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World Trade Center Health Registry


The city's health department has announced plans for what could become the largest public-health investigation ever: a comprehensive survey to follow the health of those people most directly exposed to 9/11's World Trade Center collapse and the subsequent clean-up efforts. 

The launching of the World Trade Center Health Registry was announced at a September 5 press conference by the city's Health and Mental Hygiene Commissioner, Thomas R. Frieden, MD, and Dr. Henry Falk, Associate Administrator for the Agency for Toxic Substances and Disease Registry and the director of the federal Centers for Disease Control's National Center for Environmental Health.

"The effects of 9/11 are still being felt today by all New Yorkers, and all Americans. Hundreds of thousands of people from all walks of life were in the vicinity of the twin towers when they collapsed, and were exposed to a combination of smoke, dust, and debris.  We need to study the health of these people in order to understand the possible health consequences related to 9/11," said Dr. Frieden. "If you were there on 9/11, you are strongly encouraged to sign up for the WTC Health Registry."

Dr. Falk said, "The World Trade Center Health Registry will do what no other health survey is doing. It will record and measure the health impact of 9/11 in the broadest possible terms.  The Registry is a tool for giving us health data that could guide how we respond to this kind of disaster for generations to come.  The more people enroll - even if they feel perfectly healthy - the better our chances will be of understanding any health effects from this tragic event."

People in any one or more of the following categories are eligible to enroll in the registry, regardless of whether they have experienced any health problems:  

· People who were in a building, on the street, or on the subway south of Chambers Street on 9/11/01;
· Workers involved in the rescue attempts, recovery, or clean-up work at the World Trade Center site, and/or the associated recovery operations on Staten Island, at any time between 9/11/01 and 6/30/02;
· Students and staff at schools (pre-K to 12) or daycare centers south of Canal Street on 9/11/01; and
· People living south of Canal Street on 9/11/01.

If enough people enroll, city and federal health officials said, the registry could result in an investigation as much as five times the size of the one following the 1979 Three-Mile Island nuclear accident in Pennsylvania. That study tracked 38,000 people. Falk noted that the report based on the Three-Mile Island registry, which was issued last year and stated that people who lived near the nuclear plant showed no significant increase in cancer deaths, probably served to calm a population nervous about the unknown long-term health effects of the accident.

"I plan to enroll in the World Trade Center Health Registry, and I encourage all Battery Park City residents and workers who were here on 9/11 to step forward and enroll too," said Timothy S. Carey, CEO and president of the Battery Park City Authority, who was also present at the press conference.

To advertise the registry, which is being funded with $20 million in federal funds, the city health department says it will put posters in subways and commuter trains that read, "I was there September 11th." It will also use billboards, direct-mail solicitations, Internet ads, and brochures to urge people to step forward and enroll.

Officials stressed that all medical information collected from individuals will be kept strictly private and confidential, and that no medical examinations or tests will be required for participation.  People can drop out of the registry at any time.

Those who enroll in the registry will be asked to answer a 30-minute telephone survey of where they were on 9/11, how long they were in areas afflicted by smoke and fumes, and whether they have had any health problems since.  Registrants will be periodically contacted to report any health changes.  This information will then be compared with that of the general population, in order to identify any health problems possibly linked to 9/11.  Ultimately, findings drawn from the health registry should be able to allow researchers to observe patterns that may be invisible to individual physicians.

The announcement of the survey follows closely on recent revelations that the Environmental Protection Agency gave New Yorkers false assurances about air quality in the days after the terrorist attack.  But city health officials say that the registry was not launched in response to the recent accusations. Plans for the registry were first announced last year. The health registry's goal is to follow up with hundreds of thousands of people who were directly exposed to the aftermath of the twin towers' collapse, which produced choking clouds of dust, asbestos, smoke, and fire. It will re-contact registrants periodically over the next 20 years to track any changes in their physical or mental health. People exposed to the WTC aftermath have already reported symptoms of asthma, persistent cough, burning eyes, and other ailments presumably caused by the airborne contaminants that so thickly pervaded the downtown area in the days following 9/11/2001.

Officials said the registry will issue quarterly reports to inform the public about what it learns from the project. The reports will be posted online  www.wtcregistry.org. The first report is expected this fall.

The registry is a jointly funded effort of the New York City Department of Health and Mental Hygiene, the Agency for Toxic Substances and Disease Registry, and the Federal Emergency Management Agency (FEMA).  RTI International, a nonprofit research firm, will conduct the interviews. 

