Okay. Good morning, everyone. We'll go ahead and get started. Thank you so much for joining us this morning on this last day of AOHC. We almost never know when, you know, are there still people going to be here at the conference. So we're very glad that you're here with us. And we have a great session planned out for you. My name is Pune Saberi, and I'm here in Philadelphia, and I'm joined by Dr. Marilyn Haworth. We are both part of a center at Perlman School of Medicine in Philadelphia called the Center of Excellence in Environmental Toxicology. It is funded by NIHS, or rather, it's one of the centers that NIHS funds to have environmental research conducted. And some of this work has been done by Dr. Marilyn Haworth as part of her work with CEAT, and we want to recognize that. This is, of all the core centers, this is the only one that's in the state of Pennsylvania. And we just wanted to highlight it as a venue for those of you who might want to get involved in the core centers around where the states where you might come from. And we have nothing to declare. So without further ado, let's go ahead and get started. Anything else you want to say about that? Okay. Okay. So of course, you know, we couldn't leave Philadelphia without really acknowledging one of really fundamental, really large environmental events that happened in this city in June of 2019. We're going to get into the details of that. This is going to be all about that event. But before we get there, we wanted to use that as an example about how the environmental regulatory framework impacts the redevelopment of a hazardous site, right? Because as Dr. Haworth will talk about, that's where we are now at this moment in time. So we're going to go over the history, go over what happened, and then tell you where we are now. And then describe the implications of the legacy pollution that environmental justice communities face, and develop practical tools for engaging with different audiences, such as policymakers and concerned residents. So I want you to look at this map. And let me see. The middle one. Okay. So here's where we are. Okay. And then this is the area that we're talking about right here. For those of you who flew in and out of Philadelphia airport, you might have seen this coming over one of the bridges. And this is another way of looking at this map. And in this map, there's something else I want to talk about. I want to talk about the fact that this is the refinery. This is where we are. This is where I live. So I want this, this, you know, was really important to me to talk about because of the fact that it impacts where I live and where I work. And, but I'm not the only one who lives in this area, right? Philadelphia is a large urban city. I think it was fifth, now it's been relegated to sixth place, about 5 million people. And there was this, so that's one important reason about why we wanted to talk about this event. It involved a massive explosion and fire with release of, release of hydrogen fluoride. It's one of the oldest and largest refineries on the East Coast. And there's been a large amount of legacy pollutants on the site. So it has a lot of important things to talk about. Historically, it's very important. The Philadelphia energy solution site was in the 19, in the 1860s, the Atlantic refining company established this oil distribution center in, along the Schuylkill, but the lower Schuylkill. And through the 1900s, crude oil processing was happening there. And then gasoline production began during World War II. This site grew to approximately 1,300 acres. It's the largest refinery on the East Coast, and it was capable of refining 3,300, 335,000 barrels per day into fuel, as well as, as well as petrochemicals for the chemical industry. This process was happening until the moment, you know, where this explosion started in 2019. So Sunoco Inc. owned and operated the refinery from 1988 to 2012, and inherited a lot of the legacy contaminations that we're going to go over, and releases during that period of ownership. Also during that period, they contracted with a company called Evergreen to manage the cleanup, the legacy cleanup. And then Philadelphia Energy Solutions acquired the facility in 2012, and it's been, you know, responsible for the legacy contaminants and pollutants from 2012 to present. And energy transfer holds a minority ownership. So we just kind of want to go over the, some of the companies that are involved. And in terms of what the legacy contamination was, in 1879, a fire destroyed 25,000 cases of petroleum. And so they all leaked into the soil. And then in 1884, there was groundwater contamination reported by Philadelphia Water Department. And in 1930, they detected a leak that required, and then they recovered about 50,000 barrels of oil per month. And then fast forward to 2012, and between 2012 and 2016, 112,000 gallons of gasoline was recovered from groundwater to keep the gasoline from getting into the Schuylkill River. When they test for benzene, it was found at concentrations as high as 480,000 milligrams per liter, and the standard is 1,000. So this is clearly a lot higher than the standard. And that the concentrations of benzene and naphthalene were so high in the soil and water that vapors were measured in buildings as recently as 2017 that were above safe levels for occupancy. So let's just summarize the kind of sources of pollution prior to the explosion. When we look at the various routes of exposure from air, it was the greatest contributor of volatile organics in Philadelphia as a non-stationary source. And it was the largest stationary source of volatile organics. From water on the banks of the lower Schuylkill River, there was significant water pollution. And then, of course, we talked about the seeping into the soil. There was deep infiltration of years of petroleum products, including lead. And so the fence line communities are very