UNDP GEF Project on Global Healthcare Waste
INSTRUCTOR GUIDE
MODULE 19: RATIONALE FOR MERCURY-FREE HEALTHCARE
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UNDP GEF Project on Global Healthcare Waste
MODULE 19: RATIONALE FOR MERCURY-FREE HEALTHCARE
Estimated Time
Module Overview
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Learning Objectives
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Target Audience
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Lecture: 45 minutes
Present the chemical and physical properties of mercury
Describe the health effects of different forms of mercury from acute and chronic
exposures
Describe the health effects of mercury on children from pre-natal exposures
Present the sources of mercury in the environment
Introduce the WHO policy on mercury and the international campaign for mercuryfree health care
Understand key properties of mercury including how mercury cycles in the
environment
Describe the health effects of mercury from acute and chronic exposures, as well as
from pre-natal exposure
Describe the contribution of the health sector to global mercury emissions
Explain the WHO policy on mercury
Understand the benefit of mercury-free health care
Administrative Personnel
HCWM Coordinators
Facility Managers
Healthcare professionals
Other management staff
Facility engineers and other staff involved in the repair, clean-up and storage of
mercury devices
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Instructor Preparation
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Materials Needed
Student Preparation
Review Questions
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Make notes pages of PowerPoint slides to hand out to class
There are no directly associated Blue Book chapters for this module, but you may
want to look through the other materials included in the References and notes.
Make copies of any additional documents/readings that may be handed out to class,
such as those included in the References
If possible, download a copy of the Bowling Green State University: Mercury Vapor
Experiment video at http://wbgustream.bgsu.edu/bgsu/epa/index-fl.html
and prepare to show portions of the video in place of Slide 6
Prepare any additional notes to be discussed during the presentation
Prepare any additional discussion points or review questions
Projector
Student handouts: slides, exercise, homework
Flip chart and marker pens and/or board and chalk
Read any articles provided by the instructor.
How might a mercury spill affect patients, health providers and waste workers?
What happens to mercury when it is released into the environment?
How can mercury in the environment affect the community?
Is your healthcare facility mercury-free?
Does your healthcare facility have plans that follow the WHO policy on mercury?
What are your country specific regulations for mercury?
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PRESENTATION
Slide Number/Title
Teacher’s Notes
Slide 1: Title Slide
Note: there are some very detailed notes pertaining to many of the slides in this presentation.
You may choose to summarize the information that has been included. There are advanced
additional notes included for certain slides.
Slide 2: Module Overview
Introduce the outline and major points of the presentation
Slide 3: Learning Objectives
Describe what participants will learn at the end of this module.
Slide 4: Properties of Mercury In the next slides, we will look at the properties of mercury, beginning with its chemical forms.
We will also describe its volatility, its persistence in the environment, its bioaccumulative
properties, and its toxicity.
Slide 5: Chemical Forms of
Mercury
Mercury exists in different shapes and colors. Mercury has three basic chemical forms:
elemental mercury as shown by the drop of liquid metal, inorganic mercury compounds (such
as the white powder mercuric chloride and the red ore cinnabar), and organic mercury
compounds (such as methyl mercury, Thimerosal – an organic mercury-based preservative
whose chemical structure is shown on the bottom – and mercurochrome or merbromin, a red
tincture once used as an antiseptic.
Slide 6: Volatilization of
Mercury
Mercury has the highest volatility of all metals. Mercury droplets quickly vaporize at room
temperature. The photo on the left shows a carpet with a few droplets of mercury from a
broken thermometer. If you look closely, you can see some of the droplets on the carpet.
Although mercury vapors cannot be seen by the naked eye, it is possible to see mercury
vapors using a short-wave ultraviolet light source (black light) and a fluorescent background.
The photo on the right shows the rising fumes of mercury vapor as seen under ultraviolet
light.
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Photos from a video experiment by Bowling Green State University, Ohio EPA, and Rader
Environmental Services.
