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COMMENT
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July 26, 2000
Kitty Armstrong
Radiation Studies Branch
1600 Clifton Road, NE
Mail Stop E-39
Atlanta, GA 30333
Re: "Predecisional Draft Charter, Advisory Committee on the Health Effects of Radiation"
Dear Ms. Armstrong:
Thank you for the opportunity to comment on the July 7, 2000 proposed charter for the Advisory Committee on the Health Effects of Radiation (ACHER). As you know, Western States Legal Foundation (WSLF) has been an active participant in the work of the Advisory Committee on Energy-Related Epidemiologic Research (ACERER) since the inception of the ACERER Community Work Group in 1997. Moreover, since WSLF's founding in 1982, we have worked relentlessly to uncover, publicly disclose, and seek solutions to the public health impacts of the U.S. Department of Energy's (DOE's) nuclear weapons program.
Based on our experience with the ACERER, and with the issue of the health impacts of nuclear weapons and related technologies, we agree that the ACERER has been limited in its ability to address the issues under its purview. We believe that some, but not all, of these constraints may stem from the ACERER's charter. We therefore appreciate the efforts of the Centers for Disease Control and Prevention Radiation Studies Branch to overcome the limitations of the current ACERER charter by reorganizing the committee under a new charter. We offer the following observations and recommendations on the proposed ACHER charter:
In contrast to the ACERER, which was established to provide advice in setting the research agenda and in conducting the research program outlined in the Memorandum of Understanding between DOE and HHS, we understand the proposal to mean that the purpose of the ACHER is to make policy and procedural recommendations on how HHS and DOE program efforts related to the human health consequences of radiation exposures from a wide variety of sources should be addressed. This would include recommendations regarding HHS and DOE radiation exposure-related programs such as risk communication, education, training, surveillance, and medical monitoring and services such as those offered by DHHS. The expanded scope of the ACHER would cover the science of radiation-related health issues, health research programs, and public health services and activities related to radiation exposures among workers and community members. WSLF strongly supports the expanded purpose of the ACHER.
WSLF's support for the purpose of ACHER is predicated on our understanding that HHS' "public health services" includes the provision of health care. Access to appropriate health care is a primary concern among communities impacted by the U.S. nuclear weapons program. In this regard, in December 1999, in recognition of the limitations of the HHS/DOE energy-related research agenda to meet the needs of many directly-affected communities, the ACERER recommended that HHS initiate a national forum for discussing implementation of community-based clinics and other healthcare-related solutions that fall outside of the ACERER's purview, but that do fall under the mandates of HHS. WSLF recommends that the ACHER charter specify that policy and procedural recommendations related to health care are under the purview of the ACHER.
In contrast to the ACERER, which made recommendations to the Secretary of Health and Human Services (HHS), the proposed ACHER would advise the Secretary of HHS and the Secretary of Energy. WSLF supports that ACHER recommendations be made to both Secretaries.
Structure of the ACHER:
The proposed ACHER would consist of 15 members: a Chair, 10 technical members with expertise in fields such as health effects of radiation, epidemiology, exposure assessment, medicine and public health, and four members from public and labor interest groups familiar with public health issues relevant to the ACHER's purpose.
The recommendations made by any advisory committee including the ACHER are likely to reflect the experience and knowledge of its members. In view of the stated purpose of the ACHER, the knowledge and perspective of directly-affected workers and community members will be essential to developing meaningful recommendations. In this regard, it is unclear whether members selected from "public and labor interest groups familiar with public health issues relevant to the Committee's purpose" are equivalent to "representatives of directly affected workers and community members". WSLF recommends that the charter language be strengthened to state that members will be selected from "public and labor interest groups familiar with public health issues relevant to the Committee's purpose including representatives of directly-affected workers and community members".
