Environmental Health
EPA Efforts to Address Children's Health Issues Need Greater Focus, Direction, and Top-Level Commitment Gao ID: GAO-08-1155T September 16, 2008According to EPA, children face disproportionate risks from contaminants such as air pollution and lead paint. The health consequences to the country's 74 million children are significant. In 2006, 55 percent of children lived in counties exceeding allowable levels for at least one of the six principal air pollutants such as ozone which causes or aggravates asthma. Asthma is the third-most common cause of childhood hospitalization, resulting in $3.2 billion in treatment costs and 14 million lost school days annually, according to the Centers for Disease Control and Prevention. In 1997, EPA created the Office of Children's Health and convened the Children's Health Protection Advisory Committee (Advisory Committee) to provide advice and recommendations to assist in developing regulations, guidance, and policies to address children's health. In April 1997, the President signed Executive Order 13045, creating an interagency Task Force to recommend federal strategies for protecting children. Our testimony is based on ongoing work on the extent to which EPA has used the Advisory Committee and addressed the committee's key recommendations. It also includes information about the Task Force. We met with numerous EPA officials and analyzed the committee's letters. GAO recommends, among other things, that EPA expeditiously complete its review of the Advisory Committee's key recommendations.
EPA has not proactively used the Advisory Committee to ensure that the agency's regulations, guidance, and policies address the disproportionate risks that environmental contaminants pose to children. Our analysis found that the Advisory Committee met more than 30 times and discussed a variety of environmental health issues with dozens of officials from EPA offices such as Pesticides and Toxic Substances, and Research and Development. However, we identified just three instances where EPA specifically asked the committee for recommendations and advice on regulations--most notably an October 1997 request that the committee identify five regulations or standards for EPA to re-evaluate in order to better protect children. In the absence of focus and direction from EPA, the Advisory Committee has taken the initiative to write more than 70 letters to the Administrator since 1998 containing hundreds of recommendations on a wide variety of children's health concerns. EPA has not addressed key recommendations from its Advisory Committee, particularly those in a major April 2007 letter and in recent letters advising EPA on proposed revisions to national air quality standards. The April 2007 letter, which marked the 10th anniversary of the Executive Order, provided recommendations in seven key areas. These included the need for EPA to eliminate environmental health disparities among low-income and minority children. While EPA generally responds to the Advisory Committee's letters, the agency has not fulfilled the Administrator's commitment in his response to the 10th anniversary letter to collaboratively review recommendations from the advisory committee. The Office of Children's Health had begun forming internal workgroups, but a new acting director stopped the process in late 2007 to hold individual meetings with EPA's assistant administrators, and the process remains stalled. We also analyzed EPA's responses to the committee's specific recommendations on three recently-considered EPA air quality standards--the National Ambient Air Quality Standards for particulate matter, ozone, and lead--and we found that EPA either offered to consider the committee's recommendations as part of the public comment process or rejected them. The President's Task Force, which was authorized in April 1997, provided high-level interagency leadership and coordination on children's environmental health, but it expired in April 2005. According to the children's health experts with whom we spoke, the task force provided important leadership on initiatives such as the National Children's Study and the Healthy Schools Environmental Assessment Tool. The task force also developed federal strategies to address four threats to children--asthma, developmental disorders, cancer, and unintentional injuries. In 2003, the President ordered the task force to be extended by 2 years, but the order eliminated the provision for reassessing the task force. Since the task force's expiration, EPA no longer has a high-level infrastructure or mandate to coordinate federal strategies for children's environmental health and safety.
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Director: Team: Phone:GAO-08-1155T, Environmental Health: EPA Efforts to Address Children's Health Issues Need Greater Focus, Direction, and Top-Level Commitment
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Testimony:
Before the Committee on Environment and Public Works, U.S. Senate:
United States Government Accountability Office:
GAO:
For Release on Delivery:
Expected at 10:00 a.m. EDT:
Tuesday, September 16, 2008:
Environmental Health:
EPA Efforts to Address Children's Health Issues Need Greater Focus,
Direction, and Top-level Commitment:
Statement of John B. Stephenson, Director: Natural Resources and
Environment:
Environmental Health:
GAO-08-1155T:
GAO Highlights:
Highlights of GAO-08-1155T, a testimony before the Committee on
Environment and Public Works, U.S. Senate.
Why GAO Did This Study:
According to EPA, children face disproportionate risks from
contaminants such as air pollution and lead paint. The health
consequences to the country‘s 74 million children are significant. In
2006, 55 percent of children lived in counties exceeding allowable
levels for at least one of the six principal air pollutants such as
ozone which causes or aggravates asthma. Asthma is the third-most
common cause of childhood hospitalization, resulting in $3.2 billion in
treatment costs and 14 million lost school days annually, according to
the Centers for Disease Control and Prevention.
In 1997, EPA created the Office of Children‘s Health and convened the
Children‘s Health Protection Advisory Committee (Advisory Committee) to
provide advice and recommendations to assist in developing regulations,
guidance, and policies to address children‘s health. In April 1997, the
President signed Executive Order 13045, creating an interagency Task
Force to recommend federal strategies for protecting children.
Our testimony is based on ongoing work on the extent to which EPA has
used the Advisory Committee and addressed the committee‘s key
recommendations. It also includes information about the Task Force. We
met with numerous EPA officials and analyzed the committee‘s letters.
GAO recommends, among other things, that EPA expeditiously complete its
review of the Advisory Committee‘s key recommendations.
