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Chapter 12
Pollution and Human Health
Contents
DDT and metabolites . . . . . . . . . . . . . . . . . . . . . . 794
Toxaphene . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 794
12.1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 776
PCBs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 794
12.2. Toxicology and health effects of contaminants . . . . . . . . 777
Dioxins (PCDDs) and furans (PCDFs) . . . . . . . . . 795
12.2.1. Toxicology of persistent organic pollutants (POPs) . . . . 777
Mirex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 795
12.2.1.1. DDT/DDE/DDD . . . . . . . . . . . . . . . . . . . . . . . . 778
Chlordane . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 795
12.2.1.2. Toxaphene . . . . . . . . . . . . . . . . . . . . . . . . . . . . 778
Hexachlorocyclohexanes (HCHs) . . . . . . . . . . . . . 796
12.2.1.3. Hexachlorocyclohexanes (HCHs) . . . . . . . . . . . 778
POPs in newborn cord blood . . . . . . . . . . . . . . . . . 796
12.2.1.4. Mirex. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 779
PAHs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 796
12.2.1.5. Chlordane, oxychlordane and cis- and trans-
Mercury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 796
nonachlor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 779
Lead . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 798
12.2.1.6. Dioxins (PCDDs) and furans (PCDFs) . . . . . . . . 779
Cadmium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 799
12.2.1.7. PCBs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 780
Radiocaesium . . . . . . . . . . . . . . . . . . . . . . . . . . . . 799
12.2.1.8. Hexachlorobenzene . . . . . . . . . . . . . . . . . . . . . . 781
Radiostrontium . . . . . . . . . . . . . . . . . . . . . . . . . . . 799
12.2.2. Toxicology of PAHs . . . . . . . . . . . . . . . . . . . . . . . . . . . 781
Radioiodine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 799
12.2.3. Toxicology of heavy metals . . . . . . . . . . . . . . . . . . . . . . 781
Radiolead and radiopolonium . . . . . . . . . . . . . . . 800
12.2.3.1. Mercury (Hg) . . . . . . . . . . . . . . . . . . . . . . . . . . 782
Radium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 800
Metabolism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 782
Radon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 800
Toxic effects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 782
Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 800
12.2.3.2. Cadmium (Cd) . . . . . . . . . . . . . . . . . . . . . . . . . . 783
12.4.2. Denmark/Greenland and The Faeroe Islands . . . . . . . . . 801
Absorption and organ distribution . . . . . . . . . . . . . . . 783
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 801
Toxic effects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 783
12.4.2.1. Greenland
. . . . . . . . . . . . . . . . . . . . . . . . . . . . 801
12.2.3.3. Lead (Pb) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 784
Sources of exposure . . . . . . . . . . . . . . . . . . . . . . . . . . 801
Absorption and organ distribution . . . . . . . . . . . . . . . 784
General population . . . . . . . . . . . . . . . . . . . . . . . . 801
Toxic effects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 784
Local population groups . . . . . . . . . . . . . . . . . . . . 801
12.2.3.4. Nickel (Ni) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 785
Dietary habits . . . . . . . . . . . . . . . . . . . . . . . . . . . . 802
Absorption and organ distribution . . . . . . . . . . . . . . . 785
Levels and trends of contaminants in humans . . . . . . . 802
Toxic effects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 785
Persistent organic pollutants . . . . . . . . . . . . . . . . . 802
Hypersensitivity reactions . . . . . . . . . . . . . . . . . . . 786
Mercury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 802
Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 786
Lead . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 803
Allergic dermatitis . . . . . . . . . . . . . . . . . . . . . . 786
Cadmium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 803
Other immunotoxic responses . . . . . . . . . . . . . 786
Selenium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 804
Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 786
Other metals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 804
Miscellaneous toxicological effects
. . . . . . . . . . . 786
Other epidemiological factors . . . . . . . . . . . . . . . . 804
Reproductive and developmental toxicity . . . . 786
12.4.2.2. Faeroe Islands . . . . . . . . . . . . . . . . . . . . . . . . . . 804
Renal toxicity . . . . . . . . . . . . . . . . . . . . . . . . . 786
Levels and trends of contaminants in humans . . . . . . 804
Cardiotoxicity . . . . . . . . . . . . . . . . . . . . . . . . . 786
12.4.2.3. Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . 805
Concluding remarks . . . . . . . . . . . . . . . . . . . . . . . 786
12.4.3. Iceland . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 806
12.2.3.5. Arsenic (As) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 786
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 806
Toxic effects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 787
Sources of exposure . . . . . . . . . . . . . . . . . . . . . . . . . . 806
Toxicity of inorganic arsenic . . . . . . . . . . . . . . . . . 787
Levels and trends of contaminants in humans . . . . . . 806
Health effects of inorganic arsenic . . . . . . . . . . . . . 787
12.4.4. Norway, Russia and Finland . . . . . . . . . . . . . . . . . . . . . 806
Vascular effects
. . . . . . . . . . . . . . . . . . . . . . . 787
12.4.4.1. Norway . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 806
Neurological effects
. . . . . . . . . . . . . . . . . . . . 787
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 806
Toxicity of organic arsenic . . . . . . . . . . . . . . . . . . 788
Sources of exposure . . . . . . . . . . . . . . . . . . . . . . . . . . 806
Concluding remarks . . . . . . . . . . . . . . . . . . . . . . . 788
Water . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 807
12.2.4. Health effects of ionizing and non-ionizing radiation . . 788
Air . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 807
12.2.4.1. Radionuclides . . . . . . . . . . . . . . . . . . . . . . . . . . 788
Occupational . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 807
Radiocaesium . . . . . . . . . . . . . . . . . . . . . . . . . . . . 789
12.4.4.2. Russia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 807
Radiostrontium . . . . . . . . . . . . . . . . . . . . . . . . . . . 789
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 807
Radionuclides of lead and polonium
. . . . . . . . . . 789
Sources of exposure . . . . . . . . . . . . . . . . . . . . . . . . . . 807
Other radionuclides . . . . . . . . . . . . . . . . . . . . . . . . 789
Water . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 807
12.2.4.2. UV radiation . . . . . . . . . . . . . . . . . . . . . . . . . . . 789
Air . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 808
Biological effects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 789
Occupational . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 808
Erythema . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 790
12.4.4.3. Russia and Norway Levels and trends of
Snow blindness . . . . . . . . . . . . . . . . . . . . . . . . . . . 790
contaminants in humans
. . . . . . . . . . . . . . . . . 808
Elastosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 790
Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 808
Skin cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 790
Persistent organic pollutants . . . . . . . . . . . . . . . . . . . . 808
Cataract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 790
Metals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 809
Photodermatoses . . . . . . . . . . . . . . . . . . . . . . . . . . 790
Mercury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 809
Immune system . . . . . . . . . . . . . . . . . . . . . . . . . . . 791
Cadmium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 809
Antioxidant defense . . . . . . . . . . . . . . . . . . . . . . . . 791
Lead . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 810
General conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . 791
Nickel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 810
Copper . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 811
12.3. Essential elements and other nutrients . . . . . . . . . . . . . . . 791
Zinc . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 812
12.3.1. Copper (Cu) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 791
Selenium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 812
Copper deficiency . . . . . . . . . . . . . . . . . . . . . . . . . . . . 791
Iron . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 812
Copper toxicity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 791
Clinical chemical parameters . . . . . . . . . . . . . . . . . . . 813
Accepted reference intervals
. . . . . . . . . . . . . . . . . . . 791
Radionuclides . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 813
12.3.2. Zinc (Zn) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 791
12.4.4.4. Finland . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 814
12.3.3. Selenium (Se) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 792
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 814
12.3.4. Iron (Fe) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 792
Sources of exposure . . . . . . . . . . . . . . . . . . . . . . . . . . 814
12.3.5. Tin (Sn) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 792
Water . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 814
12.3.6. Other nutrients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 793
Air . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 814
12.4. National reports. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 793
Levels and trends of contaminants in humans . . . . . . . 814
12.4.1. Canada . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 793
Persistent organic pollutants . . . . . . . . . . . . . . . . . 814
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 793
Metals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 814
Sources of exposure . . . . . . . . . . . . . . . . . . . . . . . . . . 793
Mercury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 814
General population . . . . . . . . . . . . . . . . . . . . . . . . 793
Cadmium . . . . . . . . . . . . . . . . . . . . . . . . . . . . 815
Local populations . . . . . . . . . . . . . . . . . . . . . . . . . 793
Copper and zinc . . . . . . . . . . . . . . . . . . . . . . . 815
Levels and trends of contaminants in humans . . . . . . . 794
Selenium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 815
Radionuclides . . . . . . . . . . . . . . . . . . . . . . . . . . . . 815
776
AMAP Assessment Report
12.4.4.5. Conclusions for Norway, Russia and Finland . . 815
Observations from most parts of the Arctic ecosystem in-
12.4.5. Sweden . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 816
dicate that it is far from pristine. Pollution, both local and
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 816
due to long-range transport of contaminants, is prevalent at
Sources of exposure . . . . . . . . . . . . . . . . . . . . . . . . . . 816
Food
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 816
levels which pose a concern for human health. For some in-
Permissible levels in food . . . . . . . . . . . . . . . . . 817
digenous populations of the Arctic, blood mercury levels and
Water . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 817
concentrations of persistent organic pollutants in blood and
Air . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 817
Occupational . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 817
fat are 10-20 times higher than those found in most temper-
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 817
ate regions. Although there are currently no confirmed dia-
Levels and trends of contaminants in humans . . . . . . . 817
Persistent organic pollutants . . . . . . . . . . . . . . . . . 817
gnoses of illness in these populations which can be causally
Metals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 818
linked to contaminants, the high concentrations of toxic sub-
Mercury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 818
stances are a cause for concern.
Lead . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 818
Cadmium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 819
It is important to be able to estimate the potential risk as-
Selenium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 819
sociated with pollution and develop appropriate preventive
Arsenic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 819
measures with due respect for local cultural traditions. One
Radionuclides . . . . . . . . . . . . . . . . . . . . . . . . . . . . 819
Other potential hazards . . . . . . . . . . . . . . . . . . . . . 819
prerequisite for this is the continued monitoring of concen-
Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 819
trations of pollutants in humans in order to determine spa-
12.5. International study: Data comparison . . . . . . . . . . . . . . . . 820
tial and temporal trends. This monitoring has been initiated
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 820
through the 1994-96 AMAP data collection initiative and
Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 820
should be continued in the future.
Results and discussion . . . . . . . . . . . . . . . . . . . . . . . . 820
Persistent organic pollutants . . . . . . . . . . . . . . . . . 821
Environmental medicine is a discipline which studies the
Metals and essential elements . . . . . . . . . . . . . . . . 823
impact on human health of pollutants in air, water, and food,
12.6. Risk assessment, management and communication . . . . 823
together with physical factors such as radiation exposure or
General considerations . . . . . . . . . . . . . . . . . . . . . . . . 823
noise. Some of these factors are more relevant for popula-
Risk assessment of individual contaminants . . . . . . . . 824
Persistent organic pollutants . . . . . . . . . . . . . . . . . 824
tions in the Arctic than elsewhere, and this is reflected in the
Mercury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 826
AMAP Human Health Monitoring Program. The core pro-
Lead . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 826
gram consists of monitoring for heavy metals (mercury, lead,
Cadmium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 826
Arsenic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 827
cadmium), essential trace elements (zinc, selenium, copper),
Nickel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 827
and chlorinated organic contaminants (including pesticides,
Radionuclides . . . . . . . . . . . . . . . . . . . . . . . . . . . . 827
dioxins and PCBs) in pregnant women and newborn babies.
12.7. Conclusions and recommendations . . . . . . . . . . . . . . . . . . 827
In addition to this core program which should be followed
12.7.1. Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 827
General conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . 827
by all countries, the monitoring of other contaminants of
POPs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 827
concern, such as nickel, arsenic and radionuclides, in specific
Heavy metals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 828
parts of the circumpolar Arctic should be considered on a
Essential elements . . . . . . . . . . . . . . . . . . . . . . . . . . . . 828
Radiation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 828
subregional basis.
Estimates of exposure and effects . . . . . . . . . . . . . . . . 828
Other contaminants of growing health concern, such as
12.7.2. Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 829
heterocyclic amines and some less persistent contaminants,
On the scientific assessment level . . . . . . . . . . . . . . . . 829
On the public health policy level . . . . . . . . . . . . . . . . . 829
are not addressed in this report as they are not included in
On the national and international policy level . . . . . . 829
the AMAP mandate, but should be considered for relevance
Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 829
to the Arctic in future programs.
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 829
Human exposure to pollutants through the diet is of cen-
Annex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 837
tral concern in the Arctic. Many of the relevant pollutants,
including mercury and persistent organic pollutants, are bio-
magnified through Arctic food chains. Because humans in
the Arctic traditionally feed on other carnivores such as seals
12.1. Introduction
and whales, they are at the top of food chains which include
The chapter on human health will describe the levels of con-
other top level predators. Thus, indigenous peoples consum-
taminants in humans and their effects on human health. It
ing traditional diets are more likely to be exposed to higher
has not been written as an overview of the general health of
concentrations of these pollutants than populations elsewhere
the peoples of the Arctic. Rather, this chapter is an evaluation
in the world. However, the traditional diet is often impor-
of the current knowledge of the consequences to Arctic peo-
tant for the social, spiritual, and cultural identity of indige-
ples of environmental exposure to priority contaminants as
nous peoples. The negative attitude which can develop as a
defined in the AMAP mandate. Indirect health implications
result of, e.g., bans on consumption of local foods, can dis-
of climate change, oil pollution, and waste sites are treated
rupt this identity and can have other effects on health. Fur-
in other chapters of this report.
thermore, the traditional diet including marine mammals,
Many factors contribute to health and illness of human
birds and fish is rich in vitamins, minerals, protein and fatty
populations living in the Arctic, these include socioecono-
acids. The n-3 fatty acids which are widely marketed in the
mic conditions, availability of health services, societal and
south as `fish oils' are known to prevent arteriosclerosis.
cultural factors, individual lifestyles and behaviors, and gen-
This component of the diet is probably one of the reasons
etics. Environmental contaminants, although just one of
for the very low mortality from ischemic heart disease among
these factors, can have a significant influence on human
indigenous Arctic populations.
health. There are numerous population groups in the Arctic
As described in chapter 5, indigenous peoples of the cir-
of which many are indigenous. These groups may be more
cumpolar region represent different ethnic, historical and cul-
threatened by contaminants than immigrants from the south
tural backgrounds. In addition, their living conditions vary
since they generally live their whole lives in the Arctic and
according to climatic conditions, socio-economic conditions,
subsist to a large extent on local food. This chapter, how-
and their access to traditional and market foods. These dif-
ever, deals with the contaminant-related health implications
ferences will influence the susceptibility of the various circum-
for all Arctic inhabitants.
polar population groups to contaminant exposures and their
Chapter 12 ˇ Pollution and Human Health
777
Table 12ˇ1. Toxicological characteristics of persistent organic pollutants.
Acceptable / tolerable
Acute oral lethality
Human carcinogenicity
daily intakes,
Main sources of
Contaminant
(LD50 rats, mg/kg bw)
(IARC 1987)p
g/kg bw/d
exposure
DDT
113a
2B
20 b
Fish, marine mammals
DDE
880 a
n.a.c
20 b
Toxaphene
80-90d
2B
0.2 e
Dioxins (2,3,7,8-TCDD)
0.022-0.340 f
2B
0.00001g
Furans (2,3,7,8-TCDF)
n.a.
n.a.
0.00001g
Mirex
365-3000 h
2B
0.07e
Chlordane
127-430 i
3
0.05 (total) j
Heptachlor
71k
3
0.1 (total) l
HCH
88 ( -HCH) m
2B (mixture)
0.3 (total) j
8 ( -HCH) n
PCBs
1010-4250 (various Aroclors)o
2A
1.0 (total PCBs) e
HCB
1000-10000 q
2B
0.27 e
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
PAH (benzo[a]pyrene)
n.a.
2A
n.a.
Tobacco smoke, smoked foods,
home fuel combustion (wood)
a. ATSDR 1994a. b. WHO 1984b. c. n.a.: not available. d. ATSDR 1994b. e. Provisional TDI (PTDI) Health Canada 1996. f. WHO 1989b.
g. WHO 1992b. h. WHO 1984c. i. ATSDR 1993a. j. TDI Health Canada 1996. k. ATSDR 1993b. l. WHO 1991c. m. ATSDR 1992.
n. WHO 1989c. o. ATSDR 1995. p. Group 1: The agent is carcinogenic to humans. Group 2A: The agent is probably carcinogenic to humans. Group
2B: The agent is possibly carcinogenic to humans. Group 3: The agent is not classified as to its carcinogenicity to humans. Group 4: The agent is proba-
bly not carcinogenic to humans. q. Government of Canada 1993.
related effects. Consequently, no definitive description of the
therefore important to recognize that the paucity of health
interrelationship between environmental contaminants and
data or the absence of overt illness or malfunction does not
human health for any particular group of northerners can be
imply that the exposure of peoples in the Arctic to contami-
provided. This chapter, therefore, presents a description of
nants is without effects. Even biochemical changes in blood
the available information on specific exposure conditions and
and tissue must be regarded as undesirable effects of pollution.
possible human health consequences for seven of the eight
Existing guideline values for a range of contaminants are
Arctic countries individually.
presented in Annex Tables 12ˇA1 to 12ˇA11.
Previous chapters of this report have presented data on
contaminant concentrations in wildlife. Ideally, this informa-
12.2. Toxicology and health effects
tion could be combined with dietary intake data to estimate
of contaminants
human exposure and make quantitative risk assessments.
Such an attempt, however, would be premature. Comprehen-
The toxicological considerations, as described in the follow-
sive and quantitative dietary data are lacking for nearly all
ing sections, have been restricted to include information that
Arctic communities. In addition to measurements of food
is directly relevant for human health. Additional descrip-
intake, such data would need to include information on the
tions of pathways and ecotoxicological aspects of the conta-
age of animals consumed, storage and cooking methods,
minants can be found elsewhere in the report, see chapters
seasonal variations in amounts and types of food consumed,
6, 7, 8 and 10.
and other factors influencing contaminant burden in foods
as they are consumed. The absence of this information pre-
vents anything more than a general analysis of dietary intakes
12.2.1. Toxicology of persistent organic pollutants
of contaminants. In addition, scientific understanding of the
(POPs)
effects of long-term low-dose exposure to contaminants,
either individually or in combination, is poor, such that even
Availability of information on contaminant levels in the tis-
if quantitative estimates of exposure were available, risk char-
sues of northern residents is very recent, and the quantity is in-
acterization would remain imprecise. Since both accurate
creasing rapidly. While trends are difficult to determine, there
dietary data and a sound understanding of the risk of chronic
is a clear indication in the National Reports (section 12.4)
exposure to mixtures of contaminants are unavailable, any
and in the comparison of data from an international study
attempt to quantify human exposures in the Arctic and then
(section 12.5) that a number of persistent substances are sig-
assess their associated risks would be of low predictive value.
nificantly elevated in the tissues of several Arctic ethnic groups.
Inclusion of such speculative risk estimates in this report
This section provides a brief overview of the toxicological
would either imply a greater validity than is justified, or cast
concerns related to a variety of POPs. A summary of the
doubt on other data that are presented. For this reason, no
toxicological findings are provided in Table 12ˇ1. Detailed
attempt to make such calculations has been undertaken. The
descriptions of the past and present uses, sources, transport,
need for such assessments, however, is identified and recom-
fate, and presence of these substances in biota other than
mendations are made for future work to overcome the ob-
humans has been covered in earlier chapters of this report,
stacles outlined above.
and are not repeated here.
The effects of environmental pollutants on health are
Assessing the human health impacts of exposure to POPs
most often subtle, since they usually occur at concentrations
is a very difficult task. Human populations are always ex-
which are not expected to result in acute toxic symptoms.
posed to mixtures of POPs in the ecosystem, never to single
What might be expected are long-term, possibly transgener-
compounds. Hence, toxicological risk assessments that make
ational, effects on the neurologic and reproductive systems.
use of animal test data on individual chemicals rather than
These effects are confounded by many other factors and can
mixtures of chemicals, and their applicability to humans, is
be difficult to identify even in long-term epidemiological
frequently in question. The actual levels of individual conta-
studies in large populations. In the small Arctic populations,
minants in the mixture of POPs to which populations are
it may prove impossible to conduct epidemiological studies
exposed varies by region (because of differences in environ-
with enough power to detect the effects of concern. It is
mental occurrence and food consumption patterns), making
778
AMAP Assessment Report
comparisons of possible effects between populations very
12.2.1.2. Toxaphene
difficult. Human exposures to POPs are usually to lower lev-
els than those chosen for animal studies. Humans are also
Toxaphene, also known as camphechlor, is an insecticidal
typically exposed to these contaminants over their entire life-
mixture of over 670 chemicals. It enters the Arctic region via
time, commencing with conception, and not merely for the
long-range atmospheric transport. Significant amounts have
limited life stages chosen for most animal studies. Finally,
been reported in the Yukon Territory and coastal regions of
confounding factors of lifestyle, diet, age, reproductive sta-
Arctic Canada. It is commonly found in human tissue, how-
tus, gender, and general health also affect how individual
ever, its historical quantification has been compromised by
POPs will influence the onset of disease or adverse effects.
difficulties in analysis and in the estimation of amounts of
the various chemicals that make up toxaphene. As a result,
comparisons using published data on toxaphene are difficult.
12.2.1.1. DDT/DDE/DDD
The lethal oral dose (LD50) of technical toxaphene in rats
The use of DDT has been declining in the temperate regions
is between 80 and 90 mg/kg bw (Gaines 1969), however a
of the Northern Hemisphere since the 1960s, and especially
range of other effects, including death, can follow chronic
since the mid-1970s when it was banned by many western
exposure to levels of 20 to 30 g/kg bw/d (ATSDR 1994b).
nations. Its persistence in the environment, and its continued
Large doses of toxaphene are likely to affect the nervous sys-
entry into the Arctic region via long-range atmospheric trans-
tem (seizures, tremors, convulsions, paralysis and both behav-
port and in some river systems, has meant that it is detectable
ioral and biochemical effects), the liver (enzyme induction)
in almost all compartments of the ecosystem and in human
and the kidney (enzyme release, fatty degenerative changes
tissues. Levels of total DDT in human tissue in the Arctic are
and focal necrosis). Intermediate exposure duration for tox-
considerably higher than those in southern populations, re-
aphene may affect the adrenals, the immune system and fetal
flecting the greater consumption of high trophic level species
development. This research base is mostly limited to short-
for food.
term and intermediate-term (i.e., less than a lifetime) animal
DDT and its metabolites are stored in fatty tissue and are
studies conducted with technical grade toxaphene. Although
excreted very slowly, primarily via urine and feces. Because
there is one chronic (eighty week) study, there are no suitable
DDT and its metabolites are found in breast milk, `excre-
studies to confirm the effects of technical or environmentally
tion' also occurs during breast feeding. DDT can readily
available toxaphene on human populations. Because so little
cross the placenta.
is known about the effects of long-term exposure to both tech-
Acute lethal (LD50) oral doses in test animals range be-
nical and environmental toxaphene in animals and humans,
tween approximately 115-800 mg/kg bw (body weight).
there is considerable uncertainty over the applicability of a
No-observed-adverse-effect levels (NOAELs) for chronic ex-
TDI. Canada uses 0.2 g/kg bw/d. In the USA, the Agency
posure to DDT, DDE and DDD for most mammalian test
for Toxic Substances and Disease Registry (ATSDR 1994b)
species range between 10-100 mg/kg bw/d for respiratory,
has proposed an `intermediate-duration oral exposure minimal
cardiovascular, gastrointestinal, hematological, hepatic and
risk level' of 1 g/kg bw/d. The WHO has not proposed a TDI.
renal outcomes. However, the more serious effects (neuro-
Animal studies suggest that toxaphene is an animal car-
logical, developmental, reproductive and carcinogenic) have
cinogen. It has been classified by IARC (1987) as `possibly'
lowest-observed-adverse-effect level (LOAEL) values more
carcinogenic to humans. Toxaphene does not appear to be a
in the 8-50 mg/kg bw/d range for chronic exposure (ATSDR
very active estrogenic mimic (Soto et al. 1992). Recent data,
1994a). Some forms of DDT are considered to have weak
however, indicate that toxaphene is a potent estrogen recep-
estrogen-like responses with potencies relative to estradiol of
tor antagonist (Jørgensen pers. comm.). Furthermore, it has
between approximately 0.01 and 0.0001 (Soto et al. 1992).
been shown by Arnold et al. (1996), that the potency of the
This estrogenic effect is probably responsible for DDT im-
antagonistic effect of toxaphene was greater by an order of
pacts on reproduction in animals (ATSDR 1994a). DDE has
magnitude in synergistic interaction with other chlorinated
recently been shown to be a potent androgen receptor anta-
contaminants such as dieldrin and endosulfan.
gonist (Kelce et al. 1995).
Toxaphene is readily absorbed. Intakes in Arctic popula-
In humans, acute lethal exposures to DDT are probably
tions are entirely dependent on the type and amount of food
greater than 250 mg/kg bw. Very little data on the effect of
consumed. It is likely that the highest levels in food occur in
chronic exposure is available. Long-term exposure of volun-
narwhal and beluga blubber in the eastern Canadian Arctic
teers to amounts up to approximately 0.6 mg/kg bw/d did
(Kuhnlein et al. 1995a) and in some fish in a small area of
not lead to any observable neurological signs (Hayes et al.
the western Canadian Arctic. Toxaphene is known to be
1956). The World Health Organization (WHO) have pro-
transported northward from past high-use areas in the south-
posed a Tolerable Daily Intake (TDI) of 20 g/kg bw/d for
ern USA. Measurements from other regions of the Arctic are
DDT (including metabolites).
few. Absorbed toxaphene is readily metabolized and excreted
Epidemiology studies have not established an association
(90% in 24-36 hours), however, some constituents remain in
between DDT exposure and cancer, even though cancer is an
fatty tissues for prolonged periods (ATSDR 1994b). Stern et
outcome of long-term animal-feeding studies. The Interna-
al. (1992) report that the two most common compounds re-
tional Agency for Research on Cancer (IARC) has classified
tained are an octachlorocamphene (T2) and a nonochloro-
DDT and DDE as `possibly' carcinogenic to humans based
camphene (T12). There is no toxicological information avail-
on evidence from animal studies.
able for T2 and T12.
Suppression of reflexes in neonates appears to be associ-
ated with levels of DDE in breast milk exceeding 4 g/g
12.2.1.3. Hexachlorocyclohexanes (HCHs)
lipid, however, it has not been substantiated that DDE is the
causative factor (Rogan et al. 1986). Elevated levels of DDE
HCHs are a group of organochlorine pesticides: alpha- ( -),
in human breast milk ( 3 g/g lipid) have been correlated
beta- ( -), gamma- ( -, more commonly known as lindane),
with a shortening of breast-feeding duration, and inhibition
delta- ( -) and epsilon- ( -) are the most stable isomers. Many
of lactation was hypothesized as the cause (Rogan et al.
countries in the world use large amounts of lindane. There are
1987).
some minor registered uses for lindane in some circumpolar
Chapter 12 ˇ Pollution and Human Health
779
jurisdictions (e.g., control of head lice). Like other POPs, most
ecosystem primarily via long-range transport through the
human exposure to HCHs results from food consumption.
atmosphere.
-HCH (lindane) is the most toxic of the HCH isomers.
The acute lethal (LD50) oral dose of technical chlordane is
Excessive exposures can affect the liver, the nervous system,
between 127 and 430 mg/kg bw in rats (ATSDR 1993a).
the kidney, the reproductive system, and perhaps the immune
High dose exposures affect the neurological and immune
system. IARC (1987) classifies it as `possibly' carcinogenic
systems (no-effect levels are 4-6 mg/kg bw/d). Long-term ex-
to humans. No effects have been reported in populations
posure is likely to cause cellular changes in the liver at levels
exposed to low-level environmental concentrations. Expo-
of approximately 0.5 mg/kg bw/d (WHO 1984a). Chlordane
sure levels for HCH via consumption of store-bought food
has been classified as a probable human carcinogen by the
in several countries were approximately 0.005 g/kg bw/d
US Environmental Protection Agency (EPA) based on tumor
( -HCH), 0.0003 g/kg bw/d ( -HCH) and 0.03 g/kg
identification in mice (LOAEL of 3.9 mg/kg bw/d for mice).
bw/d ( -HCH) (Gorchev and Jelinek 1985). The TDI for
The TDI for chlordane is 0.5 g/kg bw/d (WHO 1984a).
total HCHs is 0.3 g/kg bw/d (WHO 1991a).
There are few estimates of intakes for chlordane and its
HCHs, especially -HCH, accumulate readily in fatty tis-
metabolites. US estimates indicate that only very small
sues and are excreted slowly via feces, breast milk and urine
amounts are consumed, 0.002-0.005 g/kg bw/d (Gunder-
(WHO 1991a). Levels of -, - and -HCH in breast milk
son 1988).
in the general populations of Europe, Canada and the United
Chlordane and its related compounds accumulate in fat
States are in the ranges 10- 40 ng/g lipid, 10-500 ng/g lipid,
and are found in human tissues. In general, only small
and < 1-10 ng/g lipid, respectively. The most recently mea-
amounts of chlordane are found in tissues. However, they
sured `background levels' of HCHs in blood, serum, plasma,
often contain relatively larger (one or two orders of magni-
milk and adipose tissues are relatively low compared to val-
tude higher) amounts of trans-nonachlor and the metabolite
ues reported during the 1960s and 1970s and much lower
oxychlordane. Excretion of chlordane is primarily through
than levels reported from countries with extensive current
feces and breast milk.
usage. Because of its persistence, -HCH is found at the high-
est level of the four isomers reported.
12.2.1.6. Dioxins (PCDDs) and furans (PCDFs)
The exposure of babies, resulting from -HCH concentra-
tions found in breast milk, has been identified as a matter of
Polychlorinated dibenzodioxins and polychlorinated diben-
concern by the WHO (1991a), but not as a reason to stop pro-
zofurans are two structurally similar families of compounds
moting breast feeding. The high -HCH levels that have been
that include 75 congeners (different compounds) and 135
found in some breast milk samples in countries using HCH, in-
congeners, respectively. These compounds enter the Arctic
dicate that some infants may exceed the TDI of 0.3 g/kg bw/d,
ecosystem almost exclusively via long-range atmospheric
temporarily and locally. The -HCH concentrations in the blood
transport. Seventeen members of these two families of chem-
of babies lie within the same range as those in the mothers.
icals are highly toxic and contribute most to the toxicity of
complex mixtures of dioxins and furans. The seventeen more
toxic congeners in both families have chlorine substitutions
12.2.1.4. Mirex
in the 2, 3, 7 and 8 positions. These more toxic congeners
Mirex has never been used in any of the circumpolar juris-
cause a wide range of deleterious effects in laboratory animals,
dictions. It has been manufactured and applied extensively
these effects varying significantly between species (Environ-
in the continental USA and has become widely distributed
ment Canada and Health Canada 1990).
via long-range atmospheric transport. It is now found at low
The acute lethal (LD50) oral dose for 2,3,7,8-TCDD in
levels in human tissues throughout North America (Govern-
mammals varies almost 10 000-fold (0.6 g/kg bw for guinea
ment of Canada 1991) and Greenland (see section 12.4.2). It
pigs and 5051 g/kg bw for hamsters). Common signs of
is highly persistent.
acute and chronic toxicity in animals include loss of body
The acute lethal (LD50) oral toxicity of mirex ranges from
weight and thymic atrophy. Longer-term exposure to doses
365 to 3000 mg/kg bw in laboratory mammals. The effects
below the LD50 can lead to discoloration and thickening of
of long-term, low-level exposure to mirex have not been ex-
skin, skin eruptions, hair loss, liver damage, hematological
tensively studied; the primary organs affected by mirex in
changes and immune system dysfunction (IPCS 1989). Expo-
laboratory species are the liver (at 50 g/kg bw/d), kidneys,
sure of laboratory animals during gestation can lead to de-
eyes and thyroid (IPCS 1984). Mirex is considered a `possi-
velopmental deficits and altered sexual differentiation (Lind-
ble' human carcinogen (IARC 1987) and also has fetotoxic
ström et al. 1995).
and teratogenic effects on laboratory species in the 1-6 mg/kg
Laboratory rats have developed cancer when exposed to
bw/d range. There is no WHO TDI, however, the Canadian
2,3,7,8-substituted tetrachloro- and hexachlorodioxins
provisional TDI is 0.07 g/kg bw/d (Health Canada 1996).
(NOEL for 2,3,7,8-TCDD is 1 ng/kg bw/d) (Kociba et al.
Mirex is readily absorbed and stored in fatty tissues. Meta-
1978). IARC (1987) lists 2,3,7,8-TCDD as `possibly' car-
bolism to photomirex is slow and elimination is mainly via
cinogenic to humans. Dioxins and furans can directly affect
feces and breast milk.
reproduction, with a NOEL for intake of 2,3,7,8-TCDD for
Because of its persistence and accumulation in the food
this outcome of 1 ng/kg bw/d (Murray et al. 1979). The ma-
chain, mirex levels in breast milk are above average for com-
jority of TDI values are within an order of magnitude (1-10
munities consuming high amounts of fish and marine-bird
pg/kg bw/d). The WHO TDI is 10 pg 2,3,7,8-TCDD/kg bw/d
eggs (Dewailly et al. 1991).
(IPCS 1989). Recent studies, however, suggest that single ex-
posures at close to these `no-effect' doses leads to impair-
ment of development of the reproductive system in male rats
12.2.1.5. Chlordane, oxychlordane and
(Mably et al. 1992). The antiestrogenic capabilities of TCDD
cis- and trans-nonachlor
appear to be related to Ah-receptor mediated events (Zacha-
Technical chlordane is a mixture of chlordane, nonachlor,
rewski et al. 1991).
heptachlor and other chlordane isomers. It is not registered
Due to the different relative toxicity of the seventeen more
for use in circumpolar jurisdictions and enters the Arctic
toxic dioxin and furan congeners, a set of international toxi-
780
AMAP Assessment Report
city equivalency factors (I-TEFs) have been adopted, ranging
improper use, storage and disposal, or accidents at military
from 1 for 2,3,7,8-TCDD, the most toxic congener, to 0.001
sites in the Arctic, they have primarily contaminated the Arc-
for octachlorodibenzodioxin, the least toxic congener (NATO
tic ecosystem through atmospheric transport from regions
1988). By weighting (multiplying) the concentrations of dif-
farther south. Their manufacture and new usage is banned
ferent congeners in a mixture by their respective I-TEFs, and
in most circumpolar jurisdictions, but they are still present
summing the resulting values, the International Toxic Equi-
in older electrical transformers and at a number of contami-
valent (2,3,7,8-TCDD TEQ) value can be calculated. This
nated industrial sites and waste sites throughout the Arctic.
allows the total dioxins and furans in a mixture to be ex-
The toxicity of PCBs as mixtures is complicated by the
pressed as a single 2,3,7,8-TCDD TEQ value. I-TEF values
varying amounts of the 209 congeners in the mixture and
have also been established for other dioxin-like substances
the traces of other contaminants also present (e.g., PCDFs).
such as certain PCB congeners (see 12.2.1.7, below).
Individual congeners and mixtures can affect liver function,
The general population is exposed to small amounts of
reproduction, infant birth weights, neurobehavioral develop-
complex mixtures of PCDDs and PCDFs and other organo-
ment and the immune system and may cause cancer in labo-
chlorines. An extensive analysis of adipose tissue samples,
ratory animals (ATSDR 1995). The TDI for PCBs is 1 g/kg
from a number of countries, has concluded that almost all hu-
bw/d (Health Canada 1996).
mans contain TCDD at concentrations up to, and occasion-
While levels of total PCBs have declined since the 1980s
ally greater than, 3 pg/g in lipids (Travis and Hattemer-Frey
in breast milk of women in many industrialized countries
1991). These levels in the general population have not been
(Newsome et al. 1995), there is no similar information yet
associated with disease. In a few incidents, in the USA, Italy
available for Arctic residents. Nor are historical values easy
and Japan, where workers and others who have been exposed
to compare because of changing analytical techniques and
to very large amounts of a limited number of these compounds,
quantitation methods (reported PCB concentrations based
individuals have developed chloracne, a skin disorder. There
on an Aroclor 1260 standard are typically approximately
is also evidence that high level exposure to dioxins and furans
double those based on a sum of specific PCB congeners).
can cause variations in serum lipid levels, other dermatologi-
Assessing the human health effects of PCBs is very diffi-
cal effects related to chloracne, microsomal enzyme induction
cult because PCB mixtures typically used in animal studies
and gastrointestinal alterations (Schulz et al. 1990). Other stud-
or identified in accidental poisonings frequently contain
ies of high level occupational exposures have found associa-
traces of contaminants such as PCDFs and undergo exten-
tions with some types of cancer (Zober et al. 1990, Manz et
sive `environmental filtering' prior to human exposures. Many
al. 1991, Fingerhut et al. 1993, Bertazzi et al. 1996). Pluim et
of the effects of exposure to PCBs observed in humans (e.g.,
al. (1993) concluded that in utero and lactational exposures
Yusho and Yu-cheng incidents) reflect exposure to high lev-
to PCDDs/PCDFs are capable of affecting the hypothalamic,
els of both PCBs and PCDFs. PCDFs are believed to be re-
pituitary, and thyroid regulatory system in human infants.
sponsible for many of the observed human health effects.
The best documented poisonings by PCDFs in humans are
From studies following the Yusho and Yu-cheng incidents
the Yusho and Yu-cheng incidents when rice oil was acciden-
(see section 12.2.1.6, above), the earliest toxicological signs
tally contaminated with polychlorinated biphenyls (PCBs)
included chloracne. Additional generalized adverse health
from electrical transformer fluid. The PCBs were heavily
effects included hepatomegaly (enlarged liver), bronchitis and
contaminated with PCDFs. Investigators have reported low
peripheral neuropathy (nervous system damage) (Safe 1987).
birth weight, early tooth eruption, sensory losses, skin dis-
In Yu-cheng, increased upper respiratory tract infection rates
coloration, swollen eyelids (Kuratsune et al. 1972) and re-
were associated with decreased serum IgA and IgM plus in-
tarded development (Rogan et al. 1986) in infants exposed
creased IgG levels (WHO 1988). Occupational exposures to
transplacentally. It is likely that the PCDFs were the cause of
PCBs generally do not include the PCDF contaminants found
many of the reported effects (Rappe et al. 1983, Rappe and
in the rice oils, so the effects seen are often different.
Nygren 1984). The mean total intake of PCDFs by the Yusho
A small group of PCB congeners have dioxin-like activity
and Yu-cheng patients has been estimated to be 0.9 g/kg
and have been assigned dioxin toxic equivalency factors
bw/d (Hayabuchi et al. 1979) or 3.3 ng 2,3,7,8-TCDD TEQ/
(Ahlborg et al. 1994), cf. section 12.2.1.6. In a number of
kg bw/d (Ryan et al. 1990). The smallest amount of total
human tissue samples, such as breast milk or adipose tissue,
PCDFs causing chloracne has been estimated to be 0.16 g/
it has been found that the dioxin-like PCBs contributed a
kg bw/d (Hayabuchi et al. 1979).
large proportion of the total 2,3,7,8 TCDD TEQ (Dewailly
Average daily intake of PCDDs and PCDFs over a lifetime
et al. 1992). Because PCB congeners co-exist with dioxins
is similar in most industrialized regions, between 2 and 10 pg
and furans in the environment, ascribing an effect to one or
2,3,7,8-TCDD TEQ/kg bw/d for a 60 kg person (Birming-
the other contaminant is almost impossible.
ham et al. 1989). Back calculations from human tissue levels
Some studies from Japan have found levels of dioxin-like
in Canada have confirmed this estimated intake, i.e., deriv-
PCBs, such as the congeners CB 77, 126, and 169, up to sev-
ing likely intakes of 1.9 pg/kg bw/d (Environment Canada
eral orders of magnitude higher than the levels of 2,3,7,8-
and Health Canada 1990). The mean PCDD and PCDF con-
TCDD in human adipose tissue samples (Tanabe et al. 1987,
centrations in the breast milk of Arctic and non-Arctic pop-
Kannan et al. 1988, Kashimoto et al. 1989). Results from
ulations are similar: 10-20 pg 2,3,7,8-TCDD TEQ/g lipid
analysis of human adipose tissue and serum collected in the
(see Ryan et al. 1993 for Canada, Nygren et al. 1986 for
USA show that concentrations of coplanar PCBs (cf. chapter
Sweden, Schecter et al. 1987 for the USA). Breast milk levels
6, section 6.1.1.1.1) can be more than an order of magni-
in the Netherlands can be slightly higher: 30 pg 2,3,7,8-TCDD
tude higher than the concentrations of 2,3,7,8,-TCDD (Pat-
TEQ/g lipid (Koopman-Esseboom et al. 1994a).
terson et al. 1994).
Data obtained from epidemiological studies on cohorts of
US infants from Michigan (Jacobson et al. 1990, 1992) and
12.2.1.7. PCBs
North Carolina (Rogan et al. 1986, 1987, Gladen et al.