To find out more about the WTC Health Registry and the enrollment process, you can visit www.wtcregistry.org or call 311 or toll-free to 1-866-NYC-WTCR (1-866-692-9827).

Sue Wilson is a journalist who writes frequently on health and science topics for such outlets as the New York Times, WNET, and UNICEF.

 

Obesity


According to an alarming study released last month by the city's health department and Department of Education, almost half (43 percent) of the children in New York City's public elementary schools are overweight to some extent, and a quarter qualify as obese. Hispanic children had nearly double the obesity rates of white and Asian children (31 percent versus 16 and 14 percent, respectively). African-American children fell in the middle, with a 23 percent obesity rate.

The city's 24 percent obesity rate among children in kindergarten through fifth grade is significantly higher than the national rate, which in 2000 was 15 percent. City health officials say that some, though not all, of that difference can be attributed to New York's high proportion of Hispanic and African-American children. (The study also did not include children in the city's private schools, about one-quarter of local schoolchildren. Since obesity correlates with low income, including these relatively privileged children would almost certainly have lowered the proportion of the total found to be overweight.)

In many ways, the statistics on excess weight among New York's schoolchildren mirror those of their elders. A 2002 health department survey of nearly 10,000 adult New Yorkers found that 53 percent are overweight, with 18 percent qualifying as obese. Poorer and heavily minority communities have higher rates of obesity - in neighborhoods like Central and East Harlem, the South Bronx, East New York, Flatbush, Canarsie-Flatlands, Bedford Stuyvesant, Crown Heights, Williamsburg, and Bushwick, as many as one in four adults are obese. Poor diet and lack of exercise are contributing factors. In some of these neighborhoods, almost 15 percent of the population has diabetes, a weight-related disease that can have severe complications and shorten lives. (see previous health topic page update on this subject.) In the case of Hispanic adults and children, who suffer from significantly higher rates of overweight and obesity than whites, researchers think a combination of physiological vulnerabilities, diet, cultural factors, and possibly lack of exercise may be responsible. (In a study published in the Archives of Internal Medicine, 65 percent of Mexican American men and 74 percent of Mexican American women reported that they participated in little or no leisure-time physical activity.)

Still, New York's adults are doing no worse than the average American. It's no secret that Americans have been growing steadily fatter over the past decades; and today nearly two-thirds of all American adults are overweight, with nearly one-third ranking as obese. (Both New York City surveys and the national one all use the Body Mass Index, or BMI, method of categorizing people as "healthy weight," "overweight," or "obese.")

It is disturbing, though, to find significant weight problems starting so very young, among so many of the smallest New Yorkers. The health and education departments' report on children showed that obesity was already common among kindergarteners, with 21 percent qualifying; by the first grade, obesity levels had already topped out at one in four.

Obesity in childhood is associated with serious long-term health consequences, including diabetes, heart disease, asthma, depression, high blood pressure, and some cancers. Obese children frequently grow into obese adults, and a RAND study done last year found that obesity raises a person's healthcare costs by 36 percent and medication costs by 77 percent - much more than do, say, smoking and problem drinking.

"I am deeply concerned about the troubling childhood obesity figures found in the survey," said Schools Chancellor Joel I. Klein.

In June, the Department of Education announced plans to remove soda, candy, snack cakes, and other junk food from the thousands of vending machines in New York City schools and replace the sugar- and fat-laden offerings with snacks that meet nutritional standards the department specifies. One hundred percent fruit juice will replace sugary fruit drinks, and Twinkies will give way to energy bars. Schools will also have to use a Department of Education central contract to supply and fill their vending machines according to department nutritional standards; rather than individual schools and districts contracting with a hodgepodge of different vending machine companies, as is currently the case.

More ambitiously, the education department plans sweeping changes, aimed at making them more nutritious and less fattening, in the more than 800,000 breakfasts and lunches that city public schools serve each day. Working with the Department of Health and Mental Hygiene, the Department of Education came up with a set of nutritional standards for school meals that will take three to five years to fully implement.

Children returning to school in September will find that cafeterias have already retooled some of their most popular items, such as Jamaican beef patties, chicken fingers, and cheese pizza, to cut back on fat, sugar, and salt. Rich foods will be served in smaller portions. Some items that resist "lightening" may disappear from school menus altogether, among them lunch classics like macaroni and cheese and various mayonnaise-based dishes such as potato salad. Federal guidelines recommend that the percentage of calories in school lunches coming from fat should not exceed 30 percent, averaged over a five-day period. The city Department of Education says it plans to meet that 30 percent goal each and every day.