What GAO Found:
EPA has not proactively used the Advisory Committee to ensure that the
agency‘s regulations, guidance, and policies address the
disproportionate risks that environmental contaminants pose to
children. Our analysis found that the Advisory Committee met more than
30 times and discussed a variety of environmental health issues with
dozens of officials from EPA offices such as Pesticides and Toxic
Substances, and Research and Development. However, we identified just
three instances where EPA specifically asked the committee for
recommendations and advice on regulations”most notably an October 1997
request that the committee identify five regulations or standards for
EPA to re-evaluate in order to better protect children. In the absence
of focus and direction from EPA, the Advisory Committee has taken the
initiative to write more than 70 letters to the Administrator since
1998 containing hundreds of recommendations on a wide variety of
children‘s health concerns.
EPA has not addressed key recommendations from its Advisory Committee,
particularly those in a major April 2007 letter and in recent letters
advising EPA on proposed revisions to national air quality standards.
The April 2007 letter, which marked the 10th anniversary of the
Executive Order, provided recommendations in seven key areas. These
included the need for EPA to eliminate environmental health disparities
among low-income and minority children. While EPA generally responds to
the Advisory Committee‘s letters, the agency has not fulfilled the
Administrator‘s commitment in his response to the 10th anniversary
letter to collaboratively review recommendations from the advisory
committee. The Office of Children‘s Health had begun forming internal
workgroups, but a new acting director stopped the process in late 2007
to hold individual meetings with EPA‘s assistant administrators, and
the process remains stalled. We also analyzed EPA‘s responses to the
committee‘s specific recommendations on three recently-considered EPA
air quality standards”the National Ambient Air Quality Standards for
particulate matter, ozone, and lead”and we found that EPA either
offered to consider the committee‘s recommendations as part of the
public comment process or rejected them.
The President‘s Task Force, which was authorized in April 1997,
provided high-level interagency leadership and coordination on
children‘s environmental health, but it expired in April 2005.
According to the children‘s health experts with whom we spoke, the task
force provided important leadership on initiatives such as the National
Children‘s Study and the Healthy Schools Environmental Assessment Tool.
The task force also developed federal strategies to address four
threats to children”asthma, developmental disorders, cancer, and
unintentional injuries. In 2003, the President ordered the task force
to be extended by 2 years, but the order eliminated the provision for
reassessing the task force.
Since the task force‘s expiration, EPA no longer has a high-level
infrastructure or mandate to coordinate federal strategies for
children‘s environmental health and safety.
To view the full product, including the scope and methodology, click on
[hyperlink, http://www.gao.gov/cgi-bin/getrpt?GAO-08-1155T]. For more
information, contact John Stephenson at (202) 512-3841 or
stephensonj@gao.gov.
[End of section]
Madam Chairman and Members of the Committee:
I am pleased to appear here today to discuss our ongoing work regarding
the Environmental Protection Agency's (EPA) efforts to protect children
from environmental health risks such as pollution in the air, lead
paint in homes, pesticide residues on food, and treatment-resistant
microbes in drinking water. Many of the nation's 74 million children
are exposed to such hazards daily. In 2006, for example, 55 percent of
children lived in counties that exceeded one or more of the six
principal air pollutants, two of which--ozone and particulate matter--
are known to cause or aggravate respiratory diseases such as asthma.
Asthma is the third most common cause of hospitalizations among
children, resulting in $3.2 billion for treatment and 14 million lost
days of school annually, according to the Centers for Disease Control
and Prevention.
Children's environmental health is a complex but vitally important
subject. The federal government has therefore taken several steps to
make it a priority and to ensure that it has access to the best
available expert advice. In April 1997, for example, the President
signed Executive Order 13045, Protection of Children from Environmental
Health Risks and Safety Risks (Executive Order), which mandated a
concerted federal effort to address children's environmental health and
safety risks. Among other things, the Executive Order established an
interagency President's Task Force on Environmental Health Risks and
Safety Risks to Children (President's Task Force) for a period of 4
years and charged it with recommending strategies to the President for
protecting children's environmental health and safety. The President's
Task Force was co-chaired by the Administrator of EPA and the Secretary
of Health and Human Services and included the heads of at least 14
other departments, agencies, commissions, and councils.
Also in 1997, EPA established the Office of Children's Health
Protection to support its efforts. In addition, EPA formed the
Children's Health Protection Advisory Committee (Advisory Committee) to
provide advice, information, and recommendations to assist the agency
in the development of regulations, guidance, and policies relevant to
children's health. Instead of a panel of experts on a single academic
discipline, the Advisory Committee is made up of a broad cross-section
of children's health experts from the academic, healthcare, industry,
local government, and non-profit sectors.
In April 2007, the Advisory Committee wrote to the Administrator to
reflect on EPA's achievements protecting children from environmental
health threats in the 10 years since the Executive Order was signed.
The committee cited successes such as increased margins of safety for
pesticides mandated under the Food Quality Protection Act and the
creation of the National Children's Study.[Footnote 1] However, the
committee also expressed serious concerns about EPA's continued lack of
focus on children's environmental health issues and the lack of
progress in addressing its many recommendations.
My testimony is based on ongoing work for the Senate Committee on
Environment and Public Works, which we expect to complete in mid-2009,
that examines the extent to which EPA has maintained its focus on
children's environmental health issues and capitalized on opportunities
to solve some significant and emerging environmental health challenges
in the decade since the Executive Order was signed. My statement today
addresses: (1) the extent to which EPA has used the Children's Health
Advisory Committee and (2) the extent to which EPA has addressed the
Advisory Committee's key recommendations. In addition, as you
requested, my statement includes information about the activities and
status of the President's Task Force on Environmental Health Risks and
Safety Risks to Children. In conducting our work, we met with EPA and
Advisory Committee officials and analyzed documents--including
committee meeting agendas, summary documents, letters to the EPA
Administrator, and EPA's response letters--using the content analysis
software NVivo. We also reviewed key documents and interviewed agency
officials to determine the major activities and current status of the
President's Task Force. We also obtained EPA's views on the facts
presented in my statement and made minor modifications based on the
agency's comments. Our ongoing work for this performance audit began in
December 2007, and continues in accordance with generally accepted
government auditing standards.