concerned. They felt that there was higher rates of cancer and other illnesses in their communities. So in this soil, there was lead, which obviously is a neurotoxin, can be inhaled or ingested. And so the questions were, where would it be moved to? And to what degree will it be cleaned up? These questions are questions that are on the table currently as the redevelopment of the site is happening. And then for air, the volatile organics were highest during time of the explosion. The volatile organics were highest during times of operation. And really, Philadelphia has never been in compliance with the ozone standard. And there's been a number of code orange days for air quality index, which is, of course, an issue for sensitive groups. For water, Philadelphia doesn't use water wells as its source of drinking water. But New Jersey does. And there's possible migration of water underground into New Jersey, where they do use that for drinking water. And of course, we talked about the petroleum products that could be found in groundwater, and then vapor intrusion into the buildings on the site through soil and water. And there's also a really important concept in environmental health, where we don't think about each of these risks and hazards individually, but cumulatively, right? It's kind of a cocktail of as the body sees it. So this is the numbers from 2007 to 2011. And it turns out that this area has cancer rates that are, let me, I wrote that down, I just want to make sure I definitely get that right, 15% higher than the national average. And so even though, of course, you know, we can't say that this is exactly that, it definitely, you know, bears questioning in terms of whether this site would be, should be considered as possible contributor of the increased cancer rates in the area. I'm going to show you a video, which I'm hoping is going to work. June 21st, 2019. The Philadelphia Energy Solutions, or PES Refinery in Philadelphia, Pennsylvania. A dangerously corroded pipe elbow ruptured, releasing process fluid into the refinery's hydrofluoric acid, or HF alkylation unit. The process fluid then ignited, causing a fire and series of explosions. The fire and explosions caused the release of over 5,000 pounds of highly toxic HF, launched a 38,000 pound vessel fragment off site and resulted in an estimated property damage loss of $750 million. Thankfully, despite the urban location of PES Refinery, the local community was not seriously harmed, but it could have been worse. Our investigation found that a critical safeguard intended to protect the local community from a release of hydrofluoric acid did not function as designed. If a large amount of hydrofluoric acid had escaped from the refinery, the consequences could have been disastrous. This incident should be a wake-up call to industry and regulators to take every step possible to prevent a similar event from occurring. Okay, so to summarize, there was a pipe elbow that had corroded so thin that it was half the thickness of a credit card, and it ruptured in refinery's alkylation unit, and it released 5,000 pounds of hydrofluoric acid. Now to tell you guys a little bit about hydrofluoric acid, it's not used in all refineries. It is a caustic and corrosive agent. As you know, it's used to make refrigerants, herbicides, high octane gasoline, plastics, and electrical components. It is water soluble, so it goes into the ground, and it can be inhaled. Nasal eye inhalation serves severe lung irritation, and it could lead to things like pulmonary edema, death, and cardiac arrhythmia. So the key point about here is that the hydrofluoric acid that was released, fortunately, was diverted. Remember where I lived? Very, very close. And because if the release had not been controlled, the results would have been catastrophic. The one issue that happened at the time was that the disaster management messaging was that to stay in place, so if you're at your house, stay in your house, don't come out. But later on, experts were saying actually the message should have been evacuate, like get as far away as possible. So these are kind of like, some of the issues that we can talk about during the discussion. So the U.S. Steelworkers Union, they launched a campaign in 2010 to replace hydrofluoric acid in refineries. It forms vapor clouds that are close to the ground that can move off-site. And then in 2019, EPA was petitioned by a community group to ban hydrofluoric acid in refineries. The Chemical Safety Board estimates that 50 of the total 135 U.S. refineries currently use hydrofluoric acid, but there are safer alternatives that exist and are in regular use, but they are costly to retrofit the older units. So what we'd like to do now is we'd like to have a little bit of a discussion, and then I'm going to hand it over to Dr. Haworth here. We're going to be split up into three groups, and each of those three groups, I want you to kind of like put yourself in the role of the stakeholder. And of course, there is many other stakeholders that we could list here, but we just, you know, kind of for interest of time, then we're just going to go with these three groups. So one group, you're like, imagine you're living in this community that's fence line to this site, and maybe you've lived there for years and maybe like through generations. What are you worried about? What can you do about it? And then there's the worker perspective. This refinery was one where it was actually, you know, workers were paid very well and, you know, well taken care of. And so imagine being the refinery worker. So what is the idea of safety in the workplace versus pollutants in the workplace? And then think about like, you know, are you worried about your health? Are you, you know, kind of concerned about economics? Are they mutually exclusive? And then this is the aim of kind of this session at the end is as like we are all the OAM providers, imagine yourself if