1
Introduction

The effects of ionizing radiation on human health and the environment have been a serious public concern since the United States began producing and testing nuclear weapons during World War II. These public concerns emerged in response to the unknown health consequences of exposure to radioactive materials and the potential for extensive environmental contamination. Growing public interest regarding exposures at or near nuclear weapons facilities was a major impetus for many of the early epidemiologic studies that examined the health effects of radioactive material exposures of former and current workers and the public living near the nuclear facilities.

The “nuclear weapons complex” in the United States resulted in one of the earliest occupational research programs to study and monitor worker exposures to ionizing radiation and radioactive materials at nuclear weapons facilities. The Atomic Energy Commission (AEC), established in 1946, was charged with regulating the development of nuclear science and technology in addition to conducting research on health issues related to occupational exposures to radiation at nuclear weapons sites. In the early 1960s, the AEC designed a series of feasibility studies to determine whether personnel records could be used to monitor mortality at the Manhattan Engineering District facilities. Pilot studies were initiated by the AEC in 1964, and a long-term epidemiologic study of former workers (the Worker Health and Mortality Study) was implemented in 1970 (NRC 1990).

In 1977, the Department of Energy (DOE) was created to consolidate energy policy programs from the AEC into the succeeding Energy Research and Development Administration (ERDA) (AEC was reorganized into the U.S. Nuclear Regulatory Commission and ERDA in 1974; ERDA was reorganized along with



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Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services 1 Introduction The effects of ionizing radiation on human health and the environment have been a serious public concern since the United States began producing and testing nuclear weapons during World War II. These public concerns emerged in response to the unknown health consequences of exposure to radioactive materials and the potential for extensive environmental contamination. Growing public interest regarding exposures at or near nuclear weapons facilities was a major impetus for many of the early epidemiologic studies that examined the health effects of radioactive material exposures of former and current workers and the public living near the nuclear facilities. The “nuclear weapons complex” in the United States resulted in one of the earliest occupational research programs to study and monitor worker exposures to ionizing radiation and radioactive materials at nuclear weapons facilities. The Atomic Energy Commission (AEC), established in 1946, was charged with regulating the development of nuclear science and technology in addition to conducting research on health issues related to occupational exposures to radiation at nuclear weapons sites. In the early 1960s, the AEC designed a series of feasibility studies to determine whether personnel records could be used to monitor mortality at the Manhattan Engineering District facilities. Pilot studies were initiated by the AEC in 1964, and a long-term epidemiologic study of former workers (the Worker Health and Mortality Study) was implemented in 1970 (NRC 1990). In 1977, the Department of Energy (DOE) was created to consolidate energy policy programs from the AEC into the succeeding Energy Research and Development Administration (ERDA) (AEC was reorganized into the U.S. Nuclear Regulatory Commission and ERDA in 1974; ERDA was reorganized along with

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Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services other activities into DOE in 1977). DOE was charged with management and oversight relating to radioactive waste disposal programs, energy-related research, the nuclear weapons program, and those epidemiologic studies of workers at nuclear weapons facilities previously administered by AEC. DOE and its predecessors also conducted many animal studies of radiation health effects, partially funds the Radiation Effects Research Foundation (RERF), and administers a low-dose radiation effects program. Currently, most of the research on the health effects of radiation exposure in occupationally exposed populations is managed by DOE’s Office of Environment, Safety and Health (ES&H).1 Management of the program was being reorganized within DOE during the time this report was in review; the program will reside in the Office of Illness and Injury Prevention, Office of Health, Safety and Security, HS-13. DEPARTMENT OF ENERGY’S OFFICE OF ENVIRONMENT, SAFETY AND HEALTH In 1981, DOE established ES&H to enhance the performance of the department’s environment, safety, and health programs and to advise the Secretary of Energy regarding the health and safety of workers and environmental issues at DOE sites (DOE 2006a). ES&H is responsible for formulating environmental standards; developing directives related to environmental, safety, and health issues; enforcing compliance with nuclear safety regulations; and funding epidemiological studies of workers at nuclear facilities (DOE 2006a). Epidemiological research on worker exposures at the DOE sites is currently housed within the Office of Health (OH) in ES&H. The OH manages current epidemiologic research and dose reconstruction efforts to understand the health consequences of exposure related to ionizing radiation and selected non-radioactive materials, such as beryllium, that are used in the weapons program. The OH also supports RERF jointly with Japan’s Ministry of Health, Labour, and Welfare. Data from the RERF still provide the basis for the radiation risk estimates that are used to estimate risk to workers and others exposed to ionizing radiation. The office also maintains extensive records on data collected during health studies, including the Comprehensive Epidemiologic Data Resource, which is a public use data repository for such information. The Worker and Public Health Activities Program, which is the focus of this report, is one specific worker safety and health program managed by DOE’s OH, in collaboration with the Department of Health and Human Services (HHS). At the time this report was in review, the program under the Memorandum of Understanding (MOU) was being reorganized within DOE and will reside in the Office of Health, Safety and Security. 1 See http://www.eh.doe.gov/health/orgchart.pdf and http://www.eh.doe.gov/ehorganization.pdf. Last accessed October 2006.