Polychlorinated biphenyls (PCBs) are a group of 209 struc-
1988, 1991) suggest adverse neurobehavioral effects from in
turally similar compounds (congeners) commercially pro-
utero exposure to PCBs (calculated as Aroclor 1260 equiva-
duced as mixtures. Although PCBs have been released due to
lents). High cord blood concentrations were associated with
Chapter 12 ˇ Pollution and Human Health
781
low birth weight and small head circumference (Jacobson
other PAHs are also known to be animal carcinogens (IARC
et al. 1990). Birth size among male infants (Inuit) was in-
1987). PAHs are readily absorbed and can be metabolized
versely related to PCB concentration in breast milk of the
with relative ease in the liver and kidney. They are excreted
mother (Dewailly et al. 1993a). Perinatal exposures to PCBs/
in bile, feces and urine. The total daily potential exposure of
dioxins/furans may impair immune responses to infection, as
adult males to carcinogenic PAHs is estimated to be 3 g
suggested by a 20-fold higher incidence of infectious diseases
(median), and may be as high as 15 g. For smokers, expo-
(e.g., meningitis, measles) and ear infections (otitis media)
sure levels may be twice as high. Exposure to PAHs through
among 1-year old Inuit with high PCB exposures than among
cigarette smoke has been associated with reduced fecundity
lesser exposed controls (Dewailly et al. 1993b). The infec-
and low fetal birth weight (Weinberg et al. 1989) and is
tious disease data may be confounded by a lower serocon-
thought to be a major factor in lung cancer.
version rate (successful immunization) among Inuit com-
The daily intake of all PAHs from foods has been esti-
pared to controls (Dewailly et al. 1993b).
mated to be 2-20 g (Pucknat 1981). PAH concentration in
It is not clear whether PCB exposure is the sole factor
food depends on both the method of preparation and the
leading to neurodevelopmental deficits in the Wisconsin or
origin of the food. Barbecuing foods increases their PAH
Michigan cohorts, or if other contaminants, such as mer-
concentration. Smoked and cooked fish and meats are higher
cury, or socio-demographic characteristics might also be as-
in PAHs than uncooked products. Despite considerable po-
sociated with these results (Ayotte et al. 1996). Caution
tential dietary exposure to PAH from smoked food, there is
must be used when examining data from the Lake Michigan
little risk to health from this route of intake. Inhalation of
cohort in relation to assessing health risks for Inuit new-
PAHs from tobacco smoke (active or passive) is associated
borns in the Arctic. The mixture of contaminants to which
with a significant risk to health (IARC 1987).
Lake Michigan infants were exposed may be very different
There are no data available on PAH levels in breast milk,
from that found in Arctic ecosystems (regional industrial
fat or blood of Arctic residents.
sources as opposed to long-range atmospheric transport). In
addition, the Lake Michigan population exposure was
12.2.3. Toxicology of heavy metals
through fish consumption, while the diet of northern Inuit
also includes species at higher trophic levels (e.g., marine
Metals can occur in ecosystems in organic and inorganic
mammals). These dietary differences may lead to quite dif-
form as well as in different oxidation states. These factors
ferent contaminant exposure profiles. Studies underway in
will affect the absorption, metabolism and toxicity of met-
northern Quebec and the Faeroe Islands should help to an-
als, making information on their form and speciation crucial
swer these questions.
for realistic risk estimates.
The toxicology of metals involves approximately eighty el-
ements and their compounds ranging from simple ionic salts
12.2.1.8. Hexachlorobenzene
to complex molecules such as organometallic compounds.
Hexachlorobenzene (HCB) was widely used as an anti-fun-
The term `heavy metals' is not well defined chemically, but
gal agent for various seed crops and is also an important in-
in a biological context has been applied to metals having a
dustrial feedstock for production of chlorinated solvents and
specific gravity of 5 or higher. Within this arbitrary group
pesticides (Government of Canada 1993). HCB is still widely
are many of the trace elements essential to plants and ani-
used in the world and atmospheric transport is a major path-
mals, as well as metals not known to have any essential prop-
way to the Arctic.
erty. Some may give rise to toxic reactions, even at low levels
HCB causes a wide range of effects in laboratory animals,
of exposure and concentrations only moderately in excess of
including liver pathology, skin lesions (porphyrial cutanea
the background levels. In this latter group, mercury (Hg), lead
tarda in humans), behavioral changes, reproductive changes
(Pb), and cadmium (Cd) are regarded as priority contaminants.
in primates, and effects on the immune system. The provi-
The toxicity of metals is often due to their interference
sional TDI for HCB is 0.27 g/kg bw/d (Government of Can-
with important sites in cellular biochemical systems, such as
ada 1993).
the sulfhydryl groups in enzyme systems. This interference
HCB is found at higher levels in serum of newborn Inuit
often results in cell death. Metals may also compete with
from Arctic Canada compared to southern Canadian popu-
essential elements as enzyme co-factors, creating a toxic re-
lations (CACAR 1996).
sponse that is manifested as a deficiency of an essential metal.
For this reason, it is also important to consider the status of
essential elements when evaluating an exposure to the toxic
12.2.2. Toxicology of PAHs
metals. There is an abundance of data on such interactions
Polynuclear aromatic hydrocarbons (PAHs) are a family of
(for a review see Nordberg et al. 1986). Mercury, lead, and
ring-structured compounds that do not include chlorine in
to a lesser degree cadmium, can all cross the placenta and
their molecular structure. Several PAHs are carcinogenic to
can affect the developing fetus.
animals. While PAHs can enter the Arctic from remote loca-
Important natural sources of metals in the atmosphere
tions (with sources including industrial activity and forest
include volcanic activity and forest fires. Rock-weathering,
fires), the primary sources of human exposure in the Arctic
land runoff, and atmospheric deposition are the most impor-
are local. The greatest pathways of exposure to PAHs for the
tant sources in the hydrosphere. Major anthropogenic sources
general population are inhalation of tobacco smoke (active
are combustion of fossil fuels, including vehicular emissions,
or passive), wood smoke and smoke from other fuel sources,
mining and smelting operations, processing and manufactur-
indoors and outside, and the ingestion of PAHs through con-
ing industries, and waste disposal. Sources and environmen-
sumption of smoked, fried or broiled food. For non-smok-
tal occurrence of metals, in particular mercury, cadmium, lead
ers, food is the main source of exposure (99% of total benzo-
and selenium are considered in chapter 7. The following sec-
[a]pyrene (B[a]P) intake), and air a much less important source
tions include a brief summary of sources of the metals discus-
(0.9% of total B[a]P intake).
sed, with more extensive summaries for nickel and arsenic
Benzo[a]pyrene, one well studied PAH, is a carcinogen in
which are important in relation to human health, but have a
animals and is `probably' carcinogenic to humans. Several
lower priority as environmental contaminants in the Arctic.
782
AMAP Assessment Report
Table 12ˇ2. Some limit values for cadmium, lead and mercury in the environment.
Limit for
Provisional tolerable
Limit for air a
drinking waterb
weekly intakec
Main sources of exposure
Cadmium
10-20 ng/m3 (urban air)
3 g/L
Approx. 7 g/kg body weight
Occupational; cigarette smoke; food
Lead
0.5-1 g/m3
10 g/L
50 g/kg body weight
Occupational; picad; deposition from leaded particles
Mercury
1 ĩg/m3
1 g/L
5 g/kg body weight
Occupational; marine food
as total mercury
3.3 g/kg body weight as
methyl mercury (MeHg)
a. Guideline value for upper limit of concentration as time-weighted average over 1 year (WHO). b. Guideline value for upper limit of concentration in
drinking water (WHO). c. Maximum acceptable weekly intake for adults (WHO/FAO). The value quoted should be multiplied by the body weight in
kilograms to obtain the total maximum acceptable weekly intake for an individual. d. Pica is the habit of eating clay, soil, dirt, and other non-food items.
It is an important source of lead intake for children who live in contaminated environments, particularly houses with old lead-based paints.
From the point of view of human exposure, marine foods
1986, Tsubaki and Takahashi 1986). Until recently, it was
are of major importance since the traditional diets of many
thought that demethylation does not generally take place in
Arctic populations include species from the top of the marine
the brain, however, this has now been shown to occur in hu-
food chain. Historically, technological development and in-
mans (Tsubaki and Takahashi 1986), in dogs (Hansen et al.
dustrialization seem generally to have increased human expo-
1989a, Hansen and Danscher 1995), and in monkeys (Lind
sure, especially for mercury and lead (Hansen et al. 1989b).
et al. 1988). The demethylation process in the brain is slow
Exposure limit values have been proposed by WHO and
compared to other organs and for this reason it may, there-
FAO (cf. Table 12ˇ2) for most of the metals of concern.
fore, not have been noticed previously in short-term animal
experiments. No demethylation seems to take place in skele-
tal muscles. Hansen et al. (1989a), and Hansen and Dan-
12.2.3.1. Mercury (Hg)
scher (1995) found all mercury in muscle tissue from dogs
Mercury is ubiquitous in the environment. The primary source
chronically exposed to methylmercury to be in the methy-
is from degassing of the earth's crust especially in connection
lated form (i.e., no transformation to inorganic mercury was
with geothermal activities (Lindquist et al. 1991). Although
observed). Demethylation is thought to take place via reac-
a minor portion is of anthropogenic origin, it may contribute
tions with reactive oxygen intermediates. Suda et al. (1991)
to the global level and give rise to local pollution, in particu-
reported that OH ˇ is the responsible free radical. They later
lar when it enters into lakes and rivers.
suggested that the myeloperoxidase-halide system is also in-
Inorganic mercury compounds from natural degassing or in-
volved in the process (Suda and Takahashi 1992).
dustrial waste can be methylated in the aquatic environment,
The biochemical mechanism for the toxicity of methylmer-
and methylmercury (MeHg) can then be introduced into the
cury seems to be based on: 1) binding to gluthation (GSH),
aquatic food chains where it is biomagnified. Consequently, ex-
leading to instability of microtubules, i.e., the cytoskeletal
posure to methylmercury is of significance for inhabitants of the
system, (Brown et al. 1988, Kromidas et al. 1990); 2) intro-
Arctic, whereas exposure to the metallic vapors from dental
duction of lipid peroxidation (Fujimoto et al. 1985, Sarafian
amalgam fillings, a problem discussed in other parts of the world
and Verity 1991); and 3) inhibition of glutathione peroxi-
(Vimy and Lorscheider 1985a, 1985b), is of minor importance.
dase (GSHPx) (Bem et al. 1985, Hirota 1986). All three mech-
Methylmercury is readily absorbed through the intestinal
anisms involve the influence of oxidative reactions which ap-
wall, and blood concentrations at steady state reflect the
pear to be of central importance to mercury toxicity.
daily intake. Sherlock et al. (1984) have suggested the fol-
lowing relationship between blood and exposure: Hg con-
Toxic effects
centration in blood ( g/L) = 0.8
daily intake ( g/adult).
Methylmercury is neurotoxic and the incidence of signs and
This equation can be used to estimate human exposure
symptoms of Hg poisoning are related to its concentrations
levels from data on blood Hg concentration.
in the brain. Few data exist on Hg concentrations in human
The provisional tolerable weekly intake (PTWI) for total
brain; levels between 1 and 2 mg/kg fresh tissue in brain cor-
mercury has been set by the WHO (1990b) at 5 g/kg bw/
respond to the lowest blood Hg concentration at which neu-
week, and for methylmercury at 3.3 g/kg bw/week or 231
rological signs have been observed (Berlin 1986).
g/kg/week for a 70 kg person. According to the above-men-
Methylmercury (MeHg) readily crosses the placental bar-
tioned equation, this intake corresponds to a blood Hg con-
rier such that exposure to methylmercury in utero can give
centration of about 26 g/L. The lowest blood Hg concentra-
rise to severe neurological damage in children (Amin-Zaki et
tion at which neurological signs have been observed in exposed
al. 1974, Harada 1977). The fetal central nervous system
adults is often accepted as being 200 g/L. For protection of
(CNS) has been found to have higher concentrations than the
the fetus, maternal blood Hg should not exceed 50 g/L.
maternal CNS in both humans and in experimental animals
The biological half-life of methylmercury in humans has
(Marsh et al. 1980, Reynolds and Pitkin 1975). Further-
been estimated by Åberg et al. (1969). Using a one-compart-
more, it is likely that the fetal CNS reacts differently and is
ment model, a half-life of 73 days was determined. This cor-
more sensitive than the maternal CNS. Even if there are sim-
responds to the elimination of about 1% of the body burden
ilarities in neuropathological findings between adults and in-
per day. Recently, Smith et al. (1994) have estimated a half-
fants (Choi et al. 1978), there are specific findings in children,
life of 44 days and an excretion of 1.6% of the body burden
such as ectopic cells and cortical disintegration, which are
per day using a five-compartment model.
not seen in adults. This suggests an effect on astroglial cells
when the fetal CNS is exposed to methylmercury. Peckham
Metabolism
and Choi (1988) have shown in experiments on mice that
Demethylation of methylmercury occurs in the liver, kidney,
methylmercury disturbs development of astroglia resulting
intestine and stomach (Norseth and Clarkson 1970, Norseth
in abnormal distribution of cortical neurons. This may ex-
1971, Syversen 1974, Berlin et al. 1975, Yamamoto et al.
plain the behavioral abnormalities observed after methyl-
Chapter 12 ˇ Pollution and Human Health
783
mercury exposure. In humans, the development of astroglia
Intestinal absorption of cadmium from food is low, gener-
starts at gestational week seven and continues throughout
ally reported to be 5%, and influenced by other dietary
the fetal life (Reske-Nielsen et al. 1987). Thus, the effects of
factors such as iron and protein. Iron status may partially
methyl mercury could be exerted during most of fetal devel-
explain why dietary intake of cadmium is only reflected to a
opment. Neonatal CNS development can also be affected by
minor degree in blood Cd concentrations. Flanagan et al.
exposure to mercury through breast milk.
(1978) demonstrated in human studies that cadmium absorp-
Methyl mercury may also affect the immune system, how-
tion correlated inversely with serum ferritin. Because of these
ever, existing data are not conclusive. Ohi et al. (1976), Kol-
different factors, exposure estimates based on food data alone
ler et al. (1979), and Blakely et al. (1980) did not find signifi-
are not very useful for risk estimates.
cant immunosuppressive effects in mice and rabbits. Petruc-
Individual blood cadmium concentrations reflect: 1) pul-
cioli and Turillazzi (1990) have reported that monkeys (Mac-
monary absorption, 2) intestinal absorption, and 3) body
ca fasciculans), exposed orally to 0.4-50 g/kg bw/d, showed
burden. In smokers, the pulmonary fraction dominates, there-
a progressive dose-related reduction of IgG and, in the high-
fore, any risk assessments for cadmium should include infor-
est exposed groups, reduction in IgM and IgA. The lowest
mation on smoking habits. Where there is a constant exposure
dose used in the monkey study (0.4 g/kg bw/d) corresponds
level, the concentration in blood should reflect body burden.
to a daily intake by a 70 kg adult human of 28 g (0.4
70) ,
In animal tissues, cadmium is bound to the protein metal-
which is close to the PTWI. Based on these data, immunosup-
lothionein. Metallothionein has been shown to be absorbed
pressive effects of methyl mercury at exposure levels actually
intact by the human intestine. Cadmium absorbed through
reported in several Arctic communities cannot be excluded.
the lungs becomes bound to metallothionein in the liver and
Using the autometallographic technique, it has been dem-
transported via the blood stream to the kidney where it is
onstrated that methyl mercury exposure leads to heavy accu-
absorbed by the proximal tubular cells in the kidney cortex.
mulation of mercury in the thyroid gland (Hansen et al. 1989a,
Cadmium accumulates in the kidneys over time, in humans
Hansen and Danscher 1995). As this technique only reveals
until the age of about 50 after which time the renal concen-
inorganic mercury, this observation is consistent with a high
tration declines, probably due to the age-related loss of ac-
myeloperoxidase-iodine activity with a supposed high demeth-
tive nephrons. Cadmium also accumulate in the liver, and
ylation rate. At present, no studies have been carried out to
together the two organs contain approximately 50% of the
investigate possible adverse effects.
total body burden of cadmium (Friberg et al. 1974, 1984).
Based on kinetic studies, Friberg et al. (1984) estimated about
33% of the body burden to be present in the kidneys and
12.2.3.2. Cadmium (Cd)
about 16% in the liver. Based on an autopsy study, Samela
Cadmium was discovered in 1817, but its use in various tech-
et al. (1983) estimated that approximately 55% is stored in
nologies started late in the 19th century. Since then, the use
the kidneys and approximately 20% in the liver. However,
of cadmium has steadily increased, resulting in pollution of
these studies concern a very low exposure level. At higher ex-
the environment and in increased human exposure. In mod-
posures, a larger proportion is expected in the liver and a smal-
ern technology, cadmium has a wide spectrum of applica-
ler proportion is expected in the kidney (Friberg et al. 1984).
tions, such as in alloys, pigments, metal coating, and the elec-
tronic industry. Cadmium is a by-product of zinc and lead
Toxic effects
mining and smelting, which are important sources of envi-
The kidney cortex is the `critical target' in chronic cadmium
ronmental pollution. The toxicology of cadmium is exten-
exposure. Exposure may result in disturbances in the renal
sively reviewed by Friberg et al. (1986).
tubular function with increased excretion of small molecular
For the general population, the two main sources of expo-
weight proteins. 2 microglobulin release in urine is the first
sure are diet and tobacco smoking. Concentrations in air are
warning sign of incipient cadmium damage. Increased excre-
generally low. Cadmium is highly cumulative in animals and
tion of retinol-binding protein, N-acetyl- -glucosaminidase,
humans, with a half-life of more than ten years in humans.
amino acids and calcium are also indicators of tubular dys-
In Western countries, meat, fish and fruit typically con-
function. It has been estimated that one or more of these in-
tain 1-50 g/kg Cd, while grains typically contain 10-150
dicators are increased when the urinary cadmium excretion
g/kg. The highest Cd concentrations are found in the livers
exceeds 2-4 g/24 h (Buchet et al. 1990).
and kidneys of animals. Of special relevance to the Arctic is
Urinary excretion of cadmium is related to kidney con-
cadmium accumulation in the marine food webs and in graz-
centration and therefore to the overall body burden. Ellis et
ing mammals in cadmium rich areas. Shellfish (mussels, scal-
al. (1981) have indicated 217 mg/kg kidney cortex as the con-
lops and oysters) are reported to contain 100-1000 g/kg.
centration where 10% of a population will show signs of
In cetaceans in Greenland, levels of 3250 g/kg and 13 200
renal dysfunction, while Roels et al. (1983) have calculated
g/kg have been found in liver and kidney, respectively (Pa-
a figure of 185 mg/kg. These estimates are based on occupa-
ludan Müller et al. 1993). Caribou kidneys have been re-
tionally exposed workers, and the results could be influenced
ported to contain high concentrations of cadmium in some
by the fact that workers (i.e., persons of working age) tend
regions of Canada.
to be healthier than society in general. Recent studies indi-
Population groups with high consumption of traditional
cate that this is an underestimation of the risk. Elderly peo-
food may have cadmium intakes in excess of 700 g per
ple appear to develop renal tubular dysfunction already at
adult per day. This should be seen in relation to the PTWI
cadmium concentrations in the kidney cortex around 50 mg/
set by WHO at 490 g per person per week, i.e., 70 g per
kg (Elinder and Järup 1996), corresponding to urinary ex-
day for a 70 kg adult.
cretion of 2-3 g/24 h (Buchet et al. 1990). If the minimal
toxic concentration is indeed about 50 mg/kg kidney cortex,
Absorption and organ distribution
some people, especially elderly and diabetics, living in areas
Absorption of inhaled cadmium is about 15-30%. One cig-
with elevated cadmium levels will be affected. This also im-
arette contains 1 to 2 g of cadmium, of which 10% is in-
plies that the current provisional tolerable weekly intake is
haled (Elinder et al. 1983), thus, each cigarette smoked can
too high (Elinder and Järup 1996). This may be a significant
contribute 0.015-0.06 g cadmium to the body burden.
problem because cadmium-induced tubular dysfunction is
784
AMAP Assessment Report
irreversible (Kido et al. 1988) and no effective chelating ther-
Blood samples are most commonly used for estimating
apy has yet been found (Jones and Cherian 1990).
lead exposure. Mean blood Pb concentrations for non-occu-
Buchet et al. (1990) found an association between urinary
pationally exposed persons in industrialized areas in Europe
excretion of cadmium and calcium. Kido et al. (1991a, 1991b)
and North America are often reported to be between 100
have demonstrated that in cadmium-exposed Japanese with
and 200 g/L blood. Studies in remote societies have shown
renal tubular dysfunction, the serum concentration of the
lower concentrations. Poole et al. (1980) found a mean blood
Vitamin K-dependent calcium-binding protein, osteocalcin,
concentration of 50 g/L in 100 children from an unpolluted
was higher in exposed than in individuals in a non-exposed
area in Papua New Guinea, and Piomelli et al. (1981) found
control group, and that the osteocalcin level was associated
30 g/L in 103 Nepalese children and adults. Concentra-
with indicators of osteopenia. These findings indicate that
tions below 10 g/L have been reported among Venezuela
even a modest cadmium exposure may influence calcium ho-
Indians (Hecker et al. 1974).
meostasis. Whether or not this can exacerbate the age-related
Existing data indicate that the northern hemisphere is more
osteoporotic changes in women with low dietary calcium in-
polluted with lead than the southern hemisphere, which is in
take needs further investigation.
accordance with the fact that most lead-emitting industries
It has been hypothesized that environmental exposure to
and historically the highest concentrations of automobiles
cadmium may lead to hypertension, and as such may also con-
burning leaded gasoline are found in the north.
tribute to the pathogenesis of cardiovascular diseases. How-
Some studies have indicated a decrease in environmental
ever, a population study comprising more than 2000 persons
exposure. Rabinowitz and Needleman (1982) reported a mean
carried out in Belgium did not confirm this hypothesis. Staes-
annual decline in lead levels of 11% in umbilical cord blood
sen et al. (1991) found no association between cadmium ex-
samples taken in Boston between 1979 and 1981. Among
posure and elevation of blood pressure or higher prevalence
children in Chicago, aged 6 months to 5 years, Hayes et al.
of cardiovascular diseases.
(1994) found a decline from a median blood Pb concentra-
Neurotoxic effects of cadmium have been reported in rats
tion of 300 g/L in 1968 to 120 g/L in 1988. In maternal
exposed during the perinatal period to doses that were not
blood samples collected in Greenland between 1984 and 1989,
expected to affect the dams (Wong and Klaassen 1982, Smith
Hansen et al. (1990b) found a mean annual decrease of 7%.
et al. 1985, Anderson 1996). Clinical studies have indicated
a correlation between body burden of cadmium and certain
Absorption and organ distribution
alterations in the behavior of children (Thatcher et al. 1982,
The most important sources of lead are generally air, food
Marlowe et al. 1983).
and drinking water. Respiratory uptake depends upon a num-
A number of epidemiological studies have been done to
ber of factors, especially particle size. Particles greater than
determine the relationship between occupational exposure
0.5 m are mainly cleared from the lungs and swallowed.
to cadmium and lung cancer and prostatic cancer. These stud-
The percentage of particles less than 0.5 m that are retained
ies have been reviewed by IARC (1987), with the conclusion
increases with decreasing particle size. About 90% of ambient
that exposure to cadmium may contribute to lung cancer,
air particles containing lead are small enough to be retained.
but confounding factors including cigarette smoking prevent
The retained lead is relatively efficiently absorbed through the
a definitive conclusion. For prostate cancer, the risk appears
alveoli. Intestinal absorption in adults is between 5 and 15%.
debatable (Waalkes and Rehm 1994). However, in a later
Children are known to have a greater absorption than adults.
evaluation, IARC (1993) declared cadmium a human carci-
More than 90% of the lead in the blood is found in the
nogen (Group 1).
red blood cells. The mean Pb concentration level in whole
The fetus is protected against cadmium because the pla-
blood is significantly lower in females than in males, possi-
centa accumulates cadmium and thereby acts as a partial
bly due to menstrual blood loss or hormone effects.
biological barrier (Wier et al. 1990). However, cadmium
The total body burden of lead may be divided into at least
may have an indirect adverse effect on fetal development as
two kinetic pools with different rates of turnover. The skel-
its interaction with zinc can induce a relative zinc deficiency
etal pool is larger and has the longest biological half-life, of
in the fetus.
up to 20 years (Rabinowitz 1991); lead in the soft tissue pool
is more labile.
Lead crosses the placental barrier. Cord blood levels gen-
12.2.3.3. Lead (Pb)
erally correlate with maternal blood levels, but are slightly
Industrial and vehicle-exhaust emissions are regarded as being
lower. Lead is excreted in the urine.
the most important sources of environmental lead. As such,
most of the Arctic is expected to be an area with low human
Toxic effects
lead exposure. However, in Greenland, blood lead levels have
Toxic effects from lead constitute a continuum from clini-
been reported that are comparable to those found in West Eu-
cally overt effects to subtle biochemical effects involving the
ropean cities (Hansen 1981, Hansen et al. 1983, 1984). The
hematologic, neurologic and renal systems. In general, chil-
relatively high blood levels in Greenland have still not been
dren are more sensitive to lead exposure than adults, due to
explained, but could possibly be a result of long-range trans-
a higher intestinal absorption and high sensitivity of imma-
port of lead by atmospheric particles. The studies of Muro-
ture tissues. Prenatal life may be a period of particular vul-
zomi et al. (1969) and Rahn and McCaffrey (1980) both in-
nerability. The earliest and most sensitive effect is inhibition
dicate that a combination of mid-latitude pollution and me-
of -aminolevulinic dehydratase (ALA-D), which can be ob-
teorological conditions could account for the lead exposure
served at blood concentrations < 100 g/L. Lead also inhib-
in the Arctic.
its ferro chelatase, resulting in anemia.
The pathway from the environment to humans is not clear,
In 1979, Needleman et al. reported that children exposed
and seems to involve several sources of exposure, not just
to environmental lead who did not exhibit clinical symptoms
those related to contamination of food. As a consequence,
of lead toxicity, had deficits in psychometric intelligence,
human exposure estimates based only on results of environ-
speech and language-processing, attention, and classroom
mental monitoring of consumed foodstuffs are not generally
performance. In an eleven year follow-up, the neurobehav-
adequate.
ioral deficits were found to persist (Needlemann et al. 1990).
Chapter 12 ˇ Pollution and Human Health
785
Numerous other studies of the effects of lead on children
tude, although enhancement from leaching from stainless-
have been published, and the results have been combined by
steel piping does occur. Background soil and sediment nickel
means of quantitative meta analysis to provide a more valid
concentrations are less than 10 g/g (dw). A thousand-fold
estimate of the true effect level (Needleman and Gatsonis
increase in surface water, sediments and soil levels have been
1990). A WHO/CEC study on 1800 children in eight Euro-
noted in contaminated areas (Chau and Kulikovsky-Cordei-
pean countries confirmed that there are small but detectable
ro 1995). Comparable elevations are seen in vegetation (Mc-
exposure-related neurobehavioral effects in school-age chil-
Ilveen and Negusanti 1994). Near nickel-smelting/refining
dren. The study also found that it was not possible to iden-
operations, or in naturally nickel-enriched areas, surface
tify an effect threshold (Winneke et al. 1990). Epidemiologi-
water, sediment and soil levels of nickel are within the range
cal studies have reported that low-level exposure to lead
to cause harmful effects to sensitive water-column organisms
(100 g/L in blood) during early childhood is inversely as-
and terrestrial plants, as well as to soil microbial popula-
sociated with neuropsychological development at school-age
tions (PSL 1994). In contaminated areas, bioconcentration
(Baghurst et al. 1992). Today there is an increasing concern
of nickel occurs in aquatic and terrestrial biota; biomagnifi-
about childhood exposure to lead at levels as low as 100 g/L
cation through food chains is not known to occur.
(Davis et al. 1993).
The risk to the fetus from exposure in utero is uncertain
Absorption and organ distribution
(Rice 1990, Bellinger et al. 1992). The general sensitivity of
Inhalation and ingestion are the major routes of nickel in-
the prenatal nervous system to chemical insult, the presence
take by humans. Respiratory absorption is the most signifi-
of lead in the fetus after maternal exposure, and subtle effects
cant route in occupational settings. Dietary nickel intake has
seen in rodents exposed during gestation, all raise concerns.
been estimated at 100-300 g per day, averaging around 150
Recently, Newland et al. (1994) have demonstrated pro-
g per day (Nieboer and Fletcher 1995). Foods that are rel-
longed behavioral effects and learning deficits in squirrel mon-
atively rich in nickel include cocoa, soya beans, other dried
keys born to mothers exposed to lead during pregnancy and
legumes, nuts and certain grains (Nieboer et al. 1992). About
with blood levels equivalent to those tolerated in humans in
1% of dietary nickel is absorbed, while the amount absorbed
occupational settings. These data raise the possibility of hu-
from drinking water may be as high as 25%. Background
man fetal hazards at exposure levels actually present in cer-
serum nickel levels accepted as normal for non-occupation-
tain occupational environments and in heavily polluted areas.
ally exposed individuals are about 0.30 g/L, with a normal
Studies by Blanzka et al. (1994) suggest that low concen-
range upper limit of less than 1.1 g/L, while levels in urine
trations of lead are capable of inhibiting nitrite produced by
are less than or equal to 2 g/L (normal range upper limit of
the calcium-dependent constitutive form of nitric oxide syn-
6 g/L) (Nieboer et al. 1992, Templeton et al. 1994). Both
thase (cNOS), while the calcium-independent inducible form
urinary and serum levels constitute good indices of exposure.
of nitric oxide synthase (iNOS) is not affected. These data
On average, urinary nickel concentrations are about a factor
provide a new hypothesis for the mechanism of lead neuro-
of 10 greater than serum levels. Toxicokinetic modeling sug-
toxicity, as nitric oxide acts as a neurotransmitter in the brain
gests that an average adult excretes approximately 2-6 g
(Snyder 1992).
Ni per day with comparable levels expected for the urinary
and biliary routes (Nieboer et al. 1992). The major storage
compartments in humans are the serum and the tissues. The
12.2.3.4. Nickel (Ni)
elimination half-time into urine for nickel absorbed both from
Nickel is mined either as sulfide or lateritic ores. Major depo-
drinking water and food has been estimated as 28
9 hours
sits occur in Canada, Russia, South Africa, New Caledonia,
(range 17-48 hours). This also applies to industrial exposure
Cuba, The Dominican Republic and Indonesia. Most of the
to aerosols of water-soluble nickel compounds; half-times of
nickel production is used in the making of alloys, most no-
more than three years have been reported for retired nickel
tably stainless steel. Nickel metal and nickel compounds are
workers exposed to pyrometallurgical intermediates (pri-
used in the electroplating of consumer goods and industrial
marily as particulates).
materials, in the manufacture of nickel-cadmium batteries,
and as catalysts in chemical processes (Nieboer 1992). Nickel
Toxic effects
is extracted from its ores by pyrometallurgical or hydromet-
Due to its volatility (boiling point of 43°C), nickel tetracar-
allurgical procedures, or some combination of these, and is
bonyl (generally referred to as nickel carbonyl) is used in com-
produced in the pure state through the Mond (nickel carbo-
mercial refining of nickel to obtain a high purity product (An-
nyl) process, electrolysis or electrowinning.
tonsen 1981). The toxicity of nickel carbonyl is different from
Nickel enters surface water and the terrestrial (soil) envi-
the other nickel compounds because of its unique chemical
ronments as a result of natural weathering and erosion of
properties (e.g., zero oxidation state and high lipid solubil-
geological materials. It is also released as a result of human
ity). Nickel carbonyl poisoning is systemic, although the lung
activities, including mining, smelting, refining, alloy produc-
and brain are affected most significantly. Fatalities have been
tion, plating, fuel combustion and waste incineration.
documented.
Ambient levels of nickel are low, typically 1-20 ng/m3 in
Compared to inhalation of nickel carbonyl, ingestion of
air at urban and rural areas with no obvious nickel source.
nickel (II) sulfate or chloride is considerably less toxic. In an
Near nickel refinery sites, however, levels may be as much as
incident in which 32 electroplating workers drank water ac-
a 1000 times higher (Norseth 1994, Chau and Kulikovsky-
cidentally contaminated with nickel sulfate and nickel chlo-
Cordeiro 1995). The most important anthropogenic sources
ride (estimated as 1.63 g Ni/L; doses were estimated to be
in ambient air are base metal production (ca. 65%) and fos-
0.5-2.5 g) (Sunderman et al. 1988), most of the workers de-
sil fuel combustion. Nickel (in dissolved and particulate form)
veloped some symptoms such as nausea, abdominal cramps
enters the aquatic environment in effluents and leachates, as
or discomfort, giddiness, lassitude, and diarrhea which lasted
well as through atmospheric deposition after anthropogenic
from a few hours to 1-2 days in the most severe cases. Urin-
release. Surface freshwater typically has nickel levels less than
ary and serum nickel concentrations observed for these sub-
2 g/L, while that of marine water is less than 1 g/L. Con-
jects are by far the highest levels recorded by any laboratory
centrations of nickel in drinking water are of similar magni-
recognized for performing reliable nickel analyses: 13-1340
786
AMAP Assessment Report
g/L in serum, compared to baseline values of 0.3 0.2 g/L;
cancer risks has been accepted by IARC, although based on
230-37 100 g/L in urine compared to normal values of 2 1
animal data it is designated as possibly carcinogenic to hu-
g/L. In a human experimental study, transient neurological
mans (IARC 1990). It is also clear that respiratory cancer
disturbance (hemianopsia) occurred at a dose of 50 g Ni/kg
risks have not been found to extend to the user industries or
bw administered as nickel sulfate in drinking water (Sunder-
nickel alloy manufacturing. Exposure to nickel carbonyl, for
man et al. 1989). No adverse effects were evident at two lower
which there is limited evidence for carcinogenicity in animals,
doses (12 or 18 g Ni/kg bw), where mean peak serum lev-
is not implicated.
els for four volunteers in each of the lower dose groups were
20 and 30 g Ni/L, respectively.
Miscellaneous toxicological effects
Reproductive and developmental toxicity. Until very recent-
Hypersensitivity reactions
ly, reproductive and developmental effects in humans had
Asthma. Although nickel-related asthma is rare, periodic case
not been reported in connection with exposure to nickel com-
reports and case series studies in an occupational context
pounds (e.g., Clarkson et al. 1985, WHO 1991b). In a pre-
have been documented since 1973 (e.g., McConnell et al.
liminary and qualitative report, Chashschin et al. (1994) have
1973, Dolovich et al. 1984, Malo et al. 1985, Nieboer et al.
expressed concern about apparent increases in spontaneous
1988, Shirakawa et al. 1992).
abortions and structural malformations (especially cardio-
vascular and musculoskeletal defects) in newborn babies
Allergic dermatitis. Worldwide studies of populations sug-
whose mothers were employed in a Russian nickel refinery.
gest a rather uniform prevalence of nickel dermatitis, 7-10%
This concern requires a more comprehensive and quantita-
in females and 1-2% in males (Maibach and Menne 1989).
tive epidemiological investigation.
In dermatological clinics, 10-20% of females react to nickel,
compared to 2-10% of males. Primary contact dermatitis has
Renal toxicity. It may be concluded that nickel compounds
a good medical prognosis, although continued exposure may
have low nephrotoxicity in humans. A number of reports of
lead to chronic forms involving other sites, especially the hands
mild proteinuria are known for individuals exposed occupa-
(Christensen 1990). The majority of patients are exposed to
tionally or through consumption of contaminated well water
non-occupational sources, with the leaching of nickel from
(Gitlitz et al. 1975, Sunderman and Horak 1981). Mild tran-
inexpensive earrings, other jewelry, or wrist watches being
sient nephrotoxicity (e.g., proteinuria) was observed with
the main causes. Ear-piercing is a recognized determinant.
the accidental ingestion incident mentioned earlier (Sunder-
Nevertheless, work-related nickel dermatitis is a common dia-
man et al. 1988).
gnosis in reports of permanent disability involving skin dis-
eases (Maibach and Menne 1989). In its chronic form (i.e.,
Cardiotoxicity. Nickel (II) chloride induces coronary vaso-
presence of hand eczema), flaring of recurrent nickel derma-
constriction in the dog heart in situ and in isolated perfused
titis can occur when patients are challenged orally with a
rat heart (Rubanyi et al. 1984, Edoute et al. 1992). A critical
nickel (II) salt. Systemic induction, therefore, appears possi-
review of the available literature suggests that cardiotoxicity
ble. There is a good indication that nickel-restricted diets
or cardiovascular disease in humans is not a recognized re-
and avoidance of nickel-rich foods are helpful (Maibach and
sponse or outcome (Nieboer et al. 1988). Interestingly, in the
Menne 1989, Nielsen 1992).
above mentioned incident whereby men were acutely exposed
to nickel due to consumption of contaminated drinking water
Other immunotoxic responses. Animal studies suggest that
at work, palpitations lasting up to half a day constituted the
nickel compounds can produce immune suppression. The
extent of heart related symptoms (Sunderman et al. 1988).
thymus, T-lymphocytes, macrophages, and natural killer-cells
appear to be sensitive targets (Nieboer et al. 1988, Knight et
Concluding remarks
al. 1991, Nicklin and Nielsen 1992). There are no correspond-
Most of the health effects of Ni described above have been
ing human data, although inflammatory alterations charac-
experienced under conditions of occupational exposure or
terized by a loss of cilia and gradual modification of epithe-
acute toxicity. However, nickel contact dermatitis is primar-
lial cell shape and arrangement have been observed in the
ily a public health disease, that is both debilitating and pre-
nasal mucosa of active and retired nickel workers (Boysen et
ventable. It is exacerbated by dietary (including drinking
al. 1982, 1994).
water) intake of nickel and, thus, the pathology of the der-
matological response may be influenced by environmental
Cancer
contamination. Urinary and serum nickel levels are sensitive
Association between occupational nickel exposure and en-
indices of environmental or occupational exposure and, thus,
hanced risk of lung and nasal sinus cancers was suspected
are useful parameters in biological monitoring assessments.
over 50 years ago (Doll 1990). The first published reports
In communities where a significant proportion of the popu-
appeared in 1958 (Doll 1958, Morgan 1958). Since that time
lation is employed in nickel refining or a comparable indus-
many studies with positive findings have been published. Ini-
try, such as Nikel and Norilsk, in Russia, environmental
tially, exposure to nickel carbonyl was suspected, and in
health assessments must take cognizance of disease carry-
subsequent years it was believed that the greatest cancer risk
over such as reproductive or developmental impairments or
occurred among nickel smelter workers. A comprehensive
cancer risk due to occupational exposure to nickel. On the
reassessment (Doll 1990) concluded that, in addition to pyro-
other hand, the industrial experience must not close the door
metallurgical intermediates in the nickel-refining process
to other and perhaps unsuspected health effects.
(mostly nickel oxides and sulfides), water-soluble salts such
as nickel chloride and nickel sulfate also increase lung and
12.2.3.5. Arsenic (As)
nasal cancer risks. The respiratory cancer incidences were
primarily related to soluble nickel exposures at concentra-
Arsenic is a constituent of more than 200 different minerals,
tions more than 1 mg Ni/m3 and to less soluble forms at more
though in small amounts, and is found most frequently in
than 10 mg Ni/m3. The conclusion that nickel metal (as op-
association with sulfur. The mean concentration of inorganic
posed to Ni compounds) was not linked to lung and nasal
As in the continental crust is about 1.5-2.0 mg/kg. Soil levels
Chapter 12 ˇ Pollution and Human Health
787
are reported in the range of 0.3-10 mg/kg in cropland areas
Vascular effects. Adverse effects caused by inorganic arsenic
and 0.6-15.7 mg/kg in rural areas (values from Wolson 1983).
on peripheral circulation and even gangrene have been re-
The concentration of total As in ground and surface water is
ported in populations with a high intake of arsenic in drink-
usually below 10 g/L (Pershagen and Vahter 1979).
ing water, and in vintagers and vintners exposed to As in
As is present in higher concentrations in certain minerals.
pesticides and wine (Butzengeiger 1940, Astrup 1968, Grobe
The average As level in sedimentary iron ores is 400 mg/kg.
1976, Tseng 1977, Borgoņo et al. 1977, Lüchtrath 1983).
Certain coals are also rich in arsenic. Inorganic As, in the form
A high prevalence of gangrene (black foot disease) was
of arsenious oxide (As2O3), is released to the environment
reported from Taiwan, where the arsenic in well water ranged
through human activities, e.g., coal burning, mining, smelt-
from 0.01-1.82 mg/L (Tseng et al. 1968, Tseng 1977). Vas-
ing, and the use of As-containing pesticides (Fishbein 1981).
cular diseases were also reported from northern Chile in a
The environmental levels of arsenic around As-emitting
population exposed to arsenic in drinking water at levels of
plants are generally increased. It has been suggested that air
about 0.6 mg/L (Borgoņo et al. 1977).
levels of As are about 10 to 100 times higher in smelter areas
An increased prevalence of Raynaud's phenomenon and
than in urban and rural environments (Wolson 1983).
vasospastic tendency was found in smelter workers in north-
The background concentration of As in food and drinking
ern Sweden with long-term airborne exposure to inorganic
water is generally low and the daily intake of As will normal-
arsenic at relatively low dose (Lagerkvist et al. 1986). The
ly not exceed 50 g (WHO 1981, Wolson 1983). In certain
mean urinary concentration of inorganic arsenic and its meth-
areas of the world, As concentrations in drinking water have
ylated compounds was 71 g/L (range 10-340), and the mean
been high with serious adverse health effects after prolonged ex-
daily intake of inorganic As was estimated to be 105 g dur-
posure, e.g., vascular and neurological diseases (WHO 1981).
ing the 8-40 years (mean 23 years) period of working at the
smelter, with a higher intake in the past.
Toxic effects
Toxicity of inorganic arsenic
Neurological effects. Peripheral nerve effects caused by inor-
The main mechanism behind the toxicity of As(III) compounds
ganic arsenic, ranging from simple neuralgia to severe para-
is their interaction with sulfhydryl-(SH)-groups in tissues (for
lysis, have been known and discussed for centuries. Geyer
a review see Squibb and Fowler 1983). Other mechanisms of
cited approximately 200 references in his review of different
enzyme interactions, e.g., competitive inhibition of substrate
clinical (including neurological) manifestations of chronic As
binding due to structural similarities, may also play a role.
exposure through As-polluted drinking water (Geyer 1898).
