Dioxins - Health support programme

Dioxins

Ministry of Health's involvement

Serum dioxin study in Paritutu

Organochlorines Technical Advisory Group

Breastmilk survey

Other agencies involved

The toxic effects of dioxin

Toxicology of dioxin

Advice to medical practitioners

Health Support Service

Using the Health Support Service

Questions and answers

Dioxins
Health Support Service for Dioxin Exposed People

The Ministry of Health has commissioned Allen & Clarke to undertake the design of, and consultation on, a health support service for people exposed to dioxins.

Using the Health Support Service

A support service is now available. For more information see:

Using the Health Support Service for Dioxin Exposed People

To learn more about the support service, refer to the information below.

News and updates

1 July 2008: Support Service for Dioxin Exposed People now available
On 1 July 2008 the Ministry of Health launched a new health service for people who were exposed to dioxin from the former Ivon Watkins Dow (IWD) factory in Paritutu, New Plymouth.

29 April 2008: Health support service for people exposed to dioxin
The Ministry of Health will implement a prevention-focused health support service for people exposed to dioxin from the former Ivon Watkins Dow (IWD) agrichemicals plant in Paritutu, New Plymouth. This service will be available from 1 July 2008.

More information including questions and answers on eligibility and how to apply, and responses from the Ministry of Health to questions raised in public meetings is provided below:

9 October 2007: Summary of submissions released
Allen & Clarke have now released a summary of submissions and their preliminary thinking on which they will base their recommendations to the Ministry of Health.

The public are invited to give their views to Allen and Clarke until the end of October 2007, to ensure that their preliminary thinking is heading in the right direction. Allen & Clarke's recommendations are expected to be provided to the Ministry of Health early in 2008. The summary of submissions and preliminary thinking on health support services is published on the Allen & Clarke website (www.allenandclarke.co.nz).

Background
Between 1962 and 1987 Ivon Watkins-Dow (IWD) manufactured the herbicide 2,4,5-T at its chemical plant in Paritutu, New Plymouth. During the manufacture of 2,4,5-T, the dioxin TCDD is formed and remains as a contaminant in the herbicide. Residents of Paritutu were concerned about exposure to dioxin from the IWD plant.

In 2001 the Ministry of Health contracted the Institute of Environmental Science and Research (ESR) to investigate dioxin exposure among Paritutu residents living in the area during the time 2,4,5-T was made.

Phase I of the study, which involved extensive consultation with the Paritutu community, was completed in 2003 and resulted in an accepted study design. The initial phase was followed by a serum dioxin study, with the final report released in 2005, which showed that some Paritutu residents had blood serum levels of TCDD significantly above those of the general New Zealand population. How long people had lived there was a key factor, with those residing in the area for 15 or more years showing a significant increase in dioxin levels. The Ministry of Health concluded that the dioxin levels found may have health consequences for individuals and may cause increased rates of disease, in particular cancer, on a population basis. The extent of the increased cancer risk is difficult to precisely estimate, but is estimated that it may be up to 10% above the national cancer mortality rate for Paritutu residents who lived for at least 15 years within 400m south and 1km east of the plant between 1962 and 1987.

TCDD is thought to be a cancer promoter rather than an initiator. This means that it is unlikely that dioxin directly causes cancer, but it may have a significant impact on the growth of cancers that develop in people with elevated blood dioxin levels. For this reason, an ongoing preventive approach is important in reducing the risk of increased illness among exposed people.

At the time of the release of the serum survey results, the Ministry of Health undertook to address health needs for those residentially exposed to dioxin at Paritutu. The Ministry’s suggested option to address community concerns and health needs involves a programme, focused on primary care services, based around the following elements:

A health support service for people likely to have been exposed while living in Paritutu between 1962 and 1987, who may have been significantly exposed to dioxin from the IWD plant; and
Ongoing health information and technical support for clinicians and other health professionals dealing with those people who may have been exposed to dioxin at Paritutu between 1962 and 1987.

The Ministry needs to closely examine its proposed option, to ensure that it is practical, meets the needs of exposed people, and represents the most effective approach.

The Terms of Reference for the project to develop a framework for a health programme are provided below.

Terms of Reference
Allen & Clarke Policy and Regulatory Specialists Limited is the provider selected for this project. Allen & Clarke will develop and consult on options for a health support service for residents and former residents who may have been significantly exposed to dioxin from the Ivon Watkins Dow plant in New Plymouth between 1962 and 1987, and on the provision of health information and advice to medical practitioners and other health professionals supporting exposed persons.