The current ACERER charter specifies the same number of members as the proposed ACHER charter. In contrast to the ACERER charter, the ACHER charter prescribes the proportion of members from each group. However, the current membership of the ACERER reflects a distribution consistent with the proposed ACHER: 4 of the 14 ACERER members are representatives of community (Dr. Tuler), worker (Mr. Branham and Mr. Cameron) and Tribal (Mr. Burke) perspectives, and 10 members contribute scientific and technical expertise.
WSLF believes that the proposed distribution of technical expertise (10 of 14 members) and representatives of the perspective of public and labor interest groups (4 of 14 members) is inconsistent with the stated purpose of the ACHER. The number of ACHER members who represent public and labor interest groups (including representatives of directly-affected workers and community members as noted above) should be equal to, or exceed, the number of technical members. This could be accomplished by having eight of the 14 members represent community/worker perspectives and seven represent the scientific/technical perspective. On the other hand, if 10 members with scientific/technical expertise are essential, the committee could be expanded to 21 members and remain a functional committee.We note that the establishment of a "Citizen Subcommittee" does not adequately address the need for balance between the technical and worker/community input because Subcommittee participation is in the form of non-voting liaisons (see comment #6, below). WSLF recommends that representatives of public and labor interest groups, including representatives of workers and communities who have been directly impacted by radiation-related exposures, comprise at least 50% of the ACHER committee membership.
The proposed ACHER charter states that technical members ... "shall be selected from among experts knowledgeable in fields such as health effects of radiation research, epidemiology, exposure assessment, medicine and public health". Given the importance of expertise in environmental and occupational health, ethics, and social sciences to the deliberations of the ACHER, WSLF recommends that the charter state members ... "shall be selected from among experts knowledgeable in fields such as health effects of radiation research, epidemiology, exposure assessment, occupational and environmental health, ethics, and social sciences, medicine and public health."
In contrast to the ACERER, all of whose members are selected by the Secretary of HHS, seven of the 15 ACHER members would be selected by Secretary of Energy. We note that the ACERER was created in 1990 to improve the scientific quality and public credibility of federally-funded research into occupational and public health consequences of the U.S. nuclear weapons program. The DOE's nuclear weapons-related mission was, and continues to be, antithetical to the public health goals that will be addressed by the ACHER. The DOE remains the responsible party for the exposures to be addressed by the ACHER. Therefore the DOE's involvement in the selection process will irreparably undermine the credibility of the ACHER. WSLF strongly opposes the involvement of the Secretary of Energy in the selection process of ACHER members. WSLF recommends that all members of the ACHER be appointed by the Secretary of HHS.
The proposed ACHER charter states that a "Citizens Subcommittee" be established "to bring the perspective of local communities to the ACHER discussions". WSLF supports the goal of this subcommittee. However, the use of the word "citizen" in the name of the "Citizen Subcommittee" may discourage participation by some members of the directly-affected community (e.g., Tribes). Citizenship is not a criterion for the radiation-related exposures that will be addressed by ACHER. We also stress that the proposed Citizen Subcommittee does not obviate the need for bringing the perspective of directly-affected populations to the ACHER as voting members. WSLF supports the formation of a subcommittee that will bring the perspective of local communities to the ACHER discussions, and recommends that the name of the ACERER "Subcommittee on Community Affairs" be retained by the ACHER Subcommittee, and that the subcommittee be chaired by an ACHER member representing community concerns.
