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Implementation of the Minamata Treaty on Mercury in the U.S.

Implementation of the Minamata Treaty on Mercury in the U.S. Implications for Public Policy, Environmental Justice, and Public Health Education -By Mark Mitchell M.D., MPH. Overview. Minamata Treaty Goal Why is Mercury Exposure a Problem? Minamata Treaty Requirements

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Implementation of the Minamata Treaty on Mercury in the U.S.

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  1. Implementation of the Minamata Treaty on Mercury in the U.S. Implications for Public Policy, Environmental Justice, and Public Health Education -By Mark Mitchell M.D., MPH

  2. Overview • Minamata Treaty Goal • Why is Mercury Exposure a Problem? • Minamata Treaty Requirements • Sources of Mercury in the U.S. • Why Focus on Mercury Products? • Exposures in Vulnerable Populations • Policies Needed to Reduce Mercury Exposure

  3. Minamata Convention on Mercury Objective: “…to protect the human health and the environmental from anthropogenic emissions and releases of mercury and mercury compounds.” Mercury Treaty Negotiations

  4. Why is Mercury a Problem? • Mercury is an element • Cannot be created or destroyed by humans • Can change in form to become more or less • Toxic • Biologically available • Mercury is persistent, bioaccumulative and toxic

  5. Human Exposure to Mercury • Fish consumption is largest source • Fish consumption advisories in all 50 states • Mercury in commercial fish varies considerably • High mercury commercial fish: • Swordfish • King Mackerel (not canned, Atlantic, or Pacific Mackerel) • Shark • Tilefish • Tuna (especially albacore [white] tuna) • Mercury amalgam tooth fillings • Have not been shown to cause direct harm in adults • Some medications and multi-dose vaccines • Particularly eye, ear, and nose antibiotics • Have not been shown to cause direct harm to humans

  6. Reversing Bioaccumulation in Fish • To protect public health we must reverse the bioaccumulation in fish • To reverse bioaccumulation of mercury in fish, we must eliminate as much mercury released into air and water as possible on a global scale • The Minamata Convention on Mercury attempts to do this

  7. Minamata Convention on Mercury Requirements • Reduce or eliminate mercury from artisanal and small-scale gold mining. • Control mercury air emissions from • coal-fired power plants, • coal-fired industrial boilers, • certain non-ferrous metals production operations, • waste incineration and • cement production. • Phase out or reduce mercury in manufacturing processes • chlor-alkali production, • vinyl chloride monomer production, and • acetaldehyde production. Source: www.epa.gov/mercury

  8. Minamata Convention on Mercury Requirements (cont’d) • Phase-out or reduce mercury use in mercury containing products • batteries, switches, lights, • cosmetics, • pesticides and • measuring devices, • reduce the use of (phase down) mercury in dental amalgam In addition, the Convention addresses the supply and trade of mercury; safer storage and disposal, and strategies to address contaminated sites.

  9. Mercury Releases in the United States—2000

  10. Why Focus on Mercury Products? • Mercury in products is (arguable) easiest source to eliminate in the U.S. • Mercury in non-dental products has dropped 97% since 1980 (Source: EPA Strategy to Address Mercury Containing Products, Sept. 2014)

  11. Mercury in ProductsTons Released Per Year

  12. Mercury Use in Dentistry is Declining • Use of mercury in dentistry is declining more slowly than in other products in U.S. • There are safe substitutes • Even though only about 48-68% of dentists in the U.S. use dental amalgam,[1] dental amalgam still represents one of the leading uses of mercury in the United States at about 18 to 30 tons annually (35 to 57% of use in products).[2][3] • Many other countries have virtually eliminated dental amalgam Eleven Low Amalgam Countries

  13. Vulnerable Populations for Mercury Poisoning • Pregnant women and developing fetus • Women who might become pregnant • Nursing mothers • Young children • Subsistence fishers who fish from local waters • People who engage in cultural practices using azogue • Those who eat more than one or two tuna meals per week • Those from developing countries who live near mining or mercury storage or disposal sites

  14. Environmental Justice Concerns • People of Color are more likely to have high mercury levels (Source: Schober, S et al: JAMA. 2003;289(13):1667-1674) • From subsistence fishing or eating more local fish • From eating more canned tuna • From cultural practices using azogue • Low Income people get amalgam fillings placed more often • Amalgam is more likely to be used for American Indians, Alaska Native, Asians, and Pacific Islander patients while composite is more likely to be used in other patients.[4] • Medicaid often only covers cost of amalgam fillings • Patients often are not given a choice of fillings • Dental students are often required to place amalgam fillings in dental clinics

  15. Mercury Policies Needed in U.S. • INCREASE fish consumption in pregnant women and children while REDUCING canned tuna and other higher mercury fish • Eliminate added mercury from products, as much as possible • Increase public awareness of mercury in foods and products, and the availability of low mercury alternatives • Research alternatives to mercury in products where no good alternative currently exists • Modify insurance to cover non-mercury dental products

  16. References • [1]Haj-Ali R, Walker MP, Williams K., Survey of general dentists regarding posterior restorations, selection criteria, and associated clinical problems, Gen Dent. 2005 Sep-Oct;53(5):369-75 (“A total of 714 dentists (26.3%) responded. Direct composite was the material used most commonly for posterior intracoronal restorations. Dentists in amalgam-free practices (31.6%) were significantly more likely (p = 0.001) to use direct composite than dentists whose practices used amalgam.”); U.S. EPA, Health services industry detailed study (August 2008), http://water.epa.gov/scitech/wastetech/guide/304m/upload/2008_09_08_guide_304m_2008_hsi-dental-200809.pdf, p.3-1 (“The survey found that 52 percent of dentists do not place amalgam fillings”). • [2] U.S. Geological Survey, Changing Patterns in the Use, Recycling, and Material Substitution of Mercury in the United States(2013), p.26 (“Dental amalgam represents one of the leading uses of mercury in the United States at about 18 to 30 t annually and constitutes the largest amount of mercury in use in the United States.”) • [3]U.S. Geological Survey, Changing Patterns in the Use, Recycling, and Material Substitution of Mercury in the United States(2013), http://pubs.usgs.gov/sir/2013/5137/pdf/sir2013-5137.pdf , p.1 • [4] Sonia K. Makhija, Valeria V. Gordan, Gregg H. Gilbert, Mark S. Litaker, D. Brad Rindal, Daniel J. Pihlstrom and VibekeQvist,Practitioner, patient and carious lesion characteristics associated with type ofrestorative material : Findings from The Dental Practice-Based Research Network, J Am Dent Assoc2011;142;622-632, http://jada.ada.org/content/142/6/622.long

  17. Thank You Questions? mmitchell@enviro-md.com

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