In vivo toxicity of inorganic arsenic is dependent on many
Arsenic neuropathy is considered to be a sensory-motor
different factors, such as the animal species and the chemical
distal axonopathy with accompanying demyelination (reviews
form and the solubility of the As compound. As(III) (arsen-
in Chhuttani and Chopra 1979, and Manzo 1985). The bio-
ite) compounds are more toxic than the As(V) (arsenate) salts.
chemical effects of arsenic at the cellular level, e.g., binding
Pentavalent arsenicals, due to their structural similarity with
to SH-groups and inhibition of oxidative phosphorylation,
phosphate, uncouple oxidative phosphorylation. Part of the
are consistent with a process leading to distal axonal degen-
arsenate administered in in vivo experiments is reduced to
eration (Manzo 1985).
arsenite (Hindmarsh and McCurdy 1986).
Most of the peripheral nerve lesions described in the liter-
In humans, as in many animal species, arsenic is methyl-
ature are caused by comparatively high doses of arsenic (e.g.,
ated and excreted in the urine as monomethylarsonic acid
Jenkins 1966, WHO 1981). There are few studies on nerve
(MMA) and dimethylarsinic acid (DMA) (Smith et al. 1977).
effects resulting from occupational low-dose exposure. Hine
The metabolism of As is fairly rapid and the biological half-
et al. (1977), discussing the medical problems associated with
life in humans is about 2-3 days (Crecelius 1977, Pomroy et
As exposure in the Tacoma smelter, Washington, found no
al. 1980, review: Vahter 1983). In a study of Swedish smelter
clinical neuropathy in the employees, though they `might
workers, urinary As levels had decreased to normal values
have been heavily exposed to airborne As2O3 in the past'.
after four weeks vacation (Lagerkvist et al. 1988).
Subclinical neuropathy in high As exposure groups with a
Different studies on the distribution of inorganic arsenic
5-year average periodic urinary arsenic above 200 g/L has
in vivo show the highest concentrations in skin, gastro-intest-
been reported in a study on 70 copper smelter workers and
inal mucosa, liver and hair (Vahter 1983).
41 controls from the USA. Subclinical neuropathy was de-
fined as `one or more nerves with reduced conduction veloci-
Health effects of inorganic arsenic
ties, or two or more nerves with reduced amplitudes' (Feld-
Adverse health effects after exposure to inorganic arsenic com-
man et al. 1979).
pounds, both in the general and occupational environment,
In a study on smelter workers from northern Sweden,
are described in several reports and reviews. Both acute, sub-
Bloom et al. (l985) reported subclinical effects on the peri-
acute and chronic effects are reported. Almost every organ
pheral nervous system, i.e., reduced nerve conduction velo-
system may be affected (reviews: Jenkins 1966, Chhuttani
city (NCV). A statistically significant correlation was found
and Chopra 1979, Pershagen and Vahter 1979, WHO 1981,
between reduced NCV, decrease of finger blood pressure
Pershagen 1983, Hindmarsh and McCurdy 1986, Bates et
during cooling (vasospastic tendency) and total estimated
al. 1992). Chronic bronchitis, liver cirrhosis, peripheral vas-
absorption of arsenic.
cular disease, neuropathy, CNS disturbances, cardiovascular
In a study from Alaska on 147 Ester Dome residents ex-
diseases, and cancer in the liver, lung, stomach and other in-
posed to arsenic in well water, the median As concentration
ternal organs are considered to be associated with exposure
in the water was 41 g/L (range, 1- 4781) and in the urine it
to inorganic arsenic. Skin disorders ranging from dermatitis,
was 51 g/L (range 6- 4964). The calculated index of the daily
melanosis, and hyperceratosis to skin cancer have been de-
ingestion of As was 14.5 g and correlated closely with the
scribed in workers and populations exposed to arsenic (Tseng
urine As concentration. Median exposure time was five years
et al. 1968, WHO 1981). Peripheral vascular disease and neu-
(Kreiss et al. 1983). Symptoms or clinical signs of sensory
ropathy caused by contaminated drinking water are the most
neuropathy were found in six persons, and one or more ab-
common adverse health effects reported in population stud-
normal NCVs in 13 persons. However, no dose-response re-
ies with moderate exposure levels.
lationship was found between As ingestion and NCVs. The
788
AMAP Assessment Report
authors concluded that the As exposure had not resulted in
Table 12ˇ3. Effects of various doses of radiation
clinical or sub-clinical neuropathy.
(UNSCEAR 1988, ICRP 1991).
The urinary levels of As, assuming that comparable ana-
Dose in millisieverts (mSv)
Description
Cancer risk
lytical methods were used, were lower in the Alaskan study
on environmental exposure of As than in the studies on smel-
10000 in a short time (hours) survival unlikely
1000 in a short time (hours)
onset of acute radiation illness 1 in 20
ter workers. When monitoring arsenic in urine, inorganic As
20 in a year
occupational dose limit
1 in 1000
and its methylated metabolites should be determined since
2 in a year
background radiation dose
1 in 10000
analysis of total As includes also the organic arsenic from fish.
1 in a year
public dose limit
1 in 20000
0.1 per exposure
chest x-ray
1 in 200000
Toxicity of organic arsenic
Arsenate in seawater is transformed into organic compounds
per kilogram of tissue, or an amount of any other type of ra-
by marine algae and accumulates in the food web (Tamaki and
diation that would do as much biological damage as one
Frankenberger Jr. 1992). In fish and other seafood, organic
joule per kilogram of gamma radiation. The threshold for
As compounds, e.g., arsenobetaine, (CH3)3AsCH2COOH,
the onset of acute radiation sickness is about 1000 mSv de-
may be present in relatively large amounts. At present, these
livered over a short time period (a few hours or days). As
are not considered to be toxic to humans. Different authors
the dose increases, the symptoms become more severe. Sur-
have found no indication of bio-transformation in humans
vival of humans and other mammals is unlikely for doses
after ingestion of lobster, crab meat, or flounder containing
above 10 000 mSv. Levels such as these are almost never en-
as much as about 2 mg of organic As in one meal (Crecelius
countered in the environment. Normal background exposure
1977, Cannon et al. 1979, Charbonneau et al. 1980, WHO
is about 2 mSv per year, resulting predominantly from natu-
1981, review: Vahter 1983).
rally-occurring radionuclides in the earth's crust and in the
In recent years, some in vitro studies have shown that DMA
human body, as well as from cosmic radiation.
(one of the urinary metabolites of inorganic As) can act as a
The health effects of chronic exposure to low levels of ra-
clastogen. In one recent experimental study, tumor induction
diation are not as clearly understood. Ionizing radiation is a
in urinary bladder, kidney, liver, and thyroid gland was en-
known carcinogen and its effects in humans have been well
hanced in rats sequentially treated with three different nitro-
documented in studies of high levels of radiation exposure,
samines, methylnitrosurea and dimethylhydrazine followed
e.g., survivors of atomic bombs, occupationally exposed per-
by administration of DMA (Yamamoto et al. 1995). The au-
sons, and persons treated medically with radiotherapy (UN-
thors concluded that DMA was acting as a promotor. No tu-
SCEAR 1977, BEIR 1990, ICRP 1991). It is generally found
mors or preneoplastic lesions were observed in the two con-
that the risk of developing cancer is directly proportional to
trol groups (n = 12 in each group) given 100 and 400 mg/kg
the amount of radiation received. The risk has been found to
of DMA for 24 weeks. Thus, to date, neither epidemiologi-
be about 0.05 per sievert of exposure (or 5
105 cancers
cal nor experimental studies have demonstrated carcinogenic
per mSv of exposure). For exposures below about 100-200
effects from exposure to DMA alone or to more complex or-
mSv, the number of radiation-induced cancers becomes sta-
ganic As compounds.
tistically indistinguishable from cancers produced by other
causes. Radiation protection authorities generally assume
Concluding remarks
that there is no threshold for radiation-induced cancer, and
In conclusion, the major health risk of environmental expo-
that even a very low-level exposure carries some small but
sure to arsenic seems to be through drinking water which is
finite risk of developing cancer. It should be noted that this
locally contaminated with inorganic arsenic. In recent years,
is an assumption that is unproven and may be unprovable.
it has been suggested that inorganic arsenic might be essen-
Genetic or hereditary effects of radiation are known to oc-
tial to humans and play a role in the synthesis of taurine (Niel-
cur in animals and are presumed to occur in humans. How-
sen 1990, 1991). A possible adequate daily intake of 12 to
ever, there is no direct evidence of the latter, even in the very
25 g has been suggested (Uthus and Nielsen 1993). In fact,
high exposures sustained by A-bomb survivors.
inorganic arsenic is excreted in the urine of people with no
Radionuclides in the Arctic environment may be of natu-
known exposure (WHO 1981). In a study on pregnant wo-
ral or artificial origin. Natural radionuclides include potas-
men in northern Sweden, urinary levels of inorganic arsenic
sium (40K) and members of the uranium and thorium decay
were of the same magnitude as the daily required dose sug-
series. They form a significant part of the natural radiation
gested by Uthus and Nielsen (Jakobsson Lagerkvist et al.
background to which humankind has always been exposed.
1993). However, further studies are needed before definite
Environmental levels of these radionuclides may become en-
conclusions can be made about whether inorganic arsenic is
hanced as a result of human activities such as uranium mining.
essential to humans or not.
Artificial radionuclides in the Arctic and elsewhere are
mainly products of nuclear fission. During the 1950s and
1960s, a great deal of this material entered the environment
12.2.4. Health effects of ionizing and
as a result of fallout from nuclear weapons testing. The sign-
non-ionizing radiation
ing of the Limited Test Ban Treaty in 1963 did much to re-
12.2.4.1. Radionuclides
duce this source of contamination, however, France and China
This section provides a brief summary of information pre-
were not parties to the treaty and continued atmospheric test-
sented in more detail in chapter 8, focusing here on human
ing until 1980. Major nuclear accidents such as that at Cher-
health aspects. As an introduction to the effects of ionizing
nobyl in 1986 have injected fresh radioactive material into
radiation on human health, Table 12ˇ3 gives a description of
the Arctic region. Nuclear dump sites have also contributed.
radiation effects at various levels of exposure.
Discharges from reprocessing plants in western Europe and
Absorbed dose of radiation is measured in grays (Gy). Equi-
Russia, and from nuclear dump sites have also contributed sig-
valent dose and effective dose are both measured in sieverts
nificantly to the radioactive contamination of the Arctic seas.
(Sv); reported dose estimates are more commonly associated
The following is a brief description of those radionu-
with the unit millisieverts (mSv). One sievert (i.e., 1000 mSv)
clides, both artificial and natural, that are of greatest con-
corresponds to one joule of gamma radiation energy absorbed
cern for human health in the Arctic.
Chapter 12 ˇ Pollution and Human Health
789
Radiocaesium
are transported by atmospheric particulates and tend to set-
Environmental radiocaesium consists primarily of two iso-
tle out on vegetation. They are concentrated particularly in
topes, 137Cs with a half-life of 30 years and 134Cs with a half-
the lichen reindeer/caribou human pathway. Some Ca-
life of about two years. Radiocaesium from atomic bomb fall-
nadian studies have indicated doses of up to 10 mSv per year
out is predominantly 137Cs. Both 137Cs and 134Cs are present
to Arctic residents from exposure to these radionuclides.
in nuclear reactor wastes, in the ratio of about two to one.
Since they are naturally-occurring and ubiquitous, it is likely
In biological systems, caesium behaves in a manner similar
that these doses would be about the same in all circumpolar
to potassium, an essential nutrient. Ingested radiocaesium is
countries where caribou and reindeer are consumed. Further-
almost completely absorbed by the intestine and becomes dis-
more, these doses have remained about the same during the
tributed throughout the body, mainly in muscle tissue. It is
10 000 to 20 000 years that human populations have inhab-
cleared from the body with a half-life of two to three months.
ited the Arctic.
The radiocaesium isotopes are considered to be the artificial
radionuclides of greatest concern for human health in the
Other radionuclides
Arctic. They are concentrated particularly by two food chain
Two other long-lived radionuclides are relevant to the Arc-
pathways:
tic, radiocarbon (14C) and radioiodine (129I). Both are natu-
rally present in minute traces, but levels are enhanced by an-
Lichens reindeer/caribou humans
thropogenic sources. 14C is produced as an activation prod-
Freshwater fish humans.
uct in the nuclear fuel cycle. The individual doses from this
Chapter 8 (Table 8ˇ13) indicates average cumulative doses
radionuclide in the Arctic are quite small, as indicated in chap-
to Arctic populations of 0.74 to 11.6 mSv from the ingestion
ter 8, however, its long half-life (over 5000 years) means that
of radiocaesium. For selected populations, these doses vary
it will be available as an exposure source for generations far
from 10.5 to 152 mSv (Table 8ˇ14). It should be noted that
into the future. 129I is released in minute quantities from fuel
these dose estimates are highly variable. They depend on the
reprocessing activities. Its very long half-life (16 million years)
local concentrations of radiocaesium in reindeer and caribou
means that its potential impact will extend even further into
herds and in fish, and also on the amount consumed. The lat-
the future.
ter quantity can be particularly difficult to estimate and 152
Neither of these two radionuclides are of major health con-
mSv should be regarded as an upper limit for individual life-
cern at present. However, their long-term impacts need to be
time exposure. Most of the cumulative exposure is due to glo-
clearly understood, and their levels should be monitored to
bal fallout from nuclear weapons testing and the levels are
ensure that they are not increasing.
quite similar across all of the circumpolar countries. Fallout
from the Chernobyl accident was more variable, with the Nor-
12.2.4.2. UV radiation
dic countries receiving the largest share, followed by north-
ern Russia and North America.
Satellite measurements in the northern polar regions indicate
It is important to note that virtually all of the cumulative
a 10% reduction in levels of stratospheric ozone during the
radiocaesium dose has already been received. Barring another
last 15 years (IASC 1995). Upper atmospheric ozone deple-
major input, such as a serious nuclear reactor accident or
tion has raised concerns about the effects of increased ultra-
the resumption of atmospheric nuclear testing, the impact of
violet (UV) radiation exposure on human populations (see
current levels of radiocaesium on future generations will be
also chapter 11). Since stratospheric ozone functions as a fil-
minimal.
ter, reducing the amount of solar radiation at wavelengths
below 330 nm that reaches the Earth's surface, reductions in
Radiostrontium
ozone will allow more of these wavelengths, UV-B (290-315
90Sr is a fission product with a half-life of about 30 years.
nm) and UV-A (315-400 nm), to reach the biosphere (WHO
About 30% of ingested strontium is absorbed by the intes-
1994b). Biological activity increases as wavelength decreases.
tine and, being chemically similar to calcium, it becomes de-
For every 1 nm shift of the solar spectrum towards shorter
posited in bone where it may remain for many years. It was
wavelengths, the biological activity of sunlight may increase
largely due to concern over this radionuclide, and especially
by as much as 15% (Wulf 1994). This is sometimes referred
its effects on the bone marrow and on the developing bones
to as the `Biological Amplification Factor' for solar UV spec-
of children, that led to the banning of atmospheric nuclear
tral shifts. Such a shift toward shorter wavelengths during the
weapons tests in 1963.
Polar summer will mainly increase biologically active wave-
90Sr is concentrated particularly by the grass cow
lengths below 310 nm. Therefore, even small changes in ozone
milk human pathway. Its impact on Arctic residents is
may have substantial biological consequences and alter the
no greater that the impact on other populations groups.
health status of the Arctic population.
Chapter 8 (Table 8ˇ15) gives average 90Sr doses of 0.21 to
In the Arctic, the total annual UV-B exposure at ground
0.36 mSv, with 0.06 to 4.4 mSv to selected groups (Table
level is about two thirds of that in southern Scandinavia. In
8ˇ16). These doses are much smaller than those from radio-
addition to this surface exposure, the terrain reflection from
caesium.
ice and snow covered surfaces may increase the albedo and
contribute an additional 30% in parts of the year (Kromann
Radionuclides of lead and polonium
et al. 1986) (see chapter 11 for more details). As the ground
Lead-210 and polonium-210, two natural radionuclides, make
surface reflection is important to ocular exposure, a very sub-
a greater contribution to the present day exposure of Arctic
stantial impact upon ocular health may be expected (Sliney
populations than all artificial radionuclides combined. Both
1986, 1995).
radionuclides are members of the decay series of naturally-
occurring 238U. They become airborne as a result of the decay
Biological effects
of radon gas seeping from soil. Uranium mining and proces-
The acute effects of UV-B on humans are erythema (`sunburn')
sing operations may lead to enhanced concentrations of 210Pb
and photokeratitis (`snow blindness'). The chronic effects
and 210Po in the environment. 210Pb has a half-life of 22.3
are elastosis (wrinkles), skin cancer and possibly cataracts.
years. It decays to 210Po (half-life of 138 days). 210Pb and 210Po
The acute effects appear within hours and fade within days.
790
AMAP Assessment Report
The chronic effects take years to develop and are not revers-
Skin cancer
ible (WHO 1994b).
By far the most significant health impact of increased UV-B
Photodermatoses are often UV-A provoked while other
irradiation of the skin concerns the expected increased inci-
types of effects are mainly UV-B provoked.
dence of skin cancers as these are strongly associated with
UV-B exposure (De Gruijl and van der Leun 1994, IASC
Erythema
1995). The three most common types of skin cancers are
Erythema or sunburn (literally, reddening of the skin) is an
termed basal cell carcinoma, squamous cell carcinoma, and
acute response resulting from UV irradiation of the skin. The
malignant melanoma. These tumors are lethal in < 1%, < 5%
sunburn is the result of the release of inflammatory cytokines
and approximately < 30% of the cases, respectively. They
leading to skin reddening from the dilation of the small su-
develop from mutated cells in the basal cell layer of epider-
perficial blood vessels, and later edema and thickening of the
mis, the squamous cell layer, and from the melanocytes (pig-
stratum corneum. The skin adapts to higher UV radiation
ment cells) in the basal cell layer. The incidence of skin can-
exposure levels with melanogenesis (tanning). Although this
cers is strongly dependent upon skin phototype and melano-
optically reduces the radiation reaching the basal layer, the
competent skin type. Inuit populations are far less likely to
melanin pigment may play a greater role in reducing the ox-
develop skin cancers than are those with incomplete photo-
idative damage to DNA and other key biological molecules
repair mechanisms.
in less superficial layers. The maximal reaction is found 8-24
In Greenlanders, only about 15% of all three types of tu-
hours after irradiation and in severe cases blistering may be
mors are found relative to the expected prevalence from the
seen (McKinlay and Diffey 1987). Erythema is not very prob-
frequency among Danes living in Denmark (Prener et al.
lematic in itself but repeated heavy sunburns during child-
1991). The reasons for this lower incidence in Greenlanders
hood have been related to the development of the skin can-
are protection against exposure. In part this is due to the dark
cer, malignant melanoma.
pigmentation of skin compared to Danes in Denmark. Addi-
tionally, whereas Danes living in Denmark engage in sun-
Snow blindness
bathing, in particular combined with travel and vacations in
Snow blindness, the transient damage of the cornea (photo-
regions of high UV, Greenlanders are protected by more or
keratitis) and conjunctiva (photoconjunctivitis) resulting
less complete clothing cover year-round. Wulf (1994) has
from acute exposure to solar UV-B reflected from ice and
demonstrated that, among Inuit, pigment protection of the
snow (Hedblom 1961, Sliney 1983, 1995), has been known
skin against UV-B is about twice as efficient as that in the
since ancient times in the Arctic. Because the diffusely reflected
Scottish population.
UV-B comes from all sides, it is difficult to protect the eyes,
The UV-B exposure level of unprotected skin in Arctic re-
even with modern sunglasses with UV-absorbing lenses, since
gions has not been investigated, and studies of ground radi-
photokeratitis is known to result from UV-B entering from
ation in Nuuk, the most populated area of Greenland, has
the temporal areas of the lenses (Sliney 1994). Antique Inuit
just begun.
protective masks and slit goggles (Figure 12ˇ1), however, ap-
pear to offer effective protection since spatial rather than spec-
Cataract
tral attenuation is emphasized. Sliney (1994) found that less
Animal studies have shown that cortical and posterior sub-
capsular cataract can be caused by UV-B (Pitts 1970). In hu-
mans, cortical cataract has also been linked to chronic UV-B
radiation exposure (WHO 1994a).
The action spectrum for cataract formation, together with
the absorption spectrum of the cornea, reveals that wave-
lengths between 295 and 325 nm are most effective (Pitts
1970). Because these wavelengths correspond exactly to the
wavelength region that will increase as a result of ozone de-
Figure 12ˇ1. Traditional Inuit slit goggles from Greenland; the goggles pro-
tect the eyes against ultraviolet radiation. Photo: Rikke Claesson.
pletion, special attention should be paid to proper eye pro-
tection, keeping in mind that ground reflection with diffuse
than 1% UV-B entered a UV detector mounted in a manne-
radiation requires goggles with side shielding.
quin's eye position fitted with an Inuit bone slit goggle, com-
Increases in UV-B radiation should be considered a prob-
pared to 10-20% for conventional UV-B-absorbing sunglasses.
lem which could be costly for health care in remote areas
The incidence of snow blindness is unknown (WHO
(IASC 1995). Other eye diseases such as spheroidal degen-
1994a), but it is more common in the spring, when snow is
eration of the cornea, conjunctiva (climatic droplet kera-
still present and the sun's angle of elevation is such that sub-
topathy), and pterygium, may or may not be associated
stantial UV-B is present in the terrestrial solar spectrum. The
with UV-B exposure. However, pterygium mainly occurs
symptoms are severe pain, and in some cases blepharospasm
under conditions of climatic extremes and might therefore
(uncontrolled blinking). The signs and symptoms last for a
be of special relevance for UV-B in the Arctic (IASC 1995,
day or two. The condition is almost always reversible and it
WHO 1994a).
has generally been accepted that the condition is without se-
quelae. However, repeated severe episodes of snowblindness
Photodermatoses
may well increase the risk of delayed corneal pathologies.
There are a number of skin pathologies which are caused by
UV radiation. Photodermatoses are often provoked by UV-A
Elastosis
exposure and may actually be improved by some UV-B irra-
UV-B is the primary cause of destruction of collagen and
diation. For example, polymorphic light eruptions (PLE) is a
elastic fibers of the skin leading to inelastic skin and wrin-
common skin disease which appears most often with heavily
kles (Bissett et al. 1987). Such changes are commonly ob-
itching papules. The rash is primarily UV-A induced and may
served in facial skin of Inuit hunters who have rather normal
actually be improved slightly if the ratio of UV-B to UV-A
skin in areas protected by clothes. Studies of elastosis in Arc-
increases, as will occur with ozone depletion. The beneficial
tic populations have not been reported in the literature.
effect should be caused by increased skin thickness, increased
Chapter 12 ˇ Pollution and Human Health
791
pigmentation, and the UV-B suppression of immune function.
12.3.1. Copper (Cu)
The frequency of this disorder in the Arctic is not known.
Actinic prurigo (AP), a skin disorder, is described as affect-
Copper is an essential trace element. It is an important co-
ing the Canadian Inuit and may be hereditary. AP is most often
factor in oxidative proteins or enzymes (da Silva and Wil-
provoked by UV-B and will be worsened with an increase in
liams 1991). For example, cytochrome-c oxidase, which is
ambient UV-B radiation. This seasonal disease starts in child-
critical to respiration, contains copper; similarly, tyrosinase
hood (Orr and Birt 1984).
is a copper-based enzyme involved in the oxidative catabo-
lism of tyrosine. Ceruloplasmin is the most important serum
Immune system
copper-transport protein.
There has been a growing recognition during the last decade
Good dietary sources of copper are organ meats, especi-
that UV irradiation of the skin can alter the immune system.
ally liver, followed by seafood, nuts and seeds (US National
Although very low, sub-erythemal doses have long been re-
Research Council 1989). Human milk contains approximate-
ported to enhance the general immune system, the adverse
ly 0.3 mg/L, while cow's milk contains around 0.09 mg/L.
affects of UV exposure particularly UV-B are now recog-
An intake of 1.5-3.0 mg Cu per day for adults (between 1.0-
nized. UV-B exposure affects the function of the antigen-pre-
2.0 mg per day for children) is considered adequate and safe
senting cells of the skin, thereby affecting the immune system
(Burtis and Ashwood 1994).
(Schwarz 1995). The immune effect is not limited to the skin
as there is also experimental evidence of a systemic immuno-
Copper deficiency
suppressive effect of UV-B radiation (Goettsch et al. 1994).
Although copper deficiency is not frequently reported, it
It is unclear how much exposure is necessary to induce sys-
produces a plethora of clinical symptoms (Burtis and Ash-
temic immune suppression (IASC 1995).
wood 1994). Patients exhibit low plasma ceruloplasmin
The immune function may be easily affected by UV-B irra-
levels, anemia, neutropenia, and scurvy-like bone changes
diation because trans-urocanic acid on the skin surface is con-
which respond to copper supplements. Deficiency is also il-
verted by UV-B to cis-urocanic acid, which directly affects
lustrated by Menke's disease, a sex-linked disorder of cop-
the Langerhans cells in the skin (Pasanen et al. 1990, Noonan
per metabolism in which a defective copper transport gene
and deFabo 1992).
is responsible for systemic copper deficiency. Individuals
The suppression of the immune system is primarily a func-
exhibit progressive cerebral degeneration, retarded growth
tion of UV-B irradiation. The immune defense system may
and abnormally sparse and brittle hair (`kinky hair syn-
thus be impaired as a result of increased UV-B radiation due
drome').
to ozone depletion (IASC 1995).
Copper toxicity
Antioxidant defense
Copper toxicity is rare (Burtis and Ashwood 1994). The gen-
Free oxygen radicals play an important role in causing DNA
etically determined Wilson's disease clearly illustrates that
and cell membrane damage (Halliwell and Gutterridge 1989).
copper is a systemic poison. In this inborn error of metabo-
UV-B irradiation of the skin results in formation of reac-
lism, there is an accumulation of copper in all body tissues
tive oxygen intermediates and elevated oxidative stress. Al-
due to a defective gene encoding for a protein involved in
so, dietary contaminants such as heavy metals may result in
copper transport. A positive copper balance leads to deposi-
this type of reaction. It is therefore possible that dietary con-
tion of copper in the liver where it causes cirrhosis; in the
taminants and UV-B radiation may act together to reduce the
brain, causing mental disturbances, spasticity and tremor; in
naturally-occurring antioxidant defense systems of the skin.
the cornea, where the deposits are visible as the Kayser-Flei-
However, the diet in the Arctic is, in general, rich in antioxi-
scher ring; and in the kidneys, causing renal tubular loss of
dants, which may provide some protection (Halliwell and
amino acids, phosphate, bicarbonate and urate.
Gutteridge 1989). Improvements in the defense systems in re-
lation to chronic UV-B exposure have also been described
Accepted reference intervals
(Shindo et al. 1993). The overall result of increased UV-B ra-
The generally accepted serum Cu levels are between 601 and
diation should be considered harmful (Punnonen et al. 1995).
1373 g/L (Minoia et al. 1990). In pregnant women, the con-
centration is generally higher, increasing during pregnancy.
General conclusions
Accepted values at term are between 1180 and 3200 g/L.
Since Arctic populations are largely well clothed and the skin
The blood Cu concentration is known to increase in women
covered except for the face, one may expect only a slight in-
using estrogen therapy or substitution. A variation through
crease in the risk of skin cancer other than for the face. Of
childhood and youth is recognized, with low levels of 200-
far more serious concern may be ocular exposure.
700 g/L between 0-6 months, increasing to 900-1900 g/L
by 6-12 years of age. There are also gender differences, with
slightly lower levels in males (700-1400 g/L) than in fe-
males (800-1550 g/L).
12.3. Essential elements and other nutrients
Traditional diets of all cultural groups in the Arctic include
12.3.2. Zinc (Zn)
large amounts of animal foods. These diets are known to be
rich sources of most of the required nutrients, and it is evi-
More than 70 metalloenzymes are known to require zinc as
dent that the majority of essential minerals, protein and es-
a cofactor. One of these is the zinc- and copper-containing
sential fatty acids in the total diet come from the animal spe-
superoxide dismutase (SOD), which is important in the ox-
cies traditionally used for food.
idative defense system. Zinc also induces metallothionein, a
This section discusses the essential trace elements included
free radical scavenger. Metallothionein also binds other heavy
in the human health core program (Cu, Zn, Se), as well as
metals, especially cadmium, and as such acts as a detoxify-
iron and tin. It also looks at fatty acids, vitamins and pro-
ing agent.
tein intakes, all of which may modify the effects of contami-
To meet the needs of most healthy people, the recommended
nants.
zinc intake for adults in North America is 15 mg/d for males
792
AMAP Assessment Report
and pregnant women, 12 mg/d for other females and 10 mg/d
Plasma selenium concentrations decrease during pregnan-
for children. Zinc supplementation is normally not required.
cy compared to plasma concentrations of non-pregnant wo-
The accepted reference interval for zinc in plasma is 700 to
men. This is probably a result of the increased total plasma
1500 g/L. Plasma zinc concentrations exhibit both circadian
volume. In cord blood plasma, the selenium concentration is
and post prandial fluctuations, and are low during pregnancy.
about 40% lower than the maternal plasma level, while ma-
Fasting morning values of plasma Zn below 700 g/L suggest
ternal and cord blood whole blood levels are the same (Han-
marginal zinc deficiency.
sen et al. 1984). This may be partly due to the higher hemat-
Although zinc levels in the body are regulated by home-
ocrit value of cord blood as well as the higher binding capa-
ostatic mechanisms and do not accumulate with continued
city of fetal hemoglobin.
exposure (Bertholf 1988), the margin of safety for dietary
There is some evidence that low selenium intake may be
zinc intake is relatively narrow. The effects of excess zinc
associated with low sperm motility (MacPherson et al. 1994).
intake include: impairment of copper status (hypocupre-
A review of selenium in relation to fertility is provided in
mia), microcytosis, neutropenia, immune response impair-
Hansen and Deguchi (1996).
ment and reduction in high density lipoprotein concentra-
It has also been suggested that selenium is a protective
tions (HDL).
factor in the development of atherosclerotic lesions and is-
chemic heart disease (IHD). However, essential fatty acids of
the n-3 series have also been suggested as protecting against
12.3.3. Selenium (Se)
this disease. Because selenium and n-3 fatty acids are both
Populations depending mainly on marine foods have a rela-
present in large quantities in marine food, it is difficult to
tively high dietary intake of selenium, while those consum-
conclude definitively the role of selenium in the protection
ing food from the terrestrial food chain generally receive a
against IHD. It is possible that selenium acts as an impor-
moderate or low amount. Daily recommended dietary intake
tant co-factor, contributing to the oxidative defense system
in most countries is 50-250 g/d for adults.
(for review see Hansen et al. 1994). A recent study (Tsuka-
Very high blood selenium levels have been reported in some
hara et al. 1996) indicates that selenium is of importance for
Inuit populations for whom marine mammals are an impor-
collagen metabolism in young infants.
tant food source. In the Thule district in North Greenland, a
Epidemiological investigations have indicated a decrease
median blood Se concentration of 1225 g/L has been reported
in human cancer death rates (age and sex adjusted) corre-
(Hansen 1990). The highest individual concentration was
lated with increased selenium intake. There is also experi-
3000 g/L. Chronic selenosis is known in China, and symp-
mental evidence in animals to support the antineoplastic
toms in susceptible patients were found at blood concentra-
effect of selenium. A possible mechanism of the protective
tions above 1000 g/L (Yang et al. 1989).
effects of selenium has been postulated involving the inhibi-
The Chinese study suggests a selenium intake of 400 g/
tion of the formation of carcinogen malonaldehyde, a prod-
person/d as a maximum safe daily intake, corresponding to
uct of peroxidative tissue damage.
560 g/L in blood. No signs of chronic selenosis have been
In addition to the apparent protective effect against some
observed in the population of North Greenland. This may
carcinogenic agents, selenium is an antidote for the toxic ef-
be due to the fact that in the Arctic, selenium is supplied
fects of other metals, particularly arsenic, cadmium, mercury
through food of animal origin where the selenium is protein-
(organic and inorganic), and copper. The mechanisms under-
bound as Se2 in selenomethionein or selenocysteine. In Chi-
lining these interactions are not fully understood. The pro-
na, the selenium is present in the soil and probably also in
tective effect of selenium on mercury toxicity is discussed in
drinking water as selenate (Se6+) or selenite (Se3+), which
more detail in chapter 7.
have oxidative properties. As such, the suggested maximum
safe intake of 400 g/person/d is not appropriate for Arctic
12.3.4. Iron (Fe)
populations.
Whole blood Se concentrations up to 80 g/L are signifi-
While iron is as an essential element, there are also toxico-
cantly correlated with increased activity of the hydroperox-
logical considerations associated with excess dietary iron.
ide-reducing enzyme glutathione peroxidase (GSHPx), suggest-
Body iron stores are affected by a variety of factors and are
ing that 80 g/L is close to the saturation limit for this enzyme
strongly influenced by nutritional iron intake. Serum fer-
(Thomson and Robinson 1986). It is not known whether
ritin correlates well with iron stores in healthy individuals.
this level in blood is sufficient to meet the requirements of
Milman et al. (1992) demonstrated that Inuit hunters in
other functional selenoproteins and for a possible cancer
North Greenland had high serum ferritin levels and ample
prevention effect.
body iron reserves. Eight of 67 individuals investigated
A daily selenium intake of 50-250 g is regarded as safe
showed values greater than 300 g/L, i.e., increased iron
and adequate. This corresponds to whole blood Se levels be-
stores. The serum ferritin levels increased with age without
tween 115 and 390 g/L according to the regression between
the plateau seen in Caucasians which suggests continued ac-
blood selenium concentration (y mg/L) and dietary selenium
cumulation of iron reserves in elderly Inuit associated with
intake (x g/d) calculated by Yang et al. (1989):
consumption of large quantities of iron rich meat from ma-
rine mammals and/or genetic differences in the regulatory
logy = 0.767 logx 2.248.
mechanisms for body iron stores. The high dietary intake of
There is a good correlation between serum- and erythro-
iron may protect against absorption of cadmium also pre-
cyte-selenium under conditions of low selenium intake. At
sent in marine food. Iron deficiency has, however, been de-
higher intakes, the serum selenium concentration tends to
scribed among Canadian Inuit (Valberg et al. 1976).
level off at a concentration of approximately 150 g/L, while
erythrocyte selenium increases with intake. Consequently,
12.3.5. Tin (Sn)
the erythrocyte-selenium to plasma-selenium ratio seems to
be the best measure of selenium status, especially in the Arc-
Although animal experiments indicate that tin is an essential
tic where there is a very high dietary supply in some popula-
nutrient, naturally occurring tin deficiency is unknown in both
tion groups.
animals and humans.
Chapter 12 ˇ Pollution and Human Health
793
The use of tin cans for food preservation presents little ha-
min D3 (cholecalciferol), while stimulating the absorption of
zard to health unless the tin surfaces are exposed to the air
calcium, phosphate and other essential elements, also in-
and contain acidic material. Ingested inorganic tin is poorly
creases the absorption of some toxic metals (cadmium, lead)
absorbed and is mainly excreted in the feces. Apart from rare
and radionuclides (strontium, caesium) (Moon 1994).
reports of gastrointestinal symptoms, there is little evidence
Traditional diets provide a strong nutritional base for the
of human toxicity from inorganic tin in foods.
health of Arctic indigenous peoples. While evidence of clini-
The organo-tin compound tributyltin (TBT) may, however,
cal deficiencies of individual vitamins or minerals has not
be of importance to the Arctic marine environment. Low con-
been documented in Arctic populations, a move away from
centrations of TBT originating from antifouling paint used
the consumption of traditional foods, especially animal foods,
on ships have been shown to have reproductive effects in mol-
would most likely lead to significant nutritional deficiencies
lusks (Svavarsson and Skarpheinsdottir 1995). TBT has also
and poor health.
been shown to be highly toxic in experimental animals, act-
ing through the generation of reactive oxygen species (Cleri-
ci 1996). The documented effects of TBT on human health
12.4. National reports
are inflammation of the airway, and eye and skin irritation
12.4.1. Canada
(WHO 1990a, Snoeij et al. 1987). The effect of TBT on skin
is suggested to involve intercellular modulation of interleu-
Introduction
kin-1 IL-1 (Corsini et al. 1996). An evaluation of the human
The 93 000 people of Canada's north populate a very large
toxicity of TBT, as a marine contaminant, is warranted if it
land mass encompassing the Yukon Territory in the west, the
is shown to be transported through the food chain.
central and northern Northwest Territories (NWT), and north-
ern Quebec and Labrador in the east. The 46 500 indigenous
peoples living in the north make up 17-90% of the popula-
12.3.6. Other nutrients
tion in the various territories/regions, and include the Inuit,
While this report focuses on contaminants in the circumpo-
the Indians or First Nations, and the Métis (see chapter 5)
lar region, it is important not to lose sight of the larger bene-
(Figure 12ˇ2).
fits that traditional diets provide to the health and well-being
In response to concerns about environmental contami-
of Arctic peoples.
nants and the importance of country foods in the north, the
Traditional foods, especially marine mammals and fish,
Government of Canada instituted the national Arctic Environ-
contain large amounts of specific essential lipids (n-3 fatty
mental Strategy, Northern Contaminants Program in 1991.
acids), and their consumption has been associated with a low-
Much of the new data reported here is a product of this pro-
er incidence of ischemic heart disease in Greenland, Japan and
gram and should help to demonstrate if (and how) the north-
Canada (Dyerberg et al. 1975, Yamori et al. 1985, Young et
ern people (Figure 12ˇ2) and/or their environment are being
al. 1993). A high ratio of eicosapentaenoic acid (EPA), an n-
adversely affected by these contaminants.
3 fatty acid, to arachidonic acid (AA), a non-n-3 fatty acid,
is considered a valid indication of low risk of ischemic out-
Sources of exposure
comes (Hirai et al. 1987). For Inuit living along the shore of
General population
Hudson Bay in the Canadian Arctic, death from ischemic ill-
The indigenous peoples of the north are much more likely to
ness is very rare and EPA to AA ratios are more than seven
be exposed to several environmental contaminants than the
times higher than in southern Canadian populations (De-
non-indigenous population of Canada's north, because they
wailly et al. 1994b, and pers. comm.).
consume a much larger proportion of traditional foods, i.e.,
The contribution of traditional diets to total energy re-
the products of hunting, fishing or gathering in the north.
quirements, and intakes of proteins, vitamins, and essential
Harvest surveys indicate country food consumption in the
elements will vary by indigenous group, by region, by food
Canadian Arctic ranging from 27 to 292 kg per person per
items consumed, and by frequency/seasonality of consump-
year. The leading foods include caribou, moose, fish, seal,
tion. Total daily energy provided by country food has been
muskox and waterfowl, though some indigenous groups
reported to range between 47% (Wein 1995 Hudson Bay,
consume over 80 different northern species (CACAR 1997)
Canada), 29% (Kuhnlein et al. 1996 Baffin Island, Cana-
(for more detailed information see chapter 5). In the eastern
da) and 19% (Kuhnlein et al. 1995a Central Arctic Canada).
Canadian Arctic, the major sources of exposure of coastal
The majority of the protein intake, and well in excess of re-
peoples are seal and beluga meat for mercury and beluga fat
quired nutrient intakes, for both Inuit and Dene/Métis comes
for POPs, and to a lesser extent fish for both of these conta-
from their traditional diet (Kuhnlein et al. 1995b, 1996).
minants. In the western Canadian Arctic, the primary source
These same diets also provide more than adequate amounts
of POPs for non-coastal peoples comes from freshwater fish.
of iron and zinc, vitamins D and E and thiamin, riboflavin and
Consumption of large land mammals contributes to body
niacin. High levels of vitamin A (as retinol) are found in ani-
burdens of cadmium and radionuclides.
mal liver and blubber. Only a few essential elements and vita-
mins (calcium, vitamin C and B6, folic acid) are found in barely
Local populations
adequate amounts (Doolan et al. 1991, Lawn and Langrer
There are very few significant sources of local pollution in
1994, Wein 1994a, 1994b and 1995, Kuhnlein et al. 1995b).
Arctic Canada. PCBs have been reported near abandoned
Nutrients in the diet often interact directly to influence the
Distant Early Warning (DEW) Line sites, but these are not a
uptake or toxicity of environmental contaminants. Zinc, iron,
major contributor to total Arctic environmental loadings.
calcium, selenium, cobalt, manganese, pyridoxine (B6 com-
Past and present mining operations in the Northwest Terri-
plex vitamin), ascorbic acid and dietary protein all interact to
tories, including Yellowknife and Port Radium, may lead to
reduce cadmium toxicity, while zinc, iron, calcium, selenium,
local exposures to some heavy metals. Geological cadmium
cobalt and chromium can all influence the toxicity of lead
in the Yukon Territory is probably responsible for the slight-
(dietary deficiencies increase lead toxicity) (Chowdury and
ly higher concentrations in caribou kidney in the western Ca-
Chandra 1987). Dietary calcium has also been inversely asso-
nadian Arctic. There is, as yet, no consensus on the reasons
ciated with blood lead levels in children 1-11 years old. Vita-
for elevated mercury levels in the eastern Canadian Arctic.
794
AMAP Assessment Report
I n
I
u i t
n
I n
u
u
i t
Baffin
v
D e n
i
e
a
Island
l u
Yukon
i t
Territory
Iqaluit
I
Port Radium
n u i t
I n u i t
D
Whitehorse
e n e Northwest Territories
Yellowknife
I n u i t
Nunavik
M é t i s
D e n e
I n u i t
I n u i t
I
Hudson
n n u
Bay
Labrador
Quebec
C r e e
Figure 12Ŗ3 : Indigenous Peoples of the Canadian Arctic.
