Environmental Health Risk Assessment, Case Study of Lebak District

This document discusses the importance of environmental health risk assessment in analyzing the impacts of activities in Lebak District. It specifically focuses on the link between gold mining practices using mercury and health issues such as cardiovascular system infections, neurological disorders, and kidney diseases.

Running Head: ENVIRONMENTAL HEALTH RISK ASSESSMENT, CASE STUDY OF LEBAK DISTRICT 1
Environmental Health Risk Assessment, Case Study of Lebak District
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ENVIRONMENTAL HEALTH RISK ASSESSMENT, CASE STUDY OF LEBAK DISTRICT 2
Environmental Health Risk Assessment, Case Study of Lebak District
When analyzing the environmental impacts of certain activities, risk assessment is very
important. Over the last few years, growth in environmental issues to promote sustainability and
developmental management in harmony with the environment has taken another face.
Environmental health risk assessment is currently the most popular and widely used
environmental management technique (Vinceti, Filippini, Cilloni, Bargellini, Vergoni, Tsatsakis,
& Ferrante, 2017). Environmental health risk assessment is the identification and prediction of
the impacts of legislative proposals, operational procedures, policy programs, and certain
projects on the environment and human health to facilitate interpretation and communication of
those impacts. Environmental health risk assessment process entails scoping, screening,
predicting and evaluating risks and decision making with public consideration and participation
incorporated in all the stages of the entire process.
Environmental health risk assessment has also been defined by the US National Research
Council as a characterization of all potential adverse impacts of human exposure to
environmental hazards. The stages involved when assessing risks include hazard identification,
risk estimation, risk management, risk evaluation, and exposure assessment. It is also a generic
term used in various places to denote the series of tools and environmental risks together with
their formation judgment (Forouzanfar, Afshin, Alexander, Anderson, Bhutta, Biryukov &
Cohen, 2016). Risk assessment concept emerged in the early 1970s as an administrative tool in
form of executive orders and statues which required not only the extensive documentation and
regulations to justify proposed risks but also the harmonizing of risks against economic gains and
costs.

ENVIRONMENTAL HEALTH RISK ASSESSMENT, CASE STUDY OF LEBAK DISTRICT 3
The Research Question (in PICO format)
The clinical question to be addressed in this paper is: Can the high rates of cardiovascular
system infections, neurological disorders, behavioral disorders, kidney diseases and
neuromuscular complications among the Lebak people be linked with a large number of artisanal
and small scale gold mining practices in the area which use mercury for the amalgamation
process? (Chittamuru, Thakkar & Pasricha, 2016) Research has revealed that the most common
route of exposure to mercury is through the sea, particularly the oldest fish which have had
enough time in the ocean eating smaller species of fish already contaminated with
methylmercury. The location where fish is caught also matters a lot, but people should worry
about certain types of fish like shark, tilefish and swordfish
People living in areas where mercury contamination is rampant should avoid aquatic
products like fish, especially the older fish which have had enough time in the ocean eating
smaller species of fish already contaminated with methylmercury. Also, before setting gold
mines, people should be relocated and moved to a far distance where mercury vapor won’t have
adverse impacts on them. This is in consideration of the fact that the other main route of
exposure for the elemental mercury is through inhalation of vapors produced during the
amalgamation process. In regard to this fact, research has revealed that 80% of the inhaled
mercury vapors are absorbed directly by the lung tissues. When absorbed, the mercury vapor
penetrates directly into the blood-brain barrier to cause neurotoxicant. Also, inhalation of
elemental mercury vapor has been associated with behavioral and neurological disorders which
include tremors, insomnia, headaches, emotional lability, memory loss, and neuromuscular
changes. In addition, elemental mercury has adverse impacts on thyroid and kidney tissues.

ENVIRONMENTAL HEALTH RISK ASSESSMENT, CASE STUDY OF LEBAK DISTRICT 4
According to research by the IARC, high exposures to mercury can result in death. This
is in regard to its carcinogenicity. The overall evaluation by this research institute revealed that
inorganic mercury and metallic mercury compounds were not classifiable as to carcinogenicity to
human beings. A critical effect where risk assessment can be based on is the neurotoxic effects
of mercury, like the induction of tremor. The effects of mercury on kidneys must also be
considered because they have adverse impacts when people are exposed to inorganic mercury
compounds.
The two interventions identified above; avoiding or reducing the consumption of aquatic
products obtained in water catchment areas close to gold mining projects and migrating people
prior to setting a gold mining project will minimize the health impacts of mercury on Lebak
people. This is in consideration of the fact that people get exposed to mercury contaminations
through either mercury vapor or consumption of aquatic foods like fish.
Use of PICO format in this paper has provided an efficient framework to support deep
search on the electronic databases, which are relevant to the clinical question. Also, formulating
the PICO question has enhanced the likelihood of getting evidence-based research that can apply
to the paper’s topic of interest and hence increasing the research knowledge in question.
(Chittamuru, Thakkar & Pasricha, 2016)Using the PICO acronym, the paper question has been
‘Can the high rates of cardiovascular system infections, neurological disorders, behavioral
disorders, kidney diseases and neuromuscular complications among the Lebak people be linked
with the large number of artisanal and small scale gold mining practices in the area which use
mercury for the amalgamation process?’ where:
P (population) - Lebak people

