5. Enact RISK REDUCTION STRATEGIES THROUGH Policy
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Reducing Environmental and Occupational Cancer Risks Toolkit
Evidence-Informed Interventions
5. Enact RISK REDUCTION STRATEGIES THROUGH Policy
As noted in earlier sections, policy-level interventions are important strategies for creating change, including at the institutional level. Schools, universities, and businesses may issue their own policies to support the use of healthier products and processes, for example. Additional policy-level intervention strategies include approaches being used by municipalities and state governments to support chemical restrictions and air quality improvements.
Intervention Strategy Types: Eliminate, Substitute, Redesign
There is consistency in the research literature regarding the increased risk of childhood leukemias associated with the use of home and garden pesticides (Chen et al. 2015); (Van Maele-Fabry et al. 2019). These same pesticides are used by facility staff at schools, daycares, public parks, and other public locations and facilities. Integrated Pest Management (IPM), is a strategy that focuses on the long-term prevention of pests or their damage, using chemical pesticides as a last resort. The creation of policies to support the implementation of IPM as a substitute for conventional pesticides is an intervention strategy being utilized by state-wide and municipal-level asthma programs. Where IPM reduces or eliminates pesticides that contribute to cancer, these programs provide co-benefits by reducing cancer risk. Most states have agricultural extension programs with deep experience with IPM that can be leveraged for a variety of use needs. However, since IPM practices still allow for the use of conventional pesticides as a last resort, it is important that jurisdictions pursue aligned policies that also restrict the use of carcinogenic pesticides, for example use of Round-up, given links with non-Hodgkin lymphoma (IARC 2015). Policies directing the use of IPM as substitutes for conventional pesticides are available at the state level, e.g., Massachusetts, and municipal level e.g., San Francisco, CA, Portland, OR, Santa Fe, NM.
Intervention Strategy Type: Substitute
Although the U.S. EPA has recently pursued several chemical restrictions made possible by recent amendments to the Toxics Substances Control Act, the U.S. lags significantly behind banning or restricting from commerce highly hazardous chemicals, including carcinogens. As such, states across the country have issued a range of chemical restrictions, many of which focus on chemicals in consumer products because of widespread exposures. Safer States tracks and creates a compendium of state chemicals policies which can be used as motivation and models for other states. Prohibition policies range from PFAS in food packaging, heavy metals in children’s jewelry, a number of chemicals in cosmetic and personal care products, and halogenated flame retardants in textiles, furnishings, and children’s products (e.g., clothing, and mattresses).
Intervention Strategy Types: Redesign; Substitute
Air pollution can be an important contributor to the development of cancers. The mixture of air pollution as well as individual components in the air pollution mix are considered known human carcinogens by the World Health Organization’s International Agency for Research on Cancer (IARC) (IARC 2015). Increasing evidence suggests that near roadway air pollution exposure is also a risk factor for childhood cancers (Boothe et al. 2014); (Heck et al. 2013); (Filippini et al. 2019). In addition, evidence suggests that exposure to air pollution is associated with poorer cancer survival and treatment complications among cancer patients (Eckel et al. 2016); (McKeon 2022); (Ou et al. 2019). Researchers recently reviewed a number of evidence-based interventions to support air pollution exposure reductions (Turner et al. 2020).
Intervention Strategy Types: Encourage; Educate; Redesign; Substitute; Eliminate
In the 1980s, a growing number of Massachusetts communities were suffering the consequences of poorly managed hazardous waste sites, including the emergence of cancer clusters. In July 1989, the Massachusetts legislature passed the Toxics Use Reduction Act which was supported by environmental advocacy organizations, academic institutions, public health organizations, and industry associations alike. Key features of the business-focused policy include: (a) requiring “polluters to pay” – mandating a reporting fee associated with the use of toxic chemicals to support understanding of where, why, and how much toxic chemicals are being used and generated as waste; (b) requiring education and planning to identify options to reduce toxic chemical use; and (c) using revenue generated from fees to provide direct technical support to industry to implement toxics use reduction options.
The law has been highly effective at reducing the use of toxic chemicals in the state, including carcinogens. In a published evaluation, the state documented a 32% decline in the use of carcinogens and a 93% decline in carcinogenic emissions over a 20-year period (1990-2010). During this period, there was a 92% decline in the use of trichloroethylene, an 85% reduction in tetrachloroethylene, and a 69% reduction in the use of cadmium and cadmium compounds. Use reductions in particular showcase the importance of encouraging and educating companies about toxic use reduction options; redesigning industrial processes to minimize or eliminate the use of toxic chemicals; and using substitution strategies to transition to safer alternatives.