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News Article | May 1, 2017
Site: www.theguardian.com

It’s a fairly common tactic in Peru to issue a significant or potentially controversial decision or resolution when you hope no one is paying attention. 24, 26 or 31 December, for example. The Environment Ministry (MINAM) recently adopted that ploy by releasing, just before the Easter week holiday, proposals to dramatically roll back certain air quality standards across the country. The draft National Environmental Quality Standards for Air propose maintaining the maximum legal limits for nitrogen dioxide, carbon monoxide, hydrogen sulphide, lead and benzene, but doubling the limit for some particulate matter. Most startling, they propose increasing the limit of sulfur dioxide by more than 12 times. MINAM effectively claims that Peru is the global leader in sulfur dioxide limits because it is the “only country in the world” which meets World Health Organisation (WHO) recommendations. That limit is 20 micrograms per cubic metre over a 24 hour averaging period, compared with 210 in Australia, 250 in Chile and Colombia, 288 in Mexico, 300 in Canada and 365 in Brazil, according to the ministry. Elsewhere in the world - although these are not acknowledged by MINAM - the limit is 150 in China, 125 in the EU, 131 in South Korea and 80 in India. The current proposal is to raise Peru’s limit to 250. One justification is that “no clearly defined link exists” between sulfur dioxide and negative impacts on human health, MINAM claims, according to its interpretation of research by the WHO, the US’s Environmental Protection Agency and Health Canada, among others. Further justifications are that no other country in the world has a limit as stringent as 20 and adopting it was a mistake out of touch with “national reality.” It isn’t being complied with, the ministry argues, and therefore undermines the public’s faith in government and the law. “[The 20 limit] was adopted in a very short timeframe without a solid technical and economic argument and without considering sustainable development policy that involves taking acceptable risks to public health while at the same time introducing effective strategies to reduce environmental contamination,” MINAM states. The ministry’s proposals have met with serious concern and criticism from Peru’s Congressional Commission on the Environment, Ecology and Andean, Amazonian and Afroperuvian Peoples, NGOs, and many others. Lima-based APRODEH and the Interamerican Association for Environmental Defense (AIDA) say that MINAM is ignoring scientific evidence of the “serious health harms” caused by both sulfur dioxide and particulate matter. These include lung problems and premature death - with children, the elderly and people with asthma being particularly vulnerable. “There is overwhelming scientific evidence to conclude that sulfur dioxide pollution poses a serious health risk, particularly when the contamination reaches high levels over short periods of time, something the proposal does not take into account,” says AIDA’s co-director Anna Cederstav in a joint statement with APRODEH. Both organisations argue that MINAM’s proposals violate the American Convention on Human Rights and other international treaties binding on Peru. In addition, the public consultation was “flawed”, they state, with too little time for discussion and the scientific basis for the proposals not made public. That opinion is shared by the Congressional Commission on the Environment, which has written to Environment minister Elsa Galarza requesting a further 30 days for the public consultation process. The Commission is presided by Maria Elena Foronda, who has taken the lead in drawing public attention to the issue. “In the Commission’s view any law that would reduce environmental quality standards requires a responsible and timely technical evaluation, as much by members of congress as civil society,” Foronda says. “It’s appropriate to point out that MINAM is trying to establish parameters that are weaker than those recommended by the WHO.” Other NGOs like Red Muqui and the Sociedad Peruana de Derecho Ambiental (SPDA) have also issued critical statements. SPDA argues that the government is legally prohibited from weakening environmental standards, that MINAM failed to provide sufficient justification for its proposals, and that the WHO, contrary to the ministry’s interpretations of its research, has proved that sulfur dioxide negatively impacts human health. According to Red Muqui, a collective of 29 organisations across Peru, the proposals are “regressive” and ignore WHO recommendations. MINAM failed to coordinate with the Health Ministry, they argue, and the timeframe for public discussion was too short. “Life and health shouldn’t be dependent on economic interests,” Red Muqui states. “[The proposals] fail to consider that particulate matter is very fine and can easily penetrate respiratory tracts and blood, increasing the risk of morbidity and premature death following short- and long-term exposure.” Former high-ranking MINAM personnel are critical too. Ex-Environment minister Manuel Pulgar-Vidal was quoted in El Comercio newspaper saying the proposals would reduce air quality. Mariano Castro, former vice-minister, told the Guardian the proposals are “wrong”, “very risky” for Peruvians’ health, and ignore the “scientific evidence in epidemiological and toxicological studies that show the serious dangers that sulfur dioxide poses for peoples’ health.” So why propose raising the legal limits? According to AIDA, APRODEH and anyone else following the issue, the answer is an infamous poly-metal smelter in a town in Peru’s central Andes, La Oroya, which 10 years ago was named as one of the top 10 most polluted places on earth by the US-based Blacksmith Institute. Formally called the Metallurgical Complex of La Oroya, the smelter has been the property of Doe Run Peru since 1997, and ultimately under the control of the US’s Renco Group. It closed in 2009 and partially re-opened in 2012. Now it is administered by liquidators - and Peru’s sulfur dioxide limits are reported to be scaring off potential investors. This is despite the fact that La Oroya has been exempted from the national 20 limit. In recent years it was raised to 80 and then to 365 for a 14 year period until it is scheduled to revert to 80 again, according to APRODEH’s Christian Huaylinos. He told the