In summary:
* EPA has not proactively used the Advisory Committee to ensure that
the agency's regulations, guidance, and policies address the
disproportionate risks to children that result from environmental
contaminants. Our analysis found that the Advisory Committee met more
than 30 times since 1997 and discussed a variety of environmental
health issues with dozens of officials from EPA offices such as
Pesticides and Toxic Substances, Air and Radiation, and Research and
Development. However, we identified just three instances where EPA
specifically asked the committee for recommendations and advice on
regulations--most notably an October 1997 request that the committee
identify five regulations or standards for EPA to re-evaluate in order
to better protect children. In the absence of focus and direction from
EPA, the committee has taken the initiative to write more than 70
letters to the Administrator since 1998 offering hundreds of
recommendations on a wide variety of children's environmental health
concerns.
* EPA has largely disregarded key recommendations from its Advisory
Committee, particularly those in its 10th anniversary letter and in
several recent letters advising EPA on proposed revisions to national
air quality standards. In April 2007, to mark the 10th anniversary of
the Executive Order, the Advisory Committee provided recommendations in
seven key areas of concern, including the need for EPA to eliminate
environmental health disparities among low-income and minority
children, strengthen the national approach to regulating toxic
chemicals, and provide necessary leadership and infrastructure to
protect children's health. While EPA generally provides a letter in
response to the committee, the agency has not fulfilled the
Administrator's commitment in his June 2007 response letter to review
the advisory committee's recommendations and EPA's children's
environmental health activities. In his response to the Advisory
Committee's letter, the Administrator agreed that the 10th anniversary
of the Executive Order was an appropriate time to review EPA's
children's health activities. He directed the Office of Children's
Health to collaborate with EPA's program offices and the Advisory
Committee to review their recommendations. In addition, the acting
director of the office committed to engage the staff involved with
Children's Health Advisory Management Partners (CHAMPS)--actions which
have yet to happen. We also analyzed EPA's response to the committee's
specific recommendations related to three recently-considered EPA air
quality standards, and we found that EPA did not acknowledge, was
noncommittal, rejected, or offered only to consider them along with
comments from the general public.
* The President's Task Force on Environmental Health Risks and Safety
Risks to Children provided important high-level leadership and
interagency coordination on children's environmental health from 1997
until it expired in April 2005. According to the EPA staff and
children's health experts we spoke with, the President's Task Force
provided critical leadership on several important initiatives such as
the National Children's Study and the Healthy Schools Environmental
Assessment Tool. The task force also developed national strategies to
coordinate federal programs to address the four major environmental and
safety threats to children that it identified--asthma, developmental
disorders, cancer, and unintentional injuries. Since the task force's
expiration, EPA no longer has a high-level infrastructure to coordinate
federal strategies for children's environmental health and safety.
According to the experts, the task force could have helped the federal
government respond to the recent health and safety concerns that
prompted the recall of 45 million toys and children's products in 2007.
Background:
According to EPA, children face disproportionate and unique threats
from environmental hazards for many reasons. For example, EPA has noted
that children may receive higher doses of environmental contaminants
because they spend more time close to the ground, touch their hands to
their mouths more often, and, in proportion to their body weight,
breathe more air, consume more food, and drink more water than adults.
Contaminants may also affect children disproportionately because they
have unique exposure pathways--through the placenta and breast milk.
Furthermore, children are more vulnerable to contaminants than adults
because of the relative immaturity of their biochemical and
physiological functions. For example, air pollutants that would produce
slight breathing difficulties in adults may contribute to more serious
breathing problems in young children because of their smaller airways.
Also, EPA has noted that children have limited ability to communicate
and urge action about protecting their environment, so others must act
on their behalf.
The Children's Health Protection Advisory Committee, as a committee
chartered under the Federal Advisory Committee Act must follow broad
requirements for balance, independence and transparency. The membership
of the Advisory Committee includes a diverse range of viewpoints from
29 individuals including researchers, academicians, health care
providers, environmentalists, children's advocates, professionals, and
government employees who advise EPA on regulations, research, and
communication issues relevant to children. The current chairman of the
Advisory Committee, only the second since the committee began meeting
in 1998, has been in place since 2003. As required under FACA, a
designated federal official from EPA's Office of Children's Health
oversees the Advisory Committee's activities, including approving
meeting agendas and attending all meetings. To ensure that suitable
speakers are invited to committee meetings, the meeting agendas and
speakers are set by a steering committee comprised of the director of
EPA's Office of Children's Health, the chairman of the Advisory
Committee, and the chairs of any active workgroups created by the
committee to examine a specific children's issue. According to the
Advisory Committee's charter, the committee is to send its letters to
the EPA Administrator. In addition, the Advisory Committee announces
meetings ahead of time and gives notice to interested parties about
such meetings. The plenary sessions of meetings are open to the public
and EPA ensures that meeting minutes are prepared and posted to their
website.
As shown in figure 1, the committee has directed the vast majority of
its letters to the EPA Administrator but periodically directs letters
to other EPA officials such as the Director of the Office of Research
and Development.
