IX. Public Health Action Plan

The Public Health Action Plan for Vieques contains a description of actions taken and those to be taken by ATSDR, the Navy, EPA, PREQB, and the Puerto Rico Department of Health (PRDOH). The purpose of the Public Health Action Plan is to ensure that this PHA not only identifies potential public health hazards, but also provides a plan of action to mitigate and prevent harmful human health effects that may be resulting from exposure to hazardous substances in the environment. The public health actions that are completed, ongoing, and recommended are as follows:

Actions Completed:

• In August 1999, ATSDR conducted an initial site visit to Vieques to meet with the petitioner, tour the island and bombing range, and gather environmental data. As a result of this site visit, ATSDR accepted the resident's petition and initiated the public health assessment process.
• In June and October 2000, ATSDR discussed with local health care providers their public health concerns and provided training regarding how to medically assess environmental exposures. During these visits ATSDR met with numerous residents of the island to discuss health concerns.
• In September 2000, ATSDR met with various agencies, including PRDOH, PREQB, EPA, the US Geological Survey, and the Navy, to gather data and to discuss the scope and nature of ATSDR investigations. ATSDR also met with the petitioner to tour various sites on Vieques and to update the petitioner on its efforts.
• In March 2001, ATSDR held a public availability session to meet individually with community members regarding the findings of the evaluation of drinking water and groundwater on Vieques.
• In April 2001, ATSDR toured Vieques both by land and by air with the principal purpose of identifying suitable areas to sample fish and shellfish off the coast of Vieques.
• In June 2001, the Navy, ATSDR, and their contractors collected air samples on Vieques to characterize levels of air contamination during air-to-ground bombing exercises.
• In July 2001, ATSDR, the Ponce School of Medicine, and CDC sponsored an expert review panel to address whether an association existed between place of residence (Vieques or Ponce Playa) and morphological cardiovascular changes among fishermen.
• ATSDR worked with EPA/ERT to collect and analyze fish and shellfish in the coastal waters and near shore areas of Vieques in July 2001. At this time, ATSDR also met with the petitioner to provide an update on ATSDR efforts.
• In September 2001, ATSDR conducted additional community involvement activities to inform participants of the scope of ATSDR investigations and seek additional community input. Continuing education and public health training was held for the nurses of Vieques and environmental health instruction was given to area parents and high school students.
• In October 2001, ATSDR released the Public Health Assessment for the Drinking Water Supplies and Groundwater Pathway Evaluation (ATSDR 2001a). This report concluded that the public drinking water supply on Vieques poses no public health hazard. However, high nitrates and nitrites, most likely resulting from agricultural pollution, in one private drinking water well indicate a health concern for children and pregnant women if they drank water from that well.
• In October 2001, ATSDR released a report summarizing the expert panel review addressing whether an association existed between place of residence and morphological cardiovascular changes among fishermen (ATSDR and PSM 2001). The panel found that the well-executed study showed no indication of abnormal heart function attributable to pericardial thickening.
• In November 2001, the Navy conducted a site investigation and characterized the biological organisms to assess the health of the marine species on and around the Killen and to assess potential impacts on the surrounding biota. EPA and PREQB will review the results and determine if further analysis is warranted.
• In February 2003, ATSDR released a PHA addressing public health implications from exposures to soils on Vieques (ATSDR 2003). This document concluded that there is no evidence that residents are being exposed to harmful levels of contamination in the soil.

Actions Ongoing:

• ATSDR continues to evaluate the public health implications of exposure to air contaminants. In a PHA released for public comment in November 2002, ATSDR addressed potential health issues resulting from air releases from the LIA, including wind-blown dust and the use of practice bombs, live bombs, and various other munitions.
• ATSDR is continuing to meet with various community members and organizations to receive concerns and exchange information. This effort will continue throughout the public health assessment process.
• ATSDR will continue to meet with local health care providers to discuss health concerns for the community and to provide educational materials for addressing the community's health needs.
• PRDOH is working on Vieques and in Puerto Rico generally to gather information regarding the incidence of cancer in Puerto Rico and on Vieques. That information will be added to the current cancer registry information.
• ATSDR will review cancer registry information and data gathered by PRDOH. The information will be evaluated as it relates to potential pathways of environmental exposure.