Downloading and showing the video by Bowling Green State University is recommended.
http://wbgustream.bgsu.edu/bgsu/epa/index-fl.html
Slide 7: Persistence of
Mercury in the Environment
Mercury persists in the environment through the mercury cycle. The cycle begins when
mercury vapor is emitted into the air from human activity (such as incineration or breaking a
thermometer) and from natural sources such as degassing from rocks, soils, bodies of waters
or volcanoes. Mercury then circulates in the atmosphere for between 3 months to 1-1/2 years.
Eventually, mercury is deposited down into the ground or water by rain or snow or as
mercury particles falling out of the atmosphere. In the water or in some soils, mercury is
converted into insoluble forms which settle in the sediment. The mercury compounds are then
converted by bacteria into an organic form which enters the food chain. Mercury is eliminated
from organisms back into the environment or remains in the organism until it dies and
decomposes. Eventually, mercury and its volatile forms in the soil and water are re-emitted
back into the atmosphere to continue the mercury cycle.
Slide 8: Bio-magnification of
Mercury
What is bio-magnification?
When mercury falls in rain or snow, or when it falls out of the air as dry deposition, it may
eventually be washed into waterbodies by rain. Bacteria in soils and sediments convert
mercury to methylmercury. In this form, it is taken up by tiny aquatic plants and animals. Fish
that eat these organisms build up methylmercury in their bodies. As ever-bigger fish eat
smaller ones, the methylmercury is concentrated further up the food chain and bioaccmulates
in the larger species.
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Slide 9: Health Effects of
Mercury (Hg)
All forms of mercury are toxic at varying degrees, but the health effects depend on the form of
mercury (whether it is elemental, inorganic, or organic), and the type of exposure (whether it
is acute, meaning a short-duration exposure such as a few hours usually at high
concentrations, or chronic, meaning long-duration such as exposures for months or years
usually at very low concentrations). The health effects also depend on the route of exposure
(whether the mercury is inhaled, ingested, or absorbed through the skin), and the dose or the
amount of mercury.
Acute exposure to high levels of elemental mercury in humans results in effects on the central
nervous system such as tremors, slowed nerve functions or memory loss. Acute exposure of
high concentrations of mercury through inhalation can result in kidney failure. Respiratory
effects, such as chest pains, shortness of breath, and pulmonary function impairment have also
been reported. Acute exposure to inorganic mercury by ingestion may result in nausea,
vomiting, and severe abdominal pain. The major effect from chronic exposure to inorganic
mercury is kidney damage.
ADDITIONAL NOTES:
Acute inhalation exposure of humans to high concentrations has resulted in kidney effects
ranging from mild transient proteinuria to acute renal failure. Gastrointestinal effects and
respiratory effects, such as chest pains, dyspnea, cough, pulmonary function impairment, and
interstitial pneumonitis have also been noted from human inhalation exposure to elemental
mercury.
Slide 10: Chronic Exposure to
Elemental Hg
Chronic exposure to elemental mercury in humans affects the central nervous system in what
has been called the Mad Hatter syndrome. In Lewis Carroll's famous book Alice's Adventures in
Wonderland, the Mad Hatter is a fictional character who appeared to be crazy. Hatters, that is,
people who made hats, used mercury to treat fabric before drying and stretching it to make
felt hats. The mercury vapors poisoned the hatters, causing severe neurological damage. It
was not unusual for hatters to appear mentally disturbed or confused. Other symptoms
included erethism (abnormal irritability), tremors, and gingivitis (inflammation of the gums),
as well as kidney disease. These are the chronic symptoms of exposure to elemental mercury.
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Slide 11: Chronic Exposure to
Elemental and Inorganic
Mercury
Another disease caused by chronic exposure to either elemental or inorganic mercury is a rare
syndrome called acrodynia, or “Pink disease.” It’s an allergic reaction that occurs in some
children exposed to mercury compounds. Its symptoms include severe leg cramps, rashes,
fever, and a painful peeling of hands and feet which turn pink.