you were the provider in the community, your patients, your clients in the community, or the workers, what are the health impacts of these legacy pollutants? What are the implications of redevelopment that the trucks, the additional air pollutions? What are some of the ways that the OAM physician provider can engage with various stakeholders around large areas of environmental contamination? So maybe what we'll do is we'll have this group be the community. Maybe we'll split up here and then we'll have half of, you know, this group be the worker and then the half in the back of the room and the last row will ask you to be the OAM provider. And, you know, just maybe think about it for like, you know, 30 seconds or so and just kind of raise your hand and speak up in terms of what are some of the things that come to mind, and then I'll try to capture them here on the slide. Carl. But the workers are going to be concerned both about the safety and the hazard, but they're going to wonder if they have a job. That's exactly right. Job safety. And in fact, that's exactly what a lot of the community meetings, right, is what they were worried about. I'm sorry, job security. That's what I meant to say. We lost the visual on that. Oh. Oh. You know what it is? I can either show it or... We'll tell you what. We'll just... Yeah, why don't we just... We can just keep track. You don't have to write it. Okay. Kathleen. What about my kids? Right. What does this do to my kids? My kid's going to get sick. Not only that I live in a community that's fence-lining, but my husband works at the plant, so am I going to be kind of double-whammy exposed? You know, the smoke, the pollutants that are airborne, but also it's closed, double-closed. So I'm on the fence. Do I want to be worried about my community, or my husband's job, or all together? Mixed concerns, for sure. Oh, I'm going to worry about my property values, because the home is all I've got. We've spent our lives making this home here, and it doesn't seem like much to you all. That's all we've got for our future. So if my property values plummet because of this stuff, I want to know what's going on with the elective people I work with. Great. Yes. There's somebody with cancer on every block in my neighborhood. Absolutely. Why does this always happen to us? Can someone use it? We haven't heard anything yet from the OEM doc contingent. What are your plans to engage around this issue? Yes. What type of help are we going to get from the federal government to try to build the greatest programs to help these people work more frequently? What is the exposure level? What are they doing to help us off that? Right. What's the data around the exposure? And is it available to docs in the community and others who are interested in investigating and helping? Good. I have a garden, a vegetable garden. Should I worry about the vegetables in the garden? Can I eat them? Good. Yes. How are we going to get you gas since you're a minor and you're excluding us from all this stuff? Great. Yes. Will the docs and the company and the local city management come to talk about what happened in, you know, irregularly or what would happen if we were ever asked to evacuate? Somebody had to talk to us and not talk down to us, but just come and explain what's going on. Right. Realistic, real community engagement at every step in this process. Great. Yes. I've been working here for 20 years and now this happened. Does that mean that there are lots of other rights that are up to do the same thing? How do we make that happen again? Great. Real occupational safety concerns regarding, gee, we thought we were doing the right thing, but maybe not. Yes. Right. What, what, who's, who's calling the shots when, when something happens and is the messaging to be trusted? Great. And as the issue of emergency preparedness, I, I think this is not my thing that I've been talking, but it's been talked about in the last 20 years, you know, prior to my residency, public health master's program. And yet, after all these disasters and all these pandemics, you have many communities that don't have anything in place. And so you don't know who's calling who's talking. And even in a big community like Philadelphia, it's a question as to whether or not what's in place is adequate. Yes? I just want to say something, we're all Erin Brockovich, and we need to all be Erin Brockovich. It's interesting because the breakdown of the comments is very reflective of what happens in real life. Yeah. The barriers of engagement around issues like this, and the barriers that we feel, but the actual barriers that really are there. Oh, I'm sorry. I'm so sorry. Is this mic working? Yes, it is on. Great. Thank you, Carl. I appreciate it. I'll walk to whoever wants to speak. Right here. As an OEM provider, what does the local medical community know about this? And so that our community providers, not just OEM providers, what do they know as potential red flags if there's any connection between what happened and medical conditions that patients might present with? Right. Both chronically and after the acute event, right? How do they get that information? How are we sure that they're knowledgeable? Good point. Anyone else? Now that you can be heard, nobody wants to talk. From the country I am, India, it's very complicated there. I have told in another lecture also that we are 92% of us are unorganized. Only the eight are organized industries, 8% of it. And we contribute to the 25% of global workforce. But the 92% is the catch. In organized sectors, we call something as extended stakeholders. I'll give you an example. A pesticide manufacturing industry, yes. The systems are in place because of the laws. So we can, you know, that organized sector can take a little bit of care of the extended stakeholders. But the person who is actually using the pesticide, that is the largest unorganized sector, which is agriculture, I