Readers' Note: Since the beginning of research into the socioeconomic impacts of the high-level radioactive waste repository proposed by the U.S. Department of Energy for Nevada's Yucca Mountain the State of Nevada Agency for Nuclear Projects has been evaluating the need for a program to monitor potential health effects of such a facility. The Agency's concerns grew out of a recognition that the federal government has largely ignored health impacts to Nevada's citizens from nuclear activities associated with the Nevada Test Site (NTS)where over 900 atomic weapons tests were conducted between 1952 and 1992 and where thousands of shipments of low-level waste have been disposed of over the years.

The report that follows represents an effort by the Agency in conjunction with other relevant State of Nevada agencies to develop a blueprint for a statewide program to put in place the essential components of an adequate public health monitoring system designed specifically for the types of activities currently ongoing at NTS and for those that may take place in the future. Additional background on the health effects issues involving NTS and Yucca Mountain can be found in the paper titled "Studies of Potential Yucca Mountain Health Effects Seek to Learn from Past Experience" by Dr. Marie I. BouttJ .




Prepared By

The Nevada Agency for Nuclear Projects


During the 1950s through the first part of the 1990s, State of Nevada communities and citizens were subjected to radiation exposures resulting from activities at the Nevada Test Site. These exposures were primarily from fallout generated by above and below ground nuclear tests conducted at the site over a period spanning more than 40 years. In addition, the disposal of low-level radioactive wastes and other radiation-related activities at NTS likely contributed to some level of public radiological exposure.

Over the years, there has been considerable controversy about the actual public health consequences of radiation exposures from NTS activities. After decades of debate, Congress in 1990 passed the Radiation Exposure Compensation Act which, for the first time, acknowledged the causal relationship between fallout from atomic tests conducted in Nevada and certain types of cancers in persons downwind from NTS in Nevada, Utah, and Arizona. However, since no pre-testing baseline information was collected before the onset of the weapons= testing program, it was extremely difficult to determine just how widespread and serious fallout and related effects were within the populations exposed. All of the work identifying exposures and related health impacts to Adownwinders= had to be accomplished through retrospective studies which sought to recreate types and degrees of exposures and the general health status of the at-risk population at the time of exposure. This approach made it extremely difficult to identify relationships between exposures to specific radiological sources and actual health problems that were identifiable in communities subsequent to exposure episodes.

While nuclear testing at NTS has been indefinitely suspended with the end of the Cold War, the U.S. Department of Energy (DOE) has continuing plans for the intensive use of the NTS and some adjacent lands for activities involving significant quantities of nuclear materials. DOE has been using NTS as a disposal location for low-level radioactive wastes (LLW) for several decades. In the final Waste Management Programmatic Environmental Impact Statement, a nationwide study released in May, 1997 examining the environmental impacts of managing more than 2 million cubic meters of radioactive wastes from past, present, and future DOE activities., the Nevada Test Site is identified as a potential central storage and disposal location for as many as 290,000 shipments of low-level radioactive waste shipment from throughout the country. In addition, DOE is currently studying Yucca Mountain on the northwestern edge of NTS as a possible location for a repository to dispose of spent fuel and other high-level radioactive wastes (HLW) from commercial nuclear power plants and DOE defense facilities. Should all of the expected inventories of spent fuel and HLW be disposed of at Yucca Mountain, the site could see over 100,000 MTU (with the radiological equivalent of over 2 million nuclear detonations the size of the Hiroshima bomb) emplaced underground over a 25 year period. Congress is also considering legislation that would accelerate the movement of spent fuel to Nevada by authorizing construction of an interim, above ground storage facility at NTS sometime between 1999 and 2003.

All of these activities have significant implications for putting Nevadans (and others) at risk for as yet undetermined levels of exposures to ionizing radiation. Because the current and planned waste disposal activities are substantially different from past nuclear activities at NTS (i.e. primarily weapons testing), they pose new and different challenges for monitoring exposure occurrences and levels and for identifying and monitoring the health effects of such exposures. For example, LLW and HLW destined for disposal at NTS or Yucca Mountain would have to be transported into Nevada through populated areas via rail and truck. These shipments would pose risks of exposure from both routine operations (cumulative exposures to low levels of radiation over several decades) and accident conditions (potentially higher exposures concentrated in the vicinity of the accident). There will also be risks of exposure from operations at the waste handling facilities and from possible surface and groundwater contamination over longer periods of time.

As was the case in 1950, Nevada has no current capability for identifying exposures or monitoring the health impacts of potential future exposures resulting from waste disposal activities at NTS or Yucca Mountain. The purpose of this scope of work is to provide for the development of a systematic radiological health monitoring program that can be institutionalized within appropriate State agencies and/or university entities. Such a program needs to include both the capability to collect and monitor baseline data that is indicative of health problems associated with radiation exposures of the types expected to occur in regard to the transport, handling, and disposition of various radiological materials. The program will need to address the unique requirements for monitoring radiological exposures and health consequences of waste shipments occurring within Nevada communities though which waste is transported.