Slide 12: Health Effects of
Organic Forms of Hg
The health effects of chronic exposure to organic mercury are different from effects related to
elemental or inorganic mercury. Methylmercury is the form of mercury most easily absorbed
through the gastrointestinal tract (about 95% is absorbed). Methylmercury is absorbed about
six times more easily than inorganic mercury, and can migrate across the blood-brain and
placental barriers, allowing it to affect brain and fetal cells.
Slide 13: Health Effects of
Organic Forms of Hg
The most famous example of chronic exposure to methyl mercury happened in Minamata,
Japan—a small town consisting mostly of farmers and fishermen and dominated by the
chemical company Chisso. From 1932 to 1968, Chisso dumped an estimated 27 tons of
mercury waste into Minamata Bay (as shown in the photo), with most of the mercury released
after 1951. By the mid-50s, people started noticing a strange disease that affected cats, dogs,
pigs, birds and people. That illness became known as the "Minamata Disease". It was caused
by mercury in Chisso’s wastewater, which was transformed into methyl mercury,
biomagnified in fish and shellfish, and then eaten by the local population.
ADDITIONAL NOTES:
The Chisso Corporation began as a fertilizer company, and gradually became a petrochemical
and plastics company. Accused of polluting the bay, Chisso transferred their dumping in 1958
from the bay to the Minamata River which flows past the town of Hachimon and into the
Shiranui Sea. Soon, people in this area also began developing the disease.
According to the Japanese Ministry of the Environment (in Minamata Disease The History and
Measures), 2,265 persons have been confirmed with Minamata disease in the Yatsushiro Sea
coast around Minamata Bay as of the end of March 2001.
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Slide 14: Chronic Exposure to
High Levels of Methyl
Mercury
According to the Japanese Ministry of the Environment (in Minamata Disease The History and
Measures), 2,265 persons have been confirmed with Minamata disease in the Yatsushiro Sea
coast around Minamata Bay as of the end of March 2001.
Chronic exposure to methyl mercury in humans affects the central nervous system with
symptoms such as constriction of the visual field, irregular gait, and loss of coordination. The
photo shows Yae Sato who is carrying fish home for her family. She is lame due to poisoning
by methyl mercury in Minamata. Some victims suffered brain damage which made them
resemble “living wooden dolls.”
ADDITIONAL NOTES:
Chronic exposure to methyl mercury in humans affects the central nervous system with
symptoms such as loss of speech, paresthesia (a sensation of pricking on the skin), blindness,
and malaise.
Slide 15: Photo: 16-year old
child with congenital
Minamata disease
Tomoko Uemura, shown here with her mother, is an example of a living wooden doll. After
Tomoko’s mother ingested high levels of methyl mercury during pregnancy, she was born
with severe cognitive impairment, ataxia (gross lack of coordination of muscle movement),
blindness, and cerebral palsy. Tomoko, who is 16 years old in this photo, was poisoned in the
womb and has been physically crippled since birth. Minamata disease is the result of chronic
exposure to high concentrations of methyl mercury.
Slide 16: Health Effects of
Prenatal Exposure to
Mercury:
Faroe Islands Study
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Slide 17: Results of Faroe
Island Study
This graph shows some of the results of the Faroe Islands research. The light blue-green
columns on the left represent children in the lowest mercury exposure group. The red
columns represent children in the highest mercury exposure group. The y-axis shows the
percent of children in each exposure group that scored poorly in each category. Within each
skill category, brain function impairment increases as mercury exposure increases. The
adverse effects of mercury on attention, memory, and language are significant.
