Implications for Public Policy, Environmental
Justice, and Public Health Education
-By Mark Mitchell M.D., MPH
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Minamata Treaty Goal
Why is Mercury Exposure a Problem?
Minamata Treaty Requirements
Sources of Mercury in the U.S.
Why Focus on Mercury Products?
Exposures in Vulnerable Populations
Policies Needed to Reduce Mercury
Exposure
Objective:
“…to protect the
human health and the
environmental from
anthropogenic emissions
and releases of mercury
and mercury
compounds.”
Mercury Treaty
Negotiations
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Mercury is an element
◦ Cannot be created or destroyed by humans
◦ Can change in form to become more or less
 Toxic
 Biologically available
Mercury is persistent,
bioaccumulative and toxic
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Fish consumption is largest source
◦ Fish consumption advisories in all 50 states
◦ Mercury in commercial fish varies considerably
◦ High mercury commercial fish:
 Swordfish
 King Mackerel (not canned, Atlantic,
or Pacific Mackerel)
 Shark
 Tilefish
 Tuna (especially albacore [white] tuna)
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Mercury amalgam tooth fillings
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Some medications and multi-dose vaccines
◦ Have not been shown to cause direct harm in adults
◦ Particularly eye, ear, and nose antibiotics
◦ Have not been shown to cause direct harm to humans
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To protect public health we must reverse the
bioaccumulation in fish
To reverse bioaccumulation of mercury in fish, we
must eliminate as much mercury released into air
and water as possible on a global scale
The Minamata Convention on
Mercury attempts to do this
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Reduce or eliminate mercury from artisanal and
small-scale gold mining.
Control mercury air emissions from
◦ coal-fired power plants,
◦ coal-fired industrial boilers,
◦ certain non-ferrous metals
production operations,
◦ waste incineration and
◦ cement production.
Phase out or reduce mercury
in manufacturing processes
◦ chlor-alkali production,
◦ vinyl chloride monomer production, and
◦ acetaldehyde production.
Source: www.epa.gov/mercury
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Phase-out or reduce mercury use in mercury
containing products
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batteries, switches, lights,
cosmetics,
pesticides and
measuring devices,
reduce the use of (phase down) mercury in dental
amalgam
In addition, the Convention addresses the supply
and trade of mercury; safer storage and disposal,
and strategies to address contaminated sites.
(tons)*
Intentional Use in
Products
Combustion of Coal
and
Other Fuels
Mining (mercury in ore)
Other
Total
Releases to
Air
Releases to
Water
Releases to
Land
41
0.8
106
60
15
10
0.2
45
0.1
33
2585
2
126
46.1
2726
* Source: Cain, et al, Substance Flow Analysis of Mercury Intentionally Used in Products in the
United States.
Journal of Industrial Ecology 2007 Vol: 11(3):61-75. DOI: 10.1162/jiec.2007.1214
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Mercury in products is (arguable) easiest
source to eliminate in the U.S.
Mercury in non-dental products has dropped
97% since 1980 (Source: EPA Strategy to Address Mercury Containing
Products, Sept. 2014)
120
Dental Amalgam
100
Flourescent Lamps
80
HID and Other Lamps
Bulk Liquid Mercury
60
Switches and Relays
40
Measurment and Control Devices
20
Batteries
Paint
0
1990
2000
2005
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Use of mercury in dentistry is
declining more slowly than in
other products in U.S.
There are safe substitutes
Even though only about 48-68%
of dentists in the U.S. use dental
amalgam,[1] dental amalgam
still represents one of the
leading uses of mercury in the
United States at about 18 to 30
tons annually (35 to 57% of use
in products).[2][3]
Many other countries have
virtually eliminated dental
amalgam
Eleven Low Amalgam
Countries
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Pregnant women and developing fetus
Women who might become pregnant
Nursing mothers
Young children
Subsistence fishers who fish from local waters
People who engage in cultural practices using
azogue
Those who eat more than one or two tuna meals
per week
Those from developing countries who live near
mining or mercury storage or disposal sites
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People of Color are more likely to have high mercury
levels (Source: Schober, S et al: JAMA. 2003;289(13):1667-1674)
◦ From subsistence fishing or eating more local fish
◦ From eating more canned tuna
◦ From cultural practices using azogue
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Low Income people get amalgam fillings placed more
often
◦ Amalgam is more likely to be used for American Indians,
Alaska Native, Asians, and Pacific Islander patients while
composite is more likely to be used in other patients.[4]
◦ Medicaid often only covers cost of amalgam fillings
◦ Patients often are not given a choice of fillings
◦ Dental students are often required to place amalgam
fillings in dental clinics
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INCREASE fish consumption in pregnant women and
children while REDUCING canned tuna and other
higher mercury fish
Eliminate added mercury from products, as much as
possible
Increase public awareness of
mercury in foods and products,
and the availability of low mercury
alternatives
Research alternatives to
mercury in products where no
good alternative currently exists
Modify insurance to cover
non-mercury dental products
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[1]Haj-Ali R, Walker MP, Williams K., Survey of general dentists regarding posterior
restorations, selection criteria, and associated clinical problems, Gen Dent. 2005
Sep-Oct;53(5):369-75 (“A total of 714 dentists (26.3%) responded. Direct
composite was the material used most commonly for posterior intracoronal
restorations. Dentists in amalgam-free practices (31.6%) were significantly more
likely (p = 0.001) to use direct composite than dentists whose practices used
amalgam.”); U.S. EPA, Health services industry detailed study (August 2008),
http://water.epa.gov/scitech/wastetech/guide/304m/upload/2008_09_08_guide_
304m_2008_hsi-dental-200809.pdf, p.3-1 (“The survey found that 52 percent of
dentists do not place amalgam fillings”).
[2] U.S. Geological Survey, Changing Patterns in the Use, Recycling, and Material
Substitution of Mercury in the United States(2013), p.26 (“Dental amalgam
represents one of the leading uses of mercury in the United States at about 18 to
30 t annually and constitutes the largest amount of mercury in use in the United
States.”)
[3]U.S. Geological Survey, Changing Patterns in the Use, Recycling, and Material
Substitution of Mercury in the United
States(2013), http://pubs.usgs.gov/sir/2013/5137/pdf/sir2013-5137.pdf , p.1
[4] Sonia K. Makhija, Valeria V. Gordan, Gregg H. Gilbert, Mark S. Litaker, D. Brad
Rindal, Daniel J. Pihlstrom and Vibeke Qvist,Practitioner, patient and carious lesion
characteristics associated with type ofrestorative material : Findings from The
Dental Practice-Based Research Network, J AM DENT ASSOC2011;142;622-632,
http://jada.ada.org/content/142/6/622.long
Questions?
mmitchell@enviro-md.com