Design of a Comprehensive Health Effects Program

A truly comprehensive program for identifying and monitoring the possible effects of radiation exposures resulting from future NTS and Yucca Mountain activities require four interrelated components: health assessment, health monitoring, environmental assessment, and environmental monitoring. These four components can be briefly summarized as follows:

Health Assessment

This element of the program involves the establishment and maintenance of requisite health-related data and statistics that are meaningful in ascertaining the health status of target populations with regard to health effects associated with radiological causes. This aspect of the program generally involves assuring that State health information collection and analysis resources are adequately monitoring needed health indicator data for the population identified as being at risk for NTS or Yucca Mountain related exposures and that the information collected is appropriately and routinely analyzed. Information sources such as a statewide cancer registry, birth defects registry, morbidity and mortality data, vital statistics, reproductive health data, and other such information are part of the health assessment component. In addition, capacities for evaluating the data so as to identify indications of health effects from specific sources and types of exposures must be put into place.

Health assessment also involves the collection and routine monitoring of community-level information for communities considered to be vulnerable to exposures from NTS or Yucca Mountain activities. This involves the identification of potentially vulnerable communities (i.e. those along transportation routes or in proximity to fixed facilities), the systematic collection of health baseline information for each community, and subsequent monitoring of community health status over time.

Health Monitoring

Health monitoring involves the extensive evaluation and monitoring of targeted groups of people considered at risk of radiological expose. This would involve the identification of specific individuals in selected communities, along with people in control communities, whose health status would be monitored through a regular program of medical monitoring (baseline physical exams and health status work ups plus regular, systematic follow-ups). Health monitoring is used in conjunction with the health assessment component, focusing resources in areas where risks of exposure are predicted to be high or where assessment data indicates that radiological health impacts may be occurring. This is an extremely expensive and time intensive element of the program and would need to be designed and implemented in a careful and targeted manner.

Environmental Assessment

This element of a comprehensive health effects program involves the systematic collection and maintenance of baseline data regarding environmental conditions that relate to the level of radiation exposures for targeted populations. Types of data required include background radiation levels; sources of existing radiation exposures such as radon, etc.; local environmental conditions that may affect how and when people are exposed; and other relevant environmental information.

Environmental Monitoring

This component addresses the sources of radiological exposure from waste transportation, handling, and storage/disposal activities. It involves establishing the capabilities needed to measure the different types and occurrences of exposures over time, including monitoring stations along transportation routes; monitoring exposures to workers, drivers, etc.; monitoring contamination at handling and disposal/storage locations; monitoring levels and extent of soil, air, and water contamination; etc. This aspect of the program will require the establishment of fairly extensive monitoring systems, both for fixed facilities (at NTS, Yucca Mountain, and any intermodal/transfer facilities that may be required) and along transportation routes, especially in areas where repeated exposures to waste shipments are expected to occur over long periods of time (i.e. congested intersections, places where lengthy stops may be required in areas where people live or work in close proximity to the road or rail line, etc.).

Requirements for a Health Assessment Component

While all four of the above components are needed for a comprehensive approach to radiological health effects identification and monitoring, this scope of work focuses on the process for operationalizing only the health assessment component for the State of Nevada and affected communities. The establishment of a State - level information collection and monitoring system is a pre-requisite for the other components of the program and is the starting point for any effective health effects monitoring effort.

Proposed Approach

During the past year, the Nevada Agency for Nuclear Projects, in conjunction with the University of Nevada Reno Department of Anthropology, has carried out a preliminary surveillance of the health information systems currently in place at the State level. This work has involved fairly extensive literature reviews, reconnaissance of analogous radiation monitoring efforts and studies, and the development of possible exposure scenarios to identify the type of radiation exposures and health effects that Nevada should be concerned with. It also has involved periodic information gathering meetings with State agency representatives involved with the collection and analysis of health related data and the convening of a State agencies working group to provide input and guidance for the effort. In addition, a pilot study for obtaining community-level health baseline data has been initiated in Caliente, Nevada, and plans for a more extensive community health survey as part of this pilot effort have been made.

One of the important finding of the work to date is that Nevada lacks the resources and organizational capacity to develop a comprehensive health information system geared towards the collection and analysis of information required for effectively and routinely monitoring potential radiological health impacts. While pieces of the required system exist - and in many cases are generating extremely useful and well developed data - there appear to be many gaps in terms of information that is either not available, not being routinely collected, or not being evaluated in a manner to allow for the identification of potential radiation-relayed health effects.