ADDITIONAL NOTES:
In this study, the mercury exposure of about 1000 children was evaluated prenatally and at
the time of birth. Seven years later, impairments in attention, memory, and language were
associated with increasing prenatal mercury exposure. The analysis controlled for potential
social, economic, medical, and toxicologic confounders. The y-axis shows the percent of
children in each exposure group that scored poorly (in the lowest quartile) in each cognitive
category. The results are particularly striking for attention, where the percent of children
scoring poorly more than doubles between the lowest and highest exposure quartiles. The
effects of mercury on attention, memory, and language are all significant at the p<0.05 level.
Slide 18: Seychelles Study
Another famous study was conducted in the island nation of Seychelles in the Indian Ocean.
The inhabitants have a diet high in fish. Although the study indicated a possible adverse
association between mercury levels in the mothers’ hair during pregnancy and hand-eye
coordination in the children, the Seychelles study showed no other developmental or IQ
effects on children from the low levels of mercury their mothers were exposed to from eating
fish.
Slide 19: Follow-up to the
Seychelles Study
A few years later, the same researchers presented a follow-up study. They discovered that
when beneficial effects of long-chain polyunsaturated fatty acids, such as omega-3 fatty acids,
are taken into account, prenatal methyl mercury exposure shows an adverse effect on the
Psychomotor Developmental Index of the children at 30 months of age. Therefore, if the
beneficial effects of long-chain polyunsaturated fatty acids in fish are not considered, the
adverse effects of prenatal methyl mercury exposure can be masked.
MeHg = methyl mercury; PDI = Psychomotor Developmental Index
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Slide 20: Prenatal Methyl
Mercury Exposure and
Cognitive Development
One study quantified the impact of prenatal methyl mercury exposure on cognitive
development. The researchers looked at three major epidemiological studies to quantify the
association between prenatal methyl mercury exposure and cognitive development as
measured by the intelligence quotient (IQ). They concluded that prenatal methyl mercury
exposure that is sufficient to increase the mercury concentration in mother’s hair at child birth
by 1 microgram per gram, decreases IQ by 0.7 points.
ADDITIONAL NOTES:
This analysis aggregates results from three major prospective epidemiology studies to
quantify the association between prenatal MeHg exposure and cognitive development as
measured by intelligence quotient (IQ). This paper identifies important sources of uncertainty
influencing this estimate, concluding that the plausible range of values for this loss is 0 to 1.5
IQ points.
Slide 21: Maternal Fish
Consumption
and Risk of Preterm Delivery
Another fairly recent study indicated a higher risk of preterm delivery among women with
low to moderate exposure to mercury. Preterm delivery is the most common cause of
premature birth. In this large, community-based study, total fish consumption was associated
with increasing mercury levels in hair. The study showed that compared with women who
delivered at full term, the women with preterm deliveries, that is, women who delivered
before 35 weeks' gestation, were more likely to have higher hair mercury levels.
ADDITIONAL NOTES:
This is the first large, community-based study to examine risk of every preterm birth in
relation to mercury levels among women with low to moderate exposure. Total fish
consumption and consumption of canned fish, bought fish, and sport-caught fish were
positively associated with mercury levels in hair. The greatest fish source for mercury
exposure appeared to be canned fish. Compared with women delivering at term, women who
delivered before 35 weeks' gestation were more likely to have hair mercury levels at or above
the 90th percentile (> 0.55 µg/g) , even after adjusting for maternal characteristics and fish
consumption (adjusted odds ratio = 3.0 ; 95% confidence interval, 1.3–6.7)
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Slide 22: Summary of Health
Effects of Methyl Mercury on
Humans
This chart summarizes the health effects of methyl mercury according to the route of exposure
(inhalation, ingestion or oral exposure, and dermal contact), based on studies reviewed by the
U.S. Agency for Toxic Substances and Disease Registry in 1998. Methyl mercury has
neurologic, developmental, and genotoxic impacts, as well as systemic effects depending on
the route of exposure.
