Intervenor: Vol 23. No 1 January - March 1998

It's Our Health: Coming to Terms With the Politics of Cancer

One of the most frustrating and discouraging aspects of CELA's work over the two decades I have worked here has been our chronic inability to deal with the health problems of our clients. We have had clients who have lived near industrial facilities and legal and illegal waste disposal sites, have contaminated well water and soils, ailing livestock, work or live in hazardous environments, have played in radioactive dumps as children, have been exposed to pesticide spraying, live under transmission lines or electro-magnetic fields. They are suffering from cancers, chemical sensitivity and other new diseases leaving them with intolerance to their environments and a host of other health and developmental problems affecting their families. CELA staff continues to be frustrated with our inability to find justice and compensation for them. We are told we must establish a direct cause and effect and we face a phalanx of confounding arguments constantly trotted out that say any health outcome could have been caused by the lifestyle of the victim concerned.

The State of the Debate

There is however a vast difference between voluntary and involuntary exposure to harm which gets overlooked in these debates. While pollution prevention seems to be a logical path to limit a lot of the involuntary assaults and stresses on our health, corporations and governments continue to require absolute proof, risk analysis and evidence-based cause and effect, chemical by chemical. This still leaves the burden of proof on the victim to prove he or she has been harmed, rather than on the polluters to prove their products are not harmful to human health.

The system continues to deny that we are exposed to a range of contaminants from a range of pathways in our lives, and that it is this battering, and the synergistic effects of multiple assaults that is most likely to cause complex diseases like cancer. If this reality were accepted, our health and environmental protection budgets would support a precautionary approach with aggressive prevention programs.

Increasingly, CELA finds allies in the medical reform community and the powerful voices of survivors. However, embarking on a prevention path has many obstacles in these times. The environmental community managed to shift attention to prevention temporarily in the early 1990s, until industrial forces mustered and turned the focus away from pollution prevention back to pollution control. In the current frenzy of deregulation and voluntary compliance in aid of competitiveness and profit, there is little room for effective pollution prevention. Will the same thing happen to disease prevention initiatives?

CELA joins Health Alliances

Last summer CELA was invited to represent environmental interests on a working group considering ways to implement the March 1995 Report of the Ontario Task Force on the Primary Prevention of Cancer, produced under the leadership of then Minister of Health, Ruth Grier. Cancer is one of the leading causes of morbidity and mortality in Ontario. It accounts for 27% of all deaths and the loss of 20,000 lives a year in the Province. This report sets out an agenda for cancer prevention "as a part of cancer control" in the Province.

The Report makes recommendations for a number of pathways contributing to cancer, including tobacco use, dietary factors, alcohol, occupational and environmental carcinogens, sunlight, reproductive factors, infections, medications and genetics. It also sets out strategies for implementation. Other members of the working group include representatives from the Centre for Health Promotion at the University of Toronto, Cancer Care Ontario, breast cancer survivor groups, cancer advocacy and care groups and the City of Toronto Department of Health.

After several months of planning, the work group sponsored a meeting on February 9, 1998, "Towards a Toronto Cancer Prevention Council" in the new city. The meeting at Victoria College brought together over sixty oncologists, academics, cancer survivor and care advocacy groups, cancer agencies, municipal and provincial government staff, labour and food policy groups, and poverty and environmental activists. Certainly it was a good foundation for the formation of the Council.

There are also many confounding factors. The politics of cancer are as complex as the disease. Indeed, cancer is not one, but fifty different diseases as key-note speaker Dr. Robert Buckman pointed out. There is considerable dis-ease between the traditionalists and those promoting prevention, aggravated by competition for funds and the turmoil caused by the current health care restructuring. The cuts in health care, lay offs, hospital closings and the cuts to local health units make this a difficult time to introduce new programs and promote paradigm shifts. Health protection, like environmental protection is fragmented between federal, provincial and local jurisdictions. The Province has just established a new agency called Cancer Care Ontario (CCO) which will take three years to put its strategic plans in place by 2000. CCO's mandate includes delivering services, improving cancer outcomes through research, evidence-based care, supportive care, reduction of incidence and mortality and improved access and use of knowledge.

The new City of Toronto's amalgamated Health Department has been told they must cut costs further by 15%. The Board of Health has voted to defy this decree. The cuts would mean that some of the most progressive preventative initiatives in North America, which were pioneered by local Boards of Health of the old City and Metro Boroughs, are threatened. The Toronto Department of Health was the first to create its own Environmental Protection Office institutionalizing the links between health and environmental protection. CELA has joined Citizens for Public Health, a coalition of groups benefiting from public health initiatives for the homeless, hungry, youth, drug users, seniors, cultural and special needs communities, and AIDs prevention.

Despite these huge obstacles, CELA is hopeful that investing time in these new health and environmental alliances will be mutually beneficial to both sectors' work in protection. The costs of ignoring the growing health problems and resultant costs in human loss is huge. The personal losses we have experienced with deaths of colleagues like Barbara Rutherford and Nettie Vaughan give us added impetus to act to prevent cancer. London, Ontario has already started its own Cancer Prevention initiative, which Toronto can draw on. CELA has volunteered to administer a Health Canada grant for the Toronto Cancer Prevention Council to create a handbook on their efforts for other municipalities to

Sarah Miller is the coordinator at CELA

Females Report More Adverse Health Outcomes from Hazardous Substances

Females exposed to certain hazardous substances report more adverse health outcomes than national norms and, in some cases, more than similarly exposed males, according to data from the National Exposure Registry of the Agency for Toxic Substances and Disease Registry. The registry currently consists of subregistries for benzene, trichloroethylene (TCE), trichloroethane (TCA), and dioxin.

The purpose of the registry is to assess the potential long-term health impact on the general population of exposures to environmental hazards, such as those at Superfund sites. Female registrants at the TCE registry seem to be particularly susceptible to illnesses. Their rates were higher than national norms and male registrants for:

Anemia & other blood disorders (18-54 yrs)
Diabetes (18-24 yrs. & 45-54 yrs)
Kidney & liver diseases (55-64 yrs)
Skin rashes (all ages)
Speech impairment (10-17 yrs)
Stroke (35-65+ yrs)
Urinary tract disorders (18-24 & 55-65+ yrs). The benzene and dioxin subregistries also recorded high rates for all ages.

(from "Hazardous Substances & Public Health", US Dept. of Health & Human Services)