Figure 12ˇ2. Indigenous Peoples of the Canadian Arctic.
Long-range transport from industrial and natural sources,
milk fat). There is no indication that DDT levels are declin-
acidification of the eastern land mass, naturally high geolog-
ing in Arctic populations, however, tissue sampling in the
ical levels and hydroelectric flooding have all been postulated.
north has only occurred relatively recently and, thus, there
are insufficient data for temporal trend analyses.
Levels and trends of contaminants in humans
DDT and metabolites
Toxaphene
For the population in southern Canada, the dietary intake of
Toxaphene intakes by Arctic populations are entirely depen-
total DDT (including metabolites) has been declining since
dent on the type and amount of country food consumed (of
the 1960s. This has been reflected by a concomitant ten-fold
all tissues tested, toxaphene levels are highest in ring seal blub-
decline in total DDT in human tissues over the last 20 years
ber and beluga blubber in the eastern Arctic) (Kuhnlein et al.
(Conacher and Mes 1993, Mes 1994).
1995a). There are very few data available on toxaphene in
Levels of total DDT and its metabolites in human tissue
the tissues of Arctic populations. A study of three Inuit wo-
in the Arctic are considerably higher than those in southern
men from northern Quebec reported levels of toxaphene in
Canadians, reflecting the greater consumption of high trophic
breast milk of 221 ng/g lipid (Stern et al. 1992). This is a
level species for food. Concentrations of DDE are four- to
very small sample size for any evaluation and is unlikely to
five-fold higher in human breast milk from Inuit in northern
be representative of the larger population. A recent analysis
Quebec than populations from southern Canada (Table 12ˇ4).
of a 1987-88 dietary survey indicates that for one group of
People from the north shore of the St. Lawrence River who
Canadian Inuit women the daily intake of toxaphene fre-
quently exceeds the TDI (Table 12ˇ35).
Table 12ˇ4. Comparative concentrations of DDE
in human milk fat (Canada) and omental fat (Greenland).
PCBs
Year of
Mean,
In southern Canada, the estimated adult daily intake for to-
Location
sampling ng/g lipid
Reference
tal PCB from diet is 0.008 g/kg bw/day (Conacher et al.
Southern Canada
1992
222
Newsome et al. 1995
1994). Intakes by Arctic residents consuming large amounts
Southern Quebec
1989/90
340
Dewailly et al. 1996a
of traditional foods from the aquatic and marine environ-
Lower North Shore, Quebec
1991
823
Dewailly et al. 1991
Nunavik, northern Quebec 1989/90
1212
Dewailly et al. 1993a
ment are considerably higher. In results from two surveys of
Greenland
1993
3844
Dewailly pers. comm.
Canadian Inuit women, 16% and 4% of the women's daily
intakes exceeded the TDI (Table 12ˇ35).
consume large amounts of fish and gull eggs have intermedi-
Several studies suggest that PCB levels in breast milk fat
ate levels of DDE in breast milk. Even higher concentrations
are significantly elevated in some Inuit mothers. In breast milk
of DDE are seen in abdominal fat tissue from Greenland Inuit.
samples collected from Inuit women residing in the Nunavik
The observed differences may be due to increased consump-
region of Arctic Quebec (Hudson Bay, Hudson Strait and
tion of contaminated country foods, older age groups in the
Ungava Bay), total PCB levels were elevated 4.7-fold in 1988
Greenland Inuit study versus the Quebec Inuit study, or tissue-
and 5.6-fold in 1989/90 when compared to a southern Que-
specific concentration differences (abdominal fat vs. breast
bec non-indigenous population in the same sampling years
Chapter 12 ˇ Pollution and Human Health
795
Table 12ˇ5. Comparative concentrations of PCBs in human milk fat.
Bay), 2,3,7,8-TCDD TEQs for PCDDs and PCDFs were mod-
erately elevated when compared to the southern Quebec non-
Year of
Mean,
Location
sampling ng/g lipid
Reference
indigenous population (19.0 pg/g lipid vs. 9.6 pg/g lipid)
(Table 12ˇ6) (Dewailly et al. 1992). However, total PCBs were
Southern Canada
1992
238b
Newsome et al. 1995
more than five-fold higher in the Quebec Inuit mothers' breast
Southern Quebec
1989-90
520 a
Dewailly et al. 1992
Southern Quebec
1988
770 a
Dewailly et al. 1989
milk than the same control population. When TEQs for non-
Lower North Shore, Quebec 1991
2160 a
Dewailly et al. 1991
ortho-substituted PCBs (CBs 77, 126 and 169) were factored
Nunavik, northern Quebec
1988
3600 a
Dewailly et al. 1989
in, the 2,3,7,8-TCDD TEQ value increased to 42.3 pg/g for
Nunavik, northern Quebec 1989-90
2900 a
Dewailly et al. 1992
the Inuit milk samples compared to 17.9 pg/g for the south-
a. PCBs as Aroclor 1260. b. Sum of PCB congeners (PCBs as sum of
ern Quebec samples (Table 12ˇ6). For this Inuit population,
congeners is typically approximately one-half PCBs as Aroclor 1260).
but not the southern Quebec population, the majority of the
2,3,7,8-TCDD TEQs are due to dioxin-like PCBs.
Table 12ˇ6. Comparative concentrations of dioxins, furans and dioxin-like
PCBs in human milk fat.
A large Netherlands study of breast milk and child devel-
opment found levels of 2,3,7,8-TCDD TEQ (PCDD/PCDF/
Year of
Mean a,
coplanar PCBs) in breast milk of 46.2 pg/g lipid. These lev-
Location
sampling
pg/g lipid Reference
els are very similar to the levels in Inuit breast milk (Table
Dioxins and furans
12ˇ6). In contrast to the Inuit results, the majority of the
Southern Canada
1986-87
15.6
Ryan et al. 1993
2,3,7,8-TCDD TEQ in this Netherlands study are from the
Southern Quebec
1989-90
9.6
Dewailly et al. 1992
Nunavik, northern Quebec 1989-90
19.0
Dewailly et al. 1992
dioxin and furan component. Subtle clinical, immunologic
Netherlands
1990-92
30.2
Koopman-Esseboom
and neurodevelopmental alterations associated with breast
et al. 1994a
-------------------------------------------------------------------------------------------------
feeding have been reported in the infants/children of the Neth-
Dioxins, furans, and dioxin-like PCBs
erlands cohort (Koopman-Esseboom et al. 1994a, Huisman
Southern Quebec
1989-90
17.9
Dewailly et al. 1992
et al. 1995, Weisglas-Kuperus et al. 1995). A preliminary re-
Nunavik, northern Quebec 1989-90
42.3
Dewailly et al. 1992
Netherlands
1990-92
46.2
Koopman-Esseboom
port on a study of Canadian Inuit also shows an association
et al. 1994a
between increasing PCB/dioxin/furan levels and immune sys-
a. expressed as 2,3,7,8-TCDD TEQs.
tem deficits (Dewailly et al. 1993b).
Table 12ˇ7. Comparative concentrations of mirex in human milk fat
Mirex
(Canada) and omental fat (Greenland).
While mirex has never been registered for use in Canada as
Year of
Mean,
a pesticide, it did enter Canada as a fire retardant (dechlo-
Location
sampling ng/g lipid
Reference
rane) from the mid-1960s to mid-1970s, and via water cur-
rents from the US side of the Great Lakes basin. Mirex levels
Southern Canada
1986-87
15.6
Ryan et al. 1993
Southern Canada
1992
1.9
Newsome et al. 1995
in breast milk are above average for communities consuming
Southern Quebec
1989-90
1.6
Dewailly et al. 1993a
high amounts of fish and marine bird eggs (Dewailly et al.
Lower North Shore, Quebec
1991
12
Dewailly et al. 1991
1991). Levels in the breast milk of Inuit from Nunavik, north-
Nunavik, northern Quebec
1989-90
16
Dewailly et al. 1993a
Greenland
1993
153
Dewailly pers.comm.
ern Quebec, are ten times higher than those in southern Que-
bec residents (Table 12ˇ7). Intermediate levels of mirex can
(Table 12ˇ5). Women from the north shore of the St. Law-
be seen in the lower North Shore St. Lawrence population
rence River who consume more fish and country food than
which consumes more fish and seabird eggs than the general
women from southern Quebec but less than Inuit women
population (Dewailly et al. 1991). Even higher concentrations
had intermediate levels of PCBs in their breast milk.
of mirex are seen in abdominal fat tissue from Greenland Inuit.
While levels of total PCBs have declined since the 1980s
in breast milk of southern Canadian women (Newsome et
Chlordane
al. 1995), there is no similar information yet available for
Chlordane is not currently registered for use in Canada and
Arctic residents. Historical values are also difficult to com-
enters the Arctic ecosystem primarily via long-range atmos-
pare due to changing analytical techniques and quantitation
pheric transport. Chlordane and the compounds related to it
methods (reported PCB concentrations based on an Aroclor
accumulate in fat and are found in human tissues although gen-
1260 standard are approximately double those based on a
erally only in small amounts. Tissues often contain relatively
sum of specific PCB congeners). This may partly explain the
larger amounts of trans-nonachlor and the metabolite oxychlor-
difference seen in Table 12ˇ5 between the 1992 southern Can-
dane. The breast milk of Inuit mothers from Nunavik (north-
ada PCB level in breast milk of 238 ng/g lipid (sum of con-
ern Quebec) had chlordane levels ten times higher than levels
geners) and the 1989-90 southern Quebec PCB level of 520
seen in southern Canadian residents (Table 12ˇ8). Even higher
ng/g lipid (Aroclor 1260).
relative levels of trans-nonachlor (80-fold) and oxychlordane
(64-fold) are seen in abdominal fat from Greenland Inuit, but
Dioxins (PCDDs) and furans (PCDFs)
this may be due to several factors as indicated previously. In
In 40 breast milk samples collected between July 1989 and
results from two surveys of Canadian Inuit women, 48% and
July 1990 from Inuit women residing in the Nunavik region
75% of the women's daily intakes exceeded the TDI. Only 6%
of Arctic Quebec (Hudson Bay, Hudson Strait and Ungava
of the Dene women's intakes exceeded the TDI (Table 12ˇ35).
Table 12ˇ8. Comparative concentrations of chlordane and related compounds in human milk fat (mean, ng/g lipid).
Chlordane
Cis-
Trans-
Oxy-
Location
Year
( and )
nonachlor
nonachlor
chlordane
Reference
Southern Canada
1992
0.37
2.89
17.5
13.4
Newsome et al. 1995
Southern Quebec
1989-90
n.d.
Dewailly et al. 1993a
Lower North Shore, Quebec
1991
n.d.
Dewailly et al. 1991
Nunavik, northern Quebec
1989-90
3.7
Dewailly et al. 1993a
Greenland
1993
11.6
3.12
1463
862
Dewailly pers. comm.
n.d.: not detected. : not analyzed/not reported.
796
AMAP Assessment Report
Table 12ˇ9. Comparative concentrations of HCHs in breast milk (Canada)
wailly et al. 1996b, Walker et al. in prep.). Inuit populations
and omental fat (Greenland) (ng/g lipid).
have a greater range of POPs at detectable levels and higher
geometric mean concentrations of POPs. This is not unex-
-
-
-
Location
Year
HCH
HCH
HCH
Reference
pected as Inuit consume more marine fats, which have ele-
vated POP residues, than Dene/Métis peoples in the central
Southern Canada 1992
0.31
22.6
1.03
Newsome et al. 1995
Arctic (Kuhnlein et al. 1995b). Any comparison of maternal
Greenland
1993
108.9
Dewailly pers. comm.
and newborn cord blood concentrations of contaminants
needs to consider that the important determinants of conta-
Hexachlorocyclohexanes (HCHs)
minants level are age of the mother, number of previous chil-
Canada still has some registered uses for lindane ( -HCH).
dren, and number of children breast fed, as well as the amount
Like other POPs, most human exposure to HCHs comes from
and type of country food consumption. While these compar-
food consumption. Because of its persistence, -HCH is found
isons are as yet incomplete, it is possible to compare some of
at the highest level of the three isomers reported in the south-
the contaminants showing the highest levels and greatest dif-
ern Canadian population (Table 12ˇ9). There are no data for
ferences between the groups to verify whether previous in-
levels in Arctic populations except for one report from Green-
formation on country food consumption supports the conta-
land where -HCH levels in abdominal fat samples were five
minant patterns seen.
times higher than southern Canadian levels in breast milk fat
Based on geometric means, the contaminants present in
(Table 12ˇ9). As previously indicated for DDT, differences in
the highest concentrations in newborn cord blood are hexa-
contaminant levels in the samples from Greenland and Cana-
chlorobenzene (HCB), DDE and PCBs (Figure 12ˇ3). Levels
da may be explained by a number of factors.
of PCBs and DDE are twice as high in Nunavik (northern
Quebec) Inuit than in Inuit living in the NWT. HCB levels
POPs in newborn cord blood
are similar in Inuit in both areas. The difference between Inuit
The exposure of the developing fetus to maternal contami-
from Nunavik and Inuit from the NWT warrants further
nants through the placenta is an important route of expo-
study and analysis. Figure 12ˇ3 also shows a comparison of
sure during many critical stages of development. Data has
Inuit with other population groups. The concentrations of
recently become available on POPs in newborn cord blood
PCBs and DDE are considerably higher in the Inuit (Nuna-
from several Canadian Arctic and southern populations (De-
vik and NWT) than in the other population groups (Dene/
Métis and non-indigenous in the NWT; and residents of
ĩg/L
HCB
ĩg/L
DDE
0.20
1.0
0.97
southern Quebec). Levels of HCB in Inuit (both NWT and
0.16
0.8
Nunavik) are two to three times the levels seen in the other
0.14
0.14
0.12
0.6
population groups.
0.44
0.37
Analyses were completed for 14 PCB congeners in new-
0.08
0.4
0.06
0.25
0.04
0.043
born cord blood from Nunavik and southern Quebec popu-
0.04
0.2
0.04
lations. Similar PCB congener patterns can be seen in these
0
0
two populations, although the levels for each congener in
the Nunavik population survey are consistently higher (Fig-
ure 12ˇ4).
Aroclor
PCB
Northwest Territories residents
ĩg/L
(Mackenzie and Kitikmeot regions)
2.0
1.94
PAHs
Inuit
1.6
Dene / Metis
There are no data available on PAH levels in breast milk, fat
1.2
Non-indigenous
0.96
or blood of Canadian Arctic residents.
0.8
Quebec
0.54
Inuit from Nunavik,
0.4
Northern Quebec
Mercury
0.24
0.28
Residents of southern Quebec
0
From 1970 to 1995, the Medical Services Branch (MSB) of
Health Canada, within its Environmental Contaminants Pro-
Figure 12ˇ3. Geometric mean levels of HCB, DDE and PCBs in cord blood
of newborns in different Canadian population groups.
gram, has carried out mercury analyses of hair and blood
ĩg/L
ĩg/L
0.25
Nunavik (n= 273)
0.25
Southern Quebec (n= 502)
0.20
0.20
0.15
0.15
0.10
0.10
0.05
0.05
0.00
0.00
28
52
99
101
105
118
128
138
153
156
170
180
183
187
PCB congener
Figure 12ˇ4. Concentrations of PCB congeners in cord plasma from Nunavik and southern Quebec newborns (adapted from Dewailly et al. 1996b).
Figure 12Ŗ5 : Concentrations of PCB congeners in cord plasma from Nunavik and southern Quebec newborns.
Chapter 12 ˇ Pollution and Human Health
797
Table 12ˇ10. Individual blood methylmercury levels for NWT, Canada,
as many Inuit (57.2%) exceeded 20 g/L as Dene (19.6%)
by cultural group (1972-1989). Source: Wheatley 1995.
(Wheatley 1995, Wheatley and Paradis 1996a).
Table 12ˇ11 sets Canadian findings in the context of find-
Dene
Inuit
ings in other circumpolar countries and over time. In gen-
Methylmercury
No. of
No. of
level, g/L
individuals
%
individuals
%
eral, most the mercury data reported by Wheatley and Para-
dis (1995, 1996a, 1996b) indicate that Inuit from the east-
Less than 20
572
80.45
647
42.82
ern NWT and Nunavik, and northern Quebec Cree, have
20 to 99
137
19.27
844
55.86
100 to 199
2
0.28
16
1.06
higher levels of mercury than other circumpolar peoples. One
200 to 299
0
0
4
0.26
recent data set from Greenland indicates high cord and ma-
Total
711
100.00
1511
100.00
ternal blood mercury levels are also found in this population
(Hansen et al. 1990a, 1990b). Some archeological hair sam-
samples obtained from 38 571 residents of 514 native com-
ple results from northern Baffin Island (dated to originate
munities across Canada as part of clinical risk assessment
from the years 400 and 1150) (Wheatley and Wheatley 1988)
(Wheatley 1994). As shown in Table 12ˇ10, of 711 Dene and
and from Greenland (1485) (Hart-Hansen et al. 1991) are
1511 Inuit from the NWT who were tested, nearly three times
also included in Table 12ˇ11 (converted to blood level equi-
Table 12ˇ11. Current and historical blood mercury levels.
Year(s)
Mean a,
Range,
DLc
Location
collected
n
g/L
SD b
g/L
g/L
Reference
Comments
Canada
1970-1995
38571
14.13
22.63
1-660
1
Wheatley and Paradis 1995 d
Blood, cord blood, hair
(indigenous peoples)
Quebec
Nunavik (Inuit)
1974-1982
1114
46.76
33.08
2.67-267.33
1
Wheatley and Paradis 1996ad
Blood, cord blood, hair
1977-1982
142
48.21
43.98
4.20-254.50
1
Blood
1978-1982
125
33.80
20.09
6.00-101.80
1
Cord blood
1974-1982
847
48.42
32.10
2.67-267.33
1
Hair
Nunavik (Inuit)
1992
252
14.06
0.8-96
Dewailly et al. 1994b
Blood (men)
1992
240
15.97
2.0-112
Blood (women)
1993-1995
299
12.09
1.0-99
Dewailly et al. 1996b
Cord blood
Northern Quebec
1971-1982
4670
34.31
40.56
1.50-649.40
1
Wheatley and Paradis 1996a d
Blood, maternal blood,
(Cree)
cord blood, hair
1971-1985
1129
42.94
52.32
1.50-649.40
1
Blood
1971-1982
600
22.69
23.82
1.50-224.00
1
Cord blood
1972-1982
2940
33.38
37.29
1.67-571.00
1
Hair
Northwest Territories
Nunavut (Inuit)
1972-1989
1339
29.98
23.99
1.00-225.67
1
Wheatley and Paradis 1996a d
Blood, maternal blood,
cord blood, hair
1972-1989
286
19.52
22.33
1.00-200.00
1
Blood
1978-1988
61
17.17
15.48
1.50-86.00
1
Maternal blood
1978-1986
31
40.53
32.74
6.50-130.40
1
Cord blood
1973-1987
961
33.57
23.37
1.00-225.67
1
Hair
Nunavut (Inuit)
1994-1995
67
3.46
0.6-12.84
1
Walker (in prep.)
Maternal blood
1994-1995
62
5.72
0.6-27.88
1
Cord blood
Western NWT
1976-1983
980
16.24
16.54
1.00-138.00
1
Wheatley 1995 d
Blood, cord blood, hair
(Dene)
1982-1983
76
10.66
11.13
1.30-66.50
1
Blood
1978-1982
5
14.36
12.32
4.30-35.00
1
Cord blood
1976-1986
899
16.72
16.86
1.00-138.00
1
Hair
Western NWT
1994-1995
51
1.74
0.4-5.62
1
Walker (in prep.)
Maternal blood
(Dene)
1994-1995
47
1.91
0.4-8.83
1
Cord blood
Non-indigenous
1994-1995
121
1.25
0.20-4.21
1
Maternal blood
1994-1995
121
1.66
0.20-12.84
1
Cord blood
Yukon
1977-1978
299
7.10
6.15
1.50-67.00
1
Wheatley 1979 d
Blood, cord blood, hair
1977-1978
83
7.04
4.01
2.10-21.70
1
Blood
1977
31
4.12
1.87
1.50-7.80
1
Cord blood
1977
185
7.63
7.19
1.67-67.00
1
Hair
Comparison groups
Ontario
1992-1993
176 2.80
2.30
< 2.0-17.0
2
Kearney
et al. 1995
Whole blood (fisheaters)
Greenland
1987
35
12.00
4-23
Milman et al. 1994
Serum
1987
32
10.00
3-24
Serum
1982-1988
37
44.13
24.07
6.02-96.29
1
Hansen et al. 1990b
Maternal blood
1982-1988
37
88.25
48.34
10.03-178.54
1
Cord blood
Faeroe Islands
1986-1987
53
12.00
2.6-50.0
Grandjean et al. 1992
Whole blood
1986-1987
53
2.10
< 0.1-8.2
Serum
1986-1987
997
24.20
13.0-40.2
Cord blood
Historical levels from mummified remains
Greenland
ca. 1485
1
10.0
Hart-Hansen et al. 1991
Hair
N. Baffin (Dorset)
ca. 400
3
8.00
3-12
1
Wheatley and Wheatley 1988
Hair
N. Baffin (Thule)
ca. 1150
6
4.00
2-7
1
Hair
a. Measurements of mercury were made in a variety of tissues but all tissue levels are normalized as concentrations in blood. b. SD: Standard deviation.
c. DL: Detection limit. d. Some of these data have been specifically analyzed for this report by Wheatley et al., and are also described in Wheatley and
Paradis 1995, 1996a.
798
AMAP Assessment Report
MeHg
tion of fish and marine mammals is extensive (Wheatley and
ĩg / L
Paradis 1995). Two recent studies (1987, 1992) indicate that
50
29% and 37% of Inuit women in these communities had daily
dietary intakes of mercury which exceeded the TDI (Table
12ˇ35). The source of methylmercury (geological or anthro-
40
pogenic) in the Canadian Arctic food chain and in traditio-
nal foods, such as marine mammals consumed by Inuit, con-
30
tinues to be a subject of debate (Wheatley and Wheatley 1988,
Muir et al. 1992). There is also ongoing controversy about
possible protective mechanisms involving selenium.
20
Lead
10
Inuit from Northwest Territories (blood)
In the most recent Canadian market basket survey, the esti-
First Nation Canadians south of 60°N (blood equivalent)
mated mean dietary intake of lead for a sixty kilogram adult
in 1986-1988 was 24 g per day (Dabeka and McKenzie
0
1995). The estimated daily intakes for adults can range world-
1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989
wide from 15-316 g/d (WHO 1995). In the absence of oc-
Figure 12ˇ5. Time trends of mean methylmercury concentrations (adapted
cupational exposure, the average blood lead concentration
from Wheatley and Paradis 1996a).
in adults is 100-200 g/L, depending on the degree of indus-
valents to facilitate comparison). All are low compared with
trialization (air pollution, automobile exhaust, etc.). This val-
current human methylmercury levels in the same geographic
ue is far in excess of the estimated blood lead level in prein-
areas. Figure 12ˇ5 provides trend data over 15-20 years for
dustrialized humans of 0.16 g/L (Flegal and Smith 1992).
individuals and communities south of 60°N (First Nations)
Results of the recent Santé Quebec Health Survey of Inuit
and in the NWT (Inuit) (Wheatley and Paradis 1996a). The
from Nunavik, showed that the mean blood lead concentra-
trend in First Nations communities south of 60°N appears
tions were approximately 86 g/L. Blood lead levels could
to be downward. Whether this is because of falling mercury
be positively correlated to smoking and consumption of ma-
levels in fish or because less fish are being eaten by the peo-
rine mammals (Dewailly et al. 1994b). In a 1987 survey of
ple has yet to be determined. With the NWT data, there is
northern Greenlandic Inuit hunters and their families, the
no obvious trend. There is more recent data from the NWT
median blood lead value for males was 96 g/L (median age
and Nunavik which does suggest that some Dene and Inuit
40 years) and for females, 56 g/L (median age 36 years)
groups may have decreased blood mercury levels (means
(Milman et al. 1994) (Table 12ˇ12). The major source of
1.74 to 15.97 g/L from 1992-95 vs. 10.66 to 48.21 g/L
lead exposure was estimated to be food items of marine ori-
before 1992, Table 12ˇ11). Dietary, geographic, regional, or
gin (ringed seal, narwhal, walrus and beluga) and there was
seasonal differences may explain the apparent decrease.
a positive correlation between increasing blood lead levels
In a limited number (n = 36) of cord blood samples col-
and age. In the Faeroe Islands, 52 women (20-50 years old)
lected from Inuit and Dene from 1978 to 1986 from various
who consumed fish and pilot whale meat had a median blood
regions of the NWT, 69% had methylmercury levels equal
lead level of 20 g/L (Grandjean et al. 1992). In a 1989 sam-
to or greater than 20 g/L (mean 36.9 g/L, range 4.3-130.4)
ple of Michigan fishermen (n = 115) who consumed on aver-
(Wheatley and Paradis 1996a). This is in contrast to more
age 38 fish meals per year, blood lead levels were 55 g/L
recent data (1993-95) from the NWT and Nunavik, north-
compared to 38 g/L in the controls (n = 95, 4.1 average fish
ern Quebec, which found lower levels in cord blood of Inuit
meals per year) (Hovinga et al. 1993) (Table 12ˇ12). Blood
newborns (means 5.72 and 12.09 g/L, respectively, Table
lead values for both sample sets were directly influenced by
12ˇ11). The concentration of mercury in maternal blood was
amount of smoking. A study of fisheaters from the Canadian
also markedly lower in the 1994-95 Walker et al. study (in
side of the Great Lakes also indicated that women who con-
prep.) than was seen in the 1978-86 study (Table 12ˇ11). The
sumed Great Lakes fish had slightly higher blood lead com-
lower concentrations seen in 1994-95 cord and maternal
pared to non-fisheaters (24 vs. 19 g/L, Kearney et al. 1995,
blood samples may be due to dietary differences over time
Table 12ˇ12).
(1980 vs. 1994), geographic differences (eastern vs. western
Initial results of cord blood screening for lead from Nuna-
NWT) or seasonal differences.
vik (Table 12ˇ12) have found levels approximately three-fold
In general, levels of methylmercury were higher in the
higher than comparison samples from Toronto and Quebec City
northern and eastern Inuit communities where the consump-
(52 g/L vs. 17 and 18 g/L, respectively) (Dewailly 1994a).
Table 12ˇ12. Blood lead levels.
Year(s)
Reported
Range,
DLa,
Location
collected
n
mean, g/L
SD
g/L
g/L
Reference
Comments
Faeroe Islands
1986-87
52 &&
20
5.9%
8-36
Grandjean et al. 1992
Whole blood
Greenland
1987
35 &&
56
8-326
Milman et al. 1994
Whole blood
Greenland
1987
35 ((
96
31-240
Milman et al. 1994
Whole blood
Nunavik (Inuit-adult)
1992
492
86
4-23
Dewailly et al. 1994a.
Whole blood
Nunavik (Inuit-newborn)
1994
59
52
6.8%
8-267
2
Dewailly et al. 1994a.
Cord blood
Northwest Territories (Inuit) 1994-95
62
29
6-157
2
Walker (in prep)
Cord blood
Dene/Métis
1994-95
47
20
2-62
2
Walker (in prep)
Cord blood
Non-indigenous
1994-95
121
16
2-64
2
Walker (in prep)
Cord blood
USA, Michigan
1989
115 ((
55
10-170
10 Hovinga
et al. 1993
Fisheaters, whole blood
USA, Michigan
1989
95 ((
38
10-100
10 Hovinga
et al. 1993
Controls, whole blood
USA, California
1984
1728
49
5-150
Satin et al. 1991
Cord blood
Canada, Cornwall
1992-93
32
24
5-56
2
Kearney et al. 1995
Fisheaters, whole blood
Canada, Cornwall
1992-93
10
19
5-62
2
Kearney et al. 1995
Non-fisheaters, whole blood
a. DL: Detection limit.
Chapter 12 ˇ Pollution and Human Health
799
A similar cord blood study from the NWT found slightly
137Cs
lower lead levels in Inuit cord blood (29 g/L), but even
Bq /kg
lower levels were seen in Dene/Métis and non-indigenous
500
groups (20 and 16 g/L, respectively) (Walker et al. in prep).
400
Cadmium
In the Canadian Arctic, organ meats (liver and kidney) from
terrestrial ungulates (hoofed mammals), particularly caribou
300
and muskoxen, have been identified as the principal dietary
cadmium sources. Caribou kidney samples usually contain
200
the highest concentration of cadmium but only slightly high-
er than Ontario and Quebec moose and white-tailed deer
100
kidney samples. Cadmium content of muscle or organs other
than kidney or liver has been determined to be up to 100
0
times lower (Gamberg and Scheuhammer 1994).
1963
1964
1965
1966
1967
1968
1969
1989-90
Few, if any, comparative studies have been conducted in
Figure 12ˇ6. Body burdens of radiocaesium (yearly averages) across the
the Arctic dealing with the relationship between cadmium
Canadian Arctic.
levels in maternal vs. fetal blood. Although metallothionein
induction has been detected in placental tissue, cadmium
hart et al. 1992). For comparison, an acceptable level for
analysis in paired maternal and cord blood samples collected
137Cs in meat is 1000 Bq/kg (Codex Alimentaries Commis-
from three cities in Taiwan suggests that the placenta acts as
sion 1989).
a partial barrier. In 159 samples collected in 1988, the mean
Because of the radiation it emits, radiocaesium can be
cadmium level in cord blood was approximately 60% that
readily measured in humans by means of a portable whole-
of maternal blood (0.78 vs. 1.30 g/L, respectively) (Soong
body counter. During 1989/90, such measurements were
et al. 1991). Similar studies looking at the relationship be-
carried out on over 1100 people in five Arctic communities
tween cadmium levels in maternal vs. fetal blood are under-
where caribou hunting is prevalent (Tracy 1993, Tracy et al.
way in the NWT (Walker et al. in prep).
1996). The highest concentration of 137Cs in human tissue
The influence of dietary and environmental sources of cad-
(mainly muscle) was 110 Bq/kg, corresponding to a radiation
mium exposure appear to be minor compared to the contri-
dose of 0.40 mSv/y. This can be compared with natural back-
bution from smoking (Benedetti et al. 1994). Sampling in
ground radiation which is about 2 mSv/y. In the 1960s, some
Nunavik, northern Quebec in 1992 indicated that blood cad-
individual levels were as high as 2000 Bq/kg giving a dose of
mium values for non-smoking Inuit and non-smoking urban
up to 5 mSv/y. Figure 12ˇ6 shows the downward trend in ra-
Caucasians (Quebec City) are not appreciably different (Ben-
diocaesium body burdens from the mid-1960s to 1989/90.
nedetti et al. 1994). However, the mean blood cadmium level
Each bar represents the average body concentration across
in Inuit smokers was approximately 20-fold higher than the
all Canadian Arctic communities for a given year.
blood cadmium level of a smaller subset of non-smokers (5.4
g/L vs. 0.27 g/L). A recent study of Inuit women reported
Radiostrontium
mean cadmium levels of 1.8 g/L, however, this group is like-
90Sr is not considered a problem in the Canadian Arctic food
ly made up of both non-smokers and smokers (Table 12ˇ13).
chains; in fact, the chief route of exposure for Arctic resi-
Lower levels of cadmium were seen in the Dene/Métis and
dents to 90Sr would be from food imported from agricultural
non-indigenous mothers surveyed (0.7 g/L and 0.6 g/L,
areas in the south. The primary concern over this radionu-
respectively) (Walker et al. in prep).
clide is its effects on the developing bones of children. 90Sr
has been measured in autopsy samples of human vertebrae
Radiocaesium
across Canada. From a maximum of 150 Bq/kg calcium in
The radiocaesium isotopes 137Cs and 134Cs are considered
1964, the levels across Canada declined to 50 Bq/kg calcium
to be the artificial radionuclides of greatest concern in the
by 1978 (Meyerhof et al. 1979).
Arctic environment. The most significant route of exposure
is from the ingestion of caribou meat followed by ingestion
Radioiodine
of freshwater fish. In 1987/88, the levels of 137Cs in caribou
Because of their short half-lives, 131I and 132I are considered
herds of the Canadian Arctic varied from 50 to 700 Bq/kg
to be a problem only in freshly contaminated foods (i.e., milk,
(EHD 1991, Thomas et al. 1992). Fish from freshwater
vegetables). They are not concentrated in meat and fish which
lakes in the Arctic contain up to 20 Bq/kg of 137Cs (Lock-
are more typical of Arctic food chains.
Table 12ˇ13. Current and historical blood cadmium levels.
Year(s)
Reported
Range,
DLa,
Location
collected
n
mean, g/L
g/L
g/L
Reference
Comments
Greenland
1987
32 &&
2.2
0.8-6.5
Milman et al. 1994
Whole blood
Greenland
1987
35 ((
2.3
0.7-6.9
Milman et al. 1994
Whole blood
Nunavik (Inuit)
1988
7
0.27
0.31-0.45
Benedetti et al. 1994
Non-smokers, whole blood
Nunavik (Inuit)
1988
117
5.4
4.7-6.2
Benedetti et al. 1994
Smokers, whole blood
Northwest Territories (Inuit)
1994-95
67
1.8
0.07-7.3
Walker (in prep)
Maternal, whole blood
Northwest Territories (Dene/Métis)
1994-95
51
0.7
0.01-5.4
Walker (in prep)
Maternal, whole blood
Northwest Territories (non-indigenous) 1994-95
121
0.6
0.01-8.6
Walker (in prep)
Maternal, whole blood
USA, Michigan
1989
115 ((
0.6
0.1-5.0
0.1 Hovinga
et al. 1993
Fishermen, whole blood
USA, Michigan
1989
95 ((
0.41
0.1-2.5
0.1 Hovinga
et al. 1993
Controls, whole blood
Canada, Ontario
1992/93
65
3.94
1.0-14.6
0.2
Kearney et al. 1995
Smokers, whole blood
Canada, Ontario
1992/93
59
0.14
< 0.2-0.9
0.2
Kearney et al. 1995
Non-smokers, whole blood
a. DL: Detection limit.
800
AMAP Assessment Report
Radiolead and radiopolonium
iod of development because maternal POPs will cross the
Of all radionuclides today, natural or artificial, radiolead
placenta barrier. Two- to four-fold higher concentrations of
(210Pb) and radiopolonium (210Po) make the greatest contri-
various POPs in Inuit cord blood demonstrate that some
bution to human radiation doses in the Canadian Arctic.
Canadian Arctic populations who consume large amounts of
Polonium-210 reaches levels of 200 to 500 Bq/kg in caribou
more heavily contaminated country foods have higher levels
livers and kidneys. Levels in muscle are much lower; about
of POPs in their blood and these are being passed on to the
10 to 30 Bq/kg. Lead-210 tends to concentrate in bone; val-
developing fetus. The concentrations of POPs in Inuit breast
ues in soft tissue are about an order of magnitude lower
milk are two- to ten-fold higher than in southern Canadian
than for polonium (Thomas et al. 1994, Tracy 1993). Polo-
breast milk and have raised justifiable concern among moth-
nium-210 may also be taken up by marine shellfish (Hunt
ers in the Arctic. The health benefits to newborns of breast
and Allington 1993).
feeding are substantial, e.g., motherchild bonding, immuno-
Blanchard and Moore (1970) have reported 210Po con-
logical benefits transferred from mother to child, nutritional
centrations of up to 10 Bq/kg in the livers of Alaska resi-
value and reduced risk of bacterial contamination from poor-
dents who eat caribou. Up to 5 Bq/kg of 210Pb were found
ly prepared formulas. Studies that have evaluated the poten-
in the rib bones of these people. Some residents in northern
tial effects of the presence of PCBs in human milk on new-
communities may be receiving up to 10 mSv per year from
borns are limited and inconclusive. Breast feeding should
ingested 210Po, as compared to a normal background radia-
continue as the benefits of breast feeding far outweigh the
tion dose of about 2 mSv per year (Tracy and Walsh 1995).
currently known risks attributed to infant exposure to con-
It is likely that this has been the situation in the Canadian
taminants through breast milk.
Arctic for several thousand years.
Elevated levels of toxaphene, chlordane and mercury,
coupled with current intake scenarios, suggest some Inuit
Radium
groups are exposed to levels of these three contaminants sig-
Radium (226Ra) is present in trace amounts in all rocks and
nificantly above the Tolerable Daily Intake (TDI). The Dene
soils. Uranium mining and processing operations may lead
of the western NWT have smaller exceedances of the TDI
to enhanced local concentrations of 226Ra in the environment
for toxaphene and chlordane (CACAR 1997). There is in-
as has been observed at trans-shipment points along the Great
sufficient information to conclude whether the TDI for diox-
Bear and Mackenzie Rivers.
ins and furans and dioxin-like PCBs is being exceeded in Can-
Background levels of radium in the human body, includ-
adian Arctic populations. Also, there is as yet little conclu-
ing Arctic residents, are about 1 Bq per person (ICRP 1975).
sive scientific information directly linking harmful human
effects to these low levels of exposure. The risks associated
Radon
with a shift in dietary preference need to be considered along
There are relatively few measurements of radon (222Rn) in
with the risks associated with the presence of contaminants
Canadian Arctic dwellings, however, radon is less likely to be
in Arctic wildlife consumed as traditional food. Weighing the
a problem in Arctic Canada than in southern Canada. Perma-
uncertainty in some of the TDI values (e.g., toxaphene) against
frost and snow cover tend to inhibit the emanation of radon
the benefits of traditional food gathering and consumption,
from the soil. The northern practice of building homes on
it is generally recommended that consumption continue. How-
piles, rather than on a full concrete basement, also retards
ever, consideration needs to be given to reducing intakes of
the build-up of radon in indoor air.
some highly contaminated foods and increasing consump-
tion of other equally nutritious traditional foods that have
Conclusions
lower contaminant levels (Dewailly et al. 1996e).
The social, cultural, spiritual and physical health of Canadian
Levels of lead in adults and children are below a level of
Arctic indigenous peoples depends on the collection and con-
concern, however, there is a need to continue monitoring be-
sumption of country (traditional) foods. A diet based on tra-
cause of its extreme effects on fetal and infant neurobehav-
ditional foods is of high nutritional benefit. Marine mammals
ioral development.
and fish are rich sources of n-3 fatty acids which are thought
Cadmium levels in smokers are elevated and may have an
to protect against cardiovascular disease. The consumption
impact on kidney function. A recent risk assessment for cad-
of local fish, meat, wild greens and berries provides the nec-
mium suggests that general population effects (tubular dys-
essary dietary intake of most vitamins, essential elements and
function in the kidneys) may occur at lower levels than those
minerals.
previously considered safe.
A decrease in the use of traditional food has been docu-
The level of human exposure to anthropogenic radionu-
mented for some indigenous peoples in Canada for a variety
clides in the Canadian Arctic has declined dramatically since
of reasons, especially among younger generations. Compared
the cessation of above-ground weapons testing and is now
to a traditional diet, a diet based on market foods has less
very similar to levels in the temperate zone. Due to contami-
protein and iron, more fat (especially saturated fat) and leads
nation of the terrestrial food chain (i.e., particulates lichen
to a much higher carbohydrate intake. Dietary shifts are also
caribou), some indigenous groups may be exposed to high-
associated with `lifestyle' changes such as a more sedentary
er levels of some natural radionuclides.
lifestyle because less time is spent hunting. A loss of tradi-
Determining specific adverse human health effects in Arc-
tional knowledge can also result in a shift in diet, as hunting
tic peoples due to the presence of contaminants in traditio-
and food preparation are integral parts of indigenous people's
nal foods and human milk is extremely difficult for method-
culture. In addition, dietary shifts may result in an increase
ological and ethical reasons. Results are also difficult to
in the incidence of certain diseases such as diabetes and car-
interpret because of a wide range of confounding factors
diovascular disease.
(socio-economic, lifestyle and gender/age related). For ex-
The predominating scientific evidence, globally, suggests
ample, Arctic residents are at significantly higher risk of ex-
that the greatest health impacts of POPs are on the fetus
posure to cadmium through cigarette smoking than from
(through transplacental exposure), and newborns (through
dietary sources. Smoking is also a major risk factor for both
breast feeding). The fetus is highly vulnerable to the effects
coronary heart disease and lung cancer. These kinds of con-
of contaminants and will be exposed during this critical per-
founding factors cannot be ignored in an assessment of the
Chapter 12 ˇ Pollution and Human Health
801
Table 12ˇ14. Ongoing human health related research projects in Canada of relevance to the AMAP process.