Guardian that MINAM’s proposals are “completely connected” to the proposed Doe Run Peru sale. “[In the long-term the limit] continues being 80, which is a very demanding standard that I imagine has discouraged possible bidders for Doe Run Peru, given that it would require serious investment in new technology,” Huaylinos says. “So that’s where the issue of relaxing the standards comes in. Now they would no longer have to adjust from 365 to 80, but 365 to 250.” Tenders have been held for Doe Run Peru as recently as March this year, but no offers were reportedly received. “Now, given the lack of offers, MINAM has put forward a law to relax the limits, the aim of which is to facilitate the next tender round,” Huaylinos told the Guardian. “[This would seriously affect] the rights to health and clean environment of the people living in La Oroya.” The connection between MINAM’s proposals and Doe Run Peru also seems obvious to AIDA’s Victor Quintanilla, who told the Guardian that government representatives have said publicly that modifying environmental standards is part of promoting the smelter’s sale and re-opening. Such representatives include president Pedro Pablo Kuczynski, congressman Moisés Guía Pianto, Environment minister Galarza, and Energy and Mines minister Gonzalo Tamayo. On Friday Gestion newspaper stated that potential bidders for Doe Run Peru have been lobbying for changes to the sulfur dioxide limits - something that the Congressional Commission on the Environment has noted too. Pablo Peschiera, from DIRIGE, the liquidators, reportedly said that the next tenders will be held in July and MINAM’s proposals would save investors huge sums. “Under the previous [current] standards an investment of US$788 million [in the smelter] had been foreseen, and even then there was no guarantee of meeting the 80 standard,” Peschiera was quoted as saying in Gestion. “There was a low probability of complying even after making that investment. Now [if MINAM’s proposals are approved], with the limit being 250, the amount needed to invest will be lower.” Liliana Carhuaz, an Oroya resident and member of the Movimiento por la Salud de La Oroya (MOSAO), told the Guardian she rejects MINAM’s proposals and believes the sulfur dioxide limit should be 20. She said that local people didn’t agree with the suggested changes either, and she cited respiratory problems and lead poisoning as ongoing health impacts. “After so many years of contamination in La Oroya [the ministry’s proposal] to increase the permitted levels is not just,” she says. Last year, just before the end of the previous government, MINAM published a dossier on Doe Run Peru which included six reasons why air quality standards shouldn’t be weakened, although it acknowledged that the contamination in La Oroya was so severe that it would be impossible for the smelter to ever meet any standards, no matter how “flexible.” The dossier cited Health Ministry statistics from 2007 saying that during some hours the sulfur dioxide levels reached 28,300 and average daily emissions were over 2,000 - which MINAM alleged was one of the reasons why Doe Run Peru hadn’t yet been sold. “It’s clear that with daily emissions and yearly averages such as these, La Oroya, if its copper circuit is working, wouldn’t even comply with the most flexible environmental standards in the world,” stated the dossier, dated July 2016. In comments sent by AIDA and APRODEH to MINAM as part of the public consultation, they noted that the proposed 250 limit would permit severe short-term spikes in contamination. “With the new proposed daily average (250 micrograms per cubic metre), it would be possible to have every day a period of two hours of contamination at a level of 1,500 and another five hours of contamination at 500 without exceeding it,” the two organisations stated. “However, it is known that these levels of contamination are severely dangerous to human health.” Mariano Castro believes that this is a key weakness of MINAM’s proposals: there are no limits for short periods of time - just one hour or three hours - which would prohibit severe peaks in contamination. In Colombia, he says, the limit for 24 hours is 250, as proposed for Peru, but crucially there is also a limit for three hours set at 750. “Without this [750] limit on short-term peaks, you could get up to levels around 2,000 for several hours over a 24 hour period and never exceed the daily limit,” Castro told the Guardian. “The dangers to human health and the environment would be irreversible. Under no condition should an increase in the 24 hour limit be permitted if an appropriate limit for just one hour is not established, as in other countries.” Fernando Serrano, a scientist at Saint Louis University in the US who has conducted research in La Oroya and testified before US Congress about it, agrees with Castro. “The proposed new air standards for sulfur dioxide don’t include a hourly standard and therefore don’t hold the smelter responsible for the hourly peaks that are far greater than anything that is acceptable,” he says. “The most effective way to protect people’s health and environmental quality is to reduce smelter emissions through technical measures and to enact and enforce air quality standards and other regulations that prevent health and environmental risks.” Serrano describes the La Oroya smelter as for years “serving a toxic cocktail of metals” including lead, cadmium, arsenic and air pollutants like sulfur dioxide. “This mix of contaminants has gravely affected the health of the people of La Oroya and surrounding areas,” he told the Guardian. “The only time people enjoyed a cleaner and safer environment - low sulfur dioxide levels, decreasing blood lead levels - is when the smelter closed, which shows that it is the primary source of contamination.” The appalling health impacts of the smelter on La Oroya’s inhabitants have been reported for many years, with the government concluding almost two decades ago that more than 99% of children living nearby suffered from lead poisoning. A series of legal actions have been taken against the Health Ministry in Peru, against the Peruvian state at the Inter-American Commission on Human Rights, and against Doe Run in the US. Peru’s Congressional Commission on the Environment is scheduled to discuss MINAM’s proposals tomorrow, 2 May, and has requested Environment minister Galarza to attend. MINAM did not respond to questions.