The proposed ACHER charter states that in addition to the ACHER members, "the Chair of each site-specific Health Effects Subcommittee ... and each DOE Citizen Advisory Boards shall be invited to serve as non-voting liaison representatives of the Citizens Subcommittee". WSLF strongly opposes that community liaisons to the Citizens Subcommittee be composed entirely of the Chairs of the site-specific Health Effects Subcommittees and DOE Citizen Advisory Boards. This is because:
The proposed selection of community representatives does not adequately reflect the full range of people who have been affected by the DOE's nuclear-related activities. At the first meeting of the ACERER Community Work Group in October 1997, it was recognized that the community members initially selected did not adequately reflect the full range of people who have been affected by the DOE's nuclear-related activities. Gaps identified included the absence or under-representation of: Chicanos, Native Americans, Alaska Natives, uranium miners, Marshallese Islanders, Japanese and Korean-American survivors of the Hiroshima and Nagasaki bombings, subjects of human radiation experiments, nuclear workers, Atomic Veterans, Medical “Treatment” subjects, and Nevada Test Site Downwinders. The Centers for Disease Control and Prevention made important efforts to address these omissions. It was explicit in the discussions of the ACERER's Community Work Group that many people impacted by the DOE's nuclear weapons and related activities are not organized around a DOE site or even in a geographically-distinct area. In response to these concerns, a selection process was developed and implemented by which additional Consultants to the ACERER Subcommittee on Community Affairs were selected. Given the considerable attention given to these issues by the ACERER's Community Work Group and subsequently by the Subcommittee for Community Affairs, it is inconceivable that community input to the ACHER would be organized exclusively around DOE sites.
Not all the sites have Health Effects Subcommittees or DOE Citizen Advisory Boards, for example, Lawrence Livermore and Los Alamos National Laboratories, home to the DOE's reinvigorated nuclear weapons program. Therefore the proposal would exclude participation from the very sites that are simultaneously addressing past, present and planned future exposures as a result of DOE's nuclear weapons program.
The Health Effects Subcommittees and DOE Citizen Advisory Boards may or may not reflect the views of large segments of the directly-affected community at DOE sites.
For all of these reasons, WSLF strongly opposes that community liaisons to the Citizens Subcommittee be composed entirely of the Chairs of the site-specific Health Effects Subcommittees and DOE Citizen Advisory Boards. WSLF recommends that the process for selecting liaisons to the Citizens Subcommittee be consistent with the process developed and implemented for selecting the Consultants to the ACERER Subcommittee on Community Affairs.
In summary WSLF,
Strongly supports the expanded purpose of the ACHER.
Recommends that the ACHER charter specify that policy and procedural recommendations related to health care are under the purview of the ACHER.
Supports that ACHER recommendations be made to both the Secretary of HHS and the Secretary of Energy.
Recommends that the ACHER charter language be strengthened to state that members will be selected from "public and labor interest groups familiar with public health issues relevant to the Committee's purpose including representatives of directly-affected workers and community members".
Recommends that representatives of public and labor interest groups, including representatives of workers and communities who have been directly impacted by radiation-related exposures, comprise at least 50% of the ACHER committee membership.
Recommends that the ACHER charter state members ... "shall be selected from among experts knowledgeable in fields such as health effects of radiation research, epidemiology, exposure assessment, occupational and environmental health, ethics, and social sciences, medicine and public health."
Strongly opposes the involvement of the Secretary of Energy in the selection process of ACHER members. All members of the ACHER should be appointed by the Secretary of HHS.
Supports the formation of a subcommittee that will bring the perspective of local communities to the ACHER discussions, and recommends that the name of the ACERER "Subcommittee on Community Affairs" be retained by the ACHER Subcommittee, and that the subcommittee be chaired by an ACHER member representing community concerns.
Strongly opposes that community liaisons to the "Citizens Subcommittee" be composed entirely of the Chairs of the site-specific Health Effects Subcommittees and DOE Citizen Advisory Boards. The process for selecting liaisons to the Citizens Subcommittee should be consistent with the process developed and implemented for selecting the Consultants to the ACERER Subcommittee on Community Affairs.
We appreciate your consideration of our comments. If you have any questions, please feel free to call us at (510) 839-5877.
Sincerely,
Patrice Sutton, MPH
Secretary of the Board
Western States Legal Foundation
Consultant to the ACERER
Subcommittee on Community Affairs
Jacqueline Cabasso
Executive Director
Western States Legal Foundation
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