Slide 23: Mercury: Declining
Threshold of Harm
This graph displays the general trend in the apparent toxic threshold for mercury as
established at various points in time over the past three decades. Exposure to mercury is
shown on the vertical axis, and year is on the horizontal axis. The blue squares represent
prenatal mercury exposures associated with adverse neurodevelopmental outcomes. The
Faroe Islands study, for example, is represented by the second blue square from the right edge
of the graph. The red triangles represent recommended limits for human mercury exposure by
regulatory agencies. The graph shows the tendency for apparent toxic thresholds to decline
with advancing knowledge, as neurodevelopmental effects are seen at lower and lower
thresholds for mercury by using increasingly sensitive exposure and outcome measures, and
better statistical methods of analysis.
ADDITIONAL NOTES AND ADVANCED DISCUSSION:
The initial Iraqi toxic threshold is shown as the upper left-hand point on the graph. Within a
few years of this observation, it became apparent that many children exposed prenatally to
lower levels of mercury were delayed in learning to walk and talk, in spite of apparently
“normal” development in infancy. (1) Subsequently, a variety of studies on diverse
populations have established progressively lower thresholds for mercury effects by using
increasingly sensitive exposure and outcome measures, and better statistical methods of
analysis.(2-11) The Faroe islands study identified deficits in language, memory, and attention
that occur at prenatal mercury exposures under 0.85 micrograms per kilogram per day. This
exposure is less than 3% of the toxic threshold identified in the initial observations from the
Iraqi epidemic. The presence of mercury effects below this level of 0.85 micrograms/kg/day
implies that the actual threshold, if one exists, is lower.
The blue squares on the graph represent prenatal mercury exposures associated with adverse
neurodevelopmental outcomes. The red triangles represent World Health Organization
(WHO), EPA, and Agency for Toxic Substances and Disease Registry (ATSDR) recommended
limits for human mercury exposure. The standard issued by the FDA regulates the level of
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mercury in fish, rather than in people. Thus, a wide variety of exposures may occur within the
FDA regulatory limit, depending on how much and how often one eats fish, and the mercury
level of the fish consumed. The indicated exposure is that of a 60 kg woman eating at the high
end of fish consumption (100 grams/day, 95-97th percentile), eating fish contaminated at the
FDA permitted limit. In this worst-case scenario, the woman is exposed to 1.65
mg/kilogram/day, about 16.5 times EPA’s recommended safe limit. Studies of the
neurodevelopmental effects of mercury generally use hair or blood levels as markers of
exposure, since these are more accurate indicators of exposure than dietary surveys. Healthbased guidelines, however, are expressed as recommended limits of dietary exposure. For the
purpose of comparing data between studies, and for comparing effects levels with regulatory
guidelines, exposures as indicated by hair and blood levels of mercury have been converted to
approximate equivalent dietary exposures. The quantitative relationships are described in the
ATSDR Toxicological Profile for Mercury. (12) Study results that identified a range of
exposures within which an effect was observed have been shown at the mid-point of that
range. Due to differences in study methods, results are not strictly comparable between
studies, and are shown here mainly to indicate general trends over time.
Sources:
1. Marsh D. Fetal methylmercury poisoning: new data on clinical and toxicologic aspects.
Trans Am Neurol Assoc 102:69-71, 1977.
2. Marsh DO, Myers GJ, Clarkson TW et al. Fetal methylmercury poisoning: clinical and
toxicological data on 29 cases. Ann Neurol 7:348-353, 1980.
3. Marsh DO, Myers GJ, Clarkson TW, et al. Dose-response relationship for human fetal
exposure to methylmercury. Clinical Toxicology, 18(11): 1311-1318, 1981.
4. McKeown-Eyssen GE, Ruedy J Neims A. Methyl mercury exposure in Northern Quebec II.
Neurologic findings in children. Am J Epidemiol, 118(4): 470-479, 1983.
5. WHO task group on environmental health criteria for methylmercury: Methylmercury,
Environmental Health Criteria 101. Geneva, World Health Organization, 1990.