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Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services WORKER AND PUBLIC HEALTH ACTIVITIES PROGRAM Funded at approximately $10 million to $20 million annually for more than 20 years (see Annex 1A), the Worker and Public Health Activities Program was established to study the consequences of exposures to ionizing radiation and other hazardous materials used in DOE operations for workers and the general public in surrounding communities (DOE 2006b). Initially, the program was managed solely by DOE. Growing public concern about DOE sites and the program provided an impetus for external reviews. In the late 1980s, a number of congressional and media inquiries highlighted environmental and safety violations that had occurred at a number of DOE sites, including accidental spills and radioactive contamination. These problems coupled with other concerns regarding DOE’s handling of its epidemiologic research attracted significant public interest. DOE was criticized for a perceived inherent conflict of interest in the department’s role in conducting such studies, particularly those studies designed to evaluate the health effects of exposure to low-dose radiation; the credibility of the program was an issue because a majority of the mortality studies were carried out by DOE contractors closely associated with the production efforts. A general distrust of the results of the studies also developed in part from the fact that the data were considered proprietary by DOE and were not made publicly available (NRC 1990). In response to these criticisms, in 1989 DOE Secretary James M. Watkins established an advisory committee, the Secretarial Panel for Evaluation of Epidemiologic Research Activities (SPEERA), to conduct an evaluation of the program. Reviews of the program by SPEERA (SPEERA 1990) and National Research Council (NRC) committees (NRC 1990, 1994) were ultimately responsible for the restructuring of the program. In its evaluation in 1990, SPEERA recommended, and Congress subsequently requested, that analytic epidemiological research efforts be transferred to HHS because of concerns regarding the independence and objectivity of the DOE program. In addition, SPEERA recommended that DOE be more forthright in its efforts to communicate results of the studies to affected individuals and communities. In 1990, to address issues of credibility and transparency, DOE and two agencies within HHS (the National Institute for Occupational Safety and Health [NIOSH] and the National Center for Environmental Health [NCEH]) entered into an interagency MOU.2 DOE became the administrator and funding source for the program while HHS conducted the research, thereby improving the independence and objectivity of the program. The MOU between the agencies was renewed in 1996 without substantive changes. (The Agency for Toxic Substances and Disease Registry [ATSDR] signed separate MOUs with DOE in 1990, 1992, and 1997.) 2 1990 Memorandum of Understanding between the U.S. Department of Energy and the U.S. Department of Health and Human Services. See Appendix A.