Some onlookers, however, feel that the city's emphasis on cutting fat from school meals and replacing vending-machine sodas with juice won't help kids lose weight. Alice Lichtenstein, a professor at the Friedman School of Nutrition Science and Policy at Tufts University, said that the key to losing weight is cutting back on total calories, not cutting out fat per se; and she noted that 100 percent apple juice has as many calories, ounce for ounce, as a Coca-Cola. "Kids are eating too many calories and not getting enough exercise to burn them off," she said. "You have to focus on reducing calories, not fat or the tiny nutritional difference between sweetened and unsweetened apple juice."

Lichtenstein does approve of some of the city's other planned menu changes, including smaller portions for snack foods, more fresh vegetables ("They're calorically less dense than most other foods"), and substitution of more whole-wheat bread for white ("Whole grains increase your sense of fullness, so you eat less").

The Department of Education also plans to serve fresh fruit five days per week rather than the current three days per week, serve more fish and plant-based products, cut the number of mayonnaise-based salads offered daily from three to one and replace the jettisoned ones with fresh vegetables, and serve fewer highly processed foods.

Recent research on Americans' eating habits, obesity rates, and "environmental" food factors like portion size and ready availability suggests that these measures should, in fact, be helpful to some extent. For example, studies have shown that people, including children, do eat more, sometimes much more, when served larger portions, and don't tend to eat less at later meals to compensate. And the visibility and ease of access of tempting (i.e., fat-laden and sugary) snack foods in people's everyday environments have much to do with whether people eat these foods or not.

And then there's the exercise factor. Although the state Education Department requires children in kindergarten through third grade to have gym every day, in grades 4-6 at least three times a week, and in grades 7-12 at least twice a week, breaches of this rule are common and seldom investigated, according to a report in the New York Daily News. Some New York City public schools don't hold physical education classes at all, the Daily News reported, because they don't have room - gyms may have been turned into classrooms long ago due to overcrowding, and outdoor play areas may be nonexistent or unusable because of repairs or the danger of falling debris from crumbling school buildings. Some schools have no physical education instructors on staff.

Schools Chancellor Klein said the city is taking steps to try to make sure public schoolchildren get a chance to exercise. "We have selected a central Director of Physical Education to coordinate the efforts of the city's twelve hundred schools to promote fitness among our children and teach youngsters the vital significance of physical exercise," he said.

Addressing parents, the health department recommends that they try the following to help keep their children at a healthy weight:

Increase their activity by:
• Reducing television-viewing hours;
• Walking with the children when possible;
• Encouraging active play-time; and

Cut calories by:
• Reducing soft-drink consumption;
• Eating less fast food and serving more meals at home;
• Having healthy snack foods such as fruits and vegetables available; and
• Replacing whole milk with low-fat or skim milk for children over two years old.

Sue Wilson is a journalist who writes frequently on health and science topics for such outlets as the New York Times, WNET, and UNICEF.

Court Overturns Current Lead-Paint Law


In the wake of the state Court of Appeals' unanimous decision on July 1 to strike down the city's lead-paint law, there is much celebrating by advocates for the health of New York City's children (especially its children of color and disadvantaged background) and tenant and environmental groups.

"It's a victory for the children of this city," said City Councilmember Bill Perkins, who introduced a new, more stringent lead-paint bill to the Council more than a year ago, only to have it languish without a hearing until only nine days before the Court of Appeal's decision. "The law was a law that was ineffective. The court's ruling is also good because it means we have overcome the hurdles to focus on our bill, which will effectively address the city's lead-poisoning issues."

It has long been known that lead is toxic and can cause retardation and a variety of other lifelong impairments, especially in young children. In its 1991 report "Preventing Lead Poisoning In Young Children," for example, the U.S. Centers for Disease Control and Prevention noted that even very low levels of blood lead in children have been linked to diminished intelligence, decreased stature or growth, and loss of hearing. (Children are especially vulnerable because of their small size, the fact that they are still developing mentally and physically, and their tendency to use their hands and mouths on available surfaces and to eat things adults would avoid.)

As Gotham Gazette wrote in an Issue of the Week, when a divided City Council passed the 1999 lead-paint law, known as Local Law 38, it replaced a 1982 lead-paint law that required that all lead paint be removed from the city's older buildings. Landlords complained that that 1982 law had been onerous and unrealistic.