6. WHO Ibid.
7. Marsh DO, Clarkson TW, Cox C, et al. Fetal methylmercury poisoning. Arch Neurol 44:10171022, 1987.
8. Davidson PW, Myers GH, Cox C. Longitudinal neurodevelopmental study of Seychellois
children following in utero exposure to methylmercury from maternal fish ingestion:
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outcomes at 19 and 29 months. Neurotoxicology 16(4):677-688, 1995.
9. Grandjean P, Weihe P, White R. Cognitive Deficit in 7-year-old children with prenatal
exposure to methylmercury. Neurotox Teratol 19(6):417-428, 1997.
10. Sorensen N, Murata K, Budtz-Jorgensen, et al. Prenatal methylmercury exposure as a
cardiovascular risk factor at seven years of age. Epidemiology 10(4):370-5, 1999.
11. Environmental Protection Agency. Mercury Study Report to Congress: Executive Summary,
vol. I, p 3-39, 1997, available at: http://www.epa.gov/ttnuatw1/112nmerc/volume1.pdf
12. Agency for Toxic Substances and Disease Registry: Toxicologic Profile for Mercury, draft.
Atlanta, US Department of Health and Human Services, 1998.
Slide 24: Growing number of
fish consumption advisories
due to high fish mercury
levels
With more data on mercury pollution and its health impacts at lower concentrations, many
states have issued fish consumption advisories, warning that certain types of fish may have
high levels of mercury that are of concern. These advisories recommend limiting the amount
of fish consumed per week and avoiding certain kinds of fish. Greater than 95% of the
mercury found in fish and shellfish is in the form of methyl mercury. Since methyl mercury
concentrates in the muscle tissue of fish, it cannot be removed through cooking.
Slide 25: Hg Exposure
Potential from Seafood
Nearly all fish and shellfish contain traces of methylmercury. In general, larger fish that have
lived longer have the highest levels of methyl mercury since they generally prey on smaller
fish and have had more time to accumulate mercury. Large fish such as swordfish, shark, king
mackerel and tilefish pose the greatest risk. Typical concentrations are shown in parts per
million. Canned light tuna generally has lower levels of mercury than tuna steak. RfD is the
reference dose; it is an estimate of the highest daily exposure to a chemical over a lifetime
without an appreciable risk of adverse effects. Eating more than one serving of swordfish or
shark in one month may exceed the reference dose for methyl mercury.
ADDITIONAL NOTES:
Eating canned tuna more than two times a week (more than 12 ounces a week) may exceed
the reference dose.
RfD = reference dose, an estimate of daily exposure to the human population that is likely to
be without appreciable risk of deleterious effects during a lifetime (IUPAC Compendium of
Chemical Terminology, 2006)
Graphic: swordfish (www.fun-with-pictures.com)
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Slide 26: Mercury and
Omega-3 Fatty Acids
The beneficial impact of prenatal intake of omega-3 polyunsaturated fatty acids on cognitive
function and the extent to which fish consumption protects against coronary heart disease and
stroke in adults must be considered. Despite mercury contamination, fish are an important
source of beneficial omega-3 fatty acids. The levels of mercury and omega-3 fatty acids vary
according to fish and shellfish species. For example, fresh salmon and herring consumed in the
U.S. are generally low in mercury and high in omega-3 fatty acids. In comparison, swordfish is
generally high in both mercury and omega-3 fatty acids, while king mackerel is high in
mercury and relatively low in omega-3 fatty acids. Consumers should check with their health
authorities to find out the relative concentrations of mercury and omega-3s in locally available
fish and shellfish species.
Slide 27: Keep Mercury Out
Of The Fish Not Fish Out Of
The Mother!
Fish Consumption Advisories should inform women who may become pregnant, women who
are pregnant, nursing mothers, and the parents of young children about how to get the
positive health benefits from eating fish and shellfish lower in mercury (for example, shrimp,
canned light tuna, salmon, and catfish), while minimizing mercury exposure by avoiding types
of fish that are higher in mercury (for example, shark, swordfish and king mackerel). Keep the
mercury out of the fish, not the fish out of the mother.