Chatham-Stephens K.,Mount Sinai School of Medicine | Caravanos J.,City College of New York | Caravanos J.,Blacksmith Institute | Ericson B.,Blacksmith Institute | And 6 more authors.
Environmental Health Perspectives | Year: 2013

Background: Prior calculations of the burden of disease from toxic exposures have not included estimates of the burden from toxic waste sites due to the absence of exposure data. Objective: We developed a disability-adjusted life year (DALY)-based estimate of the disease burden attributable to toxic waste sites. We focused on three low- and middle-income countries (LMICs): India, Indonesia, and the Philippines. Methods: Sites were identified through the Blacksmith Institute's Toxic Sites Identification Program, a global effort to identify waste sites in LMICs. At least one of eight toxic chemicals was sampled in environmental media at each site, and the population at risk estimated. By combining estimates of disease incidence from these exposures with population data, we calculated the DALYs attributable to exposures at each site. Results: We estimated that in 2010, 8,629,750 persons were at risk of exposure to industrial pollutants at 373 toxic waste sites in the three countries, and that these exposures resulted in 828,722 DALYs, with a range of 814,934-1,557,121 DALYs, depending on the weighting factor used. This disease burden is comparable to estimated burdens for outdoor air pollution (1,448,612 DALYs) and malaria (725,000 DALYs) in these countries. Lead and hexavalent chromium collectively accounted for 99.2% of the total DALYs for the chemicals evaluated. Conclusions: Toxic waste sites are responsible for a significant burden of disease in LMICs. Although some factors, such as unidentified and unscreened sites, may cause our estimate to be an underestimate of the actual burden of disease, other factors, such as extrapolation of environmental sampling to the entire exposed population, may result in an overestimate of the burden of disease attributable to these sites. Toxic waste sites are a major, and heretofore underrecognized, global health problem.