Figure 1: Advisory Committee Letter Addressees:
[See PDF for image]
This figure is a pie-chart depicting the number of Advisory Committee
Letter Addressees, as follows:
Office of the Administrator: 63;
Office of Research and Development (ORD): 2;
Office of Pesticide Programs: 2;
Office of Pollution Prevention and Toxics: 1;
National Institute for Occupational Safety and Health: 1;
Environmental Health Policy Committee: 1;
No office specified: 1.
Source: GAO analysis of Advisory Committee letters.
[End of figure]
According to the committee's operating procedures and principles, "all
recommendations must reflect the consensus of the committee and that in
achieving consensus, all relevant perspectives, interests and concerns
of committee members are reflected." To accomplish detailed reviews of
children's health issues in order to achieve consensus, the committee
typically forms a taskgroup from its members that meets separately with
staff from the Office of Children's Health. Taskgroups consider
information presented during full committee meetings, identify relevant
recommendations, and draft letters for full committee review. The
committee has formed nearly three dozen such taskgroups over its
history, including taskgroups that considered EPA's proposed revisions
to air quality standards for particulate matter, ozone, and lead.
Although the committee typically reviews these letters during plenary
sessions, the committee uses a between-meeting process--to ensure that
the full committee has an opportunity to review materials, provide
input, and reach consensus without a plenary session--when a letter
must be written before the next meeting, as was the case for the
letters that addressed the air quality standards.
EPA Has Not Proactively Used the Children's Health Protection Advisory
Committee in the Development of Regulations, Guidance, and Policies:
While EPA has convened the committee for dozens of presentations and
discussions with EPA and non-EPA officials, the agency has made few
requests for the committee's advice or recommendations on regulations,
guidance or policies to address the disproportionate risks to
children's health. Nonetheless, the committee has sent more than 70
letters to the Administrator offering hundreds of recommendations on a
wide range of children's health concerns.
The Advisory Committee Has Met With Many Officials from EPA and Other
Agencies:
Since 1997, EPA has convened the Advisory Committee 32 times for
meetings which included presentations and discussions with many EPA and
non-EPA officials on a wide variety of children's health topics. Staff
from the EPA Office of Children's Health told us that the committee's
value comes, in part, from the verbal input that committee members
provide to EPA officials during the discussions surrounding those
presentations. According to our analysis of agendas and meeting
summaries, EPA and non-EPA speakers made 189 presentations for the
committee during the past decade. As shown in figure 2, EPA officials
made 79 percent of the presentations to the advisory committee, with
the Office of Children's Health (OCHP) accounting for the largest
proportion. Since 2006, for example, officials from OCHP have given
regular updates to the committee on EPA's revisions to the National
Ambient Air Quality Standards for particulate matter, ozone, and lead.
In addition, the Office of the Administrator (OA) has given a number of
presentations, and three of the four EPA Administrators since 1997 have
met with the committee.[Footnote 2]
Figure 2: Presentations Made to the Children's Health Protection
Advisory Committee, 1998-2008 (Percentage):
[See PDF for image]
This figure contains two pie-charts depicting the following data:
Presentations Made to the Children's Health Protection Advisory
Committee, 1998-2008 (Percentage):
EPA: 79%;
- OCHP[A]: 36%;
- OPPTS: 17%;
- OAR: 13%;
- ORD: 13%;
- OA: 9%;
- OW: 5%;
- Other EPA: 7%;
Non-EPA: 21%; The 21% breaks down further as follows:
- Federal: 25%;
- Industry: 10%;
- Experts: 20%;
- States and localities: 20%;
- Advocacy and non-profit: 25%.
Source: GAO analysis of Advisory Committee meeting summaries and
agendas.
[A] The Office of Children's Health (OCHP) is part of the Office of the
Administrator (OA) but is shown separately in the figure.
[End of figure]
The figure also shows that EPA's program offices made regular
presentations to the Advisory Committee, including the agency's Office
of Prevention, Pesticides and Toxic Substances (OPPTS), Office of Air
and Radiation (OAR), Office of Research and Development (ORD), and
Office of Water (OW). For example, officials from the Office of Air and
Radiation, and the Administrator himself, gave three presentations to
the committee on the air quality standards between 2005 and 2007.
Although the Advisory Committee was established to provide EPA with
advice, information and recommendations--and reports directly to the
Administrator--it also regularly hears from non-EPA officials to gather
additional information. As the figure also shows, 21 percent of
Advisory Committee presentations were made by representatives from
other federal agencies, industry, academic experts, states and
localities, and advocacy and non-profits. For example, the committee
has heard from representatives from the Centers for Disease Control and
Prevention and the National Academy of Sciences.
EPA Has Rarely Sought the Advisory Committee's Advice on Regulations,
Guidance, and Policies that Address Children's Health:
Despite convening the Advisory Committee more than 30 times over the
last 10 years for discussions with a variety of speakers, EPA has
rarely sought out the committee's advice and recommendations to assist
it in developing regulations, guidance, and policies that address
children's health. We identified only three instances where EPA
specifically asked the committee for advice on regulations, three
instances on guidance, and one instance on policies. The clearest
example is EPA's request in October 1997--prior to the committee's
first meeting--that the committee identify five regulations or
standards for the agency to re-evaluate in order to better protect
children. In another instance, in 2005, EPA asked CHPAC for comments on
data that the agency planned to use to support the Clean Air Mercury
Rule. In addition to these requests regarding regulations, guidance,
and policies, we identified 14 other instances where EPA asked for the
committee's advice on programs, plans, or other issues. The requests
varied in topic and scope, ranging from a 2005 request for advice on
evaluating EPA's pilot version of the Voluntary Children's Chemical
Evaluation Program (VCCEP) to a request in 2002 to suggest a health
organization to be asked to join EPA's Smart Growth Network.
