Analyzing the Effectiveness of Fish Consumption Advisories in Immigrant Populations

1. Analyzing the Effectiveness of Fish Consumption Advisories in Immigrant Populations Dan Endreson November 27, 2007

2. Problem Introduction and Analysis Hmong populations in the Twin Cities are adversely exposed to methylmercury contamination due to greater fish consumption.

3. Problem Introduction and Analysis Hmong populations in the Twin Cities are adversely exposed to methylmercury contamination due to greater fish consumption. • Problem Background • Mercury in the environment • Public health concerns • Hmong population and culture • Evaluation Criteria • Alternatives • Alternative Evaluation • Recommendations

4. Natural (30%) Volcanic activity Anthropogenic (70%) Product use Pesticides Paints Medical and dental use By-products Waste incineration Coal combustion Metal mining and processing Mercury Sources Sources: Mercury Fact Sheet, EPA, June 2001; Mercury Emissions Report, MPCA, March 2004

5. Natural (30%) Volcanic activity Anthropogenic (70%) Product use Pesticides Paints Medical and dental use By-products Waste incineration Coal combustion Metal mining and processing 87% from coal combustion and waste incineration Mercury Sources Sources: Mercury Fact Sheet, EPA, June 2001; Mercury Emissions Report, MPCA, March 2004

6. Human Exposure and Health Effects • Fish consumption is primary human exposure route • Methylmercury accumulates in the fat and muscle of fish • Trimming and cooking fish does not significantly reduce methylmercury concentration • Easily passes through digestive system due to lipophilic properties • Half life in body of 44-80 days • Chronic Toxicity • Central nervous system • Cardiovascular and immune systems • Kidneys • Reproduction • Possible carcinogen • Especially harmful to fetuses, infants, and children • Is passed through breast milk

7. Public Health Extent • 66% of Minnesota waters impaired due to mercury • No danger for typical consumer (10g/day ~ ¼ cup/day) • Increased danger • Consuming large fish • Pregnant women • Subsistence anglers Source: TMDL Pollutant Reduction Plan, MPCA, 2004

8. Hmong Population • Non-state culture originating in Southeast Asia • 750 immigrants arrived in 1976 through the U.S. Refugee Program • 60 in Minnesota • Continual increase in population • 41,800 in Minnesota; 50% increase from 1990 • May be as high as 70,000 • 97% live in the Twin Cities • Economic • 33% below the poverty line (Average rate is 8%) • Median Family Income = $35,864 • Per Capita Income = $7,210 Source: 2002 U.S. Census

9. A Culture of Fishing • Deep cultural ties to fishing • Used to supplement diet • Tradition continues after immigration • Eases transition after immigration • Recreational and consumptive angling • Fish for bass, perch, and trout • 90% consumption Source: Hutchinson and Kraft, 2004

10. Evaluation Criteria • Administrative Operability • Effectiveness - Health • Cost • Social Acceptability

11. Alternative #1 Continue the current practice of fish consumption advisories

12. Alternative #1: Fish Consumption AdvisoriesAdministrative Operability • Pollution Control Agency (PCA) • Developing state water standards • Statewide water quality planning and monitoring • Department of Natural Resources (DNR) • Enforce fishing regulations • Analyze fish for contaminants • Department of Health (MDH) • Develop guidelines for safe fish consumption • Publishes data and educates the public

13. Declining fertility rates 1995: 96.3 per 1,000 1998: 96.4 per 1,000 2000: 81.1 per 1,000 Increased rate of: low birth weight rates kidney stones incidence of cancer Comparative pilot study in Wisconsin Deficits in spatial learning and memory Decrease in infant mortality 1995-99: 7.1 per 1,000 2000-04: 5.0 per 1,000 Alternative #1: Fish Consumption AdvisoriesEffectiveness - Health Sources: MDH, 2004, MPR, 2005; Children’s Environmental Health Center, Univ. of Illinois-Champaign, 2007

14. Alternative #1: Fish Consumption AdvisoriesCost • PCA • Water quality - $52.7 million • DNR • Fisheries = $82.9 million • Game and Fish Protection = $38.7 million • MDH • Staff support = $33.9 million • Printing and mailing = $25,000 Total = $208 million Sources: Department of Finance, 2007; DNR FY2006-07 Operating Budget