The other major finding that emerged from the initial reconnaissance effort is that there is no one person or agency with the resources and staff to design, manage, and implement the overall radiological health assessment component that will be needed. Consequently, it is proposed that, if and when funding becomes available, consultants with expertise and experience in health information systems, epidemiological studies and data systems, radiological health effects, and community-based health assessment/medical ethnography be employed to formally survey currently available data/information systems and capabilities, identify what additional information needs to be collected, and design a health assessment system at the State-level that will permit ongoing monitoring and assessment of possible health impacts associated with NTS and Yucca Mountain activities.

Specific Tasks to be Undertaken

The difficulties in adequately conceptualizing and framing a comprehensive program that collects health information at both the state and local levels, evaluates that information in light of possible effects resulting from radiation exposures, and provides useful data on NTS and Yucca Mountain-related impacts are considerable. In order to begin to put together a health assessment component of a comprehensive health effects monitoring system, it is proposed that the overall project be divided into sub-tasks as follows:

  1. Evaluate the information currently being collected and maintained by State agencies; identify gaps in these data elements; and develop a detailed work plan and budget for filling identified gaps. Using available reports on potential exposure scenarios, literature reviews done as part of this initial reconnaissance effort (including work on thyroid and leukemia studies), and information from analogous studies/efforts such as the Hanford health studies, etc. identify those specific types of health information that are needed to monitor radiation-related health effects;

  3. Formally survey State of Nevada agencies involved with the collection, maintenance, and evaluation of health-related data and identify specifically what information is currently available (and how adequate that information is for our purposes);

  5. Assess available information/monitoring data in light of what is minimally required for a radiation monitoring program focused on areas/communities of Nevada impacted by the federal HLW program and other radiation-related activities.

  7. Prepare a design for a data collection and analysis system based on the results of work in Task >A= above. Prepare a plan that integrates existing data collection capabilities with specific plans for implementing data collection for new/needed data elements identified in Task 1; Prepare a detailed scope of work and budget for implementing the integrated data collection and monitoring system; Prepare a detailed design for a data analysis system that is capable of evaluating the information being collected in the integrated data collection system, including adequately specified and formatted research questions, analytical models, and other aspects of an adequate assessment system.

  9. Implement a Community-based Heath Assessment Program in Targeted Communities potentially impacted by NTS/Yucca Mountain radiological activities, either from impacts associated with fixed facilities or from impacts related to the transportation of radiological materials. Design and implement a program for systematically conducting health baseline data in targeted vulnerable communities at the local level; Continue with implementation of pilot programs in Caliente, Moapa, Indian Springs; Refine the community health information survey instrument and procedures for collecting data; Develop systems for analyzing the data collected; Put in place community-operated health monitoring programs in each targeted community that will permit the ongoing tracking of community-specific health indicators related to possible radiation-related health effects; and Expand pilot programs to other communities as these are identified and resources become available.

Specific Issues/Needs to be Addressed

Within the context of this scope of work, the following specific information needs, issues, and uncertainties need to be addressed:

* How useful is the currently available mortality data being collected at the State level?

* What kind of morbidity data is currently being collected and how does it relate to assessing radiological health effects?

* How adequate is specific data collected by the State Cancer Registry and the breast and cervical cancer information systems in terms of assessing radiogenic concerns/effects?

* What data is currently being collected that can be useful in assessing reproductive health and its relationship to radiation exposures? Is such data, in fact, useful and/or essential?

* What information is available that could be used in the context of a birth defects registry, and how might such a registry be integrated with a radiological health effects assessment system? What data is needed for a birth defects registry that would allow the State to identify radiation-caused birth defects?

* How can State health information systems be improved to permit State health data/conditions to be evaluated in relation to national data/conditions? Are such comparisons useful/essential for assessing radiological health impacts?

* How can State health information systems be designed and configured to permit the disaggregation of information to regional and local levels in Nevada and to provide useful information about local/community-level health effects?

Results Expected from the Initial Phase of the Proposed Health Effects Program

The ultimate goal of the overall heath assessment component is to realize the production of regularized, periodic reports on the status of the State as a whole and of targeted, at risk communities with respect to health impacts from radiation exposures resulting from NTS and/or Yucca Mountain related activities. Such reports would consist of both summaries of baseline health status information (however that baseline is ultimately defined) and assessments of actual or possible radiogenic impacts.

The intermediate steps to realizing such a reporting capability involve the assessment of existing health information systems, the identification of needs and gaps in those systems, and the development of a detailed design for a comprehensive information and assessment system.

With respect to the community-level component of the health assessment system, the continued development and refinement of a pilot community health information program, including development and testing of a community health survey, the identification of targeted pilot communities for the studies, the implementation of community-wide survey efforts in pilot communities, and the evaluation of data collected are all essential components of the effort.

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