ENVIRONMENTAL HEALTH RISK ASSESSMENT, CASE STUDY OF LEBAK DISTRICT 5
I (intervention) - Avoiding aquatic products like fish and migration of residents before gold
mines are set up
C (comparison) - people living in areas with no gold mines
O (outcome) - minimizing the health impacts of mercury on Lebak people
Background Information
The number of artisanal and small scale gold mining who uses mercury for the
amalgamation process in Indonesia is estimated to be 250,000 (Sembel, 2015). After mercury is
used, it is released freely to the environment during the refining process of gold. Artisanal and
small-scale gold mining has been linked with the increasing rate of health issues both
environmental and occupational among the Lebak district residents where the main quarry for
gold mining is located. The health issues have adversely affected the miners, family members
and the surrounding communities (WHO, 2016).
Naturally, mercury exists as a free element which can exist in water, soil, and air with a
silvery white appearance and it’s volatile. In the natural environment, it exists under very low
concentrations (Gohari, 2016). However, mercury exists in large quantities in the mining areas
(WHO, 2013). Artisanal and small-scale gold mining utilizes mercury in the processing process
of ores. Amalgamation method is used when gold ore mining is being processed, which is
defined as the process of binding gold metal from its ore using mercury.
During the amalgamation process, the amalgam which is the mixture of gold metal and
mercury is heated to separate mercury from the mixture to obtain pure gold (Dewailly, Rouja,
Forde, Peek-Ball, Côté, Smith, Robertson, 2012). The use of amalgamation process results in a
number of health-related issues, mainly as a result of the mercury released in high quantities
which to pollute water in rivers and dams. In addition, the wastes released from mercury and

ENVIRONMENTAL HEALTH RISK ASSESSMENT, CASE STUDY OF LEBAK DISTRICT 6
other heavy metals contained in the amalgam are very toxic and hazardous to the environment as
well as human health (Castilhos, Rodrigues-Filho, Cesar, Rodrigues, Villas-Bôas, De, Santos,
2015).
Arifin, Sakakibara & Sera (2015) revealed that mercury gets into the human body
indirectly through the inhabitant's food web. According to their research, diet played an
important role in exposing people around gold mining areas to environmental chemicals. The
human food chain, especially consumption of aquatic foods has been labeled as the main route
via which mercury contamination gets into the human body. Mercury has adverse health impacts
on both the environment and human beings. For instance, exposure to methyl-mercury is a clear
indication that the general population has been exposed to mercury through fish and other
aquatic products (Dewailly et al, 2012).
Lebak district, Lebaksitu, and Bantern are among the active artisanal and small-scale gold
mining areas in Indonesia. A mercury examination research on the three areas indicated that
mercury concentration in water, aquatic animals and soil were 5.709, 0.00392 and 0.5175 ppm
respectively. The statistics confirmed that mercury in the three areas had exceeded the normal
threshold levels hence causing environmental pollution (Hassan, Shakoor, Hayat, Ahmed,
Hussain, & Naveed, 2016).
Methods and Materials
The paper will use the Environmental Health Risk Assessment (EHRA) study design
which will consist of four steps: identification of hazards, analysis of dose-response, exposure
assessment and characterization of the risks. The environmental data to be used will include food
samples from foods such as fish, rice and cassava and water samples. The study will use Lebak

ENVIRONMENTAL HEALTH RISK ASSESSMENT, CASE STUDY OF LEBAK DISTRICT 7
residents as the main population under with the inclusion criteria of 1) those residing around the
small scale gold mining in Lebak area 2) those willing to become research respondents and 3)
equal opportunities to both men and women. The study population will consist of 80 residents of
Lebak district who will be obtained through the sample size formula and simple random
sampling selection. The study will be conducted between June and November 2019.
The intake (I) of mercury will be calculated using the formula below
Where:
I - will stand for the intake of mercury in mg/kg/day
C- Will be the mercury concentration in water or food consumed
R- Consumption rate of mercury-rich food per day
fE- the mercury exposure per annum
Dt- the exposure duration, yearly
Wb- the weight
Tavg- the average period of time
The health risk estimation will be derived from the Risk Quotient (RQ) formula which can be
represented by the equation:

ENVIRONMENTAL HEALTH RISK ASSESSMENT, CASE STUDY OF LEBAK DISTRICT 8
The RQ value which is obtained from the formula above will be interpreted in different ways.
For instance, if RQ>1, It will mean that there is a health risk
The RfD which in full means Oral Reference Dose will be determined. RfD is the number
of chemicals which are consumed on a daily basis in the entire lifetime of a human being without
causing any health-related issues. According to the risk contaminant table, mercury has
quantitative toxicity value of 0.0001 mg/kg/day on the basis of non-carcinogenic character and
oral inlet.
The study will start by determining the frequency distribution of economic, demographic
and social characteristics of Lebak residents, where most respondents will be women, around
77.8%. Most of the respondents will also be expected to have graduated from elementary
schools. The respondents must not be miners of the gold. This data will be summarized in a table
as shown below