Laborde A.,University of the Republic of Uruguay | Tomasina F.,University of the Republic of Uruguay | Bianchi F.,National Research Council Italy | Brune M.-N.,World Health Organization | And 14 more authors.
Environmental Health Perspectives | Year: 2015

Background: Chronic diseases are increasing among children in Latin America. Objective and Methods: To examine environmental risk factors for chronic disease in Latin American children and to develop a strategic initiative for control of these exposures, the World Health Organization (WHO) including the Pan American Health Organization (PAHO), the Collegium Ramazzini, and Latin American scientists reviewed regional and relevant global data. results: Industrial development and urbanization are proceeding rapidly in Latin America, and environmental pollution has become widespread. Environmental threats to children’s health include traditional hazards such as indoor air pollution and drinking-water contamination; the newer hazards of urban air pollution; toxic chemicals such as lead, asbestos, mercury, arsenic, and pesticides; hazardous and electronic waste; and climate change. Te mix of traditional and modern hazards varies greatly across and within countries refecting industrialization, urbanization, and socioeconomic forces. conclusions: To control environmental threats to children’s health in Latin America, WHO, including PAHO, will focus on the most highly prevalent and serious hazards—indoor and outdoor air pollution, water pollution, and toxic chemicals. Strategies for controlling these hazards include developing tracking data on regional trends in children’s environmental health (CEH), building a network of Collaborating Centres, promoting biomedical research in CEH, building regional capacity, supporting development of evidence-based prevention policies, studying the economic costs of chronic diseases in children, and developing platforms for dialogue with relevant stakeholders. © 2015 Public Health Services, US Dept of Health and Human Services. All Rights Reserved.


Caravanos J.,CUNY - Hunter College | Chatham-Stephens K.,Mount Sinai School of Medicine | Ericson B.,Blacksmith Institute | Landrigan P.J.,Mount Sinai School of Medicine | Fuller R.,Blacksmith Institute
Environmental Research | Year: 2013

Identification and systematic assessment of hazardous wastes sites in low and middle-income countries has lagged. Hazardous waste problems are especially severe in lower income Asian countries where environmental regulations are non-existent, nonspecific or poorly enforced. In these countries extensive unregulated industrial development has created waste sites in densely populated urban areas. These sites appear to pose significant risks to public health, and especially to the health of children.To assess potential health risks from chemical contamination at hazardous waste sites in Asia, we assessed 679 sites. A total of 169 sites in 7 countries were classified as contaminated by lead. Eighty-two of these sites contained lead at levels high enough to produce elevated blood lead levels in surrounding populations.To estimate the burden of pediatric lead poisoning associated with exposure to lead in soil and water at these 82 lead-contaminated sites, we used standard toxicokinetic models that relate levels of lead in soil and water to blood lead levels in children. We calculated blood lead levels, and we quantified losses of intelligence (reductions in IQ scores) that were attributable to lead exposure at these sites.We found that 189,725 children in the 7 countries are at risk of diminished intelligence as a consequence of exposure to elevated levels of lead in water and soil at hazardous waste sites. Depending on choice of model, these decrements ranged from 4.94 to 14.96 IQ points. Given the restricted scope of this survey and the conservative estimation procedures employed, this number is almost certainly an underestimate of the full burden of disease.Exposure to toxic chemicals from hazardous waste sites is an important and heretofore insufficiently examined contributor to the Global Burden of Disease. © 2012 Elsevier Inc.


Caravanos J.,York College - The City University of New York | Ericson B.,Blacksmith Institute | Ponce-Canchihuaman J.,Cayetano Heredia Peruvian University | Hanrahan D.,Blacksmith Institute | And 3 more authors.
Environmental Science and Pollution Research | Year: 2013

Previous studies have evaluated associated health risks and human exposure pathways at mining sites. Others have provided estimates of the scale of the issue based in part on surveys. However, a global census of mining-related hazardous waste sites has been lacking. The Toxic Sites Identification Program (TSIP) implemented by Blacksmith Institute (New York, NY, USA) since 2009 is an ongoing effort to catalogue a wide range of chemically contaminated sites with a potential human health risk (Ericson et al., Environ Monit Assess doi:10.1007/s 10661-012-2665-2, 2012). The TSIP utilizes a rapid assessment instrument, the Initial Site Screening (ISS), to quickly and affordably identify key site criteria including human exposure pathways, estimated populations at risk, and sampling information. The resulting ISS allows for comparison between sites exhibiting different contaminants and pollution sources. This paper explores the results of a subset of ISSs completed at 131 artisanal and small-scale gold mining areas and 275 industrial mining and ore processing sites in 45 countries. The authors show that the ISS captures key data points, allowing for prioritization of sites for further investigation or remedial activity. © 2012 Springer-Verlag Berlin Heidelberg.


