Government Affairs Specialist
The Association of Maternal & Child Health Programs
Human exposure to elevated levels of per- and poly-fluoroalkyl substances (PFAS) is a growing public health concern with unique implications for maternal and child health (MCH) populations. As communities, states, and the federal government seek to better understand and mitigate the effects of exposure to elevated levels of PFAS on human health, it is critically important that state Title V MCH personnel are involved alongside their colleagues in health department leadership, environmental protection, clinical practice, and emergency preparedness and response.
Policymakers and administrators who tap the expertise and insights of state Title V MCH agencies in responding to the health impacts of PFAS exposure will develop policies and programs that more effectively respond to the unique health care needs of MCH populations.
What Are PFAS?
PFAS are a family of man-made chemicals used by industry in the United States starting in the 1940s to make household and commercial products more resistant to stains, grease, and water. At the urging of the Environmental Protection Agency (EPA), from 2002 to 2015 most U.S. manufacturers of PFAS voluntarily phased out production of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonic acid (PFOS) – the two PFAS produced in the greatest quantities – out of concern about the impact of the chemicals on human health and the environment. The concerns were based on findings that PFOA and PFOS:
- did not readily break down in the environment;
- were present and widely distributed in the environment and in the blood of the general U.S. population;
- bioaccumulate and have a long half-life in people; and
- caused adverse health effects in laboratory animals.[i]
The concentrations of PFOA and PFOS found in the blood of the general U.S. population has decreased significantly since domestic manufacturers phased out production. However, PFOA and PFOS persist in the environment and are widely distributed in water, air, and soil at sites across the United States. Individuals who live or work at or near sites where PFOA or PFOS were historically produced (e.g., a PFOA manufacturing facility) or used (e.g., a military base that used PFOS-based firefighting foam) are at greater risk for elevated exposure to PFOA or PFOS compared with the general population.[ii] That risk continues even as exposure among the general population declines. Individuals in affected communities across the country[iii] are grappling with what elevated exposure to PFOA and/or PFOS means for their health. So, too, are researchers, clinicians, and government officials.
What Are the Effects of PFAS on Human Health?
Many questions remain unanswered about the effects of PFAS on human health. However, several studies over the past two decades have found links between elevated exposure to PFOA and/or PFOS and various adverse health effects. These health effects include:
- pregnancy-induced hypertension/preeclampsia;
- liver damage;
- increases in serum lipids;
- increased risk of thyroid disease;
- decreased antibody response to vaccines;
- increased risk of asthma diagnosis;
- increased risk of decreased fertility; and
- small decreases in birth weight.[iv]
Notably, many of the adverse health effects linked to elevated exposure to PFOA and/or PFOS have significant implications for the health and well-being of women of reproductive age, infants, and children.
In addition, the International Agency for Research on Cancer and the EPA have both found that certain PFAS are possibly carcinogenic to humans.[v]
To better understand the effects of PFAS on human health, the Centers for Disease Control and Prevention's (CDC) Agency for Toxic Substances and Disease Registry (ATSDR) will be begin conducting a nationwide study this year. Congress provided $20 million for this purpose. The multi-site study is expected to enroll 6,000 adults and 2,000 children. ATSDR expects that the information gathered from the study will be applicable to communities across the country. Applications for the funding opportunity are due May 30. State governments are eligible to apply.
Government Response & Where MCH Fits
As researchers continue to study the health effects of PFAS, state and local governments are responding now to the health-related questions and concerns of individuals and communities affected by exposure to these chemicals. The responses include testing water and soil samples, paying for bottled water for residents, issuing health advisories, conducting voluntary biomonitoring, participating in town halls, connecting with health care providers, researchers, and federal partners, and providing regularly-updated information via state websites and phone lines.
Title V agencies bring specific MCH expertise that should play an integral role in state responses to PFAS contamination. For example, the agencies can leverage existing linkages to community resources as well as existing partnerships with community organizations and health care providers to communicate effective public health messaging to MCH populations, support systems of care for those populations, and provide clinical guidance and patient education materials to health care providers. Title V agencies may also have existing surveillance systems that – with additional investment – could be leveraged to track health outcomes linked to PFAS exposure among MCH populations. An appropriate funding mechanism for this purpose could be CDC's new Surveillance for Emerging Threats to Mothers and Babies initiative. However, that would require Congress to appropriate a higher level of funding than the $10 million the program received in fiscal year 2019.
For more information about known sites of PFAS contamination and state responses, visit the "PFAS Contamination Site Tracker" and the state-by-state contamination site profiles published by a research team at Northeastern University. POLITICO Pro published an infographic in February that maps PFAS contamination sites across the country and provides a visual representation of various state actions to regulate PFAS.
For further technical background on PFAS, see the draft toxicological profile for PFAS published for public comment by ATSDR in June 2018.
Northrup, a former legislative aide in Congress, advised a U.S. senator on health care matters for several communities whose residents were exposed to elevated levels of PFAS.
[i] Environmental Protection Agency (2018). Fact Sheet: 2010/2015 PFOA Stewardship Program. Retrieved from https://www.epa.gov/assessing-and-managing-chemicals-under-tsca/fact-sheet-20102015-pfoa-stewardship-program
[ii] U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Agency for Toxic Substances and Disease Registry (2018). Toxicological Profile for Perfluoroalkyls: Draft for Public Comment. Retrieved from https://www.atsdr.cdc.gov/toxprofiles/tp200.pdf.
[iii] Northeastern University Social Science Environmental Health Research Institute (2018) PFAS Contamination Site Tracker. Retrieved from https://pfasproject.com/pfas-contamination-site-tracker/.
[iv] U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Agency for Toxic Substances and Disease Registry (2018). Toxicological Profile for Perfluoroalkyls: Draft for Public Comment. Retrieved from https://www.atsdr.cdc.gov/toxprofiles/tp200.pdf.