don't know how to, you know, deal with that. One. Second, the biomedical waste management, the incinerators, if they are not attached to hospitals or they are inside the industry campus, are not being taken care of. So, I mean, it's way too complicated. I don't know, I mean, you know, how the global, the big organizations will help us. We do understand, but we don't know how to take it further, yeah. I think you're referring to the cradle to grave kind of analysis that we need to be doing to make sure that we have safety introduced at really every stage and sustainability introduced in all those stages too. I think that's a critically important conversation, probably larger than the one we're having right now. So are there any other comments or questions or should we move to? Hey, good morning. So I just, I'll pitch in maybe with a slightly different perspective, you know, as a federal regulator, while this is really interesting to learn about this community and what, so as I think about what can be done, you know, I think about what authorities do I have to be able to act on in order to accomplish anything. And it's not always so clear as one might suspect. Thank you. And, you know, that couldn't possibly be a better segue into where we're starting next. So thank you. Perfect. So let's look at this timeline after the explosion. There was a partial closure of the refinery with laying off of workers from June to October of 2019. The PES refinery itself declared bankruptcy in December of 2019. The judge put the property up for auction and Hilco redevelopers bought it. This is a company that actually has done this kind of thing throughout the country. They've bought up large former industrial sites and made them into something else. Evergreen, which is actually a subsidiary of Sunoco, continued to be the cleanup entity that was responsible for remediation of the legacy contaminants. And as you saw, the chemical safety board found that the pipe connections in the alkylating unit were not routinely inspected. First thing that you can all go and do is find those 50 other alkylating units that are throughout the country and might be in your backyard and engage with those companies around whether or not they are following best practices regarding looking at those pipes in the alkylating unit because it is still not an EPA requirement to do so, despite the potential catastrophic outcomes that could happen. So let's look at some of the laws and regulations that are in play here. There really wasn't much before 1976. And then we had RCRA, Resource Conservation and Recovery Act, that actually required facilities that handled hazardous waste to do so according to guidelines. In 1984, there was the Hazardous and Solid Waste Amendments that required corrective action for past releases that had been previously unregulated. And it also applied to past soil and other solid waste disposals on property. And so these are two very good federal regulations that would bear on this kind of site. As you heard from Pune, we are talking about 24-7 oil recovery operations that are happening on this site just so that we are not dumping groundwater and off-site oil into the Schuylkill River. And this is happening every minute of every day. Even now, when the infrastructure is gone from this site, you'd think that that would be a Superfund site. I think most people would assume it would be a Superfund site. But I think many of you know that oil and gas has always been exempt from Superfund. So every single place in the country that's had this kind of contamination from oil and gas, the oil and gas industry, cannot be deemed a Superfund site, automatically exempt. So what that means, really, is that it's more of a patchwork of federal and state regulations that deal with the cleanup and deal with the monitoring of the site, and not the very, I think, clearly prescribed set of evaluation and monitoring and cleanup and end-use development that the Superfund actually lays out. So until the 1980s, there was really no comprehensive evaluation of the site, no remedial plan, and certainly no remedial action. So what is the state? What's the state's role? And I would suggest to you that my next couple of slides are both relevant to all of you, but also a little bit Pennsylvania-specific. So I'll try and highlight that as I get to it. The State Departments of Environmental Protection generally provide operational permits for activities. So they get involved in the discharges to, in our case, the Schuylkill River, infiltration into the city's sewer system and requirements to do vapor collection systems and prevent explosions like we did actually have in Philadelphia as a result of vapor intrusion into our sewer system. They regulate the off-site petroleum and groundwater migration and the recovery of oil at the subsurface. This permitting process is very variable by state, and some states are really quite permissive, whereas others are a little bit more protective. In Pennsylvania, though, we have something called the Act II, or the Pennsylvania Land Recycling Program, and it makes really good sense. In a state with a lot of former industry, we've got a lot of really large infrastructure sitting around that's an eyesore in communities, that's been abandoned, that's just really not providing productive use of the land and probably downgrading the value of people's properties and also may be hazardous. The idea here was that we would marry state and federal regulations through this Act II program and do cleanup faster, get these sites back into good use for the public. It sounds great, except it's really regulation by committee. If you're catching an undertone of it's not the best way to do it, you're right on point with my understanding of it. It really leaves everybody involved and nobody in charge, and so even though the Department of Environmental Protection is the lead agency and the EPA is