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Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services Each of the agencies within HHS (i.e., NIOSH, NCEH, and ATSDR) conducts research for the Worker and Public Health Activities Program based on its legislative mandates. This research is conducted both intramurally and extramurally, with NIOSH, NCEH, and ATSDR conducting, respectively, 10, 40, and 10 percent of their portion of the research extramurally. NIOSH is tasked with studying occupational exposures including the epidemiological studies of workers at DOE sites. NCEH evaluates exposures at the sites through historical dose reconstruction projects and community epidemiological studies. ATSDR is responsible for assessing environmental exposures and related health effects in communities surrounding the DOE sites, all of which are considered Superfund sites. In 2000, the interagency agreement3 was modified, per congressional request, to direct “DOE to develop a single memorandum of understanding with HHS agencies that would set forth the authority, resources, and responsibility for conduct of HHS public health activities conducted by CDC [the Center for Disease Control and Prevention] and ATSDR at the DOE sites.” A draft MOU is currently under negotiation between DOE and HHS. Once signed, this MOU will not be renewed beyond 2009 unless the need for additional significant health research is indicated. Figure 1-1 illustrates a timeline of selected activities relevant to worker and public health at the DOE sites. Current Responsibilities Within the Worker and Public Health Activities Program Since 1990, NIOSH, NCEH, and ATSDR have been involved in a wide range of research activities related to assessing occupational and environmental exposures at or near DOE sites, including epidemiological studies of occupationally exposed workers, community assessments of health issues related to exposures at the sites, dose reconstruction to determine retrospective exposures, and dissemination of information to affected communities. DOE and HHS documented their priority research efforts in their public health agenda (Agenda for HHS Public Health Activities [for Fiscal Years 2003-2008] at Department of Energy Sites; DOE and HHS 2003). This agenda is intended to guide activities conducted under the 2000 MOU and includes information about past and current activities at each of the DOE sites. Some current efforts are described below. 3 2000 Memorandum of Understanding between the U.S. Department of Energy and the U.S. Department of Health and Human Services.

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Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services FIGURE 1-1 Timeline of activities relating to the worker and public health program.

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Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services CDC’s National Institute for Occupational Safety and Health NIOSH, the federal agency responsible for conducting research and making recommendations for the prevention of work-related injury and illness, has supported the activities of the Worker and Public Health Activities Program through its Occupational Energy Research Branch (NIOSH 2006). The mission of the branch is to conduct a variety of analytic epidemiology studies of the effects of exposure to ionizing radiation and other chemical and physical agents on the health of current and former DOE workers (Schubauer-Berigan 2005). NIOSH has been involved primarily in conducting hypothesis-based analytic epidemiology through cohort mortality studies of workers at a number of DOE sites including the Idaho National Laboratory, the Los Alamos National Laboratory, the Nevada Test Site, the Portsmouth Gaseous Diffusion Plant, the Rocky Flats Plant, the Feed Materials Production Center (Fernald), the Savannah River Site, the Oak Ridge Plant, and the Hanford site (Schubauer-Berigan 2005). Some of the current research efforts include the Multiple Myeloma Case-Control Study at the Oak Ridge Gaseous Diffusion Plant (K-25), the Cohort Mortality Study of DOE Chemical Laboratory Workers, and the Health Effects of Occupational Exposures in Paducah Gaseous Diffusion Plant Workers (Schubauer-Berigan 2005). Previous research has included a multisite multiple myeloma case-control study at various sites (Wing et al. 2000) and a cohort mortality study of workers at the Portsmouth Gaseous Diffusion Plant (NIOSH 2001). CDC’s National Center for Environmental Health The NCEH, a division of the CDC, is responsible for conducting public health surveillance, applied research, epidemiological studies, laboratory analyses, and communication and education relating to a variety of environmental health issues (NCEH 2006). The Radiation Studies Branch of NCEH is responsible for conducting dose reconstruction analyses to estimate the level of past exposure to radiation likely received by the communities surrounding DOE sites. Dose reconstruction is a comprehensive multistep process to develop individual estimates of environmental exposures of the public at the sites; it includes collecting data on radiation and chemical releases and determining potential exposure pathways for those living in the vicinity and downwind of the sites (Miller 2005). The NCEH has completed dose reconstruction analyses for the Hanford, Idaho National Laboratory, Republic of the Marshall Islands, and Fernald sites (Farris et al. 1994a, 1994b; TSP 1994a, 1994b; Meyer et al. 1995; Killough et al. 1998; Till et al. 2001, 2002; Grogan et al. 2002; Apostoaei et al. 2005; Wichner et al. 2005). Some of the dose reconstruction documents for the Hanford, Idaho National Laboratory, Savannah River, Fernald sites, and others, have been peer-reviewed by the NRC (NRC 1995, 1997, 2001). Dose reconstruction activities are being conducted at the Los Alamos and Savannah River sites. NCEH anticipates completing the study at the Savannah River site by the end of September