Ericson B.,Blacksmith Institute | Caravanos J.,City College of New York | Caravanos J.,Blacksmith Institute | Chatham-Stephens K.,Mount Sinai School of Medicine | And 2 more authors.
Environmental Monitoring and Assessment | Year: 2013

In the developing world, environmental chemical exposures due to hazardous waste sites are poorly documented. We describe the approach taken by the Blacksmith Institute's Toxic Sites Identification Program in documenting environmental chemical exposures due to hazardous waste sites globally, identifying sites of concern and quantifying pathways, populations, and severity of exposure. A network of local environmental investigators was identified and trained to conduct hazardous waste site investigations and assessments. To date, 2,095 contaminated sites have been identified within 47 countries having an estimated population at risk of 71,500,000. Trained researchers and investigators have visited 1,400 of those sites. Heavy metals are the leading primary exposures, with water supply and ambient air being the primary routes of exposure. Even though chemical production has occurred largely in the developed world to date, many hazardous waste sites in the developing world pose significant hazards to the health of large portions of the population. Further research is needed to quantify potential health and economic consequences and identify cost-effective approaches to remediation. © 2012 Springer Science+Business Media B.V.


Chatham-Stephens K.,Mount Sinai School of Medicine | Caravanos J.,City College of New York | Caravanos J.,Blacksmith Institute | Ericson B.,Blacksmith Institute | And 2 more authors.
Environmental Research | Year: 2014

Background: The impact of lead from toxic waste sites on children in low and middle income countries has not been calculated due to a lack of exposure data. We sought to calculate this impact in Disability Adjusted Life Years (DALYs). Materials and methods: Using an Integrated Exposure Uptake Biokinetic (IEUBK) model, we converted soil and drinking water lead levels from sites in the Blacksmith Institute[U+05F3]s Toxic Sites Identification Program (TSIP) into mean blood lead levels (BLLs). We then calculated the incidence of mild mental retardation (MMR) and DALYs resulting from these BLLs. Results: The TSIP included 200 sites in 31 countries with soil (n=132) or drinking water (n=68) lead levels, representing 779,989 children younger than 4 years of age potentially exposed to lead. Environmental lead levels produced a range of BLLs from 1.56 to 104.71. μg/dL. These BLLs equated to an estimated loss of 5.41-8.23 IQ points, resulting in an incidence of MMR of 6.03 per 1000 population and 76.1 DALYs per 1000 population. Discussion: Soil and water lead levels at toxic waste sites predict BLLs that lower the intelligence quotient (IQ), with the resulting MMR potentially limiting individual- and country-level development. The preventable burden of disease produced by these sites highlights the need for toxic waste sites to be systematically identified, evaluated, and remediated. © 2014 Elsevier Inc.


Caravanos J.,Blacksmith Institute | Caravanos J.,City University of New York | Gualtero S.,Blacksmith Institute | Dowling R.,Blacksmith Institute | And 4 more authors.
Annals of Global Health | Year: 2014

Background In low- and middle-income countries (LMICs), chemical exposures in the environment due to hazardous waste sites and toxic pollutants are typically poorly documented and their health impacts insufficiently quantified. Furthermore, there often is only limited understanding of the health and environmental consequences of point source pollution problems, and little consensus on how to assess and rank them. The contributions of toxic environmental exposures to the global burden of disease are not well characterized. Objectives The aim of this study was to describe the simple but effective approach taken by Blacksmith Institute's Toxic Sites Identification Program to quantify and rank toxic exposures in LMICs. This system is already in use at more than 3000 sites in 48 countries such as India, Indonesia, China, Ghana, Kenya, Tanzania, Peru, Bolivia, Argentina, Uruguay, Armenia, Azerbaijan, and Ukraine. Methods A hazard ranking system formula, the Blacksmith Index (BI), takes into account important factors such as the scale of the pollution source, the size of the population possibly affected, and the exposure pathways, and is designed for use reliably in low-resource settings by local personnel provided with limited training. Findings Four representative case studies are presented, with varying locations, populations, pollutants, and exposure pathways. The BI was successfully applied to assess the extent and severity of environmental pollution problems at these sites. Conclusions The BI is a risk-ranking tool that provides direct and straightforward characterization, quantification, and prioritization of toxic pollution sites in settings where time, money, or resources are limited. It will be an important and useful tool for addressing toxic pollution problems in LMICs. Although the BI does not have the sophistication of the US Environmental Protection Agency's Hazard Ranking System, the case studies presented here document the effectiveness of the BI in the field, especially in low-resource settings. Understanding of the risks posed by toxic pollution sites helps assure better use of resources to manage sites and mitigate risks to public health. Quantification of these hazards is an important input to assessments of the global burden of disease. © 2014 Icahn School of Medicine at Mount Sinai.