Although EPA has not proactively requested the Advisory Committee's
advice on regulations, guidance, and policies, the members of the
committee have nonetheless devoted considerable time to drafting and
reviewing 70 letters that the committee has sent to the Administrator
since 1998. Those letters contained a range of advice, information and
recommendations, to which EPA has responded a total of 51 times.
[Footnote 3] As figure 3 shows, the committee typically sends 8 or
fewer letters a year.
Figure 3: Number of Advisory Committee and EPA Response Letters (1998-
2008):
[See PDF for image]
This figure is a multiple vertical bar graph depicting the following
data:
Year: 1998;
Number of advisory committee letter: 6;
Number of EPA response letters: 2.
Year: 1999;
Number of advisory committee letter: 11;
Number of EPA response letters: 3.
Year: 2000;
Number of advisory committee letter: 8;
Number of EPA response letters: 6.
Year: 2001;
Number of advisory committee letter: 3;
Number of EPA response letters: 5.
Year: 2002;
Number of advisory committee letter: 8;
Number of EPA response letters: 5.
Year: 2003;
Number of advisory committee letter: 4;
Number of EPA response letters: 5.
Year: 2004;
Number of advisory committee letter: 8;
Number of EPA response letters: 4.
Year: 2005;
Number of advisory committee letter: 8;
Number of EPA response letters: 6.
Year: 2006;
Number of advisory committee letter: 4;
Number of EPA response letters: 5.
Year: 2007;
Number of advisory committee letter: 7;
Number of EPA response letters: 7.
Year: 2008;
Number of advisory committee letter: 3;
Number of EPA response letters: 3.
Source: GAO analysis of EPA documents.
[End of figure]
The Advisory Committee Has Offered Hundreds of Recommendations to EPA
on a Range of Children's Health Issues:
The Advisory Committee's letters offered EPA hundreds of
recommendations about a variety of topics related to reducing
environmental health risks to children. We identified over 600
recommendations during our review of the committee's letters.[Footnote
4] A small number of letters contained recommendations relating to
multiple children's environmental health issues, such as a May 2008
letter with recommendations about mercury regulation, farm worker
protection standards, organophosphate pesticides, and air quality.
However, most letters contained recommendations on a single issue. As
shown in figure 4, the number of recommendations varied from year to
year, ranging from more than 120 recommendations in 2000 to 20 thus far
in 2008.
Figure 4: Number of Advisory Committee Recommendations by Year (1998-
2008):
[See PDF for image]
This figure is a vertical bar graph depicting the following data:
Year: 1998;
Number of recommendations: 40.
Year: 1999;
Number of recommendations: 78.
Year: 2000;
Number of recommendations: 125.
Year: 2001;
Number of recommendations: 20.
Year: 2002;
Number of recommendations: 79.
Year: 2003;
Number of recommendations: 24.
Year: 2004;
Number of recommendations: 51.
Year: 2005;
Number of recommendations: 95.
Year: 2006;
Number of recommendations: 27.
Year: 2007;
Number of recommendations: 72.
Year: 2008;
Number of recommendations: 20.
Source: GAO analysis of Advisory Committee letters.
[End of figure]
In addition, we organized the Advisory Committee's recommendations into
10 categories to help demonstrate the breadth and depth of children's
health issues that have concerned the committee[Footnote 5] Figure 5
shows that the largest number of recommendations were focused on
improving indicators and data used for tracking children's health
information (133), urging that children's health vulnerabilities are
considered in EPA risk assessments (127), and improving or developing
agency guidance documents (125). The committee also offered many
recommendations on topics such as research (99), external partnerships
and inter-agency coordination (97), policy (96), and regulations and
standards (80).
Figure 5: Advisory Committee Recommendations by Category:
[See PDF for image]
This figure is a vertical bar graph depicting the following data:
Category: Tracking and indicators;
Number of recommendations: 133.
Category: Risk assessment;
Number of recommendations: 127.
Category: Guidance development;
Number of recommendations: 125.
Category: Research;
Number of recommendations: 99.
Category: External partnership and inter-agency coordination;
Number of recommendations: 97.
Category: EPA policy;
Number of recommendations: 96.
Category: Regulations and standards;
Number of recommendations: 80.
Category: Education and public awareness;
Number of recommendations: 73.
Category: EPA processes and procedures;
Number of recommendations: 68.
Category: Budget and resources;
Number of recommendations: 45.
Source: GAO analysis of Advisory Committee letters.
[End of figure]
EPA Has Largely Disregarded Key Recommendations from the Children's
Health Protection Advisory Committee:
The process that EPA initiated to carry out the Administrator's
commitment, in a June 2007 letter, to address the Advisory Committee's
key recommendations has stalled. In addition, EPA has largely
disregarded the advisory committee's recommendations on air quality
standards, mercury, and the Voluntary Children's Chemical Evaluation
Program.
EPA Commitment to Review Key Advisory Committee Recommendations Has
Stalled:
On the 10th anniversary of the Executive Order, the Advisory Committee
wrote to EPA to express its views on key elements of a comprehensive
vision for protecting children's health and made recommendations for
action. The committee's April 10, 2007 letter provided recommendations
in seven areas for renewing EPA's vision on children's environmental
health and its commitment to the principles outlined in the Executive
Order. As illustrated in figure 6, the areas of concern to the
committee included the need for EPA to (1) eliminate environmental
health disparities among low-income and minority children, (2)
strengthen the national approach to regulating toxic chemicals, and (3)
provide necessary leadership and infrastructure to protect children's
health.