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Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services 2006, whereas the dose reconstruction at Los Alamos will continue for at least 3 more years. NCEH has also provided technical support at the Rocky Flats and Oak Ridge sites (Miller 2005). CDC’s Agency for Toxic Substances and Disease Registry The ATSDR is congressionally mandated to assess health hazards at specific hazardous waste sites, in particular at Superfund sites, and to increase public knowledge about potential health effects resulting from exposure to hazardous substances at these sites (ATSDR 2006). For the Worker and Public Health Activities Program, ATSDR has assessed the public health impact of community exposures to hazardous substances released from DOE facilities and has supported education efforts to inform the community about potential health hazards at or near the sites (Cibulas 2005). ATSDR produces public health assessments to address concerns related to potential exposures to the individuals that make up the communities at these sites. To date, the agency has completed 20 Public Health Assessments at DOE sites and is finalizing or planning to complete 5 additional assessments at the Brookhaven, Los Alamos, Savannah River, Hanford, and Oak Ridge sites (ATSDR 2005a, 2005b, 2006; Cibulas 2005). ASTDR has prepared seven extensive toxicological profiles of radionuclides and ionizing radiation in general that were funded completely or partially by DOE: namely, americium, cesium, cobalt (only the update funded with DOE monies), iodine, ionizing radiation, strontium, and uranium (ATSDR 1999, 2004a, 2004b, 2004c, 2004d). The agency is also involved in community education programs, including a program to inform the community about health issues at the Hanford site (Cibulas 2005). NRC COMMITTEE TO REVIEW THE WORKER AND PUBLIC HEALTH ACTIVITIES PROGRAM DOE’s OH requested that a committee be created by the National Academies to review the Worker and Public Health Activities Program and to assess and recommend ways to enhance the program’s scientific merit, focus, and effectiveness; its impact on DOE’s policies and decisions; and other program benefits, including the relevance to DOE’s mission, that are consistent with the objectives of this program. In addition, the National Academies’ committee was asked to address the following aspects of the program in the committee’s Statement of Task: Statement of Task A committee of the National Academies, lead by the Nuclear and Radiation Studies Board will conduct a review of the Worker and Public Health Activi-

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Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services ties Program sponsored by DOE and conducted by DHHS. The committee will assess and will recommend ways to enhance the program’s scientific merit, focus, and effectiveness; its demonstrated impact on the agency’s policies and decisions; and other benefits, such as relevance to DOE’s missions, that are consistent with the objectives of this program. This assessment will address the following aspects of the program: the congressional mandate in establishing the MOU, and how well its goals have been met through FY 2004; evaluating research priorities for projects from FY 1990 through FY 2004 and for projects included in the agenda; research project selection from FY 1990 through FY 2004 and for projects included in the agenda; usefulness of results and dissemination of completed research through FY 2005; and other aspects to be identified by the committee. The committee may also propose other appropriate measures or indicators to be used in evaluating this program. DOE is also interested in the committee’s assessment, given sufficient information and time, whether or not the individual agency programs were of the highest quality from the viewpoint of science and public policy. In response to the request, the National Academies established the Committee to Review the Worker and Public Health Activities Program Administered by the Department of Energy and the Health and Human Services, which prepared this report. Members of the committee were selected for their expertise in biostatistics, epidemiology, radionuclide and chemical risk assessment, occupational health, research program evaluation, risk communication, and toxicology. Committee members come from academia and private industry. The committee’s review of available information took place over a 9-month period from November 3, 2005, through August 9, 2006. The committee organized its efforts to review the effectiveness of the program from the standpoint of (1) the research carried out, (2) the policies and practices developed relative to the workers and communities affected, and (3) the effectiveness of communicating the program’s findings to the workers and communities affected. Both DOE and the three agencies of the HHS provided historical data that the committee requested to evaluate these three areas of activity. In addition, other public sources of information were used in the committee’s program evaluation and are referenced throughout this report. To address its task, the NRC committee held two public sessions in which it heard presentations from DOE, NIOSH, NCEH, and ATSDR officials, from former DOE Assistant Secretaries; and from a former member of the Advisory

