I appreciate the opportunity to make this presentation today. We have provided an overview and summary of our expenditure between 1995 and 2000 on health investment in this investigation.
Chairman, let me explain the difference between the figure of £767,000 indicated and the figure of £1.2 million to which you referred. The additional cost is made up of the indirect charges associated with the director of public health and his staff, in other words, staff who are normally employed by the board. It is, in effect, a charging out of time relative to costs which would not have been associated with this activity in the past.
The South-Eastern Health Board became involved in this investigation in the summer of 1995 because of concerns expressed regarding human health arising from the evidence being put forward to support concerns about animal health. It is important to note that the director of public health of the board and his staff were involved in this in concert with the department of public health medicine in University College Dublin and received support in their inquiries from external experts. The committee will have gathered from the EPA report that these included Professor Tim Aldrich from the United States, Dr. Nichol Black from Newcastle in the UK and Dr. Patrick Wall, the chief executive of the Food Safety Authority.
Several studies have been undertaken to assess whether there were indications of human health impact from industrial pollutants in the area. Over the period in question, the director of public health employed up to 17 people who were involved in a variety of activities, including consultancy work, but also the various surveys. The reports of each of the studies set out very clearly that there was no abnormality indicated in the human health of the population studied.
The study was taken in the area for investigation as well as control areas around the estuary. All the evidence has been reviewed by peer audit, that is, external experts, who examined the process used to ensure the investigation was of the highest standards. The report indicates that the process engaged in was quite extensive and comprehensive and might even have been too comprehensive in some of its aspects. Dr. Kelleher has already clarified this for the committee.
Chairman, if it is important for the record to go through each study, I would be happy to oblige. The earliest study was undertaken by the director of community care at the time, Dr. Mary O'Mahony. It was a review carried out with general practitioners in the area. It indicated that there was no cluster of adverse health effects attributable to an environmental hazard.
The key studies in the literature point out that atmospheric pollutants per se do not cause disease, but can exacerbate pre-existing conditions such as chronic bronchitis, emphysema and asthma. Again, there were no external causal factors which could be attributed to this literature statement around the growth in what we will describe as respiratory disorders. It would appear they are more internal atmospheric effects rather than external effects.
The significant areas of study included births and congenital abnormalities. In that regard, no cluster of specific abnormalities was ever reported. With regard to sex ratio, which would have shown some change in the indicators of abnormality, the ratio of male to female births is slightly higher in the Askeaton area, which is a positive indicator. Had the finding been the reverse, it would have been an indicator of some peculiarity. There was also a slightly lower incidence of twin births in Askeaton than in County Limerick and Ireland as a whole. Again, the reverse would have been a predictor of possible environmental pollution.
We also had a survey of general practitioners' perceptions of health problems in their area, to which 34 GPs responded. The questionnaire results showed that GPs in the study had more health concerns about their patients than elsewhere. This was explained by the way in which patient anxieties were being conveyed to them. The result may also have been indicative of the GPs' own concerns about their proximity to the major industry. These are subjective self reports.
The key finding of the health status survey, which is one of the critical baseline or population-wide statements of evidence, is important. For pregnancy outcomes, including miscarriages, there is no significant statistical difference between Askeaton and Rathkeale and the four comparison areas which were Ennistymon,Kildysart, Moyne Littleton and Clarecastle.
A diary study was also undertaken, a longitudinal study involving 26 families over a 13 month period. Again, the key findings in this tell us that, of 80 farm households taking part in this diary study, 13 households had good health, three had moderate health and two had excessive mild ill health. The inference from this is that nothing abnormal was indicated by the reports of the study population. We are informed that five of 76 individuals suffered frequent bouts of low level ill health throughout the study. However, in the majority of cases they did not require the intervention of a GP or other professional.
It is important to emphasise the significance of the study on cancer incidence in the human health investigation. During the early part of the study the cancer registry was not available to the investigating team. It first became available in late 1997. The key result was that there was no evidence that cancer was more common in the putative exposed area compared to the control areas and Ireland as a whole. In fact, there are contrary indications. The study demonstrates that men normally have approximately 15% less chance of developing cancer than other residents in the Mid-Western Health Board area and 30% less risk than men in the Irish population as a whole. In other words, it is a relatively healthy area from the point of view of the incidence and prevalence of cancer.
For women the risk is about one third less than the average of the health board population and approximately three quarters less than that of women in Ireland as a whole. Dr. Kelleher will inform the committee that, as a result of a recent statement by a local farming group questioning the incidence of cancer, he approached the National Cancer Registry seeking more defined or sensitive data in the area. A special study into the matter has been initiated by Dr. Kelleher and his team.
With regard to the mortality study in the Askeaton area, the findings, which are exclusive of accidents and suicides, tell us that Askeaton and Rathkeale have favourable mortality rates generally when compared to the Mid-Western Health Board region. We can also look at adolescent health, child absenteeism and a variety of other possible indicators.
We attempted to carry out a hospital study based on hospital inpatient inquiry data and the patient administration system. Unfortunately, data was not accessible in the form required to carry out a proper and full analysis. However, our overall conclusions in the human health report - Dr. Kelleher can elaborate on them - tell us that, from 12 separate studies by the investigating team over a two year period, there is no evidence to support any link to any form of local environmental pollution.
The team did not find a significant degree of excessive ill health in the Askeaton area. However, it appears that in a small number of families there was an excess of self-reported mild ill health in the Askeaton area which did not, subsequently, lead to GP visits or involvement with the health services generally. This is an overview of the investigation and its results.
Chairman, you asked a question on consultancy costs. Consultancy comes to something like £200,000. That tells us that there is no scientific evidence to link any issues or concerns around environmental health with any adverse effects in human health in that area.