Figure 6: Seven Key Recommendations to EPA from its Advisory
Committee's 10TH Anniversary Letter, April 2007:
[See PDF for image]
This illustration depicts the following seven key recommendations:
* Ensure healthy environments;
* Commit the necessary EPA infrastructure, and inter-agency
collaboration;
* Institute ’environmental health literacy“;
* Foster environmental preparedness and prevention;
* Eliminate environmental health disparities;
* Expand critical research;
* Strengthen the national approach to regulating chemicals.
Source: GAO analysis of Advisory Committee's April 10, 2007 letter.
[End of figure]
The Administrator's June 13, 2007 response letter directed the Office
of Children's Health to work collaboratively with program offices
across the agency and committed the agency to working with the
committee to review these recommendations. However, EPA has not yet
fulfilled the Administrator's commitment. The Office of Children's
Health had established workgroups within its Children's Health Advisory
Management Partners (CHAMPS) to address each of the seven areas
outlined by the committee, and the program offices had begun
identifying representatives to serve on the workgroups.[Footnote 6]
However, a new acting office director stopped the process in late 2007,
opting instead to hold individual meetings with EPA's assistant
administrators. The acting director decided that strengthening
relationships with senior management would be a quicker way to identify
leadership issues related to children's health, ensuring that they
would be engaged and invested in the agency's response. In March 2008,
a new permanent director replaced the acting director. At present, the
process of addressing the Administrator's commitment remains stalled.
Advisory Committee Recommendations on Air Quality Standards Have Not
Been Substantially Addressed:
We also examined the Advisory Committee's recommendations related to
three air quality standards--the National Ambient Air Quality Standards
(NAAQS) for particulate matter, ozone, and lead, which EPA recently
reviewed.[Footnote 7] The committee was particularly concerned about
the air quality standards because of rising rates of asthma among U.S.
children and the relationship between poor air quality and the
incidence and severity of asthma. To express its concern, the committee
wrote a number of letters to urge EPA to tighten the standards based on
scientific evidence that they were not sufficiently protective of
children's health. Specifically, we identified seven letters containing
23 recommendations with respect to EPA's proposed revisions to the
particulate matter, ozone, and lead standards. In general, the
committee's recommendations were further supported by recommendations
from EPA's Clean Air Science Advisory Committee (CASAC), which also has
been sharply critical of several of EPA's decisions.[Footnote 8] For
example, CASAC wrote to the administrator stating unanimously that the
revised air quality standard for particulate matter "does not provide
an adequate margin of safety — requisite to protect the public health."
Table 1 shows that EPA's revised air quality standards for particulate
matter, ozone, and lead are at or above the upper limits of
recommendations from both advisory committees.
Table 1: Advisory Committees Recommendations for Revisions to NAAQS
Compared to EPA's Finalized Standards:
Standard (µg/m[3] unless noted): Particulate Matter[A] (PM); Fine PM
(annual);
EPA Previous Standard[C]: 15;
Clean Air Science Advisory committee: 13-14;
Children's Advisory committee: Less than 15;
EPA Final Standard: 15.
Standard (µg/m[3] unless noted): Particulate Matter[A] (PM); Fine PM
(daily);
EPA Previous Standard[C]: 65;
Clean Air Science Advisory committee: 30-35;
Children's Advisory committee: Less than 35;
EPA Final Standard: 35.
Standard (µg/m[3] unless noted): Particulate Matter[A] (PM); Course PM
(daily);
EPA Previous Standard[C]: 150;
Clean Air Science Advisory committee: No recommendation[D];
Children's Advisory committee: Less than 70;
EPA Final Standard: 150.
Standard (µg/m[3] unless noted): Ozone (in parts per million); Human
Health standard (8-hour average);
EPA Previous Standard[C]: 0.08;
Clean Air Science Advisory committee: 0.060-0.070;
Children's Advisory committee: 0.060;
EPA Final Standard: 0.075.
Standard (µg/m[3] unless noted): Lead[B]; Human Health standard (3-
month average);
EPA Previous Standard[C]: 1.5;
Clean Air Science Advisory committee: 0.2;
Children's Advisory committee: 0.02;
EPA Final Standard: 0.10-0.30 (proposed).
Sources: GAO review of Advisory Committee letters and EPA air quality
regulations.
[A] EPA defines the standard for fine PM as consisting of particulate
matter 2.5 micrometers or less in diameter, abbreviated as PM2.5.
[B] EPA was under court order to complete the review of lead NAAQS by
September 15, 2008, but the agency received an order extending the
deadline to October 15, 2008.
[C] Although these standards were promulgated in 1997, they are only
now coming into effect, because of legal challenges, the need to
establish a monitoring network, and various administrative factors.
[D] In its September 15, 2005 letter, CASAC recommended a new course PM
indicator (PM10-2.5,), which EPA put forward in its proposed rule.
CASAC did not discuss the option of retaining the existing daily
standard for course PM (i.e., PM10) of 150 ppm during its advisory
process.
[End of table]
While EPA provided the Advisory Committee with official response
letters to six of its seven NAAQS-related letters, we found that the
agency generally did not acknowledge or was noncommittal to the
committee's recommendations, or that it offered merely to consider them
as part of the public comment process. EPA did not specifically
acknowledge 11 of the committee's 23 recommendations, but provided a
generic statement about considering the recommendations with all
others.[Footnote 9] For example, EPA did not directly address the
committee's recommendations related to the lead standards or the
ability of a national lead-monitoring system to accurately measure and
facilitate effective control of the complex exposure routes of airborne
lead. Instead, EPA responded that it would consider the committee's
recommendations along with all other public comments. EPA acknowledged
another 5 of the committee's recommendations, although it was
noncommittal, providing no details about whether or how the agency
would address them. In one instance, EPA rejected a committee
recommendation. In its February 2007 letter, the committee recommended
that EPA reinstate the opportunities for public review and input
provided for in the previous NAAQS process to allow for scientific
input and public review. This letter, as well as a similar one from
CASAC, warned that the new process could significantly reduce
opportunities for scientists to provide input, as they had at key steps
of previous NAAQS reviews. In its response, EPA stated that changes to
the review process would enhance the agency's ability to issue timely
decisions while promoting participation by scientific experts and the
public. While there are periods in the rulemaking process where EPA
officials are in ongoing deliberations and may not commit to actions
until a standard is finalized, EPA did not provide the Advisory
Committee with any explanation after deliberations were complete and
officials were free to comment.
