Public Health Assessment
Air Pathway Evaluation,
Isla de Vieques Bombing Range,
Vieques, Puerto Rico

IX. Public Health Action Plan

The Public Health Action Plan for Vieques describes specific actions that have been taken, are scheduled to take place, or should be taken by numerous parties, including ATSDR, EPA, PREQB, PRDOH, and the Navy. The purpose of this Public Health Action Plan is to ensure that this PHA not only identifies potential public health hazards, but also produces a plan of action to mitigate and prevent harmful human health effects that may be resulting from exposure to hazardous substances in the environment. The following list identifies the public health actions that have been completed, that are ongoing, and that ATSDR recommends take place:

Actions Completed:

• Ambient air sampling has been conducted by various parties, including ATSDR, PREQB, and the Navy.
• In August 1999, ATSDR conducted its initial site visit to Vieques to meet with the petitioner, to tour the island and the bombing range, and to gather available environmental data. ATSDR accepted the resident's petition and initiated the PHA process.
• In September 2000, ATSDR met with various agencies, including PRDOH, PREQB, EPA, and the Navy to gather data and to discuss the scope and nature of ATSDR's health assessment activities. ATSDR also toured various sites on Vieques with the petitioner.
• In June and October 2000, ATSDR discussed public health concerns with local health care providers and provided training about how to medically assess environmental exposures. During these visits, ATSDR also met with numerous residents to discuss health concerns.
• In February 2001, ATSDR released the public comment version of the Public Health Assessment for the Drinking Water Supplies and Groundwater Pathway Evaluation. In March 2001, ATSDR held a public availability session to meet individually with community members to discuss the findings of this document. In October 2001, ATSDR released the final version of this PHA.
• In July 2001, ATSDR, the Ponce School of Medicine, and the Centers for Disease Control and Prevention sponsored an expert review panel to address whether an association existed between place of residence (Vieques or Ponce Playa) and morphological cardiovascular changes among fishermen. In October 2001, ATSDR released a report summarizing this expert panel review.
• In September 2001, ATSDR conducted additional community involvement activities to inform participants of the scope of ATSDR investigations and to seek additional community input. Continuing education on public health training was offered to nurses on Vieques and environmental health instruction was provided to parents and high school students.
• In February 2003, ATSDR released its final version of the Public Health Assessment for the Soil Pathway Evaluation.
• In June 2003, ATSDR released its final version of the Public Health Assessment for the Fish and Shellfish Evaluation.

Actions Ongoing:

• ATSDR is continuing to meet with various community members and organizations to receive concerns and exchange information. This effort will continue throughout the public health assessment process.
• ATSDR is continuing to meet with local health care providers to discuss health concerns for the community and to provide educational materials for addressing the community's health needs.
• PRDOH is updating its cancer registries for all of Puerto Rico, and specifically for Vieques, by gathering and documenting information on the incidence of cancer. ATSDR does not know when these updates will be completed.

Recommendations for Further Action:

Note: ATSDR's public comment release PHA included several recommendations for further air sampling at Vieques. Since the Navy officially ceased its training exercises on May 1, 2003, ATSDR believes these sampling studies are no longer necessary. The following items list the remaining recommendations that ATSDR believes should be fulfilled.

• ATSDR recommends that any residents using rainfall collection systems for a drinking water supply read the documents that ATSDR has placed in the records repositories regarding good sanitation practices for harvesting rain water. These good sanitation practices will help ensure that water obtained from these systems is safe to drink and relatively free of contamination from all local sources.
• ATSDR plans to review cancer registry information and data gathered by PRDOH. This review will consider the data documented in ATSDR's PHAs and will evaluate the general health status of the communities on Vieques. ATSDR's review will follow the official release of PRDOH's review of the cancer registries, but it is not known when this will occur.
• If future data are collected that suggest that a modification of ATSDR's public health evaluations, and if requested, ATSDR will periodically review air sampling data that PREQB and other parties collect at Vieques, as these data become available.
• After completing the pathway-specific PHAs, ATSDR will prepare a brief summary of environmental health issues for Vieques.