Slide 28: Mercury Emissions
& Sources from Human
Activity
In tests of ice cores, peat cores, and lake sediment cores, an increase in mercury concentration
is observed today compared with mercury concentrations during the pre-industrial period.
Lake sediment cores, for example, indicate a three-fold increase in mercury levels compared
to pre-industrial times.
The pie-chart shows that about two-thirds of global atmospheric releases of mercury from
human activity come from Asia, with China as the largest contributor worldwide. The United
States and India are the second and third largest emitters.
Slide 29: Global Mercury
Trends
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Slide 30: Range of Global
Mercury Emissions in 2005
This chart shows the estimated range of global atmospheric mercury emissions to the
atmosphere in one year. The bottom of the bar is the low end of the estimate, the top of the bar
is the high estimate.
Human activity accounts for about 1930 tonnes of mercury emitted to the air in 2005. The
emissions from human activity alone are roughly equal to the combined estimates of natural
emissions from oceans plus those from land. Re-emissions add a further contribution, with
about half of re-emissions due to human activity. Thus, human activity accounts for a
significant portion of mercury emissions.
ADDITIONAL NOTES:
Global atmospheric emissions of mercury from human activity in 2005 were estimated to be
about 1930 (range 1230-2890) tonnes. This number is in the same range as the combined
estimates of natural emissions from oceans (400-1300 tonnes per year) plus from land (5001000 tonnes per year). Re-emissions add a further contribution of around 1800-4800 tonnes
per year.
Slide 31: Sources of Mercury
from Human Activities
What are the sources of mercury pollution? Burning of fossil fuels, primarily coal, is the largest
source of emissions from human activity, accounting for about 45%. Other sources include
small-scale gold mining, industrial gold production, other mining and metal production, waste
incineration, and releases from product use.
Mercury is a pollutant also released by the healthcare sector. The largest sources as medical
waste incinerators and the breaking and dumping of mercury-containing devices such as
mercury thermometers and sphygmomanometers.
Slide 32: Environmental
Mercury and Medical Waste
Incinerators
Slide 33: WHO: Policy on
Mercury in Health Care
The growing concern over mercury led the World Health Organization to issue a policy on
Mercury in Health Care in August 2005. In the short term, WHO called for plans to reduce
mercury use, increase use of mercury-free alternatives, and to address the problem of
mercury waste clean-up, handling, and storage. In the medium term, countries are asked to
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further reduce unnecessary mercury equipment. In the long term, WHO supports a ban on
mercury devices and promotion of alternatives.
Slide 34: The Global
Movement for Mercury-Free
Health Care
As a concrete step in achieving mercury-free healthcare, the international non-governmental
organization Health Care Without Harm and the World Health Organization are co-leading a
global initiative to achieve virtual elimination of mercury-based thermometers and
sphygmomanometers over the next decade and their substitution with alternatives. The goal
is to phase out demand for mercury thermometers and sphygmomanometers by 70% by the
year 2017 and to shift production towards accurate, affordable, and safer mercury-free
alternatives. The initiative is a component of the UN Environment Programme's Mercury
Products Partnership.
You may refer this website for more information on the current negotiations.
http://www.unep.org/hazardoussubstances/mercury/tabid/434/default.aspx
Slide 35: Picture of Poster in
Different Languages
By learning about the properties, sources and health effects of mercury, we can all do our part
in protecting public health and the environment from mercury pollution. We hope this
presentation generates discussion on the leading role that the health sector can play in
reducing the harm from mercury.
Slide 36: Minamata
Convention on Mercury
The convention took four years to negotiate and deals with a wide range of issues including
mining of mercury, import and export of mercury, and safe storage. Governments agreed to
ban the production, export and import of specific mercury-containing products by 2020,
including non-electronic mercury devices such as clinical thermometers and blood pressure
devices (sphygmomanometers). Discussion: Is you facility prepared to comply with the
Minamata Convention on Mercury?
