Featuring: Chris Groves, Hoffman Environmental Research Institute, Western Kentucky University; Robert Finkelman, U.S. Geological Survey; José Centeno, Armed Forces Institute of Pathology

By Timothy Hildebrandt and Jennifer L. Turner

Chris GrovesIn an attempt to fight off the restlessness inherent in a 16-hour transpacific flight, Chris Groves flipped through a complimentary issue of Scientific American. Chris had just left southwest China, where he had been conducting research on severe water quality and quantity problems in limestone karst regions. Thus it was not surprising he became intrigued by a story profiling the work of Robert Finkelman and Harvey Belkin of the U.S. Geological Survey (USGS) who were studying how naturally occurring arsenic and fluorine in coal and soil in southwest China were poisoning rural people. Initially, Chris was drawn to the story because the study areas that his group had just visited were just hours away from where Robert, along with his colleague José Centeno of the Armed Forces Institute of Pathology (AFIP), were conducting research. As he continued to read, however, Chris quickly recognized the potential of joining forces with USGS and AFIP. In the span of just one year, Chris Groves has succeeded in unifying his research with the work of Robert and José—this unique collaboration bringing together different research areas and expertise is devoted to addressing the often forgotten problem of human health hazards resulting not from industrial pollution, but natural geological conditions. At the heart of the partnership is the proposed creation of two environmental research centers in southwest China devoted to finding feasible solutions to naturally occurring environmental problems threatening health in the region. This meeting of the Wilson