Allen & Clarke will consider eligibility criteria for the inclusion of people likely to have been exposed while living in Paritutu between 1962 and 1987 in the health support service, and will also consider whether eligibility for access to such services should be extended to include other exposed groups (for example, occupationally-exposed people).

Assumptions:
Allen & Clarke will work from the basis that:

Paritutu residents who lived for at least 15 years within 400m south and 1km east of the IWD plant in Paritutu between 1962 and 1987 (“the exposed group”) were exposed to TCDD at levels significantly above those of the general New Zealand population;
The dioxin levels found among individuals in the exposed group indicate that there may be health consequences for individuals or there may be increased rates of disease, in particular cancer, on a population basis. The extent of the increased cancer risk is difficult to precisely estimate, but it may be up to 10% above the national cancer mortality rate;
Based on the above, the Ministry of Health has made a decision to develop a health support programme, based on early intervention, for at least the exposed group outlined above;
The health support service would include the following aspects / emphasis:
- Emphasis on a preventive approach to address the potential cancer promoter characteristics of dioxin
- Focusing on those who do not have an established diagnosis of a condition and supporting those who have conditions associated with exposure to dioxins
- Providing education and health service initiatives that aim to reduce the incidence of illnesses that may be related to dioxin exposure.

Scope of the project
Allen & Clarke will review literature and documentation, obtain advice from experts, and consult with key stakeholders and the community over:

The composition of the exposed group;
Conditions exposed groups have an elevated risk for;
The health service needs of the exposed group, based on conditions for which there is a demonstrated risk of increased incidence as a result of significant dioxin exposure;
Interventions likely to be effective in addressing the health risks and health needs of the exposed group;
The identification of possible health service models, including service delivery options,
Criteria to determine who would have access to those services;
The identification of the demand for, and cost of, a health support service;
The identification of a monitoring framework for assessing the ongoing effectiveness and acceptability of a health support service that is provided;
The development of a framework for the provision of ongoing health information and technical support to clinicians and other health professionals who provide services as part of a health support service.

Allen & Clarke have been contracted by the Ministry and will report to the Ministry on its findings. Allen & Clarke will engage directly with the community and will report its findings to the community at the completion of the project.

Allen & Clarke will not be involved in other aspects of research into dioxin exposure or responses to this exposure. Any queries over other matters regarding dioxin or other chemical exposures beyond the scope of this project will be directed to the Ministry of Health.

Methodology
Allen & Clarke will use a two-phased methodology. Elements of the project will run concurrently. The project components will be closely interlinked to provide a comprehensive, evidence-based set of recommendations on the provision of both a health support service and ongoing health information and advice for health professionals. The high level of concern and uncertainty within sections of the community is a critical factor that the provider will consider throughout the project.

Phase 1 (March to May 2007): assessment of evidence and consideration of option(s) for an early intervention programme will involve three components:

Contextual research on dioxin exposure, early intervention programmes and the role of ongoing health information and advice for health professionals;
Definition of the exposure groups;
Development and analysis of options for a health support service.

Phase 2 (June 2007 to July 2008): scoping implementation of an early intervention programme:

Development of guidelines, recommendations, and specifications for a health support service;
Development of a programme for ongoing health information and advice for clinicians and other health professionals involved in service delivery;
Consultation with the community, Government agencies, relevant organisations (including industry) and other stakeholders on the proposed health support service (as scoped out in early stages);
Identification of the resourcing and implementation implications of the health support service;
Development of a monitoring and evaluation framework for the proposed option;
Development of a final report and implementation plan, with recommendations on the design of the health support service and ongoing information and support for health professionals providing the service;
Reporting of findings to the Ministry of Health and the community.

Reports

Health Support Services for Groups Exposed to Dioxin

Phase 1: Assessment of evidence and options, interim report
This report, by Allen & Clarke Policy and Regulatory Specialists Ltd, comprises the key output of Phase 1 of a project to identify possible health support services for people who lived in Paritutu between 1962 and 1987, and other groups, who may have been exposed to higher levels of dioxin than other New Zealanders. The results of this report will inform work undertaken in Phase 2 of the project (June – October 2007).

Phase 1: Assessment of evidence and options, interim report (Word, 1 MB)
Phase 1: Assessment of evidence and options, interim report (PDF, 647 KB)

Consultation

Discussion document
The purpose of this document by Allen & Clarke Policy and Regulatory Specialists Ltd, is to set out a range of possible health support services, and to seek your views on these.

Health support services for people exposed to dioxin - Discussion document (Word, 154 KB)
Health support services for people exposed to dioxin - Discussion document (PDF, 92 KB)

Questions and answers
Frequently asked questions concerning dioxins, possible health effects, the serum dioxin study in Paritutu and other studies are located on the general questions about dioxins page.