Title
Principal investigator
Project status
Maternal and cord blood sampling in Baffin and Keewatin Regions of the NWT
J. Walker and Regional Health Boards
Ongoing
Advice on consultation, health risks, and health research
A. Gilman / D. Riedel / J. Van Oostdam
Ongoing
on contaminants in the North
Yukon First Nations. Assessment of dietary risk: benefit
Centre for Nutrition and the Environment
New
of Indigenous Peoples (CINE)
Vitamin A and calcium in traditional and market foods, NWT
CINE
New
Cord blood study - Nunavik
E. Dewailly / P. Ayotte
Ongoing
Transplacental exposure to PCBs and infant development Nunavik
G. Muckle
Pilot complete
Toxaphene- and chlordane-induced liver toxicity among Inuit
E. Dewailly / P. Ayotte
New
Variance in food use in communities
CINE
Publication in prep.
relative risk of exposure to contaminants through contami-
ing, but there remain unsubstantiated claims from the local
nated food, however, they do not diminish governmental re-
residents of fish and seals with sores or exhibiting strange
sponsibility to reduce environmental levels of contaminants
behavior. There have also been claims of increased morbid-
in the Arctic. Several ongoing studies in the Canadian Arctic
ity in the local population.
will help fill important data gaps relating to exposures and
The second involves radionuclide contamination follow-
effects (Table 12ˇ14).
ing the crash of a US Air Force B-52 bomber carrying nuclear
Considering what is known about the presence of POPs
weapons. The bomber, carrying four bombs, crashed on the
and mercury in the Canadian Arctic, and the current expo-
sea ice near Thule Air Base in 1968 and exploded, scattering
sures of some communities, it would be prudent to continue
plutonium, americium and tritium over the sea ice and into
to aggressively seek international agreement to reduce or
the ocean (see chapter 8, section 8.3.1.2.3). A large clean-up
eliminate the manufacture and use of most of these sub-
operation followed, and the Danish workers employed in the
stances.
clean-up have claimed that they have suffered from a num-
ber of symptoms and diseases due to exposure to radioactiv-
ity during this work. These include claims that mortality, in
12.4.2. Denmark/Greenland
and The Faeroe Islands
particular due to cancer, is increased among the former Thule
workers, and that their fertility is reduced. Several well con-
Introduction
ducted epidemiological investigations have failed to substan-
Greenland and the Faeroe Islands, with populations of ap-
tiate these claims (Juel 1992). However, based on the persist-
proximately 55 000 and 45 000, respectively, are parts of the
ing doubt about health effects on the exposed workers, a
Kingdom of Denmark. Although part of Greenland and all
Nordic expert group was established in 1995 to assess all
of the Faeroe Islands are subarctic, they are included in the
available information concerning the Thule accident. The
AMAP area. Living conditions and exposure are different in
main conclusion of the report of this group was that there is
the two areas and are, therefore, dealt with separately (cf.
no evidence of negative health effects, but that, based on the
chapter 5). Figure 12ˇ7 shows the main AMAP study area in
long latency period of certain types of cancer, the registry in-
Greenland, the Disko Bay region on the west coast of Green-
vestigations of cancer should continue (Lund 1996).
land. The Faeroe Islands were not included in AMAP human
Recent mining activities, such as the lead and zinc mine at
health monitoring activities carried out during 1994-96.
Mestersvig in East Greenland, and the small-scale uranium
12.4.2.1. Greenland
Sources of exposure
General population
The general population of Greenland is predominantly ex-
posed to environmental toxins through the traditional diet
Thule (Qaanaaq)
of marine mammals, i.e., seals, walrus, whales and polar bear,
Thule Air
Base
and to a lesser extent through fish consumption. Marine mam-
mals are at the top of the marine food chain and, due to bio-
magnification, have the highest concentrations of contami-
nants of any marine trophic levels. Concentrations of meth-
Mestersvig
ylmercury and a number of persistent organochlorine com-
Ukkusissat
pounds are high in the flesh, blubber and organs of these pop-
Disko
ular food items. Contaminant concentrations vary according
Bay
Ilulissat
Faeroe
to species and age of the animals consumed, and most likely
Islands
(Thorshavn)
also according to their natural habitat. Human exposure de-
pends largely upon dietary habits.
Nuuk
Local population groups
Although point sources are uncommon in Greenland, two
Narsaq
cases warrant mentioning. The first is `The Black Angel' lead
and zinc mine situated near the small village of Ukussissat in
northern West Greenland. The mine was closed in 1990 after
20 years of metal ore production which significantly conta-
minated the local environment with zinc, lead and cadmium.
Figure 12Ŗ7 : Study locations in Greenland and the Faroe Islands.
Figure 12ˇ7. Human health study locations in Greenland and the Faeroe
Islands; Disko Bay was the main area studied under the AMAP monitor-
The contamination has been monitored and is now decreas-
ing program (1994-96).
802
AMAP Assessment Report
mine near the small town of Narsaq in south Greenland, are
Table 12ˇ15. Levels of organochlorines in the omental (intra abdominal)
not known to have caused any detectable human exposure.
fat from autopsies of Inuit from Greenland (N = 42, sampled in 1993)
Waste disposal and incineration in many towns and villages
(Dewailly et al. 1995, Dewailly pers. comm.).
in Greenland does not appear to be well controlled. Although
Arithmetic mean,
95%
it has not been documented, it is possible that some town or
Contaminant
g/kg lipid
confidence interval
village dumps cause significant contamination of the local
-HCH
108.9 91.0-126.7
environment.
-chlordane
1.09
0.68-1.51
-chlordane
10.5 8.2-12.9
Dietary habits
Cis-nonachlor
311.6
260.0-363.1
p, p'-DDE
3843.8
3197.2-4490.4
Dietary habits pertaining to subsistence foods have been in-
p, p'-DDT
143.3 116.8-169.8
vestigated throughout Greenland in a recent survey (Bjerre-
Hexachlorobenzene
676.1 554.7-797.5
Mirex
152.6 123.5-181.7
gaard et al. 1995). In a food frequency questionnaire, people
Oxychlordane
862.4 679.9-1044.8
were asked to rate their consumption of various types of sub-
Trans-nonachlor
1463.1
1205.5-1720.7
sistence food. Inuit men consumed subsistence food 33 times
PCBs a
15700
13500-17900
per month on average, compared to 27 times per month for
a. PCBs measured as Aroclor 1260.
women. The frequency of consumption increased with age,
from 22 times per month in the 18-24 year old age class to
similar in mothers and babies. Concentrations for Greenland
42 times per month in the 60 years and older age class.
samples are very high compared with samples from southern
As expected, the consumption of subsistence food showed
Canada, but are low compared with another population sur-
a pronounced regional variation, with the lowest consump-
vey from Greenland (Dewailly et al. 1996d).
tion in towns and the highest consumption in villages. Geo-
graphically, the lowest frequency of consumption of subsist-
Mercury
ence food was reported in the capital (Nuuk) and in towns
The concentration and distribution of mercury in humans in
on the southwestern and southeastern coasts (23 times per
Greenland has been thoroughly studied over the last 15 years.
month). In towns on the northwestern coast, and in villages
Surveys have been performed in adults, pregnant women and
on the southwestern and southeastern coasts, frequency of
newborn babies in most parts of Greenland, including the
consumption was intermediate (31-36 times per month). The
central west coast, with the highest population concentration,
highest consumption was reported in the villages on the north-
and the hunting districts in northwestern, northern and east-
western coast and in the northernmost district (Thule) (46-
ern Greenland. In all four regions studied, the determining
50 times per month).
factor for mercury exposure was the daily intake of meat from
Seal meat is the most commonly eaten type of subsistence
marine mammals. At a regional level, the median blood mer-
food, followed by fish and whale meat, although there are
cury concentrations were directly proportional to the regis-
distinct regional patterns. In the northern and eastern villages,
tered mean number of seals caught (and consumed) indicat-
consumption of seal meat is markedly higher than consump-
ing that mercury concentration in meat is probably similar
tion of any other food item. In the towns on the south and
in all regions of Greenland (Hansen 1990).
east coast, fish consumption predominates.
In adults, median as well as maximum whole blood con-
In conclusion, marine food items, in particular meat and
centrations of mercury are lowest in the southwest, higher in
organs of marine mammals, are consumed in the Inuit popu-
the northwest and on the east coast, and very high in North
lation of Greenland to an extent that is presumed to result in
Greenland (Figure 12ˇ8). In North Greenland, 16% of the
a relatively high exposure to environmental contaminants.
adult population studied had blood mercury concentrations
exceeding 200 g/L. WHO regards this level as the mini-
Levels and trends of contaminants in humans
mum toxic blood concentration in adults. More than 80%
Persistent organic pollutants
of the population in North Greenland exceeded 50 g/L
While there are few studies of the levels of persistent organic
Hg
pollutants (POPs) in Greenlanders, results from human stud-
ĩg/L
ies in the eastern Canadian Arctic and studies on the Green-
250
landic fauna indicate that concentrations are likely high.
North Greenland
A few studies from the late 1970s on fat taken from biop-
Northwest Greenland
sies from Greenlanders showed higher DDT and DDE lev-
200
Southwest Greenland
els in Greenlanders than in the population of Denmark,
East Greenland
but lower DDE levels than in the United States, eastern
Greenlanders in Denmark
Europe and India (Clausen and Berg 1975, Jensen and Clau-
sen 1979). Concentrations of lindane, aldrin-like residue,
150
dieldrin, heptachlor-like residue, heptachlor epoxide, and
PCBs were similar in Greenlanders and Danes. Unfortunate-
ly, it was not specified where the specimens were taken from
100
in Greenland.
A recent study, in Nuuk and Ilulissat, of POPs in fat taken
at autopsy, showed very high levels in Greenland compared
with Canada, Finland and the United States. The mean con-
50
centrations in Greenland are shown in Table 12ˇ15.
Under the AMAP human health monitoring program in
Greenland, at the time of writing, 40 maternal blood sam-
0
ples and 29 cord blood samples had been analyzed for POPs,
10
50
90 95 99
Percentiles
including 24 sample pairs. Details, also including results of
Figure 12ˇ8. Distribution (in percentiles) of whole blood mercury concen-
more recent analyses, can be found in Annex Table 12ˇA12.
trations in four regions in Greenland and in Greenlanders living in Den-
It should be noted that concentrations on a lipid basis are
mark (Hansen 1988).
Chapter 12 ˇ Pollution and Human Health
803
(Hansen and Pedersen 1986). This concentration is the max-
Pb
imal acceptable blood mercury concentration for pregnant
ĩg / L
women (WHO 1990b).
450
In studies of fetal exposure, blood samples were collected
North Greenland
from pregnant women prior to delivery and from the umbi-
400
Northwest Greenland
lical cord at birth. Mercury concentrations in maternal and
Southwest Greenland
350
cord blood were linearly correlated, but concentrations
East Greenland
were somewhat higher in cord blood. Samples were col-
Greenlanders in Denmark
300
lected from 1982 to 1990. No temporal trend was ob-
served. The regional variation was similar to that of the
250
adults. A preliminary analysis of the data showed a nega-
tive correlation between blood mercury concentration and
200
birth weight (Foldspang and Hansen 1990), but a reanaly-
sis of data from the whole study showed only a minor and
150
non-significant negative association. Smoking habits and
population group were major determinants of birth weight
100
and gestational length.
Under the AMAP human health monitoring program in
50
Greenland, 20 paired maternal and cord blood samples were
analyzed for mercury. For the paired samples, the mean con-
0
10
50
90 95 99
centrations (arithmetic mean) in mothers and newborns were
Percentiles
24.2 g/L and 53.8 g/L, respectively, with medians of 16.9
Figure 12ˇ9. Distribution (in percentiles) of whole blood lead concentra-
and 56.7 g/L. Data for all samples are given in Annex Table
tions in four regions in Greenland and in Greenlanders living in Denmark
12ˇA13. These concentrations were very high compared
(Hansen 1988).
with samples from Denmark. Compared with earlier results
Cd
from Greenland, the mercury concentrations in maternal
ĩg/L
blood were lower than previously found in southwest Green-
8
land, probably a result of decreased consumption of marine
North Greenland
food by pregnant women.
7
Northwest Greenland
Southwest Greenland
Lead
6
East Greenland
Lead levels were determined in individuals living in four rep-
Greenlanders in Denmark
resentative areas of Greenland and were compared with lev-
5
els in Greenlanders living in Denmark (Figure 12ˇ9). The dif-
ferences among the four areas were relatively small and no
4
difference was found between levels in Greenlanders and
Danes living in Greenland. The blood lead levels in Green-
3
landers were also comparable to those of inhabitants of in-
dustrialized areas in western Europe. Umbilical cord blood
2
lead levels were slightly lower than those of the mothers (Han-
sen and Pedersen 1986, Hansen 1988).
1
Lead concentration in blood was not related to dietary
habits, i.e., consumption of marine mammals, or to smoking
0
habits, except in pregnant women for which a moderate re-
10
50
90 95 99
Percentiles
lationship to smoking was demonstrated. In East and North
Figure 12ˇ10. Distribution (in percentiles) of whole blood cadmium con-
Greenland, blood lead levels increased with age. This effect
Fi
12Ŗ10 Wh l bl d
d i
t ti
i f
i
i G
l d
centrations in four regions in Greenland and in Greenlanders living in
was most pronounced in women.
Denmark (Hansen 1988).
Blood lead concentrations in Greenlanders are decreasing
with time, following the same downward trends noted in
Cadmium
Europe and North America where declines are directly re-
Cadmium has been studied together with mercury and lead
lated to the introduction of lead-free gasoline. Furthermore,
in the same four regions of Greenland, however, cadmium
it has been demonstrated by analyses of lead in samples of
was only measured in the adult population. Figure 12ˇ10
inland ice that concentrations in Greenland reflect the con-
shows that the median blood cadmium concentration in East
sumption of leaded gasoline in both Europe and North Amer-
and North Greenlanders was the same as levels in Green-
ica. Therefore, it seems well substantiated that the surpris-
landers living in Denmark, and lower than levels in people
ingly high lead exposure in Greenland is caused by long-
living in West Greenland.
range atmospheric transport of lead from urbanized centers
The major determinant of blood cadmium concentration
at lower latitudes.
is smoking, such that a dietary effect can only be evaluated
Under the AMAP human health monitoring program in
in non-smokers. The median cadmium concentration in non-
Greenland, 20 paired maternal and cord blood samples have
smokers was higher in East and North Greenland, which is
been analyzed for lead. For the paired samples, the mean
in accordance with the higher intake of marine mammals in
concentrations (arithmetic mean) were 45.6 g/L in mothers
these regions. In smokers, however, as in the general popula-
and 34.9 g/L in the newborn, with medians of 34.2 and
tion, concentrations were higher in West Greenland. This
31.9 g/L, respectively. Data for all samples are given in
cannot be explained as a result of age or sex differences, as
Annex Table 12ˇA13. These concentrations are lower than
neither age nor sex were associated with blood cadmium.
those previously found and are in agreement with the de-
Neither can it be explained as being due to different propor-
creasing trends observed in other parts of the world.
tions of smokers in the sample groups. While quantitatively
804
AMAP Assessment Report
different smoking habits may be an explanation, a popula-
ples, mean zinc concentrations (arithmetic mean) were 545
tion survey has not demonstrated differences in numbers of
g/L in mothers and 870 g/L in the newborn (medians 549
cigarettes smoked in the four regions (Hansen and Pedersen
and 797 g/L, respectively). The mean concentrations of cop-
1986, Hansen 1988, Bjerregaard et al. 1995).
per (arithmetic mean) were 2237 g/L in mothers and 403
Under the AMAP human health monitoring program in
g/L in the newborn (medians 2236 and 370 g/L, respec-
Greenland, 42 maternal blood samples were analyzed for
tively). Data for all samples are given in Annex Table 12ˇA13.
cadmium. The mean concentration (arithmetic mean) was
1.29 g/L and the median was 0.9 g/L. For details see Annex
Other epidemiological factors
Table 12ˇA13. Concentrations were considerably lower than
The Greenlandic mortality pattern is characterized by a high
previously observed.
incidence of injuries, i.e., accidents and suicides, a high mor-
tality from primarily natural causes, and a relatively low
Selenium
mortality from ischemic heart disease (Bjerregaard 1991). The
Selenium has also been studied, but only in adults in East and
disease pattern and causes of death are recorded with a high
North Greenland. Selenium levels were high in Greenlanders,
degree of uncertainty which, together with the small and scat-
most notably in North Greenlanders (Figure 12ˇ11) (Hansen
tered population, makes epidemiological inference difficult.
1988). Similar to the findings for mercury, selenium concen-
To date, no diseases or symptoms have been registered which
trations were closely related to the amount of marine mammals
can be unequivocally related to environmental contaminant
eaten. The very large difference in selenium concentration
exposure. However, the measurement of more subtle neuro-
between East and North Greenland is not readily explained,
logical and reproductive outcomes have not yet taken place.
Se
The traditional Greenlandic diet is central to the issue of
ĩg/L
environmental exposure to toxins. Counter to the presumed
4 500
negative effects of environmental toxins, the traditional diet
provides compounds with known or supposed benefits to
4 000
North Greenland
health. Selenium is present in high concentrations in the tra-
East Greenland
ditional diet. It is an antioxidant and acts as an antagonist
3 500
Greenlanders in Denmark
to methylmercury. N-3 fatty acids of marine origin have been
the subject of numerous studies and are thought to be at least
3 000
part of the explanation for the low occurrence of atheroscle-
2 500
rosis and ischemic heart disease in Greenlanders. Further-
more, monounsaturated fatty acids from seal and whale blub-
2 000
ber may have the same beneficial effects on the pathology of
atherosclerosis and hypertension as have been demonstrated
1 500
for oleic acid, another monounsaturated fatty acid.
The traditional Greenlandic diet is also a very important
1 000
part of the Greenlandic culture. Eating Greenlandic food is
500
an essential part of the Greenlanders' identity. This is true
both in the hunting districts, where even young people pre-
0
fer to regularly eat seal meat, and in the capital where a tra-
10
50
90 95 99
Percentiles
ditional festive meal, large or small, always includes Green-
Figure 12ˇ11. Distribution (in percentiles) of whole blood selenium con-
landic specialties such as muktuk, dried whale meat, dried
Figure 12Ŗ11 : Whole blood selenium concentrations (in percentiles) in East
centrations in East and North Greenland and in Greenlanders living in
fish, blubber, etc.
Denmark (Hansen 1988).
but may be caused by differences in selenium contents of var-
12.4.2.2. Faeroe Islands
ious species of marine mammals. Selenium levels were also
high in umbilical cord blood, but somewhat lower than in
Levels and trends of contaminants in humans
maternal blood, indicating that selenium does not pass the
Umbilical cord blood samples from 1023 consecutive births
placental barrier as readily as mercury (Hansen and Peder-
in the Faeroe Islands showed a median blood mercury concen-
sen 1986). In North Greenland, but not in East Greenland,
tration of 24.2 g/L; 250 of the samples (25.1%) had blood
there was a positive association between mercury and seleni-
mercury concentrations that exceeded 40 g/L (Grandjean
um concentrations in individuals. The absence of this corre-
and Weihe 1992). Median mercury concentrations in mater-
lation in East Greenland may indicate that the dietary sources
nal hair were 4.5 g/g; 130 samples (12.7%) contained con-
of mercury and selenium are different between the regions
centrations that exceeded 10 g/g. Frequent consumption of
(Hansen 1988). Consumption of whale skin (muktuk), which
whale meat during pregnancy and, to a much lesser degree,
is very high in selenium, is very common in North Greenland
frequent consumption of fish, were associated with high mer-
but not as common in East Greenland.
cury concentrations in cord blood and hair. Increased parity
Under the AMAP human health monitoring program in
or age were also associated with high mercury concentrations
Greenland, 26 paired maternal and cord blood plasma samples
in cord blood and hair. Blood mercury levels were slightly
were analyzed for selenium. For the paired samples, the mean
lower if the mother had occasionally consumed alcoholic
concentrations (arithmetic mean) were 67.0 g/L in mothers
beverages. Mercury in blood correlated moderately with
and 39.1 g/L in the newborn, with median concentrations of
blood selenium (median 110 g/L). Increased selenium con-
67.8 and 37.8 g/L. This is lower than previously observed and
centrations were associated with intake of whale meat, alco-
is another indication of decreased consumption of marine foods.
hol abstention, delivery after term, and high parity. Lead in
cord blood was low (median 17 g/L), particularly if the
Other metals
mothers abstained from smoking.
Under the AMAP human health monitoring program in Green-
A questionnaire completed by 331 Faeroese adults re-
land, 26 paired maternal and cord blood plasma samples
vealed a daily consumption of 72 g fish, 12 g whale muscle
were also analyzed for zinc and copper. For the paired sam-
and 7 g of blubber. Fish and pilot whale constituted 44%
Chapter 12 ˇ Pollution and Human Health
805
and 9.5% of Faeroese dinner meals, respectively (Vestergaard
ner per week during pregnancy; and Group IV: at least five
and Zachariassen 1987). Most of the fish consumed in the
fish dinners per week during pregnancy. The frequency of
Faeroe Islands is cod with an average mercury concentration
pilot whale dinners was very low in Group I, very high in
of about 0.07 g/g (Hygiene Institute, Tķrshavn, pers. comm.).
Group II, and at the same intermediate level in Groups III
Almost all of the mercury in fish is methylated. Muscle tissue
and IV. However, the extent of blubber consumption was
of Faeroese pilot whales contained an average mercury con-
not quantified.
centration of 3.3 g/g, about half of which was methylmer-
Umbilical cord tissue from all children born on the Faer-
cury. Higher concentrations occurred in the liver, mainly in
oe Islands in 1986/87 was preserved. Preliminary data on 24
the form of inorganic mercury (Juhlshamn et al. 1987).
cord samples suggest an overall average PCB concentration
Based on the data from the questionnaires, and the total
of about 1.4 g/g lipid. This concentration is based on the
mercury concentration in whale and fish, an average daily
sum of the concentrations of PCB congeners 153, 138 and
mercury intake from these foods for individuals over 14
180, multiplied by 1.7 (Grandjean and Weihe 1992).
years of age can be calculated as being about 36 g. If the
steady-state blood level (in g/L) is numerically equal to the
12.4.2.3. Conclusions
average daily intake of a 70 kg person (expressed in g meth-
ylmercury), the expected blood level would be about 36 g/L.
In the absence of local point sources of pollution, the major
However, as only two-thirds of the total mercury in food is
routes of exposure to environmental contaminants (methyl-
methylmercury, the expected average blood levels would be
mercury, persistent organic pollutants) in Greenland are con-
about 25 g/L. This level is in agreement with the actual
sumption of meat and organs from marine mammals. Smok-
findings in the Faeroe Islands.
ing is the dominant source of cadmium exposure. The popu-
In a recent study of organochlorine concentrations in pi-
lation of Greenland is exposed to lead at approximately the
lot whales, it was found that the overall average PCB con-
same level as the populations of Western Europe and North
centration in blubber is very high, i.e., about 30 g/g lipid,
America although the pathway of exposure is not known
with total DDT being about 20 g/g lipid (Borrell and Agui-
with certainty.
lar 1993). Expressed on a lipid weight basis, the organochlo-
Exposure to contaminants of concern through the diet and
rine concentrations are about the same in muscle tissue. How-
through smoking is high. Exposure to methylmercury and
ever, the fresh weight concentration of PCB averages only
POPs is at a level where negative consequences for health
about 0.6 g/g and total DDT is about half as much (Borrell
may be expected. While there are no examples of overt toxic
and Aguilar 1993). Based on these findings, the average dai-
effects from environmental pollutants in the Greenlandic
ly intake of PCB of the Faeroe Islands is estimated at above
population, the subtle effects that may occur are very diffi-
200 g, with considerable inter-individual variation. For
cult to detect, can be easily overlooked, or can be masked by
comparison, the average daily PCB intake in Scandinavia is
other factors.
about 15-20 g. Thus, the difference in average PCB expo-
More detailed dietary information is needed concerning
sure between these two population groups corresponds to
the species, organs, and amounts eaten by Greenlanders. In
one order of magnitude.
addition, information about the relationship between diet and
Samples of human milk were collected on the third and
body burden of pollutants is needed. Ongoing studies in the
fourth day after delivery from women who had given birth
Disko Bay area will supply some of this information. It is also
in the hospital in Tķrshavn (Table 12ˇ16). Samples were col-
important to follow the temporal trends in exposure to envi-
lected over a one month period. Four pooled samples were
ronmental pollutants. A survey program of pregnant women
and their newborn babies was initiated in 1994 and continues
Table 12ˇ16. Total PCB concentrations in four pooled human milk sam-
ples from Tķrshavn, Faeroe Islands.
as part of the AMAP human health monitoring program.
Table 12ˇ17 outlines ongoing studies in Greenland and the
Whole weight,
Lipid adjusted,
Faeroe Islands that are relevant to the AMAP process.
Pool a
g/L
g/g
% lipid
At present, most health professionals with knowledge of
I
47.1
2.2
2.22
Greenland agree that the possible negative effects of pollu-
II
80.3
3.5
2.31
tants in the diet are far outweighed by the positive health-
III
46.6
1.8
2.54
IV
58.3
2.8
2.11
related and social benefits of the traditional diet. With infor-
mation from dietary surveys and AMAP human health sur-
a. For explanation, see text
veillance, and information on species- and organ-specific con-
made from 22 samples such that each mother contributed
centrations of contaminants in consumed animals, it will be
the same amount of fat to the pool. The four groups were
possible to establish more carefully constructed dietary guide-
separated as follows: Group I: low mercury concentration
lines for vulnerable population subgroups, e.g., pregnant
in the milk (< 1 g/L); Group II: high mercury concentration
women and children. It is also agreed that action should be
in the milk (> 4 g/L); Group III: no more than one fish din-
taken to reduce the high prevalence of smoking.
Table 12ˇ17. Ongoing human health related research projects in Greenland and the Faeroe Islands of relevance to the AMAP process.
Title
Principal investigator
Project status
Birth weight and mercury exposure
J.C. Hansen,
Centre for Arctic Environmental Medicine (CAM)
In progress
Exposure of pregnant women in the Disko Bay area
P. Bjerregaard,
to environmental contaminants
Danish Institute for Clinical Epidemiology (DICE)
In progress
Environmental risk factors in West Greenland
P. Bjerregaard, DICE
In progress
Dietary survey in Disko Bay area
T. Pars, DICE
In progress
Health interview survey in Greenland
P. Bjerregaard, DICE
In progress
Neurotoxic effects of prenatal exposure to mercury in the Faeroe Islands
P. Grandjean, P. Weihe
In progress
Neurotoxic effects of prenatal exposure to PCBs in the Faeroe Islands
P. Grandjean, P. Weihe
In progress
Neurotoxic effects of prenatal mercury exposure in North Greenland
P. Weihe
In progress
806
AMAP Assessment Report
12.4.3. Iceland
Bergen
Introduction
Tromsø Hammerfest
The total population of Iceland is 266 783. The Icelandic popu-
Kirkenes
Enontekiö
lation is culturally and socially homogeneous with immigrants
Utsjoki
Nikel
Inari
Zapolyarnyy
Savukoski
accounting for only 2% of the population (cf. chapter 5).
Kovdor
Pelkosenniemi
Murmansk
Salla
Olenegorsk
Sources of exposure
Monchegorsk
Kirovsk
Since heavy industry and agriculture are limited in Iceland,
Apatity
Kandalaksha
the main source of exposure to pollutants is likely dietary.
yr
Arkhangelsk
Taīm
Although Icelanders are typically western in most aspects,
etchora
Khatang
P
Khatanga
their diet has many subarctic characteristics. Icelanders con-
V
Dvina
Karaul
o l
Vorkuta
g a
Soukhona
Piassina
Inta
sume more fish than other nations in Europe and the diet is
I
Salekhard
e
Dudinkanis
Norilsk
s
b
e
O
ī
unusually rich in protein and fat. Whale meat was a season-
Volg
Nadim
a
al component of most people's diet until 1986, and seal and
Noviy
seabirds are harvested in many rural areas.
Ta
Urengoy
a
z
am
K
a
To
l
g
u
o
va
To
V
ungouska inférie
Do
O
n
b
Levels and trends of contaminants in humans
Figure 12ˇ12. Human health study locations in Arctic Norway, Russia and
There is very little data on levels of contaminants in people.
Finland; red dots indicate the main communities studied under the AMAP
Blood lead levels were measured in 37 individuals living in
monitoring program.
Reykjavik in 1992 (Thordardottir and Jķhannesson 1993).
The levels were about 50 g/L (range 25-88 g/L) and were
12.4.4. Norway, Russia and Finland
three- to five-fold lower than had been found in a similar
study in 1978 (Pormar and Jķhannesson 1979). Between
The national reports of Norway and Russia, and to a certain
1986 and 1990, lead levels in ambient air in Reykjavik de-
extent Finland, are partly integrated because of the proxim-
creased five-fold (Gísladķttir 1992). Cadmium was analyzed
ity of parts of their Arctic regions where related human health
in the renal cortex of 30 accident victims and was below 40
studies have been carried out under AMAP (Figure 12ˇ12).
g/g in all samples (Sķlbergsdķttir and Jķhannesson 1992).
The most severe ecological problems in the area are related
Mercury, arsenic, cadmium, selenium and zinc were analyzed
to the industrial pollution on the Kola Peninsula of Russia,
in human hair from 58 individuals in 1981 (Jķhannesson et
close to the Norwegian-Russian-Finnish border, and in the
al. 1981). The levels were all found to be low or normal.
Norilsk region of Siberia.
Volcanic and geothermal activity did not appear to increase
the body burden of mercury in the Icelandic population.
12.4.4.1. Norway
The levels of PCBs and organochlorine pesticides in 22
samples of breast milk collected in Reykjavik in 1993 were
Introduction
similar or higher than reported elsewhere (Jensen 1990).
The Arctic part of mainland Norway, defined as north of the
The mean levels in milk fat were: 47 ng/g HCB, 360 ng/g
Arctic Circle, has a subarctic climate because of the Gulf
DDT, 830 ng/g PCB, and 206 ng/g CB 153 (Olafsdottir
Stream influence. The three northernmost counties in Nor-
pers. comm.). The levels of PCBs and organochlorine pesti-
way are Nordland, with approximately 240 000 inhabitants,
cides in adipose tissue and brain from 15 postmortem sam-
of which nearly 160 000 live north of the Arctic Circle; Troms,
ples were determined in 1994. The levels were again found
with approximately 145 000 inhabitants; and Finnmark with
to be similar or higher than reported elsewhere (Luotamo
approximately 73 000 inhabitants (figures from Statistisk
et al. 1991, Willams and LeBel 1990). The mean levels in
Sentralbyrå, Oslo, 1994). They are treated as one region, re-
adipose tissue were: 100 ng/g lipid HCB, 1100 ng/g lipid
ferred to as Northern Norway, in matters concerning social
DDT and 550 ng/g lipid CB 153. A study of metals and
affairs, economic questions and health care. The climate is,
organochlorines in maternal blood is ongoing in collabora-
however, not significantly different from much of the rest of
tion with the other AMAP nations. Organochlorine levels
the west coast of Norway. There is only one significant source
in a pooled serum sample from 22 males are shown in
of industrial pollution within mainland northern Norway,
Table 12ˇ18.
namely the iron-producing Syd-Varanger Company in Kirke-
nes. The facilities at this point source were closed down per-
Table 12ˇ18. Organochlorines in human serum
manently in April 1996.
in Iceland. A pooled sample from 22 males,
age 31-61, mean = 45.3 7.4 years.
Sources of exposure
Contaminant
g/L
The general population of northern Norway has three main
exposure sources:
HCB
0.623 0.019
1. Dietary intake by coastal populations of global contami-
DDE
2.34
0.13
CB 74
0.120 0.005
nants, primarily persistent organic pollutants and mer-
CB 99
0.156 0.007
cury in marine foods. The main source is fish, and to a
CB 101
0.125 0.008
lesser extent marine mammals, making an important dif-
CB 105
0.065 0.019
ference in the dietary patterns to the comparable groups
CB 118
0.162 0.017
in Greenland and Canada.
CB 138
0.592 0.026
CB 153
1.22
0.05
2. The regional air pollutants, mainly SO2 and metals such
CB 170
0.320 0.027
as iron, copper and nickel, derived from the extensive in-
CB 180
0.744 0.045
dustrial emissions on the Kola Peninsula close to the Nor-
CB 183
0.115 0.009
wegian border.
CB 187
0.261 0.016
3. The radiation contamination following the Chernobyl ac-
CB 194
0.136 0.025
cident which affected the south of Nordland, and, more
Chapter 12 ˇ Pollution and Human Health
807
historically, the nuclear testing program on Novaya Zem-
Sources of exposure
lya affecting the inland areas of Finnmark. This problem
The Russian Arctic is the most industrialized of the Arctic
is discussed in more detail in chapter 8.
regions. In the former Soviet Union (FSU), it was official pol-
icy to industrialize the region, and this resulted in an exten-
Water
sive influx of people from other parts of the FSU. Political
The quality of the water supply to Norwegian communities
and social dominance by the new residents occurred through-
is routinely monitored by the local health authorities. There
out the territory. The migrants were, and continue to be, most-
are standard reference limits for metals and infectious agents,
ly concentrated in urban centers and employed in industrial
and the water quality, with very few exceptions due to sea-
activities, such as mining of coal and metal ores, and oil and
sonal variations, is of no medical concern.
gas production and refining (Table 12ˇ19). The indigenous
populations largely continue their traditional activities, such
Air
as reindeer herding, fishing and hunting. As a consequence,
The air pollution in northern Norway is of special concern
the immigrant populations are primarily exposed to contami-
in the Norwegian-Russian border area. Monitoring of air
nants through their work, while indigenous people are main-
pollution on the Norwegian side started in Sør-Varanger in
ly exposed through the food chain.
1974, and on the Russian side in 1985. The Joint Norwe-
Table 12ˇ19. Industrial cities of the Russian Arctic (reproduced from
gian-Russian Commission on Environmental Cooperation
Revitch 1995).
was formed in 1988, with a special Norwegian-Russian
Health Group established in 1991. In 1989, the total SO
Region/city
Population
Main industrial activity
2-
contamination from the Nikel and Zapolyarnyy nickel
Murmansk province
plants was 272 000 tonnes, three times the total SO2-pollu-
Murmansk
473000
Harbor, ship repair
tion originating from Norway in the same year. A total of
Severodvinsk
66000
Ship building
1100 tonnes of metals were also emitted, including 510
Kandalaksha
54000
Aluminum industry
Apatity
89000
Extraction of apatite
tonnes nickel, 310 tonnes copper and 18 tonnes cobalt. Air
Kirovsk
43000
Extraction of apatite
measurements at Norwegian border stations have exceeded
Monchegorsk
68000
Nickel industry
3000 g/m3 SO
Olenegorsk
47000
Extraction of iron
2. On the Russian side, concentrations ex-
Kovdor
31000
Extraction of iron
ceeding 500 g/m3 are instantly followed by a decrease in
Zapolyarnyy
23000
Nickel industry
production to reduce emissions. Different aspects of human
Nikel
22000
Nickel industry
health are now investigated in this area. The production of
Komi Republic
nickel has decreased in the last years, due to the economic
Vorkuta
117000
Extraction of coal
changes in Russia. There is now political agreement for the
Inta
61000
Extraction of coal
renovation of the nickel plant in Nikel.
Yamalo Nenetsky
Autonomous Okrug
New Urengoy
105000
Gas extraction
Occupational
Nadim
52000
Gas extraction
The only major industrial pollution source on mainland
Taimyr Autonomous Okrug
northern Norway was the Syd-Varanger Company which
Norilsk
169000
Nickel, copper, cobalt
was concerned with iron production (Sivertsen and Schold-
and other non-ferrous industry
ager 1991). Recently, all operations at this plant have been
terminated. The emissions of SO2 from this plant were mi-
nor compared to those from the neighboring Russian nickel
Water
industry. However, a substantial release of dioxins was rec-
The quality of drinking water sources to towns of the Rus-
ognized during the last years of operation. Investigations are
sian Arctic are, with some exceptions, generally good, be-
underway to assess any associated human health risks.
cause urban populations are supplied from centralized water
facilities (Klopov 1995 pers. comm.). However, because the
supply pipelines are often very old, and water is transported
12.4.4.2. Russia
over long distances, the water often remains in the pipes for
Introduction
long periods prior to its use as tap water, resulting in conta-
The Russian Arctic territories cover by far the largest seg-
mination with metals, especially iron. In rural areas, the wa-
ment of the circumpolar region, extending from the Kola
ter often comes from natural freshwater reservoirs, such as
Peninsula in the west to Chukotka in the east. The popula-
rivers, lakes and melting of snow in the winter. This increases
tion of the Russian Arctic, as defined by Russia and accord-
the risk of environmental contamination, especially by infec-
ing to the 1989 census, is approximately 2 million, including
tious agents. The consequence is a high occurrence of gastro-
66 000 indigenous minorities and over 22 000 indigenous
intestinal diseases, especially in children, in these areas. Upper
Yakuts. Additional areas of the Russian North, with condi-
limits for some chemical substances in fresh tap water are
tions similar to the Arctic, include another 1.7 million per-
given in Table 12ˇ20.
sons, of whom 200 000 are members of indigenous minori-
ties and other indigenous groups (Klopov pers. comm.) (see
Table 12ˇ20. Russian upper limits for
selected elements in tap water, mg/L.
also chapter 5). The region includes two particularly heavily
polluted industrial areas, namely the part of the Kola Penin-
Fluoride
1.5
sula adjacent to the Norwegian-Finnish border, and the No-
Manganese
0.1
rilsk region in Siberia. In both regions, nickel production in-
Arsenic
0.05
Mercury
0.005
dustries constitute a major source of pollution. The unique
Selenium
0.001
feature of the Russian Arctic, compared to Norway and Fin-
Cadmium
0.01
land, is that the Arctic climate reaches to areas far south of
Nickel
0.1
the Arctic Circle in most of Siberia and the Russian far east.
Copper
0.1
The AMAP human health monitoring program study areas
Lead
0.03
Zinc
1.0
within the three countries are shown in Figure 12ˇ12.
808
AMAP Assessment Report
Air
cant differences in the concentrations of PCBs were found
During the period since the communist revolution in 1917,
between the three locations, nor in the levels of PCDDs and
the Russian Arctic has been extensively industrialized. Today
PCDFs expressed as TCDD equivalents (TEQs). However, an
there are 34 cities of industrial importance in the territory (Re-
indication of regional differences was found for some PCDD
vitch 1995) and their emissions are significant point sources
and PCDF congeners, consistent with suspected sources of
of pollution. Norilsk is by far the biggest source of pollution,
these compounds. All the values were close in magnitude to
with a total release of over 2 million tonnes/y of different
data reported for other western countries.
pollutants, although primarily SO2. This is the cause of the
A more comprehensive study was carried out in the same
highest level of air pollution ever registered, with SO2 levels
areas in 1992/93 (Becher et al. 1995), also including locations
exceeding up to 22 times the maximal permissible level dur-
in Lithuania. There was no significant change in the concen-
ing some periods.
trations of PCBs between the earlier (1985/86) and more re-
cent (1992/93) studies, with means for total PCB in human
Occupational
milk of 534 g/kg lipid and 496 g/kg lipid, respectively.
Nasal and lung cancer are recognized as chronic occupatio-
In an investigation of human milk from mothers living
nal diseases in the nickel industry (Norseth 1994). Poten-
in Oslo (n = 28), Skaare et al. (1990) found a mean concen-
tial reproductive and developmental health effects for wo-
tration of total PCB of 488 g/kg lipid. Becher et al. (1995)
men of fertile age who work in nickel plants and their off-
reported total TEQs, including dioxin-like PCBs, between
spring are currently being assessed. As in other industrial
31 and 42 pg TEQ/g lipid in Norway, compared to 45-49
countries, industry-specific occupational diseases occur in
pg TEQ/g lipid in Lithuania. Dioxin-like PCBs were found
connection with the northern Russian industries identified
to contribute two to three times more to the total TEQs
in Table 12ˇ19.
than the PCDDs and PCDFs. Major congeners among the
On the Kola Peninsula, Chashschin et al. (1994) have com-
dioxin-like PCBs were CBs 126, 156, 114, 118, and 170.
pleted a cross-sectional study of 821 male and 758 female
Comparison with the 1985/86 study, indicates a decrease
workers in a nickel hydrometallurgy refining plant. Even with
in the mean TEQ levels of about 37% over a 7-year time
serious limitations in the statistical and sampling details of
span for PCDDs/PCDFs, while the levels of total PCBs have
the pregnancies and newborn babies, the results suggest some
remained unchanged or have only slightly decreased. This
adverse reproductive and developmental effects. This consti-
interesting temporal trend needs to be documented further
tutes a real concern that requires a more comprehensive and
in future studies.
quantitative epidemiological investigation. Such work has
In 1993, Polder et al. (1996) carried out a study on moth-
now been initiated and involves extensive international co-
ers milk in Murmansk and Monchegorsk on the Kola Penin-
operation.
sula. Total PCB in mothers milk from Murmansk was in the
range of 250-635 g/kg lipid, with a mean value of 484 g/
kg lipid (range 7.5-19 g/L and mean 12.6 g/L). The results
12.4.4.3. Russia and Norway
from Monchegorsk were in the range of 262-854 g/kg lipid,
Levels and trends of contaminants in humans
with a mean value of 535 g/kg lipid (range 7.8-25.6 g/L
Methods
and mean 16.1 g/L). Specific congener concentrations were
Under the AMAP human health monitoring program for
marginally higher for CBs 74, 99, 118, 138 and 153, while
Northern Norway, it was decided to solicit anamnestic in-
other congeners, such as CB 180 and 187, were lowest. This
formation and collect biological samples from 50 continu-
pattern corresponds well to the known dominance of dietary
ous delivery patients in Hammerfest and Kirkenes, and from
intake as the major exposure pathway for the general popu-
15 delivery patients in the Tromsø Regional University Hos-
lation and the similarity of dietary habits within a country.
pital who lived in Målselv. The town of Bergen in the south-
The conclusion was that the exposures in Monchegorsk and
west of Norway was used as a reference. In Russia, the same
Murmansk are relatively low. No significant geographical
protocols were carried out in Nikel, Murmansk, Apatity,
differences in levels of PCBs and PCDDs/PCDFs between
Monchegorsk, Arkhangelsk, Salekhard and Norilsk. The pa-
Murmansk and Monchegorsk were found.
tients were asked to complete a written questionnaire addres-
In central Russia, there has been an investigation of breast
sing the following: age, parity, ethnic background, places of
milk and placentas from mothers employed in a transformer
residence exceeding six months, schooling, occupation, smok-
plant in Serpuhov (Moscow County) (Pleskatchevskaya and
ing habits, alcohol, medication, serious diseases and dietary
Bovonikova 1992). The range of the total PCB levels found
habits, especially concerning certain types of food. The fol-
in milk was 14-105 g/L (467-3500 g/kg lipid).
lowing information was collected about the births: naegele
In the Russian AMAP human health monitoring study,
term, date of birth, length of baby, weight of baby, weight of
PCB levels were analyzed in plasma from women in Salek-
placenta, APGAR score, congenital malformations, gestatio-
hard and Norilsk (Klopov pers. comm.). The arithmetic mean
nal age, and individual comments by the doctor or midwife.
concentration of PCB in plasma of women 18-24 years old
The completion of the informed consent form and collection
was 7.5 g/L in Norilsk and 6.8 g/L in Salekhard. A mean
of anamnestic information was done before the delivery pro-
concentration of 9.9 g/L has been reported in a compara-
cess started, to minimize stress. Standardized procedures that
ble age group of an Inuit population in Canada (Dewailly et
minimized inadvertent contamination were employed to col-
al. 1994a). By comparison, the mean plasma PCB concentra-
lect blood and urine from mothers, cord blood, urine from
tion in a group of women 25-44 years old was 13.8 g/L in
the neonates, and placental tissue.