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Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services Committee on Energy-Related Epidemiologic Research (ACERER).4 The NRC committee requested additional information from each of the agencies to assess budgets, research outcomes, and methods for developing research priorities. In addition to the two public meetings, the committee met six times in closed sessions to discuss the program. The committee reviewed agency research priorities, research project selection, usefulness of results, and dissemination of completed research. In addition, to evaluate the quality of the programs from the viewpoint of science and public policy, the committee used a sampling strategy that reviewed selected studies, activities, and publications from three DOE sites and, in some cases, products that were not site-specific. The committee additionally targeted a sample of the information dissemination programs for a more detailed look. Sampling Strategy In discussing the Statement of Task in the context of the size of the program, the number of DOE nuclear sites and the variety of activities at these various sites, the committee concluded that a comprehensive assessment of the entire program was not possible in the time allotted for this study. Thus there were two options for carrying out this review: (1) a superficial look at the entire program, or (2) a more detailed look at a portion of the program. The committee concluded that a superficial review of the entire program would not lead to meaningful recommendations, but that a more detailed look at a representative portion of the program would be more useful. Accordingly, the committee discussed various subsets of the total program to review and arrived at a selection rationale that took into account the following factors: The range of time over which health studies were initiated. The number of workers involved as part of the program. A variety of types of dissemination and communication challenges. A variety of security challenges. Size of the surrounding public community. A geographic distribution of the sites. With these factors in mind, the committee selected three DOE nuclear operations sites, Hanford, Oak Ridge, and Los Alamos, as a subset of the total nuclear sites on which it would focus its attention. The committee also recognized that it 4 HHS established ACERER in early 1992, with its first meeting occurring in January 1993. ACERER continued to provide advice to the Secretary of HHS regarding the OERP research agenda till 2000.

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Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services would have to go beyond these sites to look at certain aspects of the program such as the technical studies (some of which were multisite studies that included more than these three sites) or the program management process which also reached beyond the three sites. For example, more than 50 percent of the nuclear workers were involved in the combined Oak Ridge and Hanford sites. Health studies were first initiated at the Hanford site and much later at the Los Alamos National Laboratory. The Hanford site had a wider range of stakeholders (i.e., communities with whom the information had to be shared) than did the other two sites. The level of security at Los Alamos appeared to be greater than at the other two sites. This selection process resulted in a subset that the committee concluded would be representative of the program activities executed by HHS. Thus the assessment of work from this subset would lead to conclusions and recommendations that would be valid for the program as a whole. In addition to this sampling strategy for site-specific aspects of the program, the committee considered detailed information from the agencies on broad aspects of the program. These topics included, for example, identification of project categories and specific studies funded by DOE and produced by the three HHS agencies, information on the DOE/HHS budgeting processes, procedures used in the establishment of project priorities, and program management processes for the overall program. By using a combination of the sampling strategy for review of site-specific activities along with a review of overall management aspects of the program, the committee concluded that its assessment would be representative of the program activities carried out by HHS. Through the use of this review strategy the committee judges that it conducted a balanced assessment of the program and that its conclusions and recommendations are valid for the program as a whole. Use of the Memorandum of Understanding Mechanism As noted earlier in this chapter, the recommendations made by SPEERA to have the analytical epidemiological studies carried out by an agency outside of DOE specified in an MOU was the mechanism of choice of DOE and HHS in 1990. The MOUs also appeared to be the mechanism Congress supported to implement cooperation between the two departments. While this mechanism improved the program, it did not solve all the problems, nor did it catalyze seamless collaboration between the departments. Rather than attempting to devise a totally new, untried mechanism to further improve the results from this program, the committee concluded that there were specific weaknesses in the MOU structure, which if modified could provide better results. Subsequent MOUs signed in 1996 and especially in 2000 further modified the working relationship between the Departments as needs changed in the program. Presently, a draft MOU exists which has not been signed off by HHS, presumably due to lack of agreement on the specifications of the proposed MOU renewal.