Advisory Committee Recommendations on Mercury and Voluntary Children's
Chemical Evaluation Program:
We also reviewed the Advisory Committee's recommendations on mercury
and EPA's Voluntary Children's Chemical Evaluation Program (VCCEP). As
with the air quality recommendations, EPA either did not acknowledge or
remained noncommittal toward most of the committee's recommendations
related to mercury and VCCEP. Specifically, we identified five Advisory
Committee letters containing 29 recommendations focused on the need to
protect children from the risks posed by mercury and three EPA response
letters. Our review of EPA's response letters indicates that the agency
did not acknowledge 10 of the recommendations. For example, EPA did not
acknowledge the recommendation that EPA create incentives in its
proposed Interstate Air Quality Rule to reduce children's exposure to
mercury. Furthermore, EPA acknowledged but provided no details about
how the agency would address another 4 recommendations.[Footnote 10]
For example, the committee recommended to EPA that hot spots--areas
disproportionately affected by mercury emissions--be prevented under
any Interstate Air Quality Rule. EPA acknowledged the recommendation in
its response, but did not address how this would be ensured, stating
instead that in implementing cap-and-trade programs in the past, the
agency has not observed the creation of hot spots, and that a cap-and-
trade program creates incentives for the utility sector to aggressively
seek reductions in nitrogen oxides (NOX) and sulfur dioxide (SO2),
which ultimately provide early mercury reductions.[Footnote 11] Only in
its 1998 response to the committee's mercury-related recommendations
did EPA acknowledge the recommendations offered by the committee and
detail how it had addressed or intended to address each of the
recommendations raised. For example, to address the committee's
recommendation about the need to take a holistic approach to evaluate
all sources of mercury emissions, EPA pointed to a November 1998 draft
strategy that addressed the multimedia nature of mercury. With respect
to the committee's recommendation to consider mercury releases from
municipal and medical waste combustion sources, EPA described actions
that, once fully implemented, would reduce mercury emissions caused by
human activities at these types of sources by 50 percent from 1990
levels.[Footnote 12]
Similarly, our review of EPA's responses to the Advisory Committee's 14
recommendations regarding VCCEP indicates that the agency largely did
not acknowledge the committee's recommendations. Half of the
recommendations were in a June 2006 letter to EPA. In its response, EPA
stated that it would carefully consider the committee's comments and
undertake a thorough evaluation of the program in the coming months,
but, stopped short of providing detail or information on if or how it
would address six of the seven recommendations in this committee
letter.[Footnote 13] Moreover, in addition to its specific
recommendations, the committee concluded in its letter to EPA that the
pilot program, as implemented, was not on track to fulfilling its
stated goal, and that there has been limited information on specific
chemicals relevant to children's health provided to the public. The
Advisory Committee added that an opportunity had been lost to develop
and disseminate more advanced methods for assessing children's
exposures and consequent risks.
President's Task Force on Children's Environmental Health Risks and
Safety Risks Expired in 2005, Eliminating An Important Opportunity for
EPA Leadership and Interagency Coordination:
The President's Task Force was authorized by executive order in April
1997 for a period of 4 years to provide high-level leadership and
interagency coordination on children's environmental health. It was
comprised of nine cabinet officials and seven White House office
directors and was co-chaired by the Administrator of EPA and the
Secretary of Health and Human Services.[Footnote 14] The task force
convened for meetings five times--in October 1997, April 1998, January
1999, September 1999, and in October 2001 after the President extended
it until April 2003. At the urging of the EPA Administrator in April
2003, the President ordered the task force to be extended for a final 2
years. However, this order eliminated the provision for reassessing the
need for continuance of the task force, which was not convened after
October 2001. Nonetheless, a senior-staff steering committee continued
to meet until 2005 to provide coordination and draft strategies to
address the threats to children's health.
The President's Task Force identified four major environmental and
safety threats to children--asthma, developmental disabilities
(including lead poisoning), cancer, and unintentional injuries, and it
recommended national strategies for each of them. The task force
recognized that an integrated solution was needed across the federal
government to address the complex interaction between a child's
biology, behavior, and the physical, chemical, biological, and social
environment. According to the children's health experts with whom we
spoke, the task force provided critical leadership on several important
initiatives such as the National Children's Study and the Healthy
Schools Environments Assessment Tool (Healthy SEAT). These national
programs focus heavily on the environmental influences on children,
with the National Children's Study examining the role of environmental
factors on health and disease and Healthy SEAT offering school
districts a self assessment tool for evaluating environment, safety and
health hazards. In addition, the departments and agencies that made up
the task force partnered to prepare a fiscal year 2001 interagency
budget initiative to fund the task force's initiatives in the four
priority areas. The Secretary of Health and Human Services and the
Administrator of EPA submitted the request to the Office of Management
and Budget with the recommendation that it be included as part of the
President's budget request that year. Officials told us that OMB's
involvement helped ensure that adequate funds were available to these
agencies to address children's health.