15. Alternative #1: Fish Consumption AdvisoriesSocial Acceptability • 2003 - Michael Joseph, Brown University • Interviewed 15 anglers of Southeast Asian descent in Providence, RI • Not concerned or did not understand advisories • Most avoided fish for taste, not safety • Contamination associated with taste, smell, sight • 2006 - Indigenous Women’s Mercury Investigation • Interviewed 11 families on native reservations in Northern Minnesota • 9 families consumed fish more than one meal per week • Many had minimal interaction with MDH literature and staff • Consumption continued even with education

16. Alternative #2 Shift public education of fish advisories to units of local government and organizations

17. Alternative #2: Local InvolvementAdministrative Operability • Local government units • Park and Recreation Departments • Enforcement and education • Non-Profit Organizations • Fox River Environment and Diet Study (FRIENDS) • Research and education

18. Alternative #2: Local Involvement Effectiveness - Health • Expect slow decrease in mercury-related illnesses over time • Able to reach subpopulations • Should be more effective than MDH advisories alone

19. Alternative #2: Local Involvement Cost • Current Advisory Costs • $208 million • Local Government • Minneapolis Park and Recreation Board • $346,921 for Public Information • $163,905 Customer Service • St. Paul Parks and Recreation • $310,546 for Community Education • Non-Profits Total = $211 million Sources: MPRB 2007 Annual Budget; SPPR 2005 Budget; DNR CO Program

20. Alternative #2: Local Involvement Social Acceptability • Tracey Nordstrom, MPRB Vice President • Local units have greater access to communities • Normally work with neighborhood associations • FRIENDS • Greater knowledge of cultural barriers • Can build trust within the community • Empower local activism

21. Alternative #3 Place a fish consumption ban on all contaminated waters in Minnesota

22. Alterative #3: Fish Consumption BanAdministrative Operability • PCA • Developing state water standards • Statewide water quality planning and monitoring • DNR • Enforcement of consumption ban • Analyze fish for contaminants

23. Alterative #3: Fish Consumption BanEffectiveness - Health • Reduction in mercury exposure • No longer able to consume contaminated fish • Lose benefits of eating fish • Lean protein source • Omega-3 fatty acids

24. Alterative #3: Fish Consumption BanCost • PCA • Water quality - $52.7 million • Additional enforcement expense • DNR • Fish = $82.9 million • Game and Fish Protection = $77.4 million • Minneapolis Park and Recreation Board • Park Police = $9.6 million Total = $222.6 million Sources: Department of Finance, 2007; DNR FY2006-07 Operating Budget

25. Alterative #3: Fish Consumption BanSocial Acceptability • Would not be accepted by the public • Too many groups tied to fish consumption • Fish consumption would occur regardless of ban

26. Alternative #4 Provide more Asian-specific items at food shelves for low-income segments of the population

27. Alternative #4: Modify Food ShelvesAdministrative Operability • Second Harvest • Provides food to local shelters and food shelves • Refrigerated and non-refrigerated items • Serves entire metro area • Center for Asian & Pacific Islanders (CAPI) • Asian-specific food shelf

28. Alternative #4: Modify Food ShelvesEffectiveness - Health • Fish is complemented with other food items • Better overall nutrition

29. Alternative #4: Modify Food ShelvesCost • Second Harvest • $47 million annual • CAPI Total = $47 million Source: Second Harvest Annual Report, 2007

30. Alternative #4: Modify Food ShelvesSocial Acceptability • Provides culturally familiar food • Increases chance of consumer using food shelf

31. Alternative Evaluation • Administrative Operability • Mechanisms in place for all 4 alternatives • Greatest Effectiveness – Health • Consumption ban • Food shelf • Least Costly • Fish Consumption Advisories • Food shelf • High Degree of Social Acceptability • Local education • Food shelf

32. Recommendations • Use a strategy of multiple alternatives • Continue Fish Consumption Advisories • Move public education to the local level • Provide culturally familiar options for low-income segments

33. Recommendations • Use a strategy of multiple alternatives • Continue Fish Consumption Advisories • Move public education to the local level • Provide culturally familiar options for low-income segments • Compliance failures are due to cultural barriers • Distrust of the unknown • Misunderstanding of danger • Decision between culture and health • Cheap food source