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Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services As this report details in Chapters 2-5, the program operating under these MOUs made some significant advances in the scientific understanding of the hazards that the nuclear workers were exposed to and in communicating this understanding to the workers and communities involved. The committee did consider whether the program should be continued or terminated and concluded, as described in detail in subsequent chapters, that it should be continued as long as DOE engaged in hazardous operations such as cleanup and remediation at the nuclear sites. With the background of accomplishment under the past three MOUs, the charge to consider ways of improving the future program led the committee to accept the MOU as a basic operating framework and consider ways of improving it to address some of the shortcomings of the past program. There was little evidence reviewed by the committee indicating that DOE had overcome the public concerns about their credibility on health issues that led SPEERA to recommend that an “independent” agency carry out the health studies. This may not be a commentary on DOE specifically, but rather a public distrust of any arrangement in which the primary objective of an operation might be better achieved through a compromise of some of its other objectives, for example, improved productivity at the expense of the health studies of its workers or communities. Thus the committee concluded that a continuing health program should be based on the MOU structure, albeit an improved one. Alternative structures for a continuing health program in which DOE was the sole governmental management group responsible for the health program of its workers were not adopted by the committee since such structures would lack credibility with the workers and the communities in which DOE operations were located and, if different from the previously used management structures, would represent untried and untested structures that might require a larger commitment of scarce resources with no surety of a better result. The present acceptance of the program under the MOU, while not perfect, is improved by DOE’s association with HHS. The committee judges that improvement of the present structure would have a better chance of success than changing strategies at this stage. Budgetary Considerations The program conducted under the MOU was supported by DOE through funding transfers to HHS. Although the funds transferred under these agreements were relatively small compared to the total budget of either agency, they had a significant impact on the DOE office that had previously been responsible for this work. That office was required to turn over a substantial portion of its funding and staff to HHS to take over and carry out subsequent research. At the time this occurred during the early 1990s, the transfer of staff positions constituted a more serious resource constraint than funding limitations. According to information provided by the three agencies in the HHS, approximately $9.1 million was transferred in FY 1992 to carry out this work (see Table 1A-1, Annex 1A). The

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Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services funding and program transfer from DOE to HHS appears to have strained the working relationship between these two agencies from the outset of the work under the MOU. Subsequently, about $210 million was provided from DOE to HHS for this program from FY 1991 through FY 2005.5 Table 1A-2 in Annex 1A shows the pattern of these expenditures over this period according to information provided by HHS agencies. DOE declined to provide any budgetary information that could be used in confirming these levels and patterns of expenditures.6 Although the allocation of these funds among HHS agencies could change substantially from one year to the next, over the entire period the funds were divided relatively evenly among the three agencies. ATSDR received the most (38 percent. ) with NIOSH close behind (36 percent. ). NCEH received the remaining 28 percent. Over the 15-year life of the program, about 31 percent. of the total expenditures have been used to support studies by outside researchers (extramural research).7 NCEH used the largest portion of its funds (78 percent. over 15 years) to support extramural work. NIOSH has used less (34 percent. over the 15 years), and the proportion has decreased in recent years. ATSDR has supported no extramural work in its studies. As this study got under way, the committee was informed that only a small fraction of the FY 2006 budget requested from DOE by HHS agencies was funded for a continuing health program. NIOSH indicated that it would consider funding some of the continuing work from its internal funds. ATSDR reportedly closed down operations at some of the DOE sites as a result of these budget cuts. Although the committee is cognizant of the budget limitations that have constrained the program in recent years, it concludes that important work still needs to be done. This report is organized into three scientific program assessment chapters, followed by one chapter on communication and a final chapter on program management. Chapter 2 evaluates the NIOSH worker epidemiology program; Chapter 3 5 The agencies indicated that in some cases, their information on expenditures was only approximate because much of the data for the earlier years had been stored in federal archives and would be difficult to retrieve. It also appears that some of the information provided was information on outlays, and some was information on obligations. Although the differences between these two ways of reporting expenditures argue against adding them together, any errors introduced by combining the data are likely to be relatively small in terms of the information they provide about the general level and pattern of expenditures. 6 DOE’s response to the committee’s request for budget information was “the budget is not part of the NAS [National Academies] Statement of Work (SOW) …. Refer to HHS for copies of annual requests to DOE for funding.” 7 Extramural work can be paid for through contracts, grants, or cooperative agreements. The committee was less interested in the mechanism for funding outside work than in the comparison between the amount of work done by employees of the agencies and the amount done by external researchers.