supposed to provide oversight, it's never quite clear exactly who is really responsible or in charge. An important feature of this regulation in Pennsylvania is that the regulator is allowed to select a site-specific standard for cleanup, so not the state standard for cleanup, not EPA's standards for cleanup of hazardous waste sites like they have under the Superfund legislation, but they get to pick their own based on what the next stage in the site or what it's intended use will be. In this case, Evergreen selected site-specific standards based on industrial use. Remember, we're talking about 1,300 acres in the middle of Philadelphia. The implications of site-specific standards, let's look at it for lead, for example. Lead is a very important contaminant at this site. As you know, it's a neurotoxin by the inhalation and ingestion route. The EPA considers 400 parts per million of lead in soil as safe for children's play areas, and I will tell you that there are probably about a dozen states that disagree and have already passed lower levels of soil for lead in their states that are safe for children's play areas. But our Department of Environmental Protection, under this Act II, approved 2,240 as the site-specific standard for lead on this property, 1,300 acres in the middle of Philadelphia. That current site-specific standard means that 1,300 acres will forever be industrial, and it means that no one can ever live on this property, no one can ever recreate on this property, because those levels of contamination will be too high. The way this site is being evaluated and remediated is in pieces. They're called areas of interest, and they're logically broken up into areas because the areas were previously used for different purposes and are contaminated in different ways. Some obviously have contaminants that are flowing into the Schuylkill River. Some are areas where there's tremendous lead exposure because it's where the storage tanks were that had leaked over years. And so the remediation is progressing along these kinds of little pieces, if you will. The contaminants on the site are many, but they're all the usual players when we're talking about oil and gas. As you can see in this list, some are volatiles, some are semi-volatiles, and then there's lead. Also glancing at the list, you'll see numerous known human carcinogens, benzene, benzoate, pyrene. So again, not questionable chemicals, certainly ones with important health implications. So limitations of the current regulatory process are that cleanup takes decades. Remember, we started this in the 1980s, and we're nowhere near any form of cleanup right now. In fact, this site will likely always be in really the containment realm rather than the cleanup realm for much of it. The Act II process gives authority to the state, which can be subject to greater influence by industry. And that's an important piece for any of your states that might be considering similar action. I would recommend against it. There is a requirement for community involvement, but as you might imagine, there has not been substantive, meaningful community involvement in this process. And again, the state's safety inspections of pipes in alkaline units are still not required by federal law. Let's move to the community perspective. Historically in neighborhoods, this refinery was the largest point source of all organics in Philadelphia. We've had increased ozone levels in Philadelphia. Some of you may have heard this morning the State of the Air report came out and showed some improvements. We still have an F in Philadelphia. Let's not be too optimistic. But we do have an improvement in our ozone level, probably due to the closure of this refinery. However, we still and never have been in compliance with the National Ambient Air Quality Standards for ozone. Philadelphia has among the highest cancer rates of large city, and residents absolutely attribute their cancer rates in their neighborhood to this refinery. I want to call your attention to this bridge in this picture. This is a bridge that you still will drive under if you drive on the Schuylkill Expressway to the airport. It is a bridge that was built linking a neighborhood to the Philadelphia PES refinery. No one really knows why it was built, but for decades it was an open access to the refinery, and it was the only green space, the refinery, was the only green space for children in the neighborhood to play in. And so our community partners tell of how they rode their bikes across this bridge and played on the refinery property for years. And it's unclear why this was not closed off before it was in probably the 80s, but it was in existence for about 40 years and children regularly crossed over. Few residents from that neighborhood actually worked at the refinery, because that's sort of the logical thinking that maybe people who are working might use it, but we didn't really find that that was the case. And I will say that the neighborhoods immediately adjacent met both poverty and racial criteria for environmental justice communities. The community reaction is exactly as you described and what you might expect. The community focused on the health effects. They wanted that refinery closed once that explosion happened. They focused on the longstanding environmental injustice that they had endured and the fact that low-income housing had been built by the city up to the fence line. They focused on the potential to use that space, those 1,300 acres, to build housing, low-income housing that people could afford, affordable housing, recreation, and good jobs for the future. And they gathered together, all of these multiple community groups, gathered together under the single moniker of a United South-Southwest Coalition, and they asked for some pretty reasonable things. A commitment to negotiate a community benefits agreement. When you have a facility that is likely to continue to create