Abstract
Cumulative risk assessment (CRA) has been proposed as a means of evaluating possible additive and synergistic effects of multiple chemical, physical and social stressors on human health, with the goal of informing policy and decision-making, and protecting public health. Routine application of CRA to environmental regulatory and policy decision making, however, has been limited due to a perceived lack of appropriate quantitative approaches for assessing combined effects of chemical and nonchemical exposures. Seven research projects, which represented a variety of disciplines, including population health science, laboratory science, social sciences, geography, statistics and mathematics, were funded by the US Environmental Protection Agency (EPA) to help address this knowledge gap. We synthesize key insights from these unique studies to determine the implications for CRA practice and priorities for further research. Our analyses of these seven projects demonstrate that the necessary analytical methods to support CRA are available but are ultimately context-dependent. These projects collectively provided advancements for CRA in the areas of community engagement, characterization of exposures to nonchemical stressors, and assessment of health effects associated with joint exposures to chemical and psychosocial stressors.
Highlights
Many low income and minority populations and communities face disproportionate burdens from multiple, often co-occurring, environmental hazards, in conjunction with elevated exposures to social inequities and psychosocial stressors
While Environmental Protection Agency (EPA) has put forward several Cumulative risk assessment (CRA) framework guidance documents, stakeholders and independent advisory bodies continue to provide strategies for EPA to improve risk assessment and risk management practices to better account for multi-stressor exposures that cumulatively impact community and population health [10,11,12,13,14]
Findings from the Rochester studies to date indicate that combined exposures to metals and stressors that share biological substrates and that produce common adverse effects can produce enhanced toxicity, or unmask effects of chemical exposures, providing support for the hypothesis of biological interactions consistent with cumulative risk (Figure 1)
Summary
Many low income and minority populations and communities face disproportionate burdens from multiple, often co-occurring, environmental hazards, in conjunction with elevated exposures to social inequities and psychosocial stressors (e.g., financial strain, housing instability, discrimination, community violence). Cumulative risk assessment (CRA) has been proposed as a means of evaluating possible additive and synergistic effects of multiple chemical, physical and social stressors on human health, with the goal of informing policy and decision-making, and protecting public health. While EPA has put forward several CRA framework guidance documents, stakeholders and independent advisory bodies (e.g., the National Academy of Sciences, the National Environmental Justice Advisory Council) continue to provide strategies for EPA to improve risk assessment and risk management practices to better account for multi-stressor exposures that cumulatively impact community and population health [10,11,12,13,14]. The National Research Council’s Committee on Improving Risk Analysis Approaches used by EPA proposed that CRA be defined as evaluating an array of stressors (chemical and nonchemical) to characterize quantitatively—to the extent possible—human health or ecological effects, accounting for population vulnerability and background exposures [13]. The approach to CRA far tends to build upon the longstanding four-step framework for conducting single chemical risk assessment: hazard identification, dose-response assessment, exposure assessment, and risk characterization [15]
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