Norilsk and 16.1 g/L in Salekhard (19.5 g/L in the Inuit
population in Canada). The mean concentration of PCB in
Persistent organic pollutants
cord blood samples was 2.1 g/L in Norilsk and 1.6 g/L in
A Norwegian survey of PCBs, PCDDs and PCDFs in human
Salekhard (2.8 g/L in the Inuit population in Canada). The
milk during 1985/86 included the town of Tromsø in the
mean concentration of PCB in breast milk of the Norilsk
Norwegian AMAP area (Clench-Aas et al. 1988). Elverum,
women was 799 g/kg lipid, while in Salekhard it was 847
an inland community in the south, and the southern indus-
g/kg lipid. The major food source of PCB is freshwater
trialized town of Porsgrunn, were also surveyed. No signifi-
fish, which constitutes a significant portion of the diet.
Chapter 12 ˇ Pollution and Human Health
809
Very high levels of DDT have been reported during
Metals
1970-1980 in human blood samples from the southern re-
Mercury
gions of the former Soviet Union (Klopov pers. comm.).
Under the joint Norwegian-Russian AMAP human health mon-
The reason for this might be the huge quantities of pesti-
itoring study of Norway, Kola and Arkhangelsk, the mean
cides used in agriculture practices. In certain regions of
maternal blood mercury levels (see Annex Table 12ˇA13)
Moldavia, this has been suggested to be a reason for a high
were marginally higher in the Norwegian population (p <
incidence of miscarriages and congenital malformations
0.01); and for both the Russian and Norwegian groups as
(Klopov pers. comm.). The mean concentrations of p, p'-
a whole, they corresponded to reference values for moderate
DDE in maternal plasma of delivering women in Norilsk
to no fish consumption (Odland et al. 1996, 1997). When
and Salekhard were found to be rather low: 0.67 and 0.38
broken down by community, the following mean values (in
g/L, respectively, compared to 11.3 g/L in the Inuit pop-
g/L) are found: 1.6 (Arkhangelsk, n = 50); 2.3 (Nikel, n = 50);
ulation of Quebec, Canada (Dewailly et al. 1994a). In cord
2.5 (Hammerfest, n = 57); and 3.4 (Kirkenes, n = 40), with
blood, the concentrations showed the same pattern: Norilsk
the difference between Hammerfest and Arkhangelsk being
0.23 g/L and Salekhard 0.28 g/L, compared to 1.63 g/
statistically significant (p < 0.0001).
L in northern Quebec. The mean p, p'-DDE in breast milk
Consistent with the previously observed correlation be-
showed levels of 1291 g/kg lipid (Norilsk) and 978.3 g/
tween fish intake and blood mercury levels (Brune et al. 1991),
kg lipid (Salekhard), compared to 1212 g/kg lipid (Nuna-
the mean for the fishing town of Kirkenes was the highest.
vik in Canada).
The very low levels for Arkhangelsk suggest that methylmer-
PAH levels in Russian human populations have not been
cury does not enter the food chain. It is clear that the levels
previously reported. These substances were analyzed in moth-
observed in Kirkenes, Hammerfest, Nikel and Arkhangelsk
ers' blood, cord blood and placenta from both Norilsk and
do not pose any health risk.
Salekhard. Naphthalene, phenanthrene, anthracene, fluor-
anthene, pyrene, benzo[a]pyrene, benzo[e]pyrene and 2-
Cadmium
methyl-naphthalene were determined (Klopov 1995 pers.
The comparisons of the results from Norway, Kola and
comm.). For naphthalene, the mean concentration in moth-
Arkhangelsk (Annex Table 12ˇA13) indicate that the cad-
ers' blood was 9.5 g/L in Norilsk and 10.7 g/L in Salek-
mium concentrations in mothers' blood are marginally
hard; in cord blood it was 2.5 and 5.8 g/L, respectively;
lower in the Russian group as a whole (p < 0.05); both sets
and in placental tissue it was 4.9 and 3.9 g/kg, respective-
of data are, however, well below the baseline reference val-
ly. The results point to the placenta as a partial barrier of
ues of < 2.0 g/L (Odland et al. 1996, 1997). The data ob-
PAH compounds, the extent of which appeared compound
tained from the Siberian locations and Tromsø conform to
specific. Benzo[a]pyrene was not found in quantifiable lev-
this trend. This comparison could not be made for the cord
els in cord blood, while anthracene and benzo[e]pyrene were
blood levels, since many of the values in both groups were
higher than in maternal blood.
below the detection limit. As expected, smokers (10% of the
Under the Norwegian-Russian AMAP human health mon-
total) had the highest blood cadmium concentrations (me-
itoring study, ten samples of breast milk were collected from
dian of 2.1 g/L).
first-delivery mothers in Arkhangelsk and Severodvinsk,
The cadmium concentrations in blood of both the Rus-
both located in Arkhangelsk County. These samples were
sian and Norwegian populations studied are very low, indi-
analyzed for chlorinated organic compounds, and the re-
cating insignificant environmental exposure. A significant
sults are summarized in Table 12ˇ21. The observed concen-
difference between the non-smoking mothers and the moth-
trations match those found in Murmansk, Monchegorsk
ers smoking more than ten cigarettes per day (p < 0.0001)
and Lithuania. Other than for total chlordanes, and possi-
was observed. Interestingly, some of the mothers smoking
bly also total PCBs and total di-ortho PCBs, concentrations
more than ten cigarettes per day have children with blood
of chlorinated compounds in breast milk are considerably
concentrations below the detection limit of 0.1 g/L, sug-
higher in samples from Russia and Lithuania than in sam-
gesting a possible threshold for the passage of cadmium
ples from Norway. The relative enhancement of total
through the human placenta. Differences between different
mono-ortho-PCBs in the Russian samples is especially in-
mammals are known, with free passage of cadmium through
teresting, since these have significant associated TEQ val-
the Wistar rat placenta, while the hamster placenta is totally
ues because of their resemblance to dioxins.
impermeable to this metal (Tsuchiya et al. 1987, Hanlon et
Considering the data in Table 12ˇ21, a final observation
al. 1989). It seems that the human placenta serves as a selec-
concerns the DDE to DDT ratio values. This ratio provides
tive barrier to cadmium with an average attenuation of 40-
information about current use of p, p'-DDT, or other possi-
50% (Lauwerys et al. 1978, Roels et al. 1978, WHO 1992a).
ble current exposure, such as through imported foods. The
Because many of the cord blood cadmium concentrations
relatively low DDE/DDT values found for the Russian breast
were below the detection limit, it may be that individual
milk samples suggest a higher current exposure to DDT
variability related to physiological phenomena such as met-
here than in Norway or Lithuania.
allothionein induction in the placenta is operative.
Table 12ˇ21. Levels of organic contaminants in breast milk from northern Russia, northern Norway and Lithuania in the period 1993-1996.
Mean values, ng/g lipid.
chlor-
Ratio
mono-
di-
n
HCB
HCH
dane
p, p'-DDE
p,p'-DDT
DDT
DDE/DDT PCBs ortho PCBs ortho PCBs
Severodvinsk 1996
10
95
467
35
1118
176
1336
6.4
517
123
394
Arkhangelsk 1996
10
99
558
27
1687
344
2088
4.9
516
116
400
Murmansk 1993
10
129
858
59
1269
178
1615
7.1
484
95
389
Monchegorsk 1993
10
111
745
33
892
145
1155
6.2
535
132
403
Tromsø 1993
10
39
34
42
310
19
328
16.3
383
54
329
Lithuania 1993
12
264
417
20
861
43
1002
20.0
529
115
414
810
AMAP Assessment Report
Mothers' blood and cord blood from Norilsk and Salek-
revealed a trend of higher blood lead levels in small, remote
hard have also been analyzed for cadmium by Russian col-
communities than in bigger cities (Nieboer pers. comm.).
leagues (Klopov 1995 pers. comm.). Comparable findings to
One possible explanation might be the lead content of wild
those described above are observed, with a very high corre-
meats due to the use of leaded ammunition, especially lead
lation between cadmium levels and smoking habits. The mean
shot. A more thorough dietary evaluation is necessary to
blood cadmium concentration of smoking mothers in Norilsk
further elucidate this important finding.
was 5.7 g/L, while in non-smoking mothers it was 1.3 g/L.
The values in women from Salekhard were 5.7 g/L for smok-
Nickel
ing women and 0.8 g/L for non-smoking mothers. Mean
Both the neonatal and maternal mean urinary nickel levels
cadmium levels in cord blood were 2.8 g/L in samples from
are considerably higher among the Russian communities
Norilsk and 2.5 g/L in the Salekhard samples. Note that
studied (p < 0.0001) (Odland et al. 1997) (Figures 12ˇ13 and
these levels are somewhat higher than those found in the
12ˇ14). Those reported for the Norwegian group fall within
AMAP study (reported in Annex Table 12ˇA13). Harmoni-
the reference interval of 0.5-6.1 g/L (Sunderman et al. 1988,
zation of analytical methods is, therefore, prudent.
Ni
ĩg/L
Lead
30
Under the joint Norwegian-Russian AMAP human health
monitoring study in Norway, Kola Peninsula and Arkh-
25
angelsk, the mean lead levels in mothers and neonates in
Range
Russia as a whole (Annex Table 12ˇA13) are significantly
Mean
20
higher than in Norway (p < 0.0001); both sets of data con-
Median
form to the expected reference values (Odland et al. 1997).
15
The recently obtained results from Siberia and Tromsø con-
cur. A linear relationship between maternal blood and cord
10
blood lead is clearly observed (e.g., for the town of Nikel,
r = 0.96, p < 0.02, n = 24).
5
Even though the Russian values are significantly higher as
a whole, both population groups have mean blood lead con-
0
centrations within the reference interval of 0-40 g/L. Rus-
Archangelsk Nikel
Nikel Monchegorsk Kirkenes
Kirkenes
Bergen Hammerfest
sian cars are still using leaded gasoline, but the traffic den-
before
after
before
after
birth
birth
birth
birth
sity is not as high as in western cities, even in a town like Mon-
n = 50
n = 49
n = 50
n = 46
n = 46
n = 50
chegorsk with a population of about 60 000 inhabitants. If
Figure 12ˇ13. Nickel levels in urine from pregnant and delivering women
the currently observed blood lead concentrations of the Rus-
in different areas of Russia and Norway.
sian women are compared with western measurements from
20 years ago (Environmental Health Perspectives 1990, 1991),
Ni
much lower concentrations are found in the Russian women.
ĩg/L
10
Overall, the Norwegian blood lead results constitute some
of the lowest concentrations reported in the literature. Im-
provement in preventing contamination during collection,
8
Range
sampling, handling and storage of the specimens might be
Mean
one reason for this. Another, of course, is that following in-
6
Median
troduction of lead-free gasoline, the effect of reduced emis-
sions are being observed in humans.
4
Whole blood lead concentrations were determined in the
children aged 2 to 13 from three Russian towns (Lovozero,
Krasnochelie and Apatity). Lovozero is the Russian center
2
for the Saami population with approximately 2000 inhabi-
tants. Krasnochelie is a very isolated community on the Po-
0
noi River, far east on the Kola Peninsula, with a mixed pop-
Archangelsk
Nikel
Monchegorsk Kirkenes
Bergen
Hammerfest
n = 46
n = 42
n = 49
n = 46
n = 31
n = 57
ulation of Saami, Komi, Nenets and Russians, totaling 850
Figure 12ˇ14. Nickel levels in urine from newborn children in different
people. Apatity is one of the bigger cities of Murmansk
areas of Russia and Norway.
County, with approximately 89 000 inhabitants. The results
Sunderman 1993), while the Russian mean values for moth-
Table 12ˇ22. Comparison of blood lead levels in children in Krasnochelie,
Lovozero and Apatity on the Kola Peninsula of Russia, g/L.
ers are higher than this interval. Breaking down the urinary
nickel concentrations for mothers by communities, the values
n
Mean
SD
Range
for the Russian towns of Nikel and Arkhangelsk are signifi-
Lovozero
50
58
22.8
21-114
cantly higher than those for the Norwegian centers (p < 0.0001)
Krasnochelie
13
83a
37.3
21-157
and different from each other (p < 0.01). In terms of the neo-
Apatity
22
54
22.8
27-81
natal first voids, there were no statistical differences between
a. Statistically different from the other two values (p < 0.001).
individual communities, whether in Russia or Norway. There
appears to be no apparent relationship between the maternal
are shown in Table 12ˇ22. The blood lead concentrations of
and corresponding neonatal urinary nickel concentrations
the children in Krasnochelie are significantly higher than the
(r = 0.11, p > 0.5, n = 224).
concentrations in both Lovozero and Apatity (p < 0.001).
The reason for the higher mean urinary nickel levels ob-
Blood lead concentrations greater than 100 g/L are of med-
served in mothers and their newborns in the Russian com-
ical concern in children, and these occur mostly in Krasno-
munities is not obvious. When the observed concentrations
chelie, but also in Lovozero. Other investigations have also
are corrected using urinary creatinine levels, the difference
Chapter 12 ˇ Pollution and Human Health
811
Table 12ˇ23. A comparison of cadmium, lead, mercury and nickel in whole blood (WB), cord blood (CB), urine of mothers (UM), and first-void urine of
neonates (UC), and 137Cs in placenta (P) in selected Norwegian and Russian communities.
Level of
Concentration mean and standard deviation
significance,
Element
Sample type
Russian communities
n
Norwegian communities
n
p
Cadmium, g/L
WB
0.4 0.2
206 b
0.5 0.6
120 b
< 0.05
CB
< DLa
73 c
< DLa
69 c
Lead, g/L
WB
33.2 16.6
206 b
12.4 6.2
120 b
< 0.0001
CB
20.7 10.4
71c
12.4 6.2
68 c
< 0.0001
Mercury, g/L
WB
1.9 0.9
60 d
2.5 0.8
25 d
< 0.01
Nickel, g/L
UM
8.9 9.7
98 e
0.9 0.7
142 e
< 0.0001
UC
2.5 3.1
64 f
0.6 0.2
77 f
< 0.0001
137Cs (Bq/kg, 7-h counting,
P
1.9 1.4 (range 1.3-7.9)
41g
5.5 11.0 (range 1.3-83.2)
74 g
DL 1.3 Bq/kg)
a. Values < DL = 0.1 g/L for statistical purposes; DL: detection limit. b. Communities include: Bergen, Hammerfest and Kirkenes (Norway); Murmansk,
Monchegorsk, Apatity, Arkhangelsk and Nikel (Russia). c. Communities include: Kirkenes and Bergen (Norway); Nikel and Arkhangelsk (Russia).
d. Communities include: Hammerfest (Norway); Nikel and Arkhangelsk (Russia). e. Communities include: Kirkenes and Bergen (Norway); Nikel and
Arkhangelsk (Russia), samples from middle of pregnancy and post partum, values are unadjusted. f. Communities include: Kirkenes and Bergen (Norway);
Nikel and Arkhangelsk (Russia); values are unadjusted. g. Communities include: Saami population of Finnmark, Kirkenes, Hammerfest, Sømna, Nam-
dal, Bergen and Valdres (Norway); Arkhangelsk and Nikel (Russia); Gomel (Belo-Russia); and Kiev (Ukraine).
between the Russian and the Norwegian communities is re-
est to Nikel, was 1.3 g/L, while the median value in the ref-
duced considerably, but nevertheless remains significant
erence group in Bugøynes was 1.0 g/L. Since these concen-
(p < 0.001). As discussed (Nieboer et al. 1992), specific grav-
trations are from a group of adult citizens living in the same
ity corrections might have been more suitable, but unfortu-
community as the women and children participating in the
nately these were not measured. The creatinine normalized
Kirkenes (AMAP) study, it is not surprising that the latter
data does, however, suggest some additional environmental
exhibited comparable concentrations.
contribution for the residents of Nikel, compared to Arkh-
The Russian-Norwegian Health Group has, in the period
angelsk. This is not unexpected, and has also been observed
1993-96, organized a comprehensive study of health condi-
for the nickel mining/refining town of Sudbury, Canada (Hop-
tions of the adult population of selected communities in Finn-
fer et al. 1989). For random, but corrected urine samples
mark in Norway and the Kola Peninsula in Russia. The in-
from Sudbury residents, urinary nickel levels averaged 3.2
vestigation has focused on health conditions in the areas con-
2.8 g/L (range 0.4 -10.0 g/L), compared to 2.0 2.0 g/L
taminated by the nickel industry of the Kola Peninsula. The
(range 0.7-5.4 g/L) for residents of Hartford, Connecticut,
results are under assessment at the time of writing of this re-
USA, a city without an obvious nickel point source (Hopfer
port (T. Smith-Sivertsen pers. comm.). Preliminary results,
et al. 1989, Nieboer et al. 1992). Clearly, the values observed
thus far, suggest that the urine nickel levels for inhabitants
for Kirkenes and Bergen are lower than those reported for
of Sør-Varanger, near the Norwegian-Russian border, are not
Hartford, presumably reflecting less industrialization and
increased compared to reference populations. However, ur-
urbanization. Interestingly, the average nickel levels in tap
ban-dwelling does appear to be a risk factor for increased
water reported by Hopfer et al. (1989) were 0.4 0.2 g/L
nickel exposure. The conclusions of this study, to date, are
in Hartford and 109 4.6 g/L in Sudbury. The industrial
that the individual nickel exposure attributed to air pollution
emissions of nickel in Sudbury are clearly reflected in the
from the neighboring Russian nickel industry is of minor im-
nickel levels in the water supply source. Recent data for tap
portance.
water from Nikel and Zapolyarnyy also show considerable
Compared to nickel workers, for whom urinary nickel
elevation (up to 90 g/L) compared to the towns of Apatity
concentrations are typically in the range 10-100 g/L, the
and Kirovsk (1- 8 g/L). Drinking water as a source of nickel
exposure to nickel in the Russian communities studied might
will need to be explored further to resolve the relatively high
be considered to be mild to moderate. Although the health
levels observed in the Arkhangelsk community. Leaching of
consequences of this implied level of exposure are not be-
nickel from stainless steel items is also known (WHO 1991b).
lieved to be of concern, the observations reported should be
Another possibility for individual exposure is nickel release
subjected to closer scrutiny. The use of 24-h urines, or spe-
from oral prostheses, which contain significant amounts of
cific gravity adjusted spot specimens are advised in future
this metal in Russia. Although the average western diet con-
studies in order to reduce the natural variation due to dilu-
tains about 150 g per day of nickel, there are certain food
tion effects (Nieboer et al. 1992). In addition, non-pregnant
items that are relatively rich in this metal, such as chocolate
females should be studied, since pregnancy and child birth
(WHO 1991b). Special dietary sources in the Russian com-
involve complex physiological processes and trauma that
munities might, therefore, also be investigated.
may influence urinary nickel levels (Nomoto et al. 1983).
Since the measurement of toxic metals in first-voided urine
A comparison of the different toxic metals between Rus-
specimens from newborns have apparently not been attempted
sian and Norwegian mothers and newborns is shown in
before, no comparison with literature values is possible. The
Table 12ˇ23.
finding of significant levels of nickel in these samples attest
to the free-flow of nickel across the placental barrier.
Copper
Sunde and Alexander (1992) have completed urinary nickel
Copper values in maternal sera show a very similar pattern
measurements for inhabitants of the Sør-Varanger region of
for Bergen, Hammerfest, Tromsø, Kirkenes, Nikel (Group 1,
Norway (Pasvik and Bugøynes districts) near the Norwe-
n = 50, sampling period 1991; Group 2, n = 50, sampling pe-
gian-Russian border, in April 1990. All participants were
riod 1993/94) and Arkhangelsk (Annex Table 12ˇA13) (Od-
over 40 years of age, with equal distribution of sex (n = 22
land et al. 1996). In the Norwegian towns of Bergen and
from the district of Pasvik, n = 24 from the district of Bugøy-
Hammerfest, the mean serum copper concentrations were
nes). The median urine nickel concentration in Pasvik, near-
2140 g/L (n = 50, range 1029-3120 g/L) and 2090 g/L
812
AMAP Assessment Report
(n = 57, range 1550-3190 g/L), respectively. Reference in-
Russian females were in the normal range. A comparison
tervals for serum copper for pregnant women at term are
according to smoking habits gave no differences in blood
1180-3200 g/L (Burtis and Ashwood 1994). In Kirkenes,
selenium levels between non-smokers and women smoking
near the Norwegian-Russian border, the mean value was
more than ten cigarettes per day. The average serum sele-
2200 g/L (n = 40, range 1582-2930 g/L). The two groups
nium levels in the mothers ranged from 79 g/L (Nikel,
from the industrial town of Nikel, sampled in 1991 and
Group 2) to 95 g/L (Kirkenes) and were higher in the Nor-
1993/94 have mean values of 2123 g/L (range 1182-3088
wegian females (p < 0.0001).
g/L) and 2160 g/L (range 1843-2491 g/L), respectively.
The serum or whole blood selenium concentrations
Arkhangelsk mothers show mean serum copper concentra-
found are within the international reference intervals for
tions of 2310 g/L, with range 1582-3629 g/L. Visual in-
adults (Minoia et al. 1990, Aro et al. 1995, Wang et al.
spection of these data suggested a normal distribution. Com-
1995a, 1995b) of 56-105 g/L in serum or plasma and 76-
paring the combined data sets within each country, there is
140 g/L in whole blood. Levels at birth, as measured in
no significant difference between the Norwegian (n = 162)
cord blood, are comparable to those observed for the cor-
and Russian (n = 100) results (p > 0.1). Arkhangelsk females
responding mothers. This is in agreement with previous ob-
have significantly higher values than Hammerfest females
servations in Finland (Aro et al. 1995). Although the mater-
(p < 0.005), while there is no significant difference between
nal and cord blood serum selenium levels were marginally
the Nikel and Kirkenes groups (p > 0.5). In both the Russian
lower (p < 0.001) in the Russian samples, the reverse trend is
and Norwegian female subjects, the reported serum copper
observed for whole blood (p < 0.001). However, in the latter
concentrations fall into the mid-range of the international
comparison, samples were included from Apatity, Monche-
reference interval for pregnant women at term.
gorsk and Murmansk, which have considerably higher aver-
It is concluded that the diets of the Russian and Norwe-
age concentrations (139, 129 and 134 g/L, respectively).
gian female subjects studied are adequate for maintaining a
The finding of normal selenium status is perhaps somewhat
proper copper balance.
surprising in the light of concern about low selenium intake/
status in Finland and Sweden (Wang et al. 1995a, 1995b).
Zinc
Zinc levels in sera of pregnant women in Bergen, Hammer-
Iron
fest, Tromsø, Kirkenes, Nikel (Group 2) and Arkhangelsk
The women in Nikel, Russia have the highest mean serum
are summarized in Annex Table 12ˇA13 (see also Odland et
iron levels in the essential element status study, namely 715
al. 1996). The highest mean serum zinc concentrations are
g/L (standard deviation 603), while Bergen and Hammer-
in the group from Bergen, with a mean value of 770 g/L.
fest women have mean values of 497 and 486 g/L (stan-
Serum zinc levels for the Russian groups of women were
dard deviation 318 and 424, respectively); these concen-
generally lower than those observed for the Bergen individ-
trations are significantly different (p < 0.05) (Odland et al.
uals, reaching statistical significance (p < 0.001). Except for
1996). A similar pattern exists for serum ferritin. Women
the Bergen group, the mean concentrations fall below the
from Arkhangelsk have the highest mean serum ferritin
accepted range for all the other groups studied. The interna-
value (37.1 g/L, standard deviation 47.7). The lowest
tional reference intervals are 700-1500 g/L for serum, with
values were found in Bergen, with a mean value of 23.4
plasma levels 5 to 15% lower (namely 587-1215 g/L) be-
g/L (standard deviation 14.6). On average, ferritin levels
cause of osmotic fluid shifts from the cells due to anticoagu-
in the Russian group are higher (p < 0.05). The Norwegian
lant use (Burtis and Ashwood 1994).
reference interval for serum iron is 503-1396 g/L. There
An explanation for the relatively low serum zinc levels is
are, however, so many confusing and complex factors in-
not immediately apparent. During pregnancy, Norwegian
fluencing the absorption, distribution and excretion of
women usually use mineral supplements and thus the low
iron that serum iron levels are not a suitable measure of
levels seen in the Hammerfest group is surprising. Further-
the iron stores in the body. By contrast, serum ferritin in
more, since the iron, selenium and copper balances were in
healthy women is a very appropriate indicator of such
the normal range for both the Russian and Norwegian sub-
stores (Burtis and Ashwood 1994, Borch-Iohnsen 1995).
jects, and since meat and/or seafood are good sources of
Reference values for serum ferritin have quite a wide
these elements, as well as of zinc, dietary deficiency is not
range, and the current Norwegian reference interval is
likely. Zinc is relatively poorly absorbed from whole grain
7-133 g/L depending on age, sex and pregnancy. Con-
products and their relative importance in the diet might fur-
centrations indicative of depleted iron stores are < 10 g/L
nish one explanation. Further research is required to verify
for age 14 years and <12 g/L for age 15 years (Issel-
the apparent low zinc status of some of the women studied,
bacher et al. 1994).
including the use of a detailed food frequency questionnaire.
For the females examined, the ferritin levels found were
within the expected range, and thus the iron status of the
Selenium
women studied may be considered normal. This conclusion
Selenium in maternal whole blood and cord blood have been
is supported by the apparent absence, according to question-
compared for a number of Russian and Norwegian commu-
naire results, of disease factors that can enhance serum fer-
nities, excluding the Siberian and Tromsø locations (Odland
ritin concentrations such as liver disease and chronic infec-
et al. 1996). The patterns for maternal blood and cord blood
tion (Isselbacher et al. 1994). Interestingly, the lowest fer-
are very similar; in Norway (excluding Tromsø), 111 (n = 114,
ritin concentrations were observed for the Norwegian towns
range 63-158) and 118 g/L (n = 69, range 79-229) , respec-
of Bergen and Hammerfest; they are not statistically differ-
tively, and in Russia (excluding Siberian locations) 126 (n =
ent (p > 0.2) compared to the groups from Nikel and Kirke-
219, range 63-205) and 111 g/L (n = 86, range 79-158), re-
nes, but are statistically lower (p < 0.05) relative to Arkhan-
spectively. Comparing the different locations (Annex Table
gelsk. Overall, the Norwegian ferritin concentrations were
12ˇA13), the highest whole blood selenium values for moth-
lower (p < 0.05). This is difficult to interpret since iron sup-
ers are found in Apatity (139 15 g/L), and the lowest in
plements for pregnant women in Norway may be considered
Norilsk (80.6 11.9 g/L) in Russia and in Tromsø (93.2
routine. The serum iron levels follow the same general trend
18.2 g/L) in Norway. All results for the Norwegian and
and are also within the accepted reference interval.
Chapter 12 ˇ Pollution and Human Health
813
Table 12ˇ24. A comparison of essential elements in whole blood (WB) or serum (S) of females in selected Norwegian and Russian communities,
with accepted reference intervals.
Reference
Concentration mean and standard deviation
Level of
interval,
Sample
Russian
Norwegian
significance,
Element
g/L
type
Communities
n
Communities
n
p
Copper a
1180-3200
S
2219 389
112
2149 350
147
> 0.1
(end-of-term values)
Ferritin a
7-133
S
33 41
100
24 19
154
< 0.05
Selenium a
55-103
S
81 15
124
94 13
154
< 0.0001
Seleniumb
79-142
WB
123 19
215
112 17
123
< 0.0001
Zinc a
700-1500
S
524 98
112
648 118
147
< 0.0001
a. Communities include: Bergen, Hammerfest and Kirkenes (Norway); Nikel and Arkhangelsk (Russia).
b. Communities include: Bergen, Hammerfest and Kirkenes (Norway); Apatity, Arkhangelsk, Monchegorsk and Murmansk (Russia).
A comparison of the different essential elements in Rus-
MeV). Cs-137 transfer to the diet is generally from grain
sian and Norwegian mothers and newborns are shown in
products, meat and milk. The lichen-caribou-human food
Table 12ˇ24.
chain represents a particularly important transfer pathway
in the Arctic. The body elimination rate for 137Cs, expressed
Clinical chemical parameters
as its biological half-life, varies with age and physiology: 19
Other clinical chemical values selected for screening were:
days (infants), 57 days (children), 49 days (pregnant women),
cholesterol, high density lipoprotein (HDL), triglycerides,
84 days (women), and 105 days (men) (WHO 1983). The
thyroxine (FT4), thyroid-stimulating hormone (TSH), ala-
concentration ratios between maternal tissue, placenta, and
nine aminotransferase (ALAT), aspartate aminotransferase
fetal tissue are 1 : 1 : 1 and this is the basis for using the de-
(ASAT), bilirubin and creatinine (Odland et al. 1996). What
termination of 137Cs in placenta for dose estimation purposes
is of special interest is that the lipid values (cholesterol, tri-
(Stather et al. 1992).
glycerides and HDL concentrations) were generally higher
Measurements of 137Cs in placenta show a more homo-
in the Russian population, although not significantly so
genous pattern in the Russian than in the Norwegian mater-
(p > 0.05); they fall within the Norwegian or international
ial, with ranges 1.3-7.9 Bq/kg ww and 1.3-83.2 Bq/kg ww,
concentration reference intervals.
respectively (Odland et al. 1997). In terms of specific com-
munities, no detectable values were found in Arkhangelsk,
Radionuclides
only two low values in Nikel, and only one low value in
Over the past 30 years, there has also been considerable con-
Kiev; the limit of detection being 1.3 Bq/kg. In Gomel, Belo-
cern about human health effects of radiation in the Norwe-
Russia, detectable values were found in six out of seven pla-
gian-Russian Arctic areas (Paakkola 1991). These questions
centas (range 1.3-7.9 Bq/kg). In Norway, no detectable val-
are addressed in more detail in chapter 8. In terms of human
ues were found in Bergen, however, all values were detect-
exposure, whole-body counting has been carried-out in cer-
able in Sømna (range 1.38-7.26 Bq/kg) and Valdres (range
tain areas, but no sampling of material from pregnant wo-
2.81-15.92 Bq/kg). Ten women from the Saami population
men or neonates has been done. Cs-137 has been recognized
of Finnmark also all had detectable values, ranging from 1.3
as the most important anthropogenic radionuclide in the nu-
to 14.6 Bq/kg. For Kirkenes and Hammerfest, near the Rus-
tritional chain (WHO 1983). The major reasons for concern
sian border, a more mixed picture is seen, with detectable
in Arctic Fennoscandia and Russia are: the nuclear testing
values in two out of ten and five out of eight placentas, re-
program on Novaya Zemlya in the 1950s and 1960s; the
spectively (ranges 1.3-3.9 and 1.3-6.13 Bq/kg). For Trønde-
Chernobyl accident in 1986, with resulting contamination of
lag, the results were also variable, below the detection limit
large areas of the Ukraine, Belo-Russia, Russia, Sweden and
in 6 out of 11 placentas but with high values in two placen-
Norway; the continued operation of aged nuclear power sta-
tas (46.3 and 83.2 Bq/kg).
tions on the Kola Peninsula; and the radioactive fuel- and
The preliminary results of this study are somewhat surpris-
waste-treatment and storage from both civilian and military
ing. Cs-137 levels found in the Norwegian samples have a
sources on the Kola Peninsula and Arkhangelsk Region (Paak-
wider range than those for the Russian samples, with two very
kola 1991, Moberg and Reizenstein 1993). In Narjan Mar,
high outliers from Namdal, Trøndelag (46.3 and 83.2 Bq/kg).
in Arkhangelsk County, close to Novaya Zemlya, unverified
The two patients with whom these high values were associ-
medical data claim that there are very high incidences of
ated revealed in their answers to the questionnaire that a sub-
spontaneous abortions, congenital malformations and can-
stantial amount of their total diet was of local, natural origin.
cer (Tkatchev et al. 1994). A group from the University of
Namdal lies in the middle of the Norwegian zone that re-
Tromsø have investigated the data files in the hospitals of
ceived the highest accumulation of radiation products from
Narjan Mar during the summer of 1996 (Lund, Special AMAP
the Chernobyl accident, indicating a connection between this
Report 1996, unpubl.). Their conclusion was that the basic
event and accumulation of 137Cs in the food chain in the pol-
information used by Tkatchev and colleagues in their assess-
luted areas. The other known Norwegian areas of concern
ment is reliable, and constitutes a valid basis for epidemio-
after the accident, Sømna and Valdres, show a very homoge-
logical research activities with improved design in this area.
nous pattern (mean 4.61 Bq/kg, standard deviation 4.21,
The specific radionuclide component of the Russian-Norwe-
range 1.38-7.26; and mean 5.94 Bq/kg, standard deviation
gian AMAP human health program was initiated to explore
5.22, range 2.81-15.92, respectively). These values are very
whether 137Cs in whole placenta is a suitable potential indi-
different from those for Bergen, which is well away from the
cator for reflecting the radiation exposure and burden to the
zone affected by Chernobyl, where all placentas had values
fetus during pregnancy.
of 137Cs below the detection limit. The Saami population of
Cs-137 is one of the most significant fission products (6-
Finnmark, outside the main zone in Norway affected by Cher-
7% of the fission yield). It has a radioactive half-life of 30.2
nobyl, but with the largest amount of local traditional food
years and its beta-particle decay (average energy of 0.19 MeV)
in their diet, have a similar pattern of placental 137Cs levels
is accompanied by gamma radiation of modest energy (0.66
to that found in the Norwegian population in the Chernobyl
814
AMAP Assessment Report
zone; mean 7.14 Bq/kg, standard deviation 5.21, range 0.87-
both the water in wells and the surface waters have a low
14.5. The Russian populations studied, namely Nikel and
mineral content (Soininen pers. comm.). In some cases, well
Arkhangelsk, and the Ukrainian city Kiev, just south of Cher-
water can contain a large amount of iron.
nobyl, show placental 137Cs values at or below the detection
limit. The wind direction immediately after the accident pro-
Air
tected Kiev from contamination. Arkhangelsk, south of No-
The prevailing winds in Lapland are from the southwest,
vaya Zemlya, the northern center of the Russian atomic bomb
and only from the opposite direction 7% of the time. Hence,
testing program, had no detectable values of 137Cs in the lo-
the air pollution from the Murmansk region does not gener-
cal placentas. Gomel, Belo-Russia, is in the Chernobyl af-
ally affect northern Finland and the average SO2 air concen-
fected zone of the FSU. Here, the results show detectable val-
trations are rather low. However, when the plumes from the
ues in six out of seven placentas (mean 4.49 Bq/kg, standard
nickel-smelters on the Kola Peninsula are transported west-
deviation 4.2, range 2.3-7.9). Overall assessment of the data
wards, hourly concentrations of several hundred micrograms
suggests good correlations between the levels of 137Cs in pla-
per cubic meter may occur in the northeastern parts of Lap-
centa (Bq/kg ww) and the dietary intake of local food. Prox-
land (Juntto 1992). The same concern is relevant for other
imity of communities to the Chernobyl contamination zone
pollutants originating from the smelters, namely carbon di-
is also important.
oxide, particles and metals.
A similar investigation of plutonium concentrations in pla-
centas has been performed by Lund (pers. comm.). The highest
Levels and trends of contaminants in humans
concentration was close to 1 mBq/kg fresh placenta, an order
The populations included in the Finnish human health moni-
of magnitude higher than levels previously reported from Eng-
toring program are from the Saami communities of Inari,
land. This study indicates that placentas could also be used for
Enontekiø and Utsjoki, and from the eastern Lapland com-
biological monitoring of external plutonium contamination.
munities of Pelkosenniemi, Salla and Savukoski. The eastern
Lund and Galanti have investigated the incidence of thy-
Lapland communities were selected because of possible ef-
roid cancer in Scandinavia in relation to 131I in fallout, based
fects of pollutants originating from the Kola Peninsula.
on information from the Norwegian and Swedish Cancer
Registers (E. Lund pers. comm., AMAP special report un-
Persistent organic pollutants
publ.). This investigation showed that there was evidence of
Organochlorine pesticide and PCB residues were analyzed in
a higher risk of thyroid cancer before the age of 25 years
183 human milk samples obtained in 1984/85 from 165 wo-
among children born between 1951 and 1962 (the cohorts
men living in different parts of Finland (Mussalo-Rauhaama
exposed during childhood to radioactive fallout from histor-
et al. 1988). The p, p'-DDE concentrations were above the
ical weapons testing) compared to those born in 1963 or later,
detection limit in 99.5% of the samples, p, p'-DDD and p, p'-
when data from both countries were analyzed together. The
DDT in 57.9%, isomers of HCH in 30%, cis-chlordane in
results of this study are compatible with the hypothesis that
4.9%, oxychlordane in 3.3%, trans-nonachlor in 6%, hep-
radioactive fallout from atomic weapons tests on Novaya
tachlor in 12%, and heptachlor epoxide in 6.6% of samples.
Zemlya had an impact on thyroid cancer risk in Norway and
Mirex was not found in any of the milk samples, whereas
Sweden. The results are, however, not easily explained by ra-
the signals of toxaphenes were detected, but could not be
dioactive fallout alone. The higher risk of thyroid cancer at
quantified. The mean fat-adjusted residue levels above the
young age among persons who were born, or were young chil-
detection limit in Finnish human milk samples of primipara
dren, between the 1950s and early 1960s, compared with
mothers were 660 g/kg lipid for total DDT compounds, 80
those born later, awaits an alternative plausible explanation.
g/kg lipid for HCB, 930 g/kg lipid for PCBs, 410 g/kg
lipid for chlordane compounds, 200 g/kg lipid for isomers
of HCH, and 100 g/kg lipid for heptachlor epoxide. The
12.4.4.4. Finland
corresponding geometric means were 460, 60, 570, 20, 20,
Introduction
and 10 g/kg lipid, respectively. The age of the mothers cor-
Finnish Lapland is the northernmost province of Finland,
related positively with the DDE concentrations in human
with about 200 000 inhabitants living in an area of 93 000
milk. The residues of organochlorine compounds in human
km2. Of the population, ca. 60% live in the towns of Rova-
milk did not differ between mothers living in industrial re-
niemi, Kemi, Tornio and Kemijarvi and their surroundings.
gions and other mothers. Small, but insignificant differences
There are no major sources of pollution in the northern parts
between regions were found. No relation was found between
of Finnish Lapland. The most northern pulp industry is in
the organochlorine contents and fish consumption, smoking
Kemijarvi, near Salla which is one of the study communities
habits, weight loss or social group of the donors. Additional
under the Finnish AMAP human health monitoring program.
AMAP data are currently being gathered.
Sources of exposure
Metals
The most important pollution exposures, with respect to hu-
Mercury. Mussalo-Rauhamaa et al. (1996) have described
man health, are to sulfur oxides and metals, which originate
trends in the concentrations of mercury, copper, zinc and se-
from the Kola Peninsula. Acidification enhances the release
lenium in hair and serum of inhabitants of northeastern Fin-
of metals from the soil. Soil buffering capacity is poor be-
nish Lapland in 1982-1991. The mean concentration of mer-
cause they lack cations, such as calcium, potassium, magne-
cury in the hair of the 19 individuals in the study from north-
sium and ammonium. Mercury is the most important toxic
eastern Lapland in 1991 was 1.5 mg/kg (range 0.2-6.2 mg/kg).
metal because it bioaccumulates in fish, one of the most im-
The men consumed more reindeer meat and fish than the wo-
portant parts of the diet in Lapland.
men, but no significant difference in mercury content between
the sexes was observed. The mean mercury concentrations in
Water
hair from people living in the Russian-Finnish border region
Most of the small communities involved in the Finnish hu-
were slightly higher, but not significantly different. The com-
man health study have their own wells or are using surface
parison of people in Lapland from 1982 to 1991 showed slight-
water for drinking water supply. In the municipality of Inari,
ly lower values in 1991, but the differences were not significant.
Chapter 12 ˇ Pollution and Human Health
815
Cadmium. An investigation of blood cadmium in 230 male
There was a significant tendency for an increase in selenium
reindeer herders was conducted in Finnish Lapland in 1991
concentration in the sera of Lapps (p < 0.05, Wilcoxon signed
(Nayha et al. 1991). The mean age of the studied group was
rank test). In 1982, the serum selenium concentration in
43 years, and 31% of them were smokers. The mean cad-
males in Ivalo was higher than the concentration in females,
mium concentration was 1.1 g/L (range 0.1-37.1 g/L) and
but this difference was not found in 1991. No association
increased from southwest to northeast. A statistical analyses,
was observed between selenium content and the consump-
accounting for smoking and age factors, showed geographi-
tion of fish, meat, dairy products or grain products, neither
cal area to be a significant factor. The health-based upper
in 1982 nor in 1991. Since 1990, the selenium concentra-
limit for blood cadmium (5 g/L) was exceeded in 4.8% of
tions of serum in the normal population in northern Finland
the men and in 10% of those living in the northeastern areas.
has been consistently higher.
Blood cadmium was twice as high in men who ate reindeer
meat at least twice a week than those who did so less often.
