title: Public health and chronic low chlordecone exposures in Guadeloupe; Part 2: Health impacts, and benefits of prevention.
abstract: Inhabitants of Guadeloupe are chronically exposed to low doses of chlordecone via local food due to its past use in banana plantations. The corresponding health impacts have not been quantified. We develop a quantitative method and present the results in two articles: 1. Hazard identification, exposure-response functions, and exposure, 2. Health impacts, and benefits of a program to reduce the exposure of the population. Here is the second article.
  
  
  
  The exposure-response functions derived in Part 1 (for liver and prostate cancer, renal dysfunction and cognitive development) are combined with the exposure data to calculate the impacts. The corresponding costs are calculated via DALY's and VOLY. A no-effect threshold is included via the marginal fraction of the collective exposure above the reference dose. The health benefits are the impacts in 2002 (before the exposure reduction program) minus the impacts in 2006 (since the program). They are compared to the costs, namely the public annual expenditures for reducing the population exposure.
  
  
  
  Without threshold, estimated annual cases of liver cancer, prostate cancer and renal dysfunction are respectively 5.4, 2.8, 0.10 in 2002; and 2.0, 1.0, 0.04 in 2006. Annual IQ points lost (cognitive development) are respectively: 1 173 and 1 003. The annual cost of total impacts is 38.3 Million Euros (M€) in 2002 and 23.7 M€ in 2006. Comparing the benefit of 14.6 M€ with the 3.25 M€ spent for prevention, the program appears well justified. With threshold, the costs of the impacts are lower, respectively: 26.5 M€ in 2002 and 12.8 M€ in 2006, but the benefit is not very different: 13.7 M€.
  
  
  
  This is the first study that quantified chronic non genotoxic effects of chlordecone exposures in Guadeloupe. According to our results, preventive actions should be focused on pregnant women because of the high social cost of development impairment and also because their exposures decreased less rapidly than others. Prevention effort should be sustained as long as chlordecone remains in soils. Additional toxicological and epidemiological research would also be required for health endpoints that could not be taken into account (neurotoxicity of adults, autoimmune diseases and other developmental effects).
authors.affiliation: Director of Vincent Nedellec Conseil, 23, rue André Masséna-83000, Toulon, France. vincent.nedellec3@gmail.com.
authors.forename: Vincent
authors.identifier: 0000-0001-8177-4777
authors.initials: V
authors.lastname: Nedellec
authors.affiliation: Retired from Ecole des Mines/ARMINES, Paris, Consultant on Environmental Impacts, 6 av. Faidherbe, 91440, Bures sur Yvette, France.
authors.forename: Ari
authors.initials: A
authors.lastname: Rabl
authors.affiliation: Conservatoire National des Arts et Métiers (CNAM), Laboratoire MESuRS (Modélisation, épidémiologie et surveillance des risques sanitaires EA 4628), 292, rue Saint Martin-75141, Paris cedex 03, France.
authors.forename: William
authors.initials: W
authors.lastname: Dab
mesh_terms: D000293:Adolescent; D000328:Adult; D007631:Chlordecone / Q000633:toxicity*; D003072:Cognition Disorders / Q000139:chemically induced / Q000517:prevention & control; D004781:Environmental Exposure / Q000009:adverse effects / Q000032:analysis / Q000517:prevention & control; D005260:Female; D019430:Guadeloupe; D006801:Humans; D007231:Infant, Newborn; D007306:Insecticides / Q000633:toxicity*; D007674:Kidney Diseases / Q000139:chemically induced / Q000517:prevention & control; D008113:Liver Neoplasms / Q000139:chemically induced / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000139:chemically induced / Q000517:prevention & control; D011634:Public Health; D018570:Risk Assessment; D012989:Soil Pollutants / Q000633:toxicity*; D055815:Young Adult
chemical_list: D007306:Insecticides; D012989:Soil Pollutants; D007631:Chlordecone
keywords: Chlordecone; Endocrine disrupter; Exposure reduction program; Low-dose; Non-mutagen agent; Risk assessment; Risk management; Threshold