hazards for a community, often a community benefits agreement can be made to potentially offset or mitigate some of those negative impacts. Involve residents in the plans for how the land would be used. Follow through on some early recommendations or early promises of carbon-free development. And actually have some accountability and transparency around impacts to the neighborhood as this redevelopment process progressed. Hilco put on their website this really beautiful picture. I love this picture. There are a lot of trees in this picture, and I don't know that trees can ever grow on that ground, but it would be a nice idea if they could. But this is what they're proposing. They're schematic. The plans are rather vague, but they do call for about a million square feet of warehousing. They're calling it a multimodal logistics facility. And 300,000 square feet of a life sciences facility. So what are the current concerns in the community? Both Evergreen, the cleanup company, and Hilco, the redevelopment company, are holding public meetings. They are. But you'd think that they might actually hold joint public meetings, because whenever the community members ask a question, it's always the other guy that has the answer. They don't know, oh, I don't know that, that's Hilco. I don't know, that's Evergreen. And so the community never gets the answers, really, to the questions that they care about. And frankly, a lot of these questions are really joint questions. They're not really one or the other. The other pieces are tremendous misleading of corporate messaging. There's a tremendous amount of greenwashing of this. Rather than saying that this is going to be a million square feet of warehousing and all of the traffic that comes with this, they're focusing on the 300,000 life sciences, which sounds so healthy, right? Life sciences, that sounds great. That's got to be good. It's not industrial. It's got to be healthy. So there is this overemphasis on this life sciences campus. And so what are the significant environmental concerns regarding the redevelopment of this largely paved distribution center? The community would like to know that there's consideration of zero carbon energy usage at this site. That's one of the things they'd like to see. They're already overburdened by air pollution, we know with our F rating. Any ports that are established on that scoop hill should really have the opportunity for ships to plug in so that they don't have idling. You may know this, that when a ship that can't plug into port, the entire time that they are there, they idle. And so it's a massive amount of air pollution to the community. And they'd like there to be consideration of the roughly doubling of the 115,000 vehicles that already pass through their neighborhood that would be expected from a warehouse distribution center of this size. And then there's the consideration of climate change. This is a map put out by NOAA of the refinery site. This is the refinery site here, this whole area on this side of the scoop hill river. And the areas in blue are the areas that will be underwater in 2100. The community around the refinery site, around this redevelopment, are imagining what will happen when much of this site is now impervious ground. And where will that water go? The water will not be able to seep into the ground. It'll run off into the adjacent communities. And so they'd like to see infrastructure in their neighborhoods that actually can accommodate for some of that runoff and an actual assessment of what that runoff will look like. And so this brings us back to what you, as occupational medicine physicians, can do. And you all have scenarios like this in your communities. You all do. You all have legacy pollution sites that are in need of redevelopment or in perhaps hazards to your communities. And so I'd like to walk you through what we've done through our center over years with the community. Before the refinery blew up, we were aware that it was a very large and health-impactful entity in Philadelphia. And so just took reading the paper, honestly, to learn that it was Philly Thrive that was doing the largest amount of work and was the community group that cared the most, seemingly, about this. And so we engaged with them. And we talked with them. And we provided science information around the volatile organics and the carcinogens that were coming from the refinery, gave a talk to their members, and helped them in their thinking about the risks. And then the refinery blew up in 2019. And there was tremendous debate around whether or not the refinery should be kept open. We knew that this was an opportunity to reduce risk in Philadelphia. And we felt that it was very important for us to provide strong messaging and science around what the right thing was to do here. So we testified before the mayor's refinery task force that was trying to decide whether or not to keep this open. We testified before city council in giving them the information, the science information that they needed, and also the state of Senate's Environmental Resources and Energy Committee. And so that, at the local and state level, to give them the impetus to really lose a lot of tax dollars, if you think about it. Because this was the other side of the argument, jobs and tax dollars. And why should we push for ending this very large taxable entity in Philadelphia? And the reason was simple. It was health. And you saw this map earlier. We provided these kinds of maps. This map was created by scientists at our seat. And so was this one. This one, in particular, is of interest. Because when the refinery blew up, it was very clear the health department was saying, we have tested the air. The air is great. No problem. And our scientists actually modeled where the plume went. And what we found was that it did not pass over any of the monitors in Philadelphia, hence why none of the monitors picked