Methodology for assessing community health in areas of concern: measuring the adverse effects on human health.

For more than 90 years, the International Joint Commission has been assisting the United States and Canadian governments in preventing and resolving potential disputes concerning the use of the boundary waters between the two countries, from coast to coast, under the Boundary Waters Treaty of 1909 (1). Because the International Joint Commission is a diplomatic organization that examines issues under dispute, it is both a political as well as a scientific organization. In the past 40 years, there has been a growing emphasis on water quality, particularly through the studies leading up to and subsequent to the signing of the 1972 Great Lakes Water Quality Agreement (2). In the 29 years since the signing, enormous progress has been made in documenting the adverse effects on many species and taxa of wildlife from exposures to persistent toxic substances and in formally demonstrating the causal links to specific pollutants. It has, however, proved more elusive to document the adverse effects on human health from exposures to pollutants. In the late 1980s, Health Canada instituted its Great Lakes Health Effects Program, and in the early 1990s, the United States mandated the Agency for Toxic Substances and Disease Registry (ATSDR) to fund epidemiologic research through the Great Lakes Critical Programs Act (3). The ATSDR studies [reviewed in Johnson et al. (4,5)] confirmed that fish consumption is the major pathway of exposure to persistent toxic substances such as dioxin, polychlorinated biphenyls, and mercury, and identified at-risk populations including Native Americans and other minorities, sport anglers, the elderly, males and females of reproductive age, and fetuses and infants of mothers who consume contaminated Great Lakes fish (4,5). In human studies, increasing consumption of sport fish has been associated with difficulties in conception for Michigan sport fish anglers. ATSDR-funded research and other community-based studies have the ability to influence policy and public health practice. These thereby directly enhance the health status of vulnerable communities by identifying at-risk groups consuming Great Lakes sport fish and by disseminating outreach materials to educate the public about safe fish consumption.