Radionuclides
The source of the cadmium was assumed to be emissions from
Finnish data from 1970-1980 show a strong association be-
the nickel smelters on the Kola Peninsula. Subsequent Norwe-
tween the intake of reindeer meat and whole-body concen-
gian/Russian investigations have not confirmed this conclusion.
trations of 137Cs in the Lapps of Lapland (Rahola et al. 1993).
As discussed for the Norwegian/Russian data, body burdens
Copper and zinc. In the study of Mussalo-Rauhamaa et al.
of 137Cs correlate with dietary habits. The average 137Cs body-
(1996), inhabitants of Lapland had high hair copper levels,
burden in Inari male Lapps in 1976 was 8473 Bq (229 nCi),
up to 671 mg/kg, which may indicate external contamina-
3663 Bq (99 nCi) and 777 Bq (21 nCi) for reindeer herders,
tion or exceptionally high intake. Well water in Finland is
fishermen, and Lapps of other occupations, respectively. whole-
usually soft, which may cause corrosion of copper water
body counts for 210Po in Lapps were about 12 times higher
pipes. No tendency for any increase or decrease in copper or
than in residents of southern Finland. Further information
zinc concentrations in the hair of inhabitants of Ivalo was
on radionuclides is contained in chapter 8.
found during the interval 1982-1991, nor was there any re-
lationship between hair and serum copper concentrations.
12.4.4.5. Conclusions for Norway, Russia and Finland
Selenium. Finland is one of the several low selenium areas
This section constitutes a preliminary overview of the status
in the world (Mussalo-Rauhaama and Lehto 1989, Mussalo-
in Arctic regions of Norway, Russia and Finland of the toxic
Raumaha et al. 1996). In studies carried out between 1941
and essential elements and organic contaminants included in
and 1984, the mean intake of Se ranged from 20 to 50 g
the AMAP human health studies. The focus has been on the
per day in Finnish adults, depending on the ratio of imported
concentrations in blood, urine or placenta from women pre-
grain to domestic grain. Lapps, however, have exhibited high
and post-delivery, and in cord blood and urine from their
selenium intake, thought to be the result of their use of the
newborn babies. For cadmium, lead and mercury, the levels
lichen-reindeer food chain. The recommended daily sele-
found are mostly within baseline reference intervals, in all
nium intake is 50-200 g/day for adults and children over
the populations examined, including groups from the Rus-
seven years of age. Since 1984, Se as sodium selenate has
sian town of Nikel which is regarded as seriously polluted.
been added to fertilizers: 16 mg/kg for soil where cereal
The urine nickel levels were significantly higher in the Russian
grains are grown, and 6 mg/kg for soil where grasses and
populations, but appear to be independent of the nearness to
silage are grown. The principal goal was to increase the Se
a nickel refinery. Other sources of nickel exposure need to
concentration in cereals to a level ten times higher than that
be explored. The 137Cs levels in placenta seem to correlate
found without supplementation. The latest reports from cen-
with the location of the collection site relative to the Cherno-
tral parts of Finland show average selenium concentrations
byl fallout zone, with the highest counts observed for indi-
in serum between 100 and 150 g/L for adult males. It is
viduals living in areas with high consumption of traditional
concluded that the average serum selenium levels are now
foods. It may be concluded that, with the exception of zinc,
comparable to those in the British and Canadian popula-
the essential element status in the Arctic centers studied ap-
tions, and to those of Finnish Lapps. The supplementation
pears to be satisfactory. The relatively low serum zinc levels
of fertilizers with selenium is continuing.
observed in both the Russian and Norwegian communities
At the present time, no specific AMAP human health mon-
needs to be confirmed as part of a more comprehensive zinc
itoring program data for Finnish pregnant women or chil-
nutrition survey. In the available studies reporting levels of
dren are available. In the study of Mussalo-Raumahaa et al.
toxic metals in biological material from Finland, no concen-
(1996), the mean concentration of selenium in the sera of 11
trations have been found near any `lowest-observed-adverse-
persons living in Ivalo was 97 g/L (range 74-116 g/L) in
effect-levels'. The concentrations reported here for chlori-
1982 and 129 g/L (range 67-204 g/L) in 1991, whereas
nated organic compounds in breast milk from Finland are
the mean value for serum selenium in the Nellim district in
intermediate in magnitude to those found in samples from
1991 was 159 g/L (range 119-174 g/L) and from the Se-
Norway (lower levels) and Russia (higher levels), except for
vettijarvi-Naatamø district 120 g/L (range 64-202 g/L).
total PCB and total chlordanes, which appear to exceed the
Table 12ˇ25. Ongoing human health related research projects in Norway and Russia of relevance to the AMAP process.
Title
Principal investigator
Project status
Comparative studies of obstetric patients and their outcomes in Norway and Russia
J.Ø. Odland
In progress
Health status of adult populations in the Norwegian-Russian border zone
E. Lund
In progress
Organic contaminant status in obstetric patients in northern Norway, Kola Peninsula and Arkhangelsk
J.Ø. Odland
In progress
Epidemiologic survey of cancer incidence in Arkhangelsk/Narjan Mar
E. Lund, A. Tkachev
In progress
Reproductive and developmental health among women working in nickel refineries on the Kola Penninsula E. Nieboer, V. Tchachtchine In progress
Influence of environmental and foodweb pollution on levels of contaminants in human media
V. Klopov
In progress
and on the health of groups at special risk in the Taimyr Autonomous Okrug
816
AMAP Assessment Report
Russian values. Further comments concerning levels in blood
area polluted with metal emissions from the Rönnskär smel-
are made in section 12.5 of this report in the context of an
ter (65°N). Lead, cadmium, mercury, arsenic, selenium, cal-
international Arctic data comparison.
cium and iron levels were measured in mothers and new-
Table 12ˇ25 outlines ongoing human health studies in
borns during a two-year period. Results from these studies
Norway and Russia that are relevant to the AMAP process.
are provided in this section. Because the emissions are lower
further north, lower levels are expected in the Arctic area. In
order to provide data which is comparable to that of other
12.4.5. Sweden
countries in the circumpolar region, monitoring of metals,
Introduction
organochlorine compounds, and caesium, in mother-new-
Due to the influence of the warm Atlantic winds, the area of
born pairs has begun in Kiruna (68°N). Metal and organo-
Sweden north of the Arctic Circle, the northern part of Norr-
chlorine levels in blood were analyzed by a Canadian labo-
botten County, has a relatively mild climate. In the most
ratory and are reported in section 12.5.
northern area, the average temperature in December is about
In the Västerbotten Intervention Program, sponsored by
15°C. Norrbotten county, covering more than one-fifth of
the county council, human blood samples are being collected
the total area of Sweden, contains about 3% of the total pop-
together with results from glucose tolerance and cholesterol
ulation. The population of the Arctic area is approximately
tests. Dietary and socio-economic surveys are also underway.
64 000. The total Saami population in Sweden is about 17 000,
All inhabitants living in Västerbotten, including the Saami
of which 3000 are dependent on reindeer herding. However,
population in the mountain region, are invited to provide
in 1990, only 523 people were registered as reindeer owners
samples on their 30th, 40th, 50th and 60th birthdays. The
in Norrbotten. The Saami villages are along the western moun-
specimen bank (at the Department of Pathology/Nutritional
tain range from the middle of Sweden up to the far north
Research, Umeå University) currently contains data from
(Figure 12ˇ15).
45 000 people. These may be used for various kinds of epi-
The two main industrial sites in the Swedish Arctic area
demiological studies, e.g., within the fields of research on
which may have caused environmental pollution are the
cardiovascular disease and cancer, and environmental studies.
large iron mines in Kiruna and Malmberget. However, there
They may also be of use for AMAP human health studies.
has not been any biological monitoring of xenobiotics in
these areas. Monitoring of metals has recently been under-
Sources of exposure
taken south of Norrbotten, in Västerbotten County, in an
Food
Between 1984 and 1987, several hundred samples of meat,
12° E
18° E
24° E
liver and kidney from Swedish pigs and cattle were analyzed
by the Swedish National Food Administration (NFA) for
68° N
lead, cadmium, arsenic and mercury (Jorhem et al. 1991).
68° N
Kiruna
Analytical procedures included extensive quality assurance.
Malmberget
The samples were taken from pigs and cattle slaughtered at
all seven abattoirs approved for export to the USA. All of
NORRBOTTEN
Arctic Circle
these abattoirs are situated in southern Sweden, which is the
Jokkmokk
main area for meat production. Meat produced there is also
distributed in northern Sweden since the farming in Nor-
rbotten is geared towards milk production. Levels are pro-
vided in Table 12ˇ26.
Skelleftehamn
VÄSTERBOTTEN
(Rönnskär smelter)
Table 12ˇ26. Lead, cadmium, mercury and arsenic concentration (mg/kg ww,
64° N
64° N
mean ą SD) in pig and bovine meat in Sweden in 1984-87 (Jorhem et al.
Umeå
1991).
S w e d e n
Pig meat
Bovine meat
F i n l a n d
Metal
MeanąSD
n
MeanąSD
n
N o r w a y
Sundsvall
Lead
< 0.005ą0.009
426
< 0.005ą0.001
34
Cadmium
0.001ą0.004
426
0.001ą0.001
34
Mercury
0.009ą0.005
390
0.005ą0.005
30
Arsenic
0.024ą0.023
338
< 0.015ą0.009
29
Borlänge
The lead levels were among the lowest reported in the lit-
60° N
60° N
erature and the cadmium levels were in the lower range of
Uppsala
the levels reported from the Netherlands during the same pe-
Stockholm
riod. No clear time trends were seen, nor was there any dif-
E s t o n i a
ference between the samples from different abattoirs, or any
seasonal variation. The arsenic levels found in pig meat were
considerably higher than levels reported in 1986 from the
L a t v i a
Göteborg
Netherlands and the former Federal Republic of Germany.
The arsenic concentrations in bovine meat were similar to
those previously reported and mercury concentrations in
both pig and bovine meat were similar to those reported
56° N
56° N
from several other countries. A decrease in arsenic and mer-
D e n m a r k
L i t h u a n i a
cury levels was found in pig tissues during the study period.
12° E
18° E
24° E
This may have been due to a decrease in the use of fish meal
in pig feed.
Figure 12ˇ15. Map of Sweden showing locations mentioned in the text;
Arctic areas comprise the two northernmost counties, Norrbotten and
Levels of metals and certain organochlorines were mea-
Västerbotten.
sured in reindeer meat in the Kiruna area during 1983-1994
Chapter 12 ˇ Pollution and Human Health
817
as part of the Swedish monitoring program in terrestrial
during January to March in 1990 in Jokkmokk, a small com-
biota. The overall geometric mean values of lead, cadmium,
munity situated at the Arctic Circle. In January, the mean
and mercury in muscle were 0.007, 0.005, and 0.001 mg/kg,
NO2 concentration was 19 g/m3, 57% of the concentration
respectively.
in Stockholm. The SO2 concentration of 11 g/m3 was com-
In a 1989/90 study of reindeer, 27% (n = 10 603) of the
parable to the values from the Swedish urban air pollution
animals had to be rejected because the caesium activity in
monitoring network. Mean concentrations of black smoke
the reindeer was above 1500 Bq/kg (Albanus et al. 1991).
were 27 g/m3.
Levels were higher in reindeer from Västerbotten than Norr-
The concentration of black smoke in Jokkmokk was
botten (the Arctic region). In domestic animals, levels were
higher than at any other site in the urban air network (55
generally below 300 Bq/kg. The 137Cs levels in dairy milk
stations). The only comparable values (20-24 g/m3) were
were below 5 Bq/L during 1991. The activity has never ex-
measured in a few communities in northern Sweden. Large
ceeded 5 Bq/L in drinking water. The 137Cs activity has never
cities, such as Stockholm (more than one million inhabitants)
been elevated in crops, vegetables and cultivated berries, and
and Göteborg (about 500 000 inhabitants), had considerably
has been below 500 Bq/kg in wild berries. While high cae-
lower concentrations of black smoke, with levels of 10 g/m3
sium activity was found in certain mushrooms, this is not
and 7 g/m3, respectively. The high concentrations of black
considered to be a health risk to the general population be-
smoke were likely due to the common use of wood heating
cause the consumption is normally low. Fish sold on the mar-
in small communities in the inland parts of northern Sweden.
ket generally had low caesium activity, although high levels
About 50% of the households in Jokkmokk have the facili-
prevail in fish from lakes in the most polluted areas. How-
ties to burn wood.
ever, these areas are not within the Arctic region. In dairy
milk, there is currently very little caesium originating from
Occupational
historical nuclear testing.
Adverse health effects caused by occupational exposure have
been reported from the iron mine in Kiruna (Sihm Jörgensen
Permissible levels in food. Maximum permissible levels
1986). One hundred and forty-four cases of silicosis were dia-
(MPL) of lead in food vary from 0.05 mg/kg in infant food,
gnosed and reported to the National Social Insurance Board
eggs, and meat, to 0.3 mg/kg in lettuce, wine, and canned
between 1931 and 1977. Only silicosis stage I has been dia-
food, except corned beef (1 mg/kg). The MPL for mercury is
gnosed since 1960. The mean concentration of quartz in air
0.5 mg/kg, with certain exceptions, e.g., the MPL for certain
decreased from 2.4 mg/m3 in the 1930s to less than 0.05
fish, such as tuna, is 1 mg/kg. The MPL for tin is 50 mg/kg
mg/m3 in the 1980s. The expected new cases of silicosis
in infant food and 150 mg/kg in all other food. Lower MPLs
among those who begin to work underground today is less
were suggested for PCBs in 1993; from 0.02 mg/kg fat in
than 1 in 500. Similar figures on silicosis have been reported
milk-based products to 0.1 mg/kg fat in eggs and meat, and
from the iron mine in Malmberget, 100 km south of Kiruna.
0.1 mg/kg whole product in fish (NFA 1993, 1994). After
Lung cancer mortality among underground workers al-
the Chernobyl accident, the Swedish NFA introduced a limit
most doubled between the two study periods of 1950-1970
value of 300 Bq 137Cs/kg in food (Slorach 1992). This limit
and 1971-1980, and the rate of risk increased from 9.2 to
value has since been changed to 1500 Bq/kg for reindeer,
17.3 cases per million person-years and work level month
game, freshwater fish, mushrooms, wild berries and nuts.
(WLM, index). This was probably due to an increased accu-
The limit value within the European Union is 600 Bq/kg.
mulated radiation dose. The concentration of radon daugh-
In order to restrict the intake of methylmercury, the Swedish
ters in the 1950s and 1960s was on average 3.3 Bq/L, i.e.,
NFA recommends that pregnant and nursing women do not
three times the concentration in the early 1970s, however,
eat pike, perch, pike-perch, burbot, eels or halibut. Other
due to the long latency period for lung cancer, the mortality
members of the population are advised to limit their fish
is increased in the later period. An increased risk of lung
consumption to once a week. Pregnant women should also
cancer has also been reported in underground workers from
restrict their consumption of liver paté. In order to restrict
the iron mine in Malmberget (Radford 1984).
the intake of such contaminants as DDT, PCBs and dioxins,
the NFA recommends that regular consumption of liver from
Other
cod and burbot be avoided. Baltic herring, wild salmon, and
Lifestyle factors such as smoking, and wine and alcohol con-
sea trout from the Baltic Sea and the Gulf of Bothnia should
sumption, may increase the uptake of cadmium and lead. In
not be eaten more than once a week on average; girls and
a study of pregnant women in Västerbotten, blood cadmium
women of reproductive age should limit their consumption
levels were twice as high in smokers than in non-smokers.
to once a month.
Smoking ten cigarettes or more per day during pregnancy
resulted in a 10% decrease in birth weight (unpubl. data).
Water
The quality of drinking water in Sweden is generally good.
Levels and trends of contaminants in humans
Most of the inhabitants obtain their drinking water from
Persistent organic pollutants
community water supplies.
Data on levels of persistent organic pollutants (POPs) in the
Swedish population north of the 65°N have not been re-
Air
ported. In addition, there is only limited data available on
The relationship between air quality and meteorology dur-
levels of these pollutants in other organisms from the Swe-
ing winter conditions in the northern parts of Sweden has
dish Arctic region. Persistent organic pollutant levels in Arc-
been studied by the National Defense Research Establishment
tic char from lake Abiskojaure have been collected as part of
in Umeå (Johansson et al. 1994a). Several air quality models
the Swedish AMAP study on freshwater biota (see chapter
have been tested against the measurements and a new im-
6). Environmental monitoring of persistent pollutants in
proved model has been developed in order to take into ac-
Sweden has, to date, focused on other (non-Arctic) regions
count conditions with low solar altitude, high albedo and
since levels are generally higher in the south of the country
low temperatures. Monthly mean and maximum daily mean
and in the central Baltic Sea. Contaminant levels are higher
concentrations of NO2, SO2 and black smoke were measured
in aquatic organisms than in terrestrial organisms.
818
AMAP Assessment Report
It is now clearly established that environmental levels of
Metals
several persistent organochlorines are declining in Sweden.
During a two-year period, lead and cadmium levels were
In the northern areas, close to or above the Arctic Circle,
measured in blood, selenium levels were measured in plasma,
levels in Arctic char, pike, burbot, white-tailed eagle, falcon
and inorganic arsenic levels were measured in urine on three
and osprey are lower compared with southern locations, and
separate occasions during pregnancy in women living in a
are decreasing. Levels in humans are also following the
smelter area and in women living in a control area in Väster-
downward trends (Noren 1993). In breast milk sampled in
botten (65°N). Umbilical cord blood metal levels were also
Stockholm between 1967 and 1989, a decrease in the levels
measured (Table 12ˇ28). The rate of participation was al-
of certain pesticides and polychlorinated biphenyls (PCBs)
most 90%. Analyses were carried out using flameless atomic
was found. The changes were related to the prohibitions and
absorption spectroscopy after acid digestion. Quality control
restrictions applied to the use of these compounds (Table
analyses were in good agreement with reference values.
12ˇ27). Downward time-trends were also seen for polychlo-
Table 12ˇ28. Lead and cadmium in whole blood ( g/L) and selenium in
rinated dibenzo-p-dioxins (PCDDs), polychlorinated diben-
plasma ( g/L) of delivery patients in a smelter and control area in north-
zofurans (PCDFs) and specific congeners of PCBs, including
ern Sweden.
non-ortho and mono-ortho coplanar PCBs. Between 1972
Smelter area
Control area
and 1989, average levels of CB 153 in breast milk decreased
Sample
MeanąSD
n
MeanąSD
n
p
from 220 to < 150 ng/g lipid, CB 138 decreased from 190
to 120 ng/g lipid, CB 180 decreased from 90 to 70 ng/g
Cadmium
Maternal blood a 1.1ą0.5
64
1.1ą0.5
43
lipid, and CB 118 decreased from 60 to < 30 ng/g lipid.
Cord blood
0.7ą0.4
60
0.7ą0.3
40
Levels of oxychlordane and trans-nonachlor also dropped
Lead
from 0.02 to 0.012 g/g lipid. Calculations using toxic
Maternal blood
32ą10
241
28ą8
144
< 0.001
equivalent factors relative to 2,3,7,8-TCDD revealed that
Cord blood
28ą8
222
22ą8
131
< 0.001
Selenium
Table 12ˇ27. Prohibitions and restrictions applied to certain organochlo-
Maternal blood
52ą10
232
63ą15
147
< 0.001
rine compounds in Sweden (Norén 1993).
Cord blood
45ą11
196
48ą10
133
< 0.01
Year
Compound
Restriction
a. Smokers: blood cadmium levels were about 50% lower in non-smokers
1966
Aldrin, dieldrin
Banned for cultivation of carrots,
cabbage and onions.
Mercury. Total mercury (Hg) concentration in hair, sampled
-------------------------------------------------------------------------------------------------
at delivery, was determined in 122 women living in the smel-
1970
Aldrin, dieldrin
All usage prohibited
ter area, and in 75 women from the control area (Oskarsson
DDT
Prohibited as an insecticide in homes,
et al. 1994). The average Hg concentration in hair was 0.27
gardens and agriculture.
Exemption for conifers until 1974.
mg/kg (range 0.07-0.96 mg/kg), which is somewhat lower
than previously reported for pregnant women in Sweden,
Chlordane
Prohibited. Minor usage only.
-------------------------------------------------------------------------------------------------
and very low compared to levels in fish-eating populations
1972
PCBs
Restrictions on use. Presently used
in other parts of the world.
only in closed systems (capacitors
and transformers). All PCBs should be
replaced by other compounds by 1995.
Lead. The blood lead levels were low in both the smelter
-------------------------------------------------------------------------------------------------
and the control areas, although women in the smelter area
1977
2,4,5-T
Prohibited.
-------------------------------------------------------------------------------------------------
and their newborn children had significantly higher lead lev-
1978
Chlorinated phenols
Prohibited with an exemption for
els than the controls. During pregnancy, there was a 20%
industrial use for textiles and leather.
and 15% increase of blood lead concentrations in the smel-
All usage forbidden in 1980
(potential risk of dioxins).
ter area and reference area, respectively. Umbilical cord blood
-------------------------------------------------------------------------------------------------
concentrations were significantly correlated with maternal
1984
1,2-dichlorobenzene
Prohibited.
blood lead levels and were 80-87% of the maternal levels
-------------------------------------------------------------------------------------------------
1987
Lindane
Agricultural usage forbidden.
recorded at delivery. Blood lead levels in pregnant women
All usage for domestic purposes
were influenced by place of residence, employment at the
prohibited in 1988.
smelter, smoking, and wine consumption. Because blood lead
concentrations increased during pregnancy, despite increased
PCB constituted the major part of the toxic equivalents in
blood volume and unchanged or decreasing environmental
human milk. Levels of PCB, total or isomer specific, have
lead levels, mobilization of lead from bone during pregnancy
also been reported in human milk from Umeå (Lindström
was considered a possibility (Lagerkvist et al. 1996).
1988). In 1986, an average level of 580 g/kg lipid was re-
In 1977, maternal and cord blood lead levels were mea-
ported (n = 10).
sured in Kiruna and Västerbotten (Zetterlund et al. 1977).
PCDDs were first reported in human tissue in Sweden in
The mean blood lead concentrations in mother-infant pairs
the early 1980s. In a 1986-88 study, levels in human milk
were 61 and 44 g/L in mothers and infants, respectively, from
from Umeå, Sundsvall, Uppsala, Borlänge and Göteborg
Kiruna, and 92 and 80 g/L in mothers and infants, respec-
showed similar mean values, of about 20 pg TEQ/g milk fat
tively, from Västerbotten. In 1991, the mean blood concen-
(Lindström 1988).
trations in the smelter area in Västerbotten were 32 g/L in
A risk assessment of PCBs, initiated by the Nordic Coun-
mothers and 28 g/L in infants (Table 12ˇ28). Current levels
cil of Ministers, was published in 1992 (Ahlborg et al. 1992).
in Kiruna are also expected to be lower than 1977 levels.
The expert group concluded that it was not yet possible to
The use of leaded gasoline decreased by 50% between
establish a tolerable exposure level for PCBs, due to incom-
1980 and 1991 in Sweden (Jorhem 1994). During that
plete scientific information. However, it could not be ruled
time, the National Food Administration (NFA) monitored
out that the current exposure of the Nordic population ap-
the lead levels in blackcurrants grown at different distances
proximates the level which may give small, but measurable
from the E4 highway in Umeå (northern Sweden). Results
effects on children's behavior and intellectual performance,
showed a decrease in lead levels with increased distance
following fetal exposure or exposure via breast milk.
from the road, as well as a decrease over time. At a distance
Chapter 12 ˇ Pollution and Human Health
819
of 14 m from the road, the lead levels in blackcurrants de-
cial interest taken in the Saami population (Johansson et al.
creased from 0.14 mg/kg ww in 1980 to 0.054 mg/kg ww in
1994a, 1994b). Measurements were performed in three
1989. At a distance of 134 m from the road, the correspond-
areas with different contamination levels, using a whole-
ing values were 0.060 mg/kg ww in 1980 and 0.024 mg/kg
body counter installed in a mobile container. Groups of 15-
ww in 1991.
year old students were randomly chosen, one group repre-
The decrease in lead levels in blackcurrants is most likely
senting the total population of the area, and the other
due to the decreased use of organic lead additives in gasoline
groups representing members of the Saami communities.
in Sweden, which decreased from 712 tonnes in 1980 to 380
The average whole-body content of 137Cs in the general
tonnes in 1991. However, over the same period, the traffic
population varied between 1.1 and 2.0 kBq, and between
intensity in the area studied increased from 6400 vehicles/24
3.4 and 25 kBq for the Saami population, dependent on
h to 8000 vehicles/24 h. Since 1986, no sample in the NFA
Chernobyl-related contamination level. The ratios between
monitoring program has exceeded the 1993 limit value of
whole-body content and 137Cs deposition found in these
0.1 mg/kg.
measurements were consistent with earlier studies of 137Cs
Biological monitoring of blood lead has also shown a de-
from Chernobyl in other areas of Sweden. However, previ-
crease in lead levels over time. Over the two-year study per-
ously published data based on measurements from historical
iod, a small but significant decrease in blood lead levels was
nuclear weapons test fallout, show a ratio 20-40 times higher.
seen in the pregnant women with low blood lead levels in
This may be due to the differences in environmental behav-
Västerbotten (Lagerkvist et al. 1996). Therefore, lead expo-
ior between caesium from Chernobyl and caesium from nu-
sure is not likely to be a major health concern in Sweden.
clear weapons test fallout. It may also be due to effective
countermeasures following the Chernobyl accident.
Cadmium. In the Västerbotten study, there were no signifi-
cant differences in blood cadmium levels between exposed
Other potential hazards
women and controls, with low blood cadmium levels ( 1
In 1991, the Swedish NFA recommended that pregnant
g/L) in both groups (Table 12ˇ28). The most important
women restrict their consumption of liver and liver prod-
cadmium exposure was a result of smoking. Blood cadmium
ucts, except liver paste/paté, because high vitamin A levels
levels were twice as high in smokers as in non-smokers in
had been reported in liver from pigs, cattle and chickens (Il-
both areas. Cadmium levels in the newborns were about 70%
bäck et al. 1991). The levels were especially high in im-
of their mothers' level.
ported beef liver, with levels of more than 40 mg retinol/100
The mean daily cadmium intake from the Swedish diet is
g. Although the NFA considered the risk of congenital mal-
10 g (Slorach et al. 1983). An intake of 25 g/d has been
formations to be small with ordinary consumption of Swe-
calculated to lead to cadmium-related kidney diseases in
dish food, the recommendations were issued as a safety pre-
0.1% of the exposed population. An intake of 50 g/d in-
caution until further information was available. The recom-
creases the frequency to 1% (Friberg et al. 1986). The risk
mended daily intake for pregnant women is 1 mg.
of kidney damage has been calculated to be two to five times
higher in people with low iron stores. Diabetics may also be
Conclusions
particularly susceptible to kidney damage from exposure to
According to recent studies in Sweden in areas south of the
cadmium (Elinder and Järup 1996). Cadmium exposure is
Arctic area, metal levels in humans are low and decreasing.
probably lower in northern Sweden than further south.
An ongoing study in Kiruna will show if the same holds true
in the Arctic area. Because exposure to persistent organic
Selenium. Plasma selenium levels were rather low in Väster-
compounds may be a problem, the Swedish NFA has issued
botten, and decreased significantly during pregnancy in both
special recommendations to girls and women of reproduc-
the smelter and the control areas (p < 0.001). Selenium levels
tive age concerning the consumption of certain fish. Studies
in newborns were significantly correlated to maternal levels
on levels of POPs in human milk and blood are also currently
and were 25% lower than their mothers' levels (Table 12ˇ28).
underway in Kiruna.
Selenium levels were lower in women living in the smelter
Table 12ˇ29 outlines ongoing human health related stud-
area than those living in the control area, probably due to
ies in Sweden that are relevant to the AMAP process.
different dietary habits.
Table 12ˇ29. Ongoing human health related research projects in Sweden
Arsenic. There were no significant differences in arsenic lev-
of relevance to the AMAP process.
els in urine between the two areas, nor were there any differ-
Principal Project
ences during the different stages of pregnancy. At week 10
Title
investigator
status
of pregnancy, the geometric mean values were 6.7 and 6.0
Background levels of metals and
B. Jakobsson Lager- In progress
g/g creatinine in the smelter and control areas, respectively.
POPs in humans in Kiruna
kvist, G. Lindström
Arsenic levels were comparable to previously reported val-
ues in Sweden (Vahter and Lind 1986).
Caesium 137 in the population
G. Ågren
In progress
of northern Sweden
Radionuclides
Ischemic heart disease in Kiruna
T. Messner
Finished
Risk factors and sequelae
In January-March 1987, approximately one year after the
Chernobyl accident, caesium levels were analyzed in the
Västerbotten County health survey:
G. Hallmans
In progress
Human specimen bank
breast milk of women living in the most contaminated areas
of Sweden (NFA 1988). The levels were generally low, 1-5
Ischemic heart disease in Norbotten
T. Messner
In progress
Bq/L, with one outlier of 11 Bq/L. Whole-body measure-
Swedish Monitoring Programme in
T. Odsjö
In progress
ments of women who were breast-feeding showed that the
terrestrial biota a
caesium levels in breast milk were about 15% of the whole-
Swedish Monitoring Programme
A. Bignert
In progress
body level.
in freshwater biota a
Whole-body content of 137Cs was measured in both 1991
a. The monitoring programs are not directly health related, but may be
and 1992 in the population of northern Sweden, with spe-
useful when considering background levels and exposure.
820
AMAP Assessment Report
Table 12ˇ30. Maternal plasma concentrations of pesticides (geometric
12.5. International study: Data comparison
means, g/kg lipid): Circumpolar study 1994-1996.
Introduction
Country a
Under the AMAP Monitoring Program, all circumpolar
Green-
Nor-
Ice-
countries agreed to monitor certain contaminants in specific
Canadab land c Swedend
way e
land
Russiaf
human tissues. During the meeting of the AMAP human
Pesticide
(n = 67) (n = 117) (n = 40)
(n = 60) (n = 40)
(n = 51)
health group, held in Copenhagen, September 26-27, 1994,
Aldrin
1.0
1.1
1.0
1.3
1.3
1.8
Canada agreed to coordinate and lead a special project for
-HCH
9.3
18.5
9.2
8.1
32.1
222.5
the monitoring of contaminants in maternal blood covering
cis-chlordane
1.0
1.1
1.0
1.3
1.3
1.6
trans-chlordane
1.1
1.3
1.0
1.3
1.3
1.4
the entire circumpolar region, using a standard sample col-
cis-nonachlor
6.6
20.9
1.2
1.8
2.7
5.3
lection procedure. It was also agreed that all analyses would
p, p'-DDE
133
407
84.0
79.4
113.2
411.9
be conducted by one laboratory to ensure direct comparabil-
p, p'-DDT
7.9
15.0
2.4
3.0
4.0
48.3
ity of results. Seven of the eight circumpolar jurisdictions
Hexachlorobenzene 55.1
97.6
15.6
23.1
41.2
62.8
Mirex
4.5
9.1
1.1
1.4
1.9
1.4
have implemented the maternal blood monitoring protocol.
Oxychlordane
27.8
60.8
1.9
3.7
6.6
3.3
Discussions with the United States (Alaska), the only non-
trans-nonachlor
30.5
110
3.8
6.8
12.2
11.5
participant, are ongoing. Samples from six of the seven coun-
a. Finnish and Alaskan data were not available in September 1996.
tries have been submitted and analyzed by the `Centre de
b. Inuit women from west/central NWT. c. Women from Disko Bay region.
Toxicologie de Quebec' in Quebec City, Canada. The study
d. Women from Kiruna. e. Women from Hammerfest and Kirkenes.
f. Women from Nikel.
was funded by the Canadian Department of Indian Affairs
and Northern Development and by Health Canada.
Table 12ˇ31. Maternal plasma concentrations of PCBs (geometric means,
The objective of this project was to obtain sufficient sam-
g/kg lipid): Circumpolar study 1994-1996.
ples during 1995/96 to assess geographical variations of con-
Country a
taminants (organochlorines and heavy metals) throughout
Green-
Nor-
Ice-
the Arctic. Each participating country agreed to send 30
Canadab land c Swedend
way e
land
Russiaf
maternal blood samples (plasma and whole blood). Mater-
(n = 67) (n = 117) (n = 40)
(n = 60) (n = 40)
(n = 51)
nal blood was selected instead of cord blood because it could
PCBs (as Aroclor 1260) 439
1577
606
458
590
570
provide sufficient sample volumes for duplicate analyses
CB 28
1.4
2.6
2.5
2.9
4.1
3.4
(one for the international reference laboratory in Quebec,
CB 52
1.7
3.8
2.0
1.8
2.2
2.3
CB 99
11.5
29.1
6.4
6.7
9.5
20.8
Canada, and one for national laboratories in Denmark and
CB 101
1.8
4.3
1.5
1.4
1.9
2.4
Norway).
CB 105
2.2
7.3
1.9
2.2
3.7
8.2
CB 118
8.8
33.7
11.4
10.5
16.2
31.3
Methods
CB 128
1.1
1.5
1.0
1.3
1.3
1.5
CB 138
29.6
118
47.4
35.1
45.7
49.8
Forty ml of blood were obtained from each mother. Each
CB 153
54.7
185
69.3
53.0
67.8
59.8
sample was analyzed for 14 PCB congeners (IUPAC Nos.
CB 156
5.0
15.4
8.6
6.3
8.0
9.0
CB 170
9.7
34.4
18.6
12.1
16.4
10.0
28, 52, 99, 101, 105, 118, 128, 138, 153, 156, 170, 180,
CB 180
26.6
82.5
34.1
25.3
34.4
20.5
183, 187) and 13 pesticides (aldrin, -hexachlorocyclohex-
CB 183
2.5
12.5
5.9
3.7
5.2
3.7
ane, cis-chlordane, trans-chlordane, cis-nonachlor, p, p'-DDT,
CB 187
10.2
41.3
11.0
10.3
13.3
8.1
14 PCB congeners 167
571
222
173
230
231
p, p'-DDE, dieldrin, heptachlor epoxide, hexachlorobenzene,
mirex, oxychlordane and trans-nonachlor). PCBs and pesti-
a. Finnish and Alaskan data were not available in September 1996.
b. Inuit women from west/central NWT. c.Women from Disko Bay region.
cides were measured in plasma using gas chromatography
d. Women from Kiruna. e. Women from Hammerfest and Kirkenes.
with electronic capture detectors according to the method of
f. Women from Nikel.
Ferron (1994). Lead, cadmium and selenium were measured
in whole blood using atomic absorption with a graphite fur-
Table 12ˇ32. Umbilical cord blood concentrations of PCBs and DDE
nace (Stoeppler and Brandt 1980, Parsons and Slavin 1993).
(geometric means, g/kg lipid): Circumpolar study 1994-1996.
Mercury (both total and inorganic) was measured in whole
Canada, gen-
blood samples using flameless atomic absorption according
eral population
Canada (Inuit) a
(Caucasian)
Greenland
to Ebbstadt et al. (1975).
(n = 319)
(n = 502)
(n = 102)
Each participating country obtained patient consent for
the sampling and completed a questionnaire for each mother
PCBs (as Aroclor 1260)
780
211
1388
PCBs (
covering, as a minimum, date of sampling, country/region of
14 congeners)
309
115
504
p, p'-DDE
384
173
424
residence and age of the mother.
a. Nunavik (northern Quebec, Canada).
Results and discussion
Table 12ˇ33. Concentrations of four elements in maternal blood (geometric
The results presented here are those of the Canadian refer-
means, g/L whole blood): Circumpolar study 1994-1996.
ence laboratory. The results for 11 of 13 pesticides and PCBs
(as Aroclor 1260 and congener-specific) are summarized in
Country a
Green-
Nor-
Ice-
Tables 12ˇ30 and 12ˇ31, respectively, for Canada, Greenland,
Canadab
land c
Swedend
way e
land
Russiaf
Sweden, Norway, Iceland and Russia (Finnish and Alaskan
Element
(n = 67)
(n = 117)
(n = 40)
(n = 60)
(n = 40)
(n = 51)
data were not available as of September 1996). In Table
12ˇ32, the concentrations of PCBs and DDE in umbilical
Mercury (total)
3.5
19.8
1.6
2.3 g
2.9
2.3
Lead
36.1
51.4
19.7
12.4 i
16.2
22.8 i
cord blood for Canadian Inuit (from Nunavik), Canadian
Cadmium
1.76
1.3
0.11
0.53 i
0.37
0.12 i
general population and Greenland Inuit populations are also
Selenium
121.6
64.3 h
79.0
105.8 i
96.4
106.6 i
presented because they were analyzed in the same reference
a. Finnish and Alaskan data were not available in September 1996.
laboratory and can be used for international comparison.
b. Inuit women from north-central NWT. c. Women from Disko Bay region;
Table 12ˇ33 provides data on levels of four metals in mater-
analyses by Deptartment of Arctic Environmental Research, Copenhagen.
nal blood for Canada, Greenland, Sweden, Norway, Iceland
d. Women from Kiruna. e. Women from Hammerfest. f. Women from
Nikel. g. n = 27 for mercury samples only. h. Plasma concentration.
and Russia.
i. Analyses by National Institute of Occupational Health, Oslo.
Chapter 12 ˇ Pollution and Human Health
821
Comparison of maternal and cord blood contaminant
With the exception of the -HCH and DDT/DDE levels
concentrations needs to take account of several important
found in the Russian samples, the patterns of POPs found
determinants of contaminant levels, i.e., age of mother, num-
in these maternal blood samples are consistent with the rel-
ber of previous children, number of children breast-fed,
ative amounts of traditional food consumed, especially
length of breast feeding, and type and amount of traditional
where marine mammals make up a larger amount of the
food consumption. Even though evaluations of these deter-
diet. The greater reliance of indigenous people on marine
minants relative to contaminant levels are not yet available,
species and the highest concentrations of contaminants in
it will be instructive to see how the overall contamination
the species consumed (see chapter 5) are found in Green-
patterns vary among the countries. Evaluation of these data
land, followed by Canada. Mothers sampled in Sweden,
incorporating the above determinations should be completed
Iceland and Norway consumed marine fish species and ter-
in the near future.
restrial mammals such as reindeer, sheep and cattle, but
very few marine mammals. Hence, levels in these countries
Persistent organic pollutants
are very similar and virtually indistinguishable from values
The levels of HCB, mirex and three chlordane metabolites
found at lower latitudes.
were markedly higher in Greenlandic maternal blood sam-
Whole blood values for selected POPs for all six coun-
ples than those from the other participating countries (Table
tries, showing data from different populations in Arctic Rus-
12ˇ30). Levels of DDE in Greenlandic and Russian samples
sia and Canada, are presented in Figure 12ˇ18. Although the
were similar and three to five times higher than levels in the
whole blood concentration values are lower than those ex-
other four countries, however, the DDE/DDT ratio for Russ-
pressed on a lipid weight basis (Table 12ˇ30), the relative
ian samples was markedly lower than that for samples from
amounts and the circumpolar patterns are similar.
all other countries (cf. Figure 12ˇ16), suggesting current con-
Table 12ˇ32 presents recent data on Canadian and Green-
tinuing use of DDT.
land cord blood concentrations for PCBs and p, p'-DDE. As
in the maternal samples, the highest concentrations are in the
DDE
DDT
cord blood samples from Greenland. The Inuit from Nunavik
ĩg/kg lipid
DDE
DDT
ĩg/kg lipid
have intermediate levels of contaminants and the general pop-
50
500
50
ulation of southern Canada (Caucasian) has the lowest lev-
els of contaminants. Samples from other countries were not
407
410
400
40
collected as part of the international comparison exercise.
Congener profiles in cord blood for each of the above popu-
lation groups are plotted together with the congener profile
300
30
for maternal blood from Greenland in Figure 12ˇ17. A similar
congener profile is seen in all the samples and the same geo-
200
20
15
133
ĩg/kg lipid
107
100
84
10
200
7.9
79
Cord blood
3.8
180
Greenland (1995) n=104
2.4
3.0
Nunavik (1993-1995) n=319
0
0
160
Canada
Greenland
Sweden
Norway
Iceland
Russia
Southern Quebec (1993-1994) n=500
140
DDE / DDT 16.8
27.1
35.0
26.0
28.6
8.2
120
Figure 12ˇ16. Mean maternal plasma lipid concentrations of DDE and
100
DDT; figures below the graph show the DDE/DDT ratios.
80
Interestingly, -HCH levels in Russian blood were 8-28
60
times higher than those in the other countries. In addition, the
40
levels of DDT were 3-20 times higher. These findings appear
20
to suggest that there are either significant uses of both HCH
and DDT in the Nikel area, or that there are significant amounts
0
28
52
99
101
105
118
128
138
153
156
170
180
183
187
of these pesticides in the food products consumed in this
PCB congener
area. These findings are similar to those reported by Polder
et al. (1996) in human breast milk from the Kola Peninsula.
ĩg/kg lipid
Pesticide levels in Canadian samples tended to be lower
200
Cord and maternal blood
than those from Greenland, but similar in terms of their rel-
180
Cord blood Greenland (1995) n=104
ative abundance, however, concentrations of cis- and trans-
Maternal blood Greenland (1995) n=117
160
nonachlor, DDT/DDE, oxychlordane, mirex and hexachloro-
benzene were greater than the levels reported in the Swedish,
140
Norwegian and Icelandic samples.