ENVIRONMENTAL HEALTH RISK ASSESSMENT, CASE STUDY OF LEBAK DISTRICT 9
Table1: frequency distribution of economic, demographic and social characteristics of Lebak
residents
Also, the average age of the respondents will be expected to be 38.21 years, ranging
between twenty to eighty years old. The average weight for the participants will be expected to
be 55.50 kg which will range between 40 to 80kg. For height, the average height will be
expected to be 153.70m and range between 140 and 172cm. This is represented below
Next will be the computation of average mercury contained in each type of food. The
foods to be involved in the computation will include Rise, Fish, and Vegetables. This will be
represented in a table as shown below (Langeland, Hardin & Neitzel, 2017)

ENVIRONMENTAL HEALTH RISK ASSESSMENT, CASE STUDY OF LEBAK DISTRICT 10
Finally, based on the RQ calculations, the health risks of the mercury contained in the
three categories of food (Li, Wu, Ding, Fu, Gan & Li, 2017); fish, vegetables and rice will be
estimated in the scale RQ>1. A representation of this information will be tabled as shown below
in order to determine the risk of mercury exposure among the Lebak people
Description of the Risk Communication Strategy
To achieve the goals of the risk assessment layout outlined above, risk communication
will play an important role. Risk communication is part of the risk governance that is defined as
the interactive process where information and opinions are exchanged among the risk assessment
team members (Lee, Markowitz, Howe, Ko, & Leiserowitz, 2015). Mainly, it involves the
exchange of risk related messages and other messages which express concern, reactions, and

ENVIRONMENTAL HEALTH RISK ASSESSMENT, CASE STUDY OF LEBAK DISTRICT 11
opinions for risk management. Communication is very important for risk mitigation, response,
preparedness and recovery (Mayer, Loa, Cwik, Tuana, Keller, Gonnerman & Lempert, 2017).
However, communicating information about risks and the vulnerabilities is challenging because
it’s human nature not to be worried about future events but those which raise immediate
concerns. The environmental health risk assessment due to mercury exposure on Lebak residents
will first identify all the advancements in the risk communication area for Lebak residents. The
barriers which might hinder effective risk communication among the population will be tabled to
enable the team members to come up with effective communication strategies.
Community-based participation and training through exercises that will include risk
communication for Lebak residents are the two risk communication strategies which will be used
in this paper. Community-based participation strategy will entail the inclusion of representatives
from Lebak community in the emergency planning (Coombs, 2015). This approach will make it
easier to inform the community about the adverse impacts of the mercury element generated in
the mining project and how the impacts will be minimized. Also, involving representatives in the
planning and review of the risks will ensure appropriate crafting of messages. Through this
strategy risk preparedness, response and recovery for Lebak residents will be strengthened.
Training the residents of Lebak district through exercises that include risk
communication will improve the response for future risks associated with mercury exposure.
Specifically, the exercises will incorporate community-based organizations and other agencies to
promote cultural competence, aid mutual learning and strengthen the response from residents in
future risks (Tong, Raynor, Blalock & Aslani, 2015). To improve the effectiveness of this
approach, team members who will be tasked with the delivery of messages about the mercury
risks will be taken through advanced training prior. The training exercise will directly address

ENVIRONMENTAL HEALTH RISK ASSESSMENT, CASE STUDY OF LEBAK DISTRICT 12
the Lebak residents including making the messages very clear and comprehensive through
concrete examples. The message will be made more immediate and tailored to specific audience
depending on the risk exposure (Salvati, Pernice, Bianchi, Marchesini, Fiorucci & Guzzetti,
2016). For instance, those whom the risk of exposure is through consumption of the aquatic
foods, the training will focus on avoiding those foods while for those who are very close to the
mines, the training will focus of mercury vapor and how it can be avoided.
Conclusion
In summary, the paper has taken an environmental health risk assessment due to the
exposure to mercury in Lebak district. Mainly, the exposure has been linked with the artisanal
and small scale gold mining which takes place in the area. Guided by the PICO framework, the
research question was framed to reveal the link between mercury element produced during the
amalgamation process of gold mining and the high rates of cardiovascular system infections,
neurological disorders, behavioral disorders, kidney diseases and neuromuscular complications
among the Lebak people. From the background information, it came out clearly that the health
impacts evident among the Lebak district residents was as a result of a large number of artisanal
and small scale gold mining who uses mercury for the amalgamation process in Indonesia. This
has been linked with the fact that mercury is released freely to the environment during the
refining process of gold. To achieve effective results in the assessment, Community based
participation and training through exercises that will include risk communication for Lebak
residents have been used as the main risk communication strategies.
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