Puerto Rico’s Invisible Health Crisis

Puerto Rico Vieques

Many thanks to Peter Jordens for bringing this item to our attention. In “Puerto Rico’s Invisible Health Crisis,” Valeria Pelet (The Atlantic, 3 September 2016) poses an important question: “The island of Vieques has some of the highest sickness rates in the Caribbean. Is the U.S. Navy responsible?” This is a must read; here are excerpts and links to The Atlantic. [AP Photo above: Fire burns a pile of military vehicle parts and disabled and non-live artillery and mortar shells on what was once the former U.S. Naval training range on Vieques Island off Puerto Rico, Saturday, May 4, 2013. For decades, warships and planes hammered the facility before it was closed in 2003, leaving behind thousands of unexploded bombs, rockets, and other munitions which are now being painstakingly cleared. The clean-up is expected to take another decade.]

For over 60 years, the U.S. Navy used the small island of Vieques, Puerto Rico, as a bombing range and site for military-training exercises. Then the island got sick. Thousands of residents have alleged that the military’s activities caused illnesses. With a population around 9,000, Vieques is home to some of the highest sickness rates in the Caribbean. According to Cruz María Nazario, an epidemiologist at the University of Puerto Rico’s Graduate School of Public Health, people who live in Vieques are eight times more likely to die of cardiovascular disease and seven times more likely to die of diabetes than others in Puerto Rico, where the prevalence of those diseases rivals U.S. rates. Cancer rates on the island are higher than those in any other Puerto Rican municipality.

The Navy eventually conceded to using heavy metals and toxic chemicals like depleted uranium and Agent Orange on the island, but denied any link between their presence and the health conditions of the people who live there. To this day, it is unclear what exactly caused the current conditions in Vieques. It’s a health crisis with a cause that’s almost impossible to prove: The government requires a particular standard of causal evidence before it will administer relief. Yet independent groups cannot necessarily provide that proof because the federal government still owns the land previously occupied by the military and controls access to it.

Conflicting studies by local scientists and the U.S. government have offered different explanations for Vieques’s sickness. Until 1997, data on the matter was scarce. That year, Nazario and a nonprofit civic organization noticed a high incidence of cancer cases in Vieques and filed a public grievance against the Department of Health. Soon after, the agency published a study showing that the prevalence of cancer in Vieques was 27 percent higher than in the rest of Puerto Rico. “For the first time, the excess of cancer in Vieques was acknowledged,” said Jorge Colón, a chemistry professor at the University of Puerto Rico known for his work advising several grassroots organizations in Vieques. The study recommended that the Department of Health carry out a public-health assessment of environmental conditions on the island.

The report went essentially unrecognized until waves of protests pressured the Clinton and Bush administrations to withdraw military presence from the island. While the Navy left Vieques from 2001 to 2003, the federal Agency for Toxic Substances and Disease Registry, or ATSDR, released reports that found no causal link between the high rates of sickness and decades of weapons use on the island. The government sought proof of cause as its evidentiary standard. In their evaluations, the ATSDR looked at four “exposure pathways”—air, seafood, soil, and water—and found them to have “no apparent public-health hazard.”

Nazario and other local scientists questioned these findings. In particular, she criticized the agency for not conducting any direct epidemiological studies on Vieques’s population, relying on soil samples collected by the U.S. Navy, and barring scientists from conducting independent research. This sentiment was shared beyond the borders of Puerto Rico. At a congressional hearing in May 2010, the Yale University environmental-health professor John Wargo said the agency’s public-health assessments “contain serious flaws in scientific methods” and added that, in Vieques, ATSDR found that an “absence of evidence of contamination is sufficient to conclude the absence of significant health threat.” In other words, he argued, the federal agency used a lack of evidence—also known as negative data—to support its hypothesis.

Congress also condemned the agency for failing to protect public health. In 2009, it issued a report, saying, “In many instances, ATSDR seems to represent a clear and present danger to the public’s health rather than a strong advocate and sound scientific body that endeavors to protect it.” The former director of ATSDR, Howard Frumkin, recognized the agency’s “need for ongoing performance evaluation and constant improvement.”

ATSDR declined to respond to any particular scientist’s critiques, including the allegations of Nazario and Wargo. In an email, a representative of the agency explained that it “listened to [scientists’] concerns about Vieques” over a two-day meeting at an unspecified date. It additionally sent its 2013 report to six peer reviewers who “generally or overall” agreed with ATSDR’s conclusions and recommendations. The agency could not divulge their names, “consistent with the typical practice of peer-review journals to maintain the integrity of the peer-review process.” The agency has not redone or corrected any of its previous research.

Since the government still oversees the former military base on Vieques, some scientists have resorted to deductive logic to provide possible explanations for the state of health on the island. Colón noted that neither he nor his colleagues have been able to identify an alternate source of pollution there. “The logical reasoning for all of us scientists was that if there was no other possible source of contamination in Vieques outside of the Navy’s military practices, the excess of deaths or incidence of cancer in Vieques came from the military practices,” he said.

Arturo Massol Deyá, a professor of microbiology and ecology at the University of Puerto Rico at at Mayagüez, has spent 17 years conducting research on Vieques—the only independent scientist to do so. Through his research, Massol Deyá has analyzed vegetation, forage samples, crabs, lagoons, and other food sources on Vieques, finding high concentrations of heavy metals throughout the island.

In one of his most recent studies, Massol Deyá discovered that lead levels in manatee grass—the most abundant plant in affected areas of Vieques—were severely toxic in 2001, when the Navy began downscaling its operations on the island, but had returned to levels found in other Puerto Rican beaches by 2015. Nevertheless, he noticed a sustained increase of lead in the region’s plants, indicating the ecological impoverishment of the area.

Back on the island, residents have virtually no access to health services. There is one hospital on Vieques, which has one emergency room, no pharmacy, and one birthing room with spotty air conditioning. Myrna Pagán, a cancer survivor from Vieques, said there are a handful of primary doctors on the island, but no specialists who can treat the growing number of patients undergoing dialysis. To receive chemotherapy, cancer patients have to travel to San Juan—an 80-mile trip over sea and land. The small, comparatively sparsely populated island is simply not equipped to keep up with the increased demand for specialized medical service. [. . .]

For full article, see http://www.theatlantic.com/politics/archive/2016/09/vieques-invisible-health-crisis/498428


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