Since the task force's expiration, EPA and HHS no longer have a high-
level infrastructure or mandate to coordinate federal strategies for
children's environmental health and safety. According to the EPA staff
and children's health experts with whom we spoke, the task force could
have helped the federal government respond to the health and safety
concerns that prompted the 2007 recall of 45 million toys and
children's products, 30 million of them from China. Furthermore, since
the provision of the executive order expired in 2005, the task force no
longer reports the results of its efforts to the President. Those
reports collected and detailed the interagency research, data, and
other information necessary to enhance the country's ability to
understand, analyze, and respond to environmental health risks to
children.
Conclusions:
In 1997, the President issued an executive order on Protection of
Children from Environmental Health and Safety Risks calling on federal
agencies to work together to protect children's health from
environmental risk. In the same year, EPA established an Office of
Children's Health Protection and formed its Children's Health
Protection Advisory Committee. In the intervening decade, we have seen
a number of successful efforts to strengthen environmental protections
for children, including the landmark Food Quality Protection Act, which
provides protections from pesticides. However, we also have seen
growing evidence that children's environmental experience before birth,
early in life, and through adolescence may have lifelong consequences
and may affect subsequent generations.
EPA's Advisory Committee and others have recently raised concerns that
the agency's focus on children's environmental health has diminished
since the executive order was signed. Based on our review of EPA's use
of the Advisory Committee and the agency's general unresponsiveness to
the committee's key recommendations, coupled with the expiration of the
President's Task Force, we believe the agency needs to reinvigorate its
focus and leadership on children's environmental health in order to
meet current and emerging challenges facing the nation's children.
Recommendations for Executive Action:
To honor the Administrator's commitment to the Children's Health
Protection Advisory Committee, we are recommending that the Office of
Children's Health Protection expeditiously complete the cross-agency
process to review the committee's key recommendations. We are further
recommending that the Administrator examine ways to more proactively
use the committee to reinvigorate its focus on protecting children's
environmental health.
Madam Chairman, this concludes my prepared statement. I would be happy
to respond to any questions that you or members of the Committee may
have at this time.
Contact and Staff Acknowledgments:
Contact points for our Offices of Congressional Relations and Public
Affairs may be found on the last page of this statement. For further
information about this testimony, please contact John Stephenson at
(202) 512-3841 or stephensonj@gao.gov. Key contributors to this
testimony were Diane Raynes, Terrance Horner, Aaron Shiffrin, and
Corissa Kiyan. Other contributors included Elizabeth Beardsley, Mark
Braza, Muriel Brown, and Benjamin Shouse.
[End of testimony]
Footnotes:
[1] The National Children's Study, led by multiple federal, state and
local agencies, as well as research institutions, will examine the
effects of environmental influences on the health and development of
more than 100,000 children across the nation, following them from
before birth until age 21. By studying children through their different
phases of growth and development, researchers will be better able to
understand the role of these environmental factors on health and
disease.
[2] The Advisory Committee met with Administrator Browner on July 6,
1998; Administrator Whitman on February 27, 2002; and Administrator
Johnson on July 17, 2007.
[3] The number of letters reviewed reflects the period between May 1998
and June 2008.
[4] For the purposes of our review, we defined a recommendation as "any
and all statements made in Advisory Committee letters that advise and
ask/request/suggest/urge EPA to take action".
[5] Some recommendations were considered to emphasize more than one
subject area and as such the categories are not mutually exclusive.
[6] CHAMPS is a cross-agency group of headquarters and regional staff
who work on children's issues that was formed by the Children's Health
Office to discuss projects and share information.
[7] EPA sets Primary National Ambient Air Quality Standards for ozone,
particulate matter, sulfur dioxide, nitrogen dioxide, carbon monoxide,
and lead.
[8] CASAC is an independent committee of scientists that advises the
EPA Administrator and was established by statute in 1977 to review the
agency's work in setting NAAQS.
[9] EPA did not provide a response to address 6 out of the 23
recommendations that we identified.
[10] EPA did not provide a response to address 13 of the 29
recommendations that we identified.
[11] We have reported previously on major shortcomings in EPA's
proposed mercury rule that limit its usefulness for informing decision
makers and the public. Among other things, we found that EPA did not
consistently analyze its mercury policy options or provide estimates of
the total costs and benefits, and that EPA did not estimate economic
benefits directly related to decreased mercury emissions (GAO-05-252).
[12] In addition, EPA described final regulations for hazardous waste
combustion facilities (e.g., incinerators, cement kilns, lightweight
aggregate kilns) that were expected to be promulgated in February 1999.
[13] EPA did acknowledge the importance of public review and stated
that it would address the committee's recommendation to publish a
Federal Register notice later that year, announcing a formal evaluation
of the VCCEP pilot and how it intended to seek stakeholder views and
comments like those provided by the committee.
[14] The Executive Order states, "The Task Force shall be composed of
the Secretary of Health and Human Services, who shall serve as a Co-
Chair of the Council; Administrator of the Environmental Protection
Agency, who shall serve as a Co-Chair of the Council; Secretary of
Education; Secretary of Labor; Attorney General; Secretary of Energy;
Secretary of Housing and Urban Development; Secretary of Agriculture;
Secretary of Transportation; Director of the Office of Management and
Budget; Chair of the Council on Environmental Quality; Chair of the
Consumer Product Safety Commission; Assistant to the President for
Economic Policy; Assistant to the President for Domestic Policy;
Assistant to the President and Director of the Office of Science and
Technology Policy; Chair of the Council of Economic Advisers; and such
other officials of executive departments and agencies as the President
may, from time to time, designate."
[End of section]
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