The Court of Appeals has now ruled that when the City Council passed Local Law 38, it violated state environmental law by failing to adequately study or explain the new law's environmental or public-health impact.

With Local Law 38 struck down, the city reverts to the 1982 law. The Court of Appeals, however, found that that law, while much more comprehensive than its replacement, also "is not a viable or realistic approach to protecting the city's population, particularly its young children, from lead exposure." The court therefore urged the various interest groups – landlord groups, tenant advocates, the current mayoral administration – to negotiate in good faith, and urged the City Council to develop a new lead-paint law without delay. Perkins agrees. " Every day of delay is a day when children are being poisoned," he said.

He acknowledges, however, that a fight still lies ahead to get his stricter bill passed, and in a form that retains teeth. "To me, this is a marathon -- the last three miles are the toughest," he said. "The landlords can be relentless in avoiding their responsibility. Our biggest problem will be that there may be others who may try to recast this bill to turn it back into Local Law 38 in another guise.

" We realize we have to fight even harder now. This victory is not a reason to relax and stop fighting."

The Bloomberg administration has opposed the bill Perkins is championing, known as Local Law 101A. Michael A. Cardozo, Corporation Counsel for the city, issued a statement about the court's ruling that said, in part, "We are disappointed by [the] court's decision. The city felt that Local Law 38 provided a comprehensive, safe, workable approach to the control of lead-based paint hazards.... In our view, the court's decision gave inadequate weight to the council's extensive consideration of potential environmental impacts."

" That said, the City Council must now act promptly to rectify the situation," he wrote.

Opponents of the change in the law point to the fact that for years there has been a sharp and steady decline in the number of the city's children identified as having elevated lead levels.

The city's Department of Health and Mental Hygiene, which tracks new cases of elevated lead levels in children, had in fact issued a press release on June 11 that headlined a 79 percent reduction in new cases from 1995 to 2002, when there were 3,985 new cases reported.

"Four thousand new cases last year is nothing to brag about," Perkins countered.

Interestingly, the department press release was subtitled, "Parents with Small Children Should Insist that Landlords Fix Peeling Paint, It's the Law" – highlighting the fact that Local Law 38 put the onus squarely on parents to know their rights under the law, know about and recognize lead-paint hazards to their young children, report violations in writing to their landlords, and make sure the landlords addressed the problem properly. It also limited tenants' ability to sue their landlords.

The new bill before the council, among other increases in stringency, shifts the burden of inspecting for lead-paint hazards from the tenant to the landlord, imposes penalties on landlords for noncompliance (according to the New York City Coalition to End Lead Poisoning, Local Law 38 provided "no penalties whatsoever for noncompliance"), includes lead dust (a known hazard to small children) among the problems that landlords must inspect for and correct, lowers the age of protected children from 6 to 5, and applies to day-care centers and schools as well as homes.

According to the city health department’s 2001 report on lead poisoning in the city, nearly 95 percent of children identified as suffering from lead poisoning were black, Hispanic, or Asian. "There is a stubborn tendency for children of color to be the ones who are affected," said Perkins.

The 3,985 new cases in 2002 also followed a well-established pattern of occurring disproportionately in poor neighborhoods, such as low-income pockets of the Bronx, Harlem, Queens, and areas like East New York and Flatbush in Brooklyn.

"The constituency that is most victimized is the least politically powerful," said Perkins, who represents parts of Harlem, Morningside Heights, and the Upper West Side. "That's why the council has to be the champion of the victims of lead poisoning. We failed at that in 1999, but I think we now have a chance to redeem ourselves.

"We need a transitional plan, so says the court. Well, we've put together an alternative law and had it before the council for a year. So we're way ahead of the game. Now, we need to start immediately to meet with the mayor, landlord bodies, and other members of the council, and to get this thing moving."

Some of the bill's supporters, who now include 37 of the City Council's 51 members, have accused Council Speaker Gifford Miller of stalling the progress of 101A, which he does not support.

"The support of the Speaker would obviously be very helpful at this point," Perkins said. "He needs to stop dragging his feet, to say the least."

In covering the Court of Appeals decision, the New York Daily News reported that Miller received $35,950 in campaign contributions from real-estate groups. Miller told the News that the money had not influenced his stance on the bill.

Sue Wilson is a journalist who writes frequently on health and science topics for such outlets as the New York Times, WNET, and UNICEF.



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