120
The highest concentrations of PCBs are in the maternal
100
blood samples from Greenland (Table 12ˇ31). This is true
80
both for PCBs measured against an Aroclor 1260 standard
and based on a sum of 14 congeners. Maternal samples from
60
other countries contain fairly similar levels of PCBs. A review
40
of the relative amounts of the top seven congeners (153 > 138 >
20
180 > 187 > 170 = 118 > 99) indicates that the congener pat-
terns are similar in all countries except Russia where there are
0
28
52
99
101
105
118
128
138
153
156
170
180
183
187
relatively lesser amounts of congeners 153, 170, 180 and 187
PCB congener
and relatively more of congeners 99 and 118 calculated as a
Figure 12ˇ17. PCB congener profiles in cord blood of Canadian and Green-
percent of the total amount of PCB (sum of 14 congeners).
Figure 12Ŗ15
l
: PCB Congener profiles in core and maternal blood.
andic population groups, and in cord and maternal blood from Greenland.
822
AMAP Assessment Report
Northwest NWT
Northwest NWT
Central NWT
Central NWT
Norilsk
Nunavik
Nunavik
Salekhard
N.Norway
N.Norway
W.Greenland
Nikel
W.Greenland
Nikel
N.Sweden
Iceland
Hg ĩg/L
N.Sweden
Iceland
PCB ĩg/L
20
15
10
10
3
5
1
1
Northwest NWT
Northwest NWT
Central NWT
Central NWT
Norilsk
Norilsk
Nunavik
Nunavik
Salekhard
N.Norway
Salekhard
N.Norway
W.Greenland
W.Greenland
Nikel
Nikel
N.Sweden
Pb ĩg/L
Iceland
80
Iceland
N.Sweden
HCB ĩg/L
1.0
50
0.5
15
0.1
Northwest NWT
Northwest NWT
Central NWT
Central NWT
Norilsk
Nunavik
Nunavik
Salekhard
W.Greenland
N.Norway
Nikel
N.Norway
W.Greenland
Nikel
-HCH ĩg/L
N.Sweden
N.Sweden
2.0
Iceland
Cd ĩg/L
Iceland
4.0
1.0
0.5
2.0
1.0
0.1
0.3
Figure 12ˇ18. Geometric mean concentrations of PCB, HCB and -HCH in
Figure 12ˇ19. Geometric mean concentrations of mercury, lead and cadmium
maternal blood plasma; AMAP circumpolar study 1995, see Annex Table
in maternal whole blood; AMAP circumpolar study 1994-95, see Table
12ˇA12.
12ˇA13.
Chapter 12 ˇ Pollution and Human Health
823
graphic/ethnic pattern is seen as in Table 12ˇ32. The concen-
Environmental risk assessment has been defined as the
trations of specific PCB congeners are only slightly higher in
evaluation of `potential adverse heath effects of human ex-
the maternal blood samples from Greenland than the Green-
posures to environmental hazards' (NAS 1983). The process
land cord blood samples. The predominant maternal and fetal
of risk assessment is commonly divided into four major steps:
PCB congeners are 153 > 138 > 180 > 187 118 99.
hazard identification, exposure assessment, dose-response
assessment, and risk characterization.
Metals and essential elements
Risk management, which is distinct from risk assessment,
Mercury levels in maternal blood from the six circumpolar
is the process of weighing policy alternatives and selecting
areas sampled are relatively similar, except in Greenland
the most appropriate regulatory action that integrates the re-
where they are 5-12 times higher than the levels in the other
sults of risk assessment with scientific data, and with social,
countries. Even though blood mercury levels have declined
economic, and political concerns (NAS 1983).
(see Table 12ˇ11) there is still a significant percentage of
Risk communication is the process of informing the pop-
samples with values above the 20-50 g/L risk range used
ulation of the risks, benefits and recommendations involved.
by the WHO for adverse effects on fetal development.
A more detailed discussion is given by Scala (1991).
Lead levels are again highest in Greenland, with interme-
Identification of sources of individual contaminants, and
diate levels in Canada, but all are well below the 100 g/L
the levels of contaminants in air, food and water can be ac-
no-observed-effect-level for protection of the fetus.
complished through environmental monitoring programs.
Cadmium levels are highest in Canadian and Greenlandic
Estimates of human exposure can be derived from human
samples. Considering the lower levels in the other countries,
tissue levels or calculated from individual intake of conta-
and the relatively similar prevalence of smoking, it is likely
minants in food, air, water and consumer products. Esti-
that considerable amounts of cadmium are consumed in tra-
mates of health outcomes are more problematic. Hypo-
ditional food, especially organ meats, in Canada and Green-
theses can be generated about expected human reactions
land. Levels in Canadian samples may also be affected by
using laboratory animal studies. These hypotheses have to
use of Canadian tobacco, which is known to have high cad-
be verified, when possible, by epidemiological studies of ef-
mium content.
fects and exposure. Occupational exposure studies can be
Selenium is included in Table 12ˇ33 because it is benefi-
instructive, but occupational exposure levels tend to be far
cial for health and found in traditional food. Blood levels
greater than those experienced through the environment,
are related to traditional food consumption. Adequate levels
and frequently they concern only one or a very few prin-
of selenium are found in maternal samples from all the par-
ciple compounds.
ticipating countries. Levels in Greenland are probably higher
Limitations to the risk assessment process include: the un-
than shown because the values for Greenland were based on
certainty regarding the similarity of responses between ex-
plasma, not whole blood.
perimental animals and humans; the fact that the epidemio-
Metal concentrations in the circumpolar region are shown
logical study approach needs to take into account other sup-
in Figure 12ˇ19.
porting information to establish causal relationships; the fact
Further assessment of the POPs and metals and essential
that experimental animal/human studies are often based
elements data must await completion of analyses of the de-
upon single compound models, while human populations
mographic data that applies to the samples.
are exposed to a multitude of environmental chemicals and
other stressors with possible mutual interactions; and the
difficulty of estimating with precision human exposure from
12.6. Risk assessment, management and
all sources. Human populations are generally exposed over
communication
several decades (i.e., a typical lifetime) to small doses of many
different contaminants, and it is often the case that no single
General considerations
contaminant exposure is sufficient (or even necessary) to pro-
Environmental contaminants regardless of their origin (anthro-
duce an adverse health outcome. Specific conditions, such as
pogenic or natural), pose a potential risk to health. Evalua-
cancer and cardiovascular diseases, are often discussed in re-
tion of actual risks, and what needs to be done to reduce these
lation to environmental contaminant exposures, but a clear
risks, is complicated because there are both scientific and social
causal relationship to exposure to a single contaminant is
components that must be taken into account (Figure 12ˇ20).
seldom identified because the conditions are a result of inter-
Scientific aspects
Societal aspects
Sources Exposure Doses Effects
Economic:
Social:
Organization/political:
ˇ Trade interests
ˇ Understanding
ˇ Ideology
ˇ Industrial policy
ˇ Perception
ˇ Policy
Animal experiments and
Animal experiments and
ˇ Employment
ˇ Acceptance
ˇ Nature conservation
clinical observations
epidemiological studies
ˇ Dietary benefits
ˇ Traditional
way of life
Toxicokinetic/
toxicodynamic/
epidemiological models
Cost/benefit analysis
Information model
Ecological model
Exposure
Hazard assessment
Doseresponse
assessment
assessment
Risk tolerance
Risk communication
Risk elimination
Risk characterization
Option evaluation
Risk assessment
Risk management
Public health policy
Figure 12ˇ20. Elements involved in the evaluation and handling of risks from environmental contaminants.
824
AMAP Assessment Report
action between genetic predispositions and overall environ-
Table 12ˇ34. Some factors influencing individual risk acceptance.
mental influences, i.e., contaminants and modifying factors
Acceptability
such as diet, physical condition, age, etc. For these reasons,
risk characterization may not represent the true risk, but
High
Low
rather the best estimate of risk based upon the current state
Risk known and understood
Risk unknown and not understood
of scientific knowledge and the assumptions used by the as-
Risk undertaken voluntarily
Risk imposed involuntarily
sessor. Where there is uncertainty in the adequacy of the toxi-
Personal benefit obvious
No personal benefit
cological or epidemiological data, risk characterization may
Occupational setting
General environment
No alternatives
Alternatives available
utilize larger safety margins to develop the tolerable daily in-
take values. This approach may exaggerate risk relative to
major factors that influence the level of acceptance. In the
benefits. Methodologies for improved risk assessment and
case of environmental pollution and exposure to contami-
characterization following exposure to hazardous substances
nants through food, public acceptance of risks to their
in the environment have recently been the subject of exten-
health will in general be low.
sive discussion (Wilson et al. 1995).
A variety of organizations (e.g., those with interests in
Environmental risks cannot be expressed in absolute terms
public health or environmental conservation) may have an
and, as a result, they are often vigorously debated. Various
impact on decision making. Some lobby groups may call for
societal interests and conditions will influence the way the
immediate and complete risk elimination, without adequate
risks are managed. In many cases, environmental contami-
regard for hunting and herding traditions of indigenous peo-
nants originate from industrial processes of economic impor-
ples. Though well intentioned, this unidimensional approach
tance to society. Economic consideration (cost/benefit analy-
may have a negative impact on cultural patterns of indige-
sis) will, therefore, be an important component in planning
nous peoples, i.e., it would favor changes of lifestyle away
reductions in emissions. Imposing regulations on production
from the traditional and towards a westernized way of life.
as a consequence of concentrations of contaminants in food-
A tendency toward westernization may impact not only on
stuffs may also need to address considerations related to the
culture, but also on public health. Avoidance of traditional
possible negative effects of loss of earning power on the pro-
foods may actually increase health risks because these foods
ducers. Risk managers will tend to take a pragmatic approach
may protect against cardiovascular diseases, and supply es-
to the question of acceptability of risk, based upon a thresh-
sential, affordable nutrients.
old of `tolerable' or `acceptable' effects which usually are
Risk management approaches are by nature complex, and
greater than zero. These effects thresholds are compared to
in the Arctic they must strike a balance between well-docu-
exposure concentrations in order to incorporate into legisla-
mented benefits from traditional food and the potential risks
tion `action levels' of some type for food, air, water and con-
from contaminants. In addition, risk management decisions
sumer products.
should allow for special consideration of the needs of the
In the general population, workers and consumers are
indigenous peoples. The AMAP human health program re-
often at the receiving end of risks accepted as tolerable by
cognizes these issues and aims to produce a set of basic re-
the decision makers, and it is very important to inform these
commendations, which can then be used to develop local or
exposed groups of the risks, benefits and basis for actions
regional recommendations according to specific needs.
taken. This is of special importance in the Arctic, where in-
digenous peoples often have limited influence on technologi-
Risk assessment of individual contaminants
cal development and regulation. Contaminants in the local
Persistent organic pollutants
environments may change the conditions for herding, hunt-
Food consumption survey data can be combined with food
ing, and fishing, and while their presence in traditional food
contaminant concentrations to develop estimates of human
items may result in direct health impacts, risk aversive be-
exposure in the Arctic. This task is complicated by the vary-
havior may harm health more than the exposure to the con-
ing levels of contaminants found in the many food items con-
taminants themselves. These `risks' to health must be balanced
sumed (geographically and seasonally), the different amounts
with the health-promoting nutrients in traditional foods, such
consumed by different ages and genders, and different meth-
as n-3 fatty acids, vitamins and trace elements, as well as di-
ods of food preparation. Nevertheless, when these estimated
rect social and cultural benefits. A balance between the posi-
one-day intakes are compared with currently held tolerable
tive and negative influences must be achieved.
daily intakes (TDIs), it is possible to gauge the relative risk,
Risk communication should be carefully developed to
but not the absolute risk, to which people are exposed. Ex-
convey an accurate and understandable message. People's re-
ceedance of TDIs by an individual is of particular concern
action will depend a great deal on their perceptions of the
where that individual continues to exceed the TDIs over a
credibility of the persons providing the information. Inform-
significant period during their life. Much of the data on in-
ing local populations must, therefore, be done by trained
takes in the Arctic is only for several one-day exposures to
and informed people with a mandate to convey reliable in-
contaminants. This needs to be borne in mind when com-
formation. In many cases, the news media are the only sources
paring daily intake estimates with TDIs, otherwise there ex-
of information available, and they should be assisted in or-
ists potential for drawing conclusions which may not be jus-
der to present information in its correct context. The success
tified on the basis of the available information.
of any communication effort will depend on people's ability
Kuhnlein et al. (1995a) plotted the range of individual
to understand the information provided, as well as their per-
one-day contaminant intakes of POPs for Baffin Island Inuit
ception of the information, which is influenced by traditional,
and Mackenzie Valley Sahtu Dene/Métis (Figure 12ˇ21).
cultural, and religious concepts, and psychological factors.
Among Inuit, the mean one-day contaminant intake values
The complexity of providing information to people implies
are higher by an order of magnitude or more for every cont-
that risk communicators should have local knowledge, be
aminant shown than among the Sahtu Dene/Métis. This is
prepared to listen, and accept dialogue as part of the com-
expected from the different amounts and types of traditional
munication process.
food consumed by these two peoples, i.e., marine mammals
Acceptability of individual risk is largely influenced by an
and fish for the former and caribou and fish for the latter.
individual's perception of the risk. Table 12ˇ34 shows some
These mean contaminant intakes can be compared to current
Chapter 12 ˇ Pollution and Human Health
825
Baffin Inuit (n=291)
Métis. Although the data sets are incomplete, chlordane, tox-
Average Intake
Average Intake
aphene, mercury and to a lesser extent cadmium and PCB,
(ĩg/d)
(ĩg/d)
show the most frequent exceedances of the TDI. These ex-
10 000
10 000
1 000
1 000
ceedances of some contaminant TDIs by indigenous groups
100
100
in Arctic Canada are in contrast to more southern Canadian
10
(1)
10
(2)
populations where the market diet is considered to have neg-
1
1
0.1
0.1
ligible amounts of POPs (Connacher and Mes 1993). In the
0.01
0.01
continental United States, the daily intakes of POPs are usu-
0.001
0.001
0.0001
0.0001
ally less than 10% of the acceptable daily intakes (Gunder-
CBZ
HCH
CHL
DDT
DIE
TOX
PCB
son 1988).
The surveys of the two Inuit populations show quite simi-
Sathu Dene/Métis (n=207)
lar results despite the methodological difficulties in food con-
Average Intake
Average Intake
(ĩg/d)
(ĩg/d)
taminant intake studies. The possible differences in the pro-
10 000
10 000
portion of TDI exceedances for chlordane and mercury
1 000
1 000
100
100
between the Baffin and the Nunavik Inuit may be due to
10
(1)
10
(2)
dietary differences, with one group consuming more beluga
1
1
whale and ringed seal and the other consuming more wal-
0.1
0.1
0.01
0.01
rus, narwhal and ringed seal (Dewailly et al. 1996c, Kinloch
0.001
0.001
et al. 1992).
0.0001
0.0001
CBZ
HCH
CHL
DDT
DIE
TOX
PCB
Support for these data can be found in the cord blood data
on POPs (see section 12.4.1 and Figure 12ˇ3). Since all of
Mean
Tolerable daily intakes (TDI) taken from Table 12.1 except :
the contaminants listed in these studies are persistent, bioac-
Median
(1) Based on provisional TDI (Health Canada1996)
cumulative, and cross the placenta, they can be expected to
(2) TDI for children (WHO 1989)
be present in the blood lipid of newborn babies. All of these
CBZ : sum of tetra-, penta- and hexachlorobenzene
contaminants occur at higher concentrations in cord blood
HCH : sum of -, - and -hexachlorocyclohexane
of Inuit babies from both Nunavik and the western NWT
CHL : chlordane ; sum of oxychlordane, cis- and trans-chlordane and heptachlor epoxide
than from Métis/Dene newborn. They also suggest that PCB
DDT : sum of p,p'DDE, p,p'DDD, p,p'DDT, o,p'DDT
and DDE levels in Inuit from the eastern Canadian Arctic
DIE : dieldrin
are higher than those in Inuit from the western Canadian
TOX : toxaphene
Arctic. In addition, back-extrapolation from maternal blood
PCB : sum of congeners.
collected in Nunavik confirm that for those contaminants
with well known biological half-lives and absorption fac-
Figure 12ˇ21. Organochlorine intake from traditional food consumed by indi-
genous women in the Canadian Arctic (adapted from Kuhnlein et al. 1995a).
tors, estimated maternal exposures were in the same order
of magnitude as those calculated from the dietary intake data
TDI values (Figure 12ˇ21). For the Inuit group, two of the
shown here (Dewailly, pers. comm.).
mean one-day intake values (HCH and PCB) are within a
Cord blood data are of potential concern in the Arctic.
factor of 10 of the TDI. For chlordane and toxaphene, these
Knowledge of effects of contaminants in animals and humans
data indicate that mean one-day intakes exceed the TDI near-
during fetal development is accumulating and makes a com-
ly ten-fold. For the Sahtu Dene/Métis, the estimated mean
pelling case for reducing population exposures as quickly as
one-day contaminant intakes are well below the TDI values,
possible, and with appropriate sensitivity to the various issues
except for toxaphene and chlordane which are only approxi-
involved. The fetus is vulnerable to the effects of several con-
mately a factor of 10 below the TDI (Figure 12ˇ21).
taminants, and there is little the mother or fetus can do to
Using different methodologies, Dewailly et al. (1996c) also
reduce exposure during this critical period of cell differentia-
estimated contaminant intakes among Nunavik Inuit women.
tion and organ development.
Ayotte (1996) and Receveur (1996) have taken the data pre-
Breast milk data comparisons clearly demonstrate that in-
sented in Dewailly et al. (1996c) and Kuhnlein et al. (1995a),
creasing concentrations of all of the persistent organic pollu-
respectively, and calculated the proportion of women in the
tants reviewed are associated with increasing consumption
studies whose dietary contaminant intakes exceeded the TDI
of traditional food (in particular fish and marine mammals).
(Table 12ˇ35). The Inuit in these two studies exceed the TDI
The concentrations of POPs in some Canadian Inuit breast
much more frequently and to a greater extent than the Dene/
milk are 2-10 times greater than the levels in breast milk of
southern Canadians (Table 12ˇ36). It is worth noting that
Table 12ˇ35. Proportion (%) of women whose daily intake exceeds the
Tolerable Daily Intake.
even though breast milk levels are considerably higher among
some indigenous groups in the Arctic than among non-indi-
Inuit
Inuit
Dene/Métis
Baffin Island a
Nunavik b Mackenzie Valleya
Table 12ˇ36. Relative increase in breast milk contaminant concentration in
Inuit women from Nunavik compared to non-indigenous women from
CBz c
9
6 g
0
southern Quebec a.
HCH d
7
n.a.
0
Chlordane e
48
75
6
Contaminant
Increase factor (north/south)
DDT f
0
0 h
0
Dieldrin
16
n.a.i
0
DDE
5.5
Toxaphene
40
n.a.
2
Toxaphene
n.a.c
PCBs (sum of congeners)
16
4
0
Dioxins/furans (dioxin TEQs)
2.0
Mercury
29
37
n.a.
Dioxins/furans/PCB (dioxin TEQs)
2.4
Cadmium
21
n.a.
n.a.
Mirex
10.0
Chlordane b
10.0
a. Source: Receveur 1996 (dietary interviews 1987-88). b. Source: Ayotte
Hexachlorocyclohexane
n.a.
1996 (dietary interviews 1992). c. Sum of tetra-, penta-, and hexachloro-
PCBs (as Aroclor 1260)
5.6
benzene. d. Sum of -, -, and -hexachlorocyclohexane. e. Sum of oxy-
HCB
4.9
chlordane, cis- and trans-chlordane, and heptachlor epoxide. f. Sum of
p, p' DDE, p, p' DDD, p ,p' DDT, and o, p' DDT. g. Hexachlorobenzene
a. See section 12.4.1; data collected in 1989/90. b. comparison between
only. h. DDE only. i. n.a.: not available.
Nunavik (1989/90) and southern Canada (1992). c. n.a.: not available.
826
AMAP Assessment Report
genous groups in the south, the levels of at least one con-
and fish, and with smoking. Mean values for various groups
taminant for which there are historical data, DDT, indicate
tested in Canada, Russia, Norway, Greenland and Sweden
the levels in southern Canadian women in 1967 were three
are below 100 g/L blood and below a level of concern based
times higher than the levels now being reported in Inuit
on WHO blood guidelines for communities (Figure 12ˇ9,
mothers (Mes 1994). Comparative data for levels of POPs in
Annex Tables 12ˇ12 and 12ˇA13).
breast milk of indigenous groups in other Arctic regions are
For children, who are most at risk from lead exposure dur-
unavailable.
ing fetal development and early infant development (quantifi-
The effects on infants of contaminants taken in during
able IQ point reductions at or above lead levels of 200 g/L
breast feeding are not yet clear (Jacobson et al. 1990, 1992,
blood and reduced gestation periods at or above 50 g/L
Dewailly et al. 1993c, Koopman-Esseboom et al. 1994a,
blood), there is a necessity to monitor cord blood and infant
1994b). In some cases in the Canadian Arctic, infants have
blood to ensure lead levels do not increase. As the majority
been exposed to contaminants at levels which are above the
of newborns are well below the 100 g/L action level, they
TDIs for certain POPs. However, TDIs are calculated for
are not considered to be at risk from in utero lead exposure.
lifetime exposures, whereas exposures through breast milk
However, lead is a cumulative toxin with exposure continu-
are limited to the first few months of life. These exposures,
ing during lactation, suggesting that, in the Arctic, biomoni-
averaged over the lifetime of the individual, contribute very
toring should continue during early childhood development.
little to the total body burden. Given the well-known bene-
fits of breast feeding, it is generally recommended that moth-
Cadmium
ers continue breast feeding unless advised otherwise by their
While traditional food (especially organ meats) is a source of
health care provider.
cadmium, the greatest source of human exposure is from to-
bacco smoking. For smokers, cadmium levels are 20-30 times
Mercury
higher than for non-smokers. These exposures are similar
Methylmercury poses a significant risk to the health of some
both within and outside of the Arctic, and blood levels sug-
peoples in the Arctic, especially in the regions where sea mam-
gest that exposure to cadmium through smoking leads to
mals are included in the diet. Large percentages (45-75%) of
large exceedances of the TDI.
the Inuit sampled in the eastern Canadian Arctic have levels
Non-smoking indigenous peoples in the Arctic tend to
above 20 g/L (Table 12ˇ10); this was also found for Cree in
have similar blood cadmium levels to people living further
the same area. Extensive research by Wheatley and his co-
south (< 1 g/L). Using data from Canada and based on a
workers (Wheatley and Paradis 1995) indicate the extent
conversion factor proposed by Louekari et al. (1991, 1992),
and range of the problem. Blood mercury levels range from
non-smoker intakes in Nunavik Inuit would be in the range
1-660 g/L in the 38 571 indigenous samples examined be-
of 0.4-0.5 g/kg bw/d which is half of the PTDI based on
tween 1970 and 1995. Some of the measurements among
the WHO PTWI (Table 12ˇ2). A recent dietary intake study
eastern Canadian Arctic Inuit and Cree were above the 200
of eastern Arctic Inuit women indicated that 21% consumed
g/L suggested by the WHO as a guidance level (i.e., 5% of
amounts of cadmium in diet greater than the current WHO
the population with levels above 200 g/L may be at risk of
PTDI. These exceedances are not likely to be far greater than
developing neurological paraesthesia). Similar results have
the PTDI, but indicate further blood monitoring is needed in
been reported by Hansen (1990) and co-workers in Green-
the Baffin region (Receveur 1996).
land, in particular northern Greenland (Figure 12ˇ8). While
In an evaluation of cadmium exposure of northern Quebec
neurological signs have been observed clinically in some
Cree, it was estimated that regular consumption of moose
highly exposed native peoples, it has as yet been impossible
and caribou kidney and liver would result in a cadmium in-
to irrefutably diagnose methylmercury poisoning. Some re-
take near the WHO PTDI of 1 g/kg bw/d. Cadmium expo-
cent data indicates that mercury levels may be decreasing in
sure from smoking one pack of cigarettes per day results in a
some Arctic populations.
cadmium intake of a similar order of magnitude (Archibald
The WHO has also proposed that there is a 5% risk of
and Kosatsky 1991). It was recommended to the Cree Regio-
neonatal neurological damage associated with peak methyl-
nal Authority that no consumption restriction be applied but
mercury exposures measured at 10-20 g/g in maternal hair.
urinary cadmium biomonitoring be implemented. Traditio-
Using the conversion factors proposed by Clarkson (1992)
nal food use, where cadmium is the contaminant of concern,
and Phelps et al. (1980), these hair levels can be roughly con-
need not be altered if smoking habits can be modified.
verted to 30-70 g/L blood. While all mean values for Dene,
Cadmium levels in caribou kidney tend to be highest in
Yukon First Nations and non-indigenous reported in Table
the Canadian Arctic in the Yukon herds and those between
12ˇ11 are below this range, 12 out of 15 mean values re-
Great Slave Lake and Hudson Bay. It is also in these areas
ported in the same table for Cree and for Inuit from Canada
that caribou consumption is greatest. Risk assessments have
and Greenland are within this range. One recent food intake
been completed for various age ranges of caribou and en-
study of Inuit in the eastern Canadian Arctic supports these
dorsed by community leaders. Caribou kidney is a healthy
findings. Receveur (1996) reports that 29% of the women in
food and significant amounts can be consumed without any
the study had daily intakes of mercury that exceeded the
concern for cadmium-related effects. More important for the
WHO TDI (Table 12ˇ35).
protection of health from the point of view of exposure, is a
reduction in tobacco smoking which leads to exceedances of
Lead
the TDI without any contribution of cadmium from tradi-
In general, current levels of lead in the Arctic do not pose a
tional foods whatsoever.
significant threat to health and, based on the declining glo-
Cadmium levels reported in recent blood samples from
bal emissions of lead, are not likely to pose a threat to the
the entire circumpolar region are generally similar, suggest-
health of northerners in the future. It is clear that average
ing that exposures are relatively similar and from common
adult blood lead levels have declined, that they are only
sources, i.e., food and tobacco smoke. The levels reported in
slightly higher in Arctic peoples than in populations in the
smokers could lead to some mild kidney damage.
south, and that these elevations are associated with con-
The fetus is generally protected from exposure to cad-
sumption of large amounts of meat from marine mammals
mium because the placenta acts as a partial barrier.
Chapter 12 ˇ Pollution and Human Health
827
Arsenic
disease. The consumption of local fish, meat, wild greens
Exposure to arsenic compounds in the Arctic comes from
and berries provide the necessary dietary intake of most
consumption of food of marine origin (organic arsenicals)
vitamins, essential elements and minerals. When market
and drinking water (inorganic arsenic). The only health risk
foods are purchased to supplement current country food
seems to be associated with drinking water which is locally
diets, they should be selected for their nutrient quality. It is
contaminated with inorganic arsenic.
unlikely that market foods currently available to most Arctic
indigenous populations can provide the nutritional equiva-
Nickel
lent of traditional food.
In communities where a significant proportion of the popu-
3. The influence of contaminants on fetal and neonatal de-
lation is employed in nickel refining and comparable indus-
velopment is of special concern. Preliminary results indicate
tries, environmental health assessments must take account of
that POP and methylmercury concentrations are two- to ten-
preexisting occupational disease conditions (such as repro-
fold higher in breast milk and cord blood in some Arctic
ductive or developmental impairments and cancer). Nickel
areas than in breast milk and cord blood from regions south
contact dermatitis is a disease which may be exacerbated by
of the Arctic. The fetus and the neonate are very vulnerable
intake of nickel in the diet and in drinking water.
to the effects of many of these contaminants during this crit-
Radionuclides
ical period of development.
Amounts of radionuclides in the Arctic environment are gen-
POPs
erally about the same as, or even lower than levels found in
4. There is both scientific and public concern about the pos-
the temperate zone. The two radiocaesium isotopes (137Cs and
134
sible adverse effects of POPs on pregnancy outcome, fetal
Cs) are considered to be the artificial radionuclides of great-
development, child development, reproduction, male and
est concern in the Arctic environment. In Canada, levels of ra-
female fertility, and the immune system. Several of these ef-
diocaesium have decreased from about 450 Bq/kg in 1965 to
fects may be mediated through endocrine disrupting proper-
roughly 10 Bq/kg in 1990 due to the cessation of atmospheric
ties of some POPs. DDT and its metabolites and some dioxin
nuclear testing. Of all radionuclides, natural and artificial, the
and PCB congeners have been implicated.
natural radionuclides 210Pb and 210Po make the greatest con-
tribution to human radiation doses in the Arctic. A recent
5. Despite the number of controls on several POPs imposed
study of caribou hunters in the Canadian Arctic indicated that
during the 1970s and 1980s, there is no evidence that levels
they may be receiving up to 10 mSv per year from ingested
in Arctic peoples have decreased. The persistence of POPs,
210Po compared to a normal background of about 2 mSv.
their presence throughout the ecosystem, and the continued
If we assume (as an upper limit) that about one-half mil-
use of some POPs for disease vector control, all contribute
lion Arctic residents depend on hunting, fishing and reindeer
to the constant influx of POPs into the arctic environment
herding and that the highest average exposure is 11 mSv,
and sustained levels of human exposure. There is very little
then the collective radiation dose is 5500 person-Sieverts.
information on temporal trends of POPs in Arctic popula-
With a cancer risk of 0.05 cases per Sievert of exposure, one
tions. Monitoring of POPs in blood over the next decade is
would expect 275 radiation-induced cancers. This would be
essential to establish whether or not risk management strate-
indistinguishable against a background of over 100 000 fatal
gies for POPs are effective.
cancers that would normally be expected to occur in a popu-
6. Elevated levels of toxaphene and chlordane, coupled with
lation of this size.
current intake scenarios, suggest some indigenous groups are
exposed to levels of these contaminants significantly above
the Tolerable Daily Intake (TDI). Information on the levels
12.7. Conclusions and recommendations
of toxaphene in human tissues is limited.
12.7.1. Conclusions
7. There is insufficient information to conclude whether the
General conclusions
TDI for dioxins and furans and dioxin-like PCBs is being ex-
ceeded in Arctic populations. Also, there is as yet little con-
1. Contaminants of anthropogenic origin, such as POPs,
clusive scientific information directly linking harmful human
metals and radionuclides, are spread globally, and contami-
effects to low levels of exposure to these contaminants.
nate the Arctic. The combination of environmental condi-
tions and biomagnification in the marine and freshwater
8. While current levels of exposure to POPs in the Arctic are
aquatic food webs results in accumulation of certain persis-
unacceptable, it is not always clear what public health mea-
tent contaminants in local food at levels which are often in
sures should be taken to reduce the exposure of Arctic popu-
excess of contaminant concentrations in the mid-latitudes
lations who rely on traditional foods for spiritual, cultural,
where these contaminants originate. Consumed fish, marine
physical, and nutritional benefits. Decision-making would be
mammals, terrestrial mammals, and birds are the major
greatly aided by studies of the interactive effects of current
sources of human exposure to environmental contaminants
levels of mixtures of POPs found in the traditional food sup-
in the Arctic and, as a consequence, several Arctic popula-
ply. In the interim, the risks associated with a shift in dietary
tion groups are much more highly exposed through the diet
preference need to be considered along with the risks associ-
than most populations in the developed world.
ated with the presence of contaminants in Arctic wildlife
consumed as traditional food. Weighing the uncertainty in
2. The social, cultural, spiritual and physical health of Arctic
some of the TDI values (e.g., toxaphene) against the benefits
indigenous peoples depends on the collection and consump-
of traditional food gathering and consumption, it has been
tion of country foods. A diet based on traditional foods is of
recommended in most Arctic jurisdictions that consumption
high nutritional benefit. Consumption of n-3 fatty acids found
continue.
in marine mammals and fish has been suggested as the com-
ponent responsible for the lower incidence of cardiovascular
9. The concentrations of some POPs in breast milk have
disease in Alaska, Greenland, Canada and Japan. However,
raised justifiable concern among mothers in the Arctic. The
other nutrients may also influence the rate of cardiovascular
health benefits to newborns of breast feeding are substantial,
828
AMAP Assessment Report
e.g., mother-child bonding, immunological benefits trans-
ulation is exposed must also include an estimate of the nat-
ferred from mother to child, nutritional value, and reduced
ural radionuclides. In some geographical areas, levels of
risk of bacterial contamination from poorly prepared formu-
natural radionuclides (derived from, e.g., radiolead and
las. Breast feeding should continue since the benefits of breast
radiopolonium) have resulted in certain indigenous peoples
feeding outweigh the currently known risks attributed to in-
being exposed to higher levels of radiation than the general
fant exposure to contaminants through breast milk.
population.
10. Existing epidemiological evidence on the adverse effects
19. Increased UV radiation due to ozone depletion is not a
of POPs in humans is inconclusive and needs to be repli-
major concern in terms of skin cancer because of the amount
cated because of the specific context in the Arctic in which
of clothing worn in Arctic environments. The primary health
there are differences in genetics, climate, food consumption
concern is the reflection of UV from snow and ice causing
patterns, and lifestyle among population groups.
snow blindness. In addition, there is growing concern about
the development of cataracts.
Heavy metals
12. Existing data from the literature do not allow a valid es-
Estimates of exposure and effects
timate of spatial and temporal trends of exposure of Arctic
20. Food is the major exposure route for contaminants in
peoples to mercury and cadmium, while for lead, a declining
the Arctic. The type and amount of human exposure to envi-
trend is observed. There is some evidence that the general
ronmental contaminants varies throughout the circumpolar
decline in lead exposure parallels the decline in lead levels in
region according to the level of contaminants in the food, the
industrialized areas.
amount and type of food consumed, and the method of food
preparation. For these reasons, wildlife monitoring data pro-
13. The high exposure of indigenous peoples to methylmer-
vide a very uncertain basis for precise human exposure esti-
cury in some Arctic areas is a matter of concern because of
mates. However, they are of great value for risk characteri-
its neurotoxic effects on the fetus. Further investigation of
zation as they identify the contaminants present in wildlife
both the levels and the influence of mercury on fetal devel-
used as traditional food, and the most contaminated species,
opment is warranted.
and can, therefore, contribute to the basis for dietary recom-
14. Lead levels in Arctic indigenous peoples have declined
mendations. Uniform methodology for dietary intake studies
since the implementation of controls on lead emissions. Con-
applied across the circumpolar region would greatly assist
centrations of lead in blood currently reported are below a
risk assessment.
level of concern, however, continued monitoring is warranted
21. Determining adverse health effects in human popula-
because of the potent effects of lead on neurological develop-
tions due to the presence of contaminants in traditional
ment in the fetus and children.
foods and human milk is extremely difficult for methodolog-
15. As elsewhere in the world, cadmium intake in the Arctic
ical and ethical reasons. Results are also difficult to interpret
is mostly through smoking. However, as with mercury, the
because of a wide range of confounding factors (socio-eco-
dietary exposure level will vary according to choice of food.
nomic, lifestyle and gender/age related). Monitoring contam-
Recent research indicates that kidney tubular dysfunction
inant concentrations in human tissues and using these data
may occur at lower levels than previously considered.
to estimate exposures will continue to be necessary as will a
general reliance on animal studies of the effects of mixtures
16. Arsenic and nickel exposures are mainly related to local
of contaminants and nutrients found in Arctic foods. Tissue
industrial activities. The impacts on health of organo-arseni-
banks would greatly assist the requirements for retrospective
cals in marine food is at present not well understood. Studies
comparative studies of contaminant levels and effects.
of speciation of the naturally-occurring arsenicals in various
animals and organs and their potential interactions with es-
22. Risk assessments are, in general, conducted for individ-
sential trace elements are needed.
ual contaminants and not mixtures of contaminants. They
are based upon extrapolations from single compound ani-
Essential elements
mal studies combined, when possible, with data from occu-
17. In general, ample supplies of selenium are provided
pational exposure or accidental intoxication events. These
through the diet in populations depending on marine food.
assessments do not adequately account for the metabolic
Muktuk (whale skin) is the richest source. Populations pre-
transformations of contaminants in the food chain, the pos-
dominately depending on food of terrestrial origin may have
sible interactions between contaminants concomitantly pre-
a marginal deficit in selenium supply. While animal experi-
sent in the environment, or the modifying influences of nu-
ments indicate selenium protects against the effects of some
trients, such as trace elements and antioxidants, naturally
heavy metals (i.e., mercury, lead, and cadmium), its role as
present in Arctic traditional food. Consequently, the accepted
an antidote for metal toxicity in humans is at present hypo-
guidelines for exposure are not necessarily applicable to Arc-
thetical. The role of selenium as a protective factor against
tic communities.
lipoprotein peroxidation and its purported beneficial effects
23. Very few studies of the effects of environmental conta-
in protecting against cancer and cardiovascular disease re-
minants on Arctic populations have been completed, there-
main to be elucidated.
fore, existing literature does not provide convincing evidence
Radiation
of adverse health effects. On the other hand, the health-pro-
18. The level of human exposure to anthropogenic radionu-
moting effects of traditional diets have been well documented.
clides such as radiocaesium in the Arctic has declined drama-
This has lead to a reluctance to recommend changes to cur-
tically since the cessation of above-ground weapons testing.
rent patterns of traditional food consumption. Based on this
However, some Arctic populations still have higher exposures
review, there may be a need to consider providing food con-
from anthropogenic radionuclides in the environment than
sumption advice to some people in some areas in order to
those in the temperate zone because of unique features of
protect the fetus from exposure to mercury and some POPs.
Arctic terrestrial and freshwater ecosystems and the people's
It would be prudent for local health care providers to con-
use of traditional foods. The cumulative dose to which a pop-
sider giving dietary advice to young women and pregnant
Chapter 12 ˇ Pollution and Human Health
829
women in order to help them reduce exposure levels prior to
Danish, Greenlandic and Faeroe Islands National Report.
and during pregnancy. The consumption of less contaminated
Peter Bjerregaard, Pal Weihe.
traditional food items that provide the nutritional needs of
Finnish National Report. Jon Øyvind Odland, Leena Soininen.
women of child-bearing age should be promoted.
Icelandic National Report. Kristin Olafsdottir.
24. Contamination of the Arctic is part of a global process.
Norwegian National Report. Jon Øyvind Odland, Evert Nie-
While human exposures in the Arctic can be moderately re-
boer, Eiliv Lund.
duced with some dietary modifications (provided these are
culturally, socially and nutritionally suitable for the specific
Russian National Report. Jon Øyvind Odland, Valeri Klopov,
communities involved), it must be recognized that long-term
Valeri P. Tchachtchine.
exposure reductions can only be accomplished through in-
Swedish National Report. Birgitta J. Lagerkvist, Gunilla Lind-
ternational conventions resulting in bans and restrictions on
ström.
production and use of the most toxic chemicals.
Contributors
Canada. M. Feeley, V. Jerome, H. Kuhnlein, B. Kwavnick,
12.7.2. Recommendations
S. Neve, B. Tracy, P. Usher, J. Walker, J.P. Weber, B. Wheatley.
On the scientific assessment level, to:
Norway and Russia. J. Brox, A. Duriagin, P.-E. Fiskebeck,
1. Continue monitoring contaminants in human blood and
E. Khotova, I. Perminova, A. Polder, N. Romanova, G. Sand,
tissues in order to reveal temporal and spatial trends.
B. Salbu, A. Tkachev, Y. Thomassen, J.U. Skaare.
2. Combine experiences from the rapidly expanding disci-
Reviewers
plines of biomarker research and molecular epidemiology
G.F. Nordberg, D. Reidel, D.H. Sliney, T. Kue Young.
with existing monitoring programs.
3. Develop uniform methods and initiate studies which
will allow objective dietary assessments and exposure
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Annex
Contents
Table 12ˇA1. Guidelines for DDT/DDE/DDD . . . . . . . . . . . . . . . . . 836
Table 12ˇA2. Guidelines for HCH. . . . . . . . . . . . . . . . . . . . . . . . . . 836
Table 12ˇA3. Guidelines for mirex. . . . . . . . . . . . . . . . . . . . . . . . . . 836
Table 12ˇA4. Guidelines for dioxin (TCDD toxequivalents) . . . . . . . 837
Table 12ˇA5. Guidelines for furans (TCDD toxequivalents) . . . . . . . 837
Table 12ˇA6. Guidelines for PCB. . . . . . . . . . . . . . . . . . . . . . . . . . . 837
Table 12ˇA7. Guidelines for mercury. . . . . . . . . . . . . . . . . . . . . . . . 838
Table 12ˇA8. Guidelines for lead . . . . . . . . . . . . . . . . . . . . . . . . . . 838
Table 12ˇA9. Guidelines for cadmium . . . . . . . . . . . . . . . . . . . . . . . 839
Table 12ˇA10. Guidelines for nickel . . . . . . . . . . . . . . . . . . . . . . . . . 839
Table 12ˇA11. Guidelines for arsenic . . . . . . . . . . . . . . . . . . . . . . . . 839
Table 12ˇA12. Plasma levels of persistent organic pollutants . . . . . . . 840
Table 12ˇA13. Blood levels of metals . . . . . . . . . . . . . . . . . . . . . . . . 831
Document Outline
- Go to opening screen
- 12.1. Introduction
- 12.2. Toxicology and health effects of contaminants
- 12.2.1. Toxicology of persistent organic pollutants (POPs)
- 12.2.2. Toxicology of PAHs
- 12.2.3. Toxicology of heavy metals
- 12.2.4. Health effects of ionizing and non-ionizing radiation
- 12.3. Essential elements and other nutrients
- 12.3.1. Copper (Cu)
- 12.3.2. Zinc (Zn)
- 12.3.3. Selenium (Se)
- 12.3.4. Iron (Fe)
- 12.3.5. Tin (Sn)
- 12.3.6. Other nutrients
- 12.4. National reports
- 12.4.1. Canada
- 12.4.2. Denmark/Greenland and The Faeroe Islands
- 12.4.3. Iceland
- 12.4.4. Norway, Russia and Finland
- 12.4.5. Sweden
- 12.5. International study: Data comparison
- 12.6. Risk assessment, management and communication
- 12.7. Conclusions and recommendations
- 12.7.1. Conclusions
- 12.7.2. Recommendations
- Acknowledgments
- References