAMR F.Y.I.: Any message you'd like to convey to our readers?
Michele: Environmental health IS human health. A person's environment greatly influences their overall health status and they should not really be separate categories.
AAMR F.Y.I.: And how can someone get involved in the environmental health initiative?
Michele: That's easy! Go to the AAMR website at www.aamr.org and click on the environmental health flash button. From there you can click on the Get Involved button. The workgroups are ad hoc and people participate as little or as much as they like. It's been a great experience so far!
Michele Wagner has a Master's degree in Public Health from the George Washington University in Washington, DC. She can be reached at mgagnon@aamr.org
To request a copy of Pollution, Toxic Chemicals, and Mental Retardation, email books@aamr.org
If you want to get more information about the environmental threats around you, Michele recommends these resources as a good start
The Institute for Children's Environmental Health (ICEH) at www.iceh.org for a great series entitled "Practice Prevention." These easy to understand fact sheets are great start to get a grasp on what's out there.
Beyond Pesticides at www.beyondpesticides.org answers all your questions regarding herbicides, insecticides and fungicides that you may use in your home and garden.
The Center for Environment Health and Justice at www.chej.org includes a whole array of issues.
For federal websites, the Center for Disease Control's National Center on Environmental Health at www.cdc.gov/nceh is a good start.
For cutting edge research news, there is a free publication on line called Environmental Health Perspectives at www.ehponline.org that might be of interest.
The Environmental Protection Agency has a website too that is very useful. It covers a whole host of environmental issues but has a section on "Human Health" at www.epa.gov/ebtpages/humanhealth.html that covers topics such as exposure issues, food safety, drinking water, toxicity, fish advisories and even a section on Seniors' Environmental Health.
Michele's own website on the Environmental Health Initiative can be accessed at www.aamr.org by clicking on the Flash button at the top.