up. This massive black plume that was clearly visible to everyone in Philadelphia, lasting for 24 hours, smelling bad, and making a lot of people be symptomatic. And then when Hilco came in and bought the refinery and proceeded on the redevelopment path, we, again, engaged with the South Southwest Coalition in their efforts to figure out, what will this mean for us? What would this mean for the community? What are the health implications? What should we be asking for? What should this community benefits agreement look like? And what should we really demand? And so we, once again, testified before city council to push for adequate water runoff plans and air emissions and traffic pattern plans so that everyone was on the same page about the fact that this was not suddenly, we've gotten rid of industry. Everything's good now. It's not really like that. There really are still health implications. And we made another map, actually, another heat map that really, unfortunately, found that this area in Philadelphia, even after the refinery closed, was still among the hotspots for lung cancer exposure risk in Philadelphia. And that was largely due to the traffic, because the Schuylkill Expressway runs immediately adjacent to this refinery site right next to the neighborhood. The neighborhood is right up against the Schuylkill in this place, 115,000 cars and vehicles of all kinds. And in a large city like this, it's not mostly cars. It's mostly those box trucks delivering goods to restaurants and stores in Philadelphia. And as you know, those box trucks have a lifespan of about 40 years. And just think about the regulation of vehicles 40 years ago. These are still extremely polluting vehicles that are on the roads impacting. And as much as we talk about how exciting it is that we all have hybrids and Teslas for cars, it's really those box trucks that each one is about 100 of our cars in terms of their emissions. And these are the impacts that our communities that are immediately adjacent to these large roadways are still experiencing. And will continue for the foreseeable future. So I hope I've given you some ideas of things that you can do in your own areas. And we'd be happy to open it up for discussion. This is what the refinery looked like before it closed. As you go over that bridge on your way back to the airport that Pune mentioned, you will see a vast wasteland. It looks like nothing to see except for a few oil sort of, what do you call them? Tanks, like tanks. There's still a few of those there. But this is what it used to look like. And please follow us on Twitter and Facebook. And you may find some other interesting areas that you would engage in in your own communities. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. So we'll take any questions? Yeah, we'll take questions, comments. And also maybe if any of you in your communities have ever engaged in any of these activities as OEM providers, please share that as well. And what I can do is I can come down and pass the microphone. Aren't you going to stand and answer the question? Can you stand and answer the question? OK. So yeah, if you would come to the microphone, we'd appreciate it. I'm wondering if there are other health effects that you're worried about or have seen, besides cancer, respiratory effects. I'm thinking about kids with asthma in the neighborhood, that kind of stuff. Go ahead. It's been very difficult to do neighborhood level work because there are so many contributors. And so we know in Philadelphia we have in some neighborhoods childhood asthma rates in the mid-20s, 24%. And so it is substantial. That is not that different, though, than other cities with similarly exposed people with this cumulative exposure kinds of problems of industry and traffic. So it was difficult. And I'm not sure that anyone actually was able to show a neighborhood level difference. But it may just be that it's on the backdrop of very high rates. Thank you very much for an excellent presentation and really thought provoking. I'm wondering, following Kathy's line about the kids, what about educational disruption or beyond below the normal, right? And things like autism spectrum disorder incidents, have you noticed anything like that? Again, I don't think we have neighborhood level data on that. But I will say that our community members talk a lot about having to get under their desks as they were growing up when there was a threat from the refinery. It was not a rare occurrence. They were frequently sheltering in place in school. And so I have been wanting my mental health colleagues to look into the early trauma that people experienced just from the recurrent events that occurred there. Just to point out that in one of the slides, that 22% of the fenceline communities below poverty level and 55% non-white. So there's such a kind of enmeshment of the various social determinants of health that sometimes it's a little bit hard to tease out exactly kind of what's what. OK, I'll ask another one. Kathy Fagan. So can you tell us a little more about your center? And do local clinicians contact you and ask for advice, things like that? Do you have a clinic? Yeah, so we do not have a clinical service as part of the center. Although we certainly refer people to the occupational medicine folks right at Penn. They certainly have that expertise and do see people. When people don't need to be seen, though, we do certainly work with doctors and help them sort out where they can find the information that they might need in order to investigate a particular exposure scenario. And we're happy to do that. We're happy to do that for anyone. And I think that is often the case that most of these environmental health core centers, that there is local expertise in exposure assessment that can be accessed. It was an excellent talk. One quick question slash comment is, have you used or utilized or have any feedback on public health nudging