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Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services assesses the DOE-funded ATSDR community health programs; and Chapter 4 evaluates the NCEH dose reconstruction efforts at DOE sites. Chapter 5 reviews HHS dissemination and communication efforts, and Chapter 6 provides a program management assessment. ANNEX 1A BUDGETARY TABLES TABLE 1A-1 DOE Analytic Epidemiological Studies and FY 1991 Resources Transferred to HHS Contractor Year of Expected Study Update FY 1991 Funding Level ($) Program Title Harvard 1992 $200,000 In vivo mutagenicity and clastogenicity of ionizing radiation HEHFa   $383,000 DOE Hanford Health and Mortality Study LANLb 1991-1992 or open for continuing surveillance $700,000 Human Health Effects of Plutonium—nine studies LLNLc   DOE funds Melanoma studies at Lawrence Livermore ORAUd 1991-1993 and one open case-control study $2.8 million Health and Mortality Study of workers at Oak Ridge, Fernald, Savannah River, Portsmouth, Paducah, and Mallinkrodt—25 studies OROe 1992 $6.1 million CDC Fernald dose reconstruction PNNLf 1992 $295,000 Statistical health effects—three studies RLg 1993 $3.65 million Hanford dose reconstruction aHanford Environmental Health Foundation. bLos Alamos National Laboratory. cLawrence Livermore National Laboratory. dOak Ridge Associated Universities. eOak Ridge Operations Office. fPacific Northwest National Laboratory. gDOE Richland Operations Office. SOURCE: Appendix A of 1990 MOU.

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Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services TABLE 1A-2 Program Expenditures by Agency (millions of dollars) Agency Exa Fiscal Year 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 Total NIOSH X 0.3 1.3 1.1 4.4 4.3 3.6 1.2 2.6 1.7 1.4 1.2 1.5 0.6 0.9 26.1   I 1.4 3.5 3.4 2.6 2.4 4.0 3.3 4.5 4.8 4.3 4.2 3.6 4.6 3.8 50.4   T 1.7 4.9 4.5 7.0 6.7 7.6 4.5 7.1 6.5 5.7 5.4 5.1 5.2 4.7 76.5 NCEHb X 0.4 0.4 2.1 3.0 2.5 2.0 3.1 3.8 5.3 5.1 4.0 3.8 4.1 2.1 42.0   I 8.8 0.0 0.4 0.0 0.9 0.5 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 12.0   T 9.2 0.4 2.5 3.0 3.3 2.5 3.1 3.8 5.3 5.1 4.0 3.8 4.1 2.1 54.0 ATSDRc I 5.7 4.9 6.0 5.0 4.4 3.7 5.5 10.6 8.5 7.6 5.4 4.4 4.4 3.8 80.1 Total X 0.6 1.7 1.5 6.5 7.3 6.1 3.2 5.7 5.5 6.7 6.3 5.4 4.4 5.0 68.1   I 8.6 17.3 9.4 8.0 6.8 8.6 9.3 15.1 13.3 11.9 9.5 8.0 9.0 7.6 142.5   T 9.1 19.0 10.9 14.5 14.1 14.6 12.5 20.8 18.8 18.6 15.9 13.5 13.4 12.6 210.6 aType of expenditure: X = extramural; I = intramural; T = total. bNCEH also reported spending $1.8 million in FY 1991. cATSDR also reported spending $0.2 million in FY 1991. SOURCE: Data provided by NIOSH, NCEH, and ATSDR.

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