Why was this work being undertaken?
A 2005 serum dioxin study concluded that a group of people who lived for at last 15 years within 400m and 1km east of the Ivon Watkins-Dow (IWD) plant in Paritutu, between 1962 and 1987, were more likely to have significantly higher dioxin levels than other New Zealanders. At that time the Ministry of Health noted that it was possible that the dioxin levels found may have health consequences for individuals and there may be a small impact on cancer mortality rates for this group of people. A health support service is being developed to address the health needs of exposed residents. This initial work is to develop and consult on options for a health support service.
Who undertook the scoping of, and consulting on, the programme?
Allen & Clarke Policy and Regulatory Specialists Limited is a well-established, Wellington-based company with specialist policy development, legal, machinery of government, and research expertise. The company has 16 permanent staff, and numerous associates on call to provide additional policy, technical and administrative support as required. Allen & Clarke works in New Zealand and internationally to support the work of public sector and local government organisations formulating and implementing policy initiatives and regulatory instruments. Further information on Allen & Clarke is available at www.allenandclarke.co.nz
Why did they develop the framework for this programme?
The Ministry of Health decided to out-source the scoping of, and consultation on, the proposed programme to an external provider so that the development work could be undertaken immediately. The project was put out to tender in September 2006 and Allen and Clarke were appointed in March 2007.
What expertise does Allen & Clarke have on this issue?
Allen & Clarke has a track record of undertaking objective and rigorous reviews of this nature, both for the Ministry of Health and other public service agencies. They have considerable public health policy and programme expertise and experience, and the ability to buy-in other specialist expertise on this project as required, such as the services of an epidemiologist. Examples of Allen & Clarke’s work can be found at www.allenandclarke.com
Was this an independent review and, if so, then why Allen & Clarke?
This project was not an independent review. Allen & Clarke undertook the project on behalf of the Ministry of Health. The Ministry set clear terms of reference for the project. Allen & Clarke reported all findings to the Ministry. It also engaged directly with, consulted, and reported back their findings to the community.
Was Dow AgroSciences involved in this project?
No. Allen & Clarke consulted with key industry stakeholders, including Dow AgroSciences, on the development of a health support service.
What other provisions currently exist for former Ivon Watkins-Dow workers?
Former IWD workers affected by workplace exposure to dioxin may be eligible for compensation through ACC. A process that will “fast-track” applications from workers who advise they may have been exposed to dioxins from the IWD plant in Paritutu has been put in place to ensure cover is considered as quickly as possible.

The New Plymouth office of the Department of Labour has staff and an occupational physician dedicated to help former IWD workers concerned about historical workplace exposure to dioxins, and they will help by providing information about dioxin and its possible workplace effects, and referring them to ACC or a local health service provider if required. Alternatively, former workers can contact ACC directly on free phone 0800 101 996.
What provisions currently exist for Vietnam Veterans?
New Zealand service personnel in Vietnam were exposed to a toxic environment (including Agent Orange and a number of other herbicides). Vietnam Veterans and their families continue to be affected by this historic exposure.

In 2006 the Government agreed a package of measures to address the health and wellbeing needs of Veterans and, where appropriate, their immediate families. The package includes: ongoing research into intergenerational effects of dioxins; a Veterans Card issued to Veterans and their children and grandchildren to allow easy identification by medical practitioners; a national register of Veterans, their children and grandchildren; provision of information to assist treatment and diagnosis and centres of excellence on Veteran's conditions; and a one-off comprehensive medical examination for Veteran’s by a registered practitioner and/or a specialist.

The package of measures also includes a range of one-off ex gratia payments to Veterans with a prescribed condition, partners/spouses of Veterans who died of a prescribed condition, children of Veterans suffering from an accepted condition and families of Veteran’s children who died of an accepted condition. The prescribed conditions are those on the US Institute of Medicine's “sufficient evidence of association with exposure to Agent Orange" list: chronic lymphocytic leukaemia, soft tissue sarcoma, non-Hodgkin's lymphoma, Hodgkin's disease, and chloracne. The accepted conditions suffered by Veteran’s children are: spina bifida, cleft lip, cleft palate, acute myeloid leukaemia, adrenal gland cancer. Further details of the provisions are at www.vietnamvetswg.govt.nz

Contacts and further information
For further information on this project, please either email the Ministry of Health at emailmoh@moh.govt.nz, or the project team at Allen & Clarke Policy and Regulatory Specialists Limited (nhardie-boys@allenandclarke.co.nz)

For information on Allen & Clarke please visit their website www.allenandclarke.co.nz

Page last updated: 14 May 2008