Sentinel human health indicators: A model for assessing human health status of vulnerable communities

The presence of toxic substances in the Great Lakes (GL) continues to be a significant concern. Eleven of the most persistent and ubiquitous substance s were identified as "critical Great Lakes pollutants" by the International Joint Commission (IJC). In some areas of the GL these toxic substances bio accumulate in sediment and organisms, biomagnify in food webs, and persist at high levels. The Agency for Toxic Substances and Disease Registry (ATSDR ) Great Lakes Human Health Effects Research Program (GLHHERP) characterizes contaminant exposures via GL fish consumption and investigates the potenti al for short- and long-term adverse health effects. The program has identif ied a set of eight indicators to determine risk. The GLHHERP findings indic ate: (1) vulnerable populations are still being exposed to persistent toxic substances (2) body burden levels are two to four times higher than in the general U.S. population, (3) women and minorities are less knowledgeable a bout fish advisories than other segments of the population, (4) the presenc e of neuro developmental deficits in newborns, and cognitive deficits in ch ildren and adults, and (5) disturbances in reproductive parameters have bee n demonstrated in adults. The public health implications of these findings and the need for intervention strategies are discussed.