PubMed | Mount Sinai School of Medicine, Columbia University, University of Santa María in Ecuador, City University of New York and Blacksmith Institute
Type: Journal Article | Journal: Annals of global health | Year: 2014

Although there has been success in reducing lead exposure with the phase-out of leaded gasoline, exposure to lead in Mexico continues to threaten the health of millions, much of which is from lead-based glazes used in pottery that leaches into food.An extensive historical review and analysis of available data on blood lead levels in Mexican populations was conducted. We used a calculated geometric mean to evaluate the effect of lead on the pediatric burden of disease.An extensive bibliographic search identified 83 published articles from 1978 to 2010 with blood lead level (BLL) data in Mexican populations representing 150 data points from more than 50,000 study participants. Values from these publications were categorized into various groupings. We then calculated the incidence of disease and disability-adjusted life-years resulting from these BLLs using the World Health Organizations burden of disease spreadsheets for mild mental retardation.Reviewing all relevant studies, the geometric means of Mexican BLLs in urban and rural areas were found to be 8.85 and 22.24 ug/dL, respectively. Since the phase-out of leaded gasoline, the mean in urban areas was found to be 5.36 ug/dL and the average in rural areas is expected to be much higher. The U.S. Centers for Disease Control and Preventions (CDC) upper limit of blood lead in children under the age of 6 years is 5 ug/dL and the current U.S. average is 1.2 ug/dL. Our results indicate that more than 15% of the population will experience a decrement of more than 5 IQ points from lead exposure. The analysis also leads us to believe that lead is responsible for 820,000 disability-adjusted life-years for lead-induced mild mental retardation for children aged 0 to 4 years.Lead continues to threaten the health of millions and remains a significant cause of disability in Mexico. Additional interventions in reducing or managing lead-based ceramic glazes are necessary to protect the public health.


PubMed | City University of New York and Blacksmith Institute
Type: Journal Article | Journal: Annals of global health | Year: 2014

In low- and middle-income countries (LMICs), chemical exposures in the environment due to hazardous waste sites and toxic pollutants are typically poorly documented and their health impacts insufficiently quantified. Furthermore, there often is only limited understanding of the health and environmental consequences of point source pollution problems, and little consensus on how to assess and rank them. The contributions of toxic environmental exposures to the global burden of disease are not well characterized.The aim of this study was to describe the simple but effective approach taken by Blacksmith Institutes Toxic Sites Identification Program to quantify and rank toxic exposures in LMICs. This system is already in use at more than 3000 sites in 48 countries such as India, Indonesia, China, Ghana, Kenya, Tanzania, Peru, Bolivia, Argentina, Uruguay, Armenia, Azerbaijan, and Ukraine.A hazard ranking system formula, the Blacksmith Index (BI), takes into account important factors such as the scale of the pollution source, the size of the population possibly affected, and the exposure pathways, and is designed for use reliably in low-resource settings by local personnel provided with limited training.Four representative case studies are presented, with varying locations, populations, pollutants, and exposure pathways. The BI was successfully applied to assess the extent and severity of environmental pollution problems at these sites.The BI is a risk-ranking tool that provides direct and straightforward characterization, quantification, and prioritization of toxic pollution sites in settings where time, money, or resources are limited. It will be an important and useful tool for addressing toxic pollution problems in LMICs. Although the BI does not have the sophistication of the US Environmental Protection Agencys Hazard Ranking System, the case studies presented here document the effectiveness of the BI in the field, especially in low-resource settings. Understanding of the risks posed by toxic pollution sites helps assure better use of resources to manage sites and mitigate risks to public health. Quantification of these hazards is an important input to assessments of the global burden of disease.

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