For more information:
http://unep.org/hazardoussubstances/Mercury/Negotiations/INC5/tabid/3471/Default.aspx
Slide 37: Discussion
Generate a discussion based off these questions
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References (in order as they
appear in slides)
Bowling Green State University: Mercury Vapor Experiment.
http://wbgustream.bgsu.edu/bgsu/epa/index-fl.html
Minolta Photography - William Eugene Smith 1918-1978 with Aileen Mioko Sprauge Smith
and Ishikawa Takeshi.
Grandjean P, Weihe P, White R et al. Cognitive Deficit in 7-yr Old Children with Prenatal
Exposure to Methylmercury. Neurotoxicology and Teratology 19(6):417-428, 1997
Myers GJ, Davidson PW, Cox C, Shamlaye CF, Palumbo D, Cernichiari E, Sloane-Reeves J,
Wilding GE, Kost J, Huang LS, Clarkson TW: Prenatal methylmercury exposure from ocean fish
consumption in the Seychelles child development study. Lancet 2003, 361:1686-1692
Landrigan PJ, Goldman L. Prenatal methylmercury exposure in the Seychelles. Lancet. 2003
Aug 23;362(9384):666.
AH Stern, JL Jacobson, L Ryan and TA Burke: Do recent data from the Seychelles Islands alter
the conclusions of the NRC Report on the toxicological effects of methylmercury?
Environmental Health: A Global Access Science Source 2004, 3:2
PW Davidson, et al.: Neurodevelopmental effects of maternal nutritional status and exposure
to
methylmercury
from
eating
fish
during
pregnancy,
NeuroToxicology
Volume 29, Issue 5, September 2008, Pages 767-775
“Long-chain polyunsaturated fatty acids and mercury,” JJ Strain, MP Bonham, (University of
Ulster) PW Davidson, GJ Myers, SW Thurston, TW Clarkson, A Stokes-Riner, J Janciuras, J
Sloane-Reeves, E Cernichiari, (University of Rochester School of Medicine and Dentistry), CF
Shamlaye (Ministry of Health, Republic of Seychelles), EM Duffy, PJ Robson, JMW Wallace
(University of Ulster), International Conference on Fetal Programming and Developmental
Toxicity, Torshavn, Faroe Islands, 20-24 May 2007.
Joshua T. Cohen PhD, David C. Bellinger PhD & Bennett A. Shaywitz MD (Harvard Center for
Risk Analysis, Harvard School of Public Health, Boston, Department of Neurology, Children’s
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UNDP GEF Project on Global Healthcare Waste
Hospital, Boston, Massachusetts, Department of Pediatrics and Neurology, Yale University),
Am J Prev Med. 2005 Nov;29(4):353-65.
Fei Xue (Harvard School of Public Health, Harvard University, USA), Claudia Holzman
(Department of Epidemiology), Mohammad Hossein Rahbar (Department of Epidemiology),
Kay Trosko (Integrative Toxicology, Michigan State University, USA) and Lawrence Fischer
(Integrative Toxicology, Michigan State University, USA)Environmental Health Perspectives
Volume 115, Number 1, January 2007
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UNDP GEF Project on Global Healthcare Waste
Environmental Protection Agency. Mercury Study Report to Congress: Executive Summary,
vol. I, p 3-39, 1997, available at: http://www.epa.gov/ttnuatw1/112nmerc/volume1.pdf
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American Heart Association & Food and Drug Administration
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WHO, Health Care Without Harm: Mercury-Free Health Care. www.mercuryfreehealthcare.org
Health Care Without Harm. www.noharm.org
UNEP, You may refer this website for more information on the current negotiations.
http://www.unep.org/hazardoussubstances/mercury/tabid/434/default.aspx
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