in terms of the concept of nudging where you take information on hazards and you educate, but you do it in a piecemeal fashion, very targeted and stratified based on the populations that you target around in order to change behavior or to move policy in the direction addressing these hazards? An example is with the social determinants of health. There is a significant population that's underserved, may not have access to certain communication tools. Have there been any studies, research, or any comments just from experts in the field of using nudging and using this concept in terms of shaping policy, education, teaching, and addressing these hazards in general? I'm not sure. Just to make sure folks heard in the back of the room, the concept, the questions about using a technique of nudging as these kind of small incremental changes with public health knowledge to change behavior. Did I? Correct. Yeah. So we haven't used it in our work, but I know we have a center at Penn that does a lot of this. And I know that they were very much involved in COVID and vaccine hesitancy. And so they did some very good work around that. But I would very much like to engage with them. I haven't gotten to do that yet. Your question does bring me to the talk that was yesterday about misinformation and how she talked about information as part of your social determinant of health and how they talked about this concept of priming. So I'm sure there's some really good information, especially in social sciences, about that. We work with partners who would be experts in that, but I haven't done that myself. Good morning. Lovely presentation. Thank you so much. My question was, when this happened, was there a general recommendation to the citizens on what to do in terms of medical care? I feel like when we have these large outbreaks or hazardous exposures, our employers know what to do with the employees, with the occupant physicians. I feel like I keep hearing, oh, go talk to your doctor. And the doctors of primary care, without really that much of an occupational exposure, then they're left calling me, like, what do I do? They're told they have bacteria in the water. And I'm like, oh, lord. So any recommendations or what happened with this situation? Thank you. So in this situation, the recommendation came out from the health department. But I would say before the current health commissioner who's excellent was on the scene. And the recommendation was that there's nothing in the air. Everything's fine. But if you did have symptoms, go and see your doctor. It was pretty much the generic recommendation. And I think you're really hitting on an extremely important point, because whenever these kinds of scenarios occur, they always say go and see your doctor. And this one, I would imagine doctors probably felt a little bit more knowledgeable about, simply because it was smoke. And so they have, in general, a sense of smoke. Maybe not hydrofluoric acid, but smoke. But often, they really feel that they don't. And so I don't know about your experience, but in mine, if you have a really anxious patient and someone, a medical professional, tells them, I don't know, that really enhances their anxiety and actually may send them down the wrong path. So the lack of information by general practitioners around occupational exposure assessment is a huge gap that I would like to see us filling in a better way. And I think that part of that can be through engaging with our public health community, like the departments of health, so that they actually get the right messaging out. Because sometimes, it's not your family doctor that can give you this information. Sometimes, it's the poison control center or a particular toxicology site. There may be better referrals that can be made that can, I think, help in this setting. Sure. Thank you for an excellent discussion. This is one of the event was one of many similar events that have occurred over the years. And there's probably no answer to this question. What about the unknowns, the ones that haven't erupted yet, the small sites that haven't been surveyed? Is there any estimate of the aggregate of these? So are you referring to brownfield sites throughout the country? Well, yeah, I mean, we know what have been identified as brownfield sites, that something came up that caused their identification. But I would postulate that there are many, many, many more TANF field sites, if you will, which have not yet been identified and are causing potential problem for the people around them. Carl, you're absolutely right. You're all familiar with EJSCREEN. You can look up brownfield sites on EJSCREEN. But you know what it takes to get on EJSCREEN? Someone had to have submitted an application to actually do something with that site. That's what allows it to be included on EJSCREEN. So the millions of other sites that are out there that are potentially contaminated, that no one has ever tried to buy or do something on or evaluate in any way, they're just out there. So there are many of them in all of your communities. And if you're interested, just looking around at the history of what sites, currently abandoned sites, used to be might give you some clues as to the nature of the contaminants and whether or not there is potentially offsite migration or contamination of groundwater or problems for the community. There is no proactive program in any of the federal or state agencies to identify these sites. It is not a proactive process. All right, I think we have to wrap this session up. Yes, we're at time. And thank you so much for joining us this morning. Really appreciate the discussion. And have a good rest of your last day at OAC. Peace. Thank you. Thank you. Thank you. Thank you. Thank you.

refinery

Philadelphia

environmental impact

pollutants

explosion

redevelopment plans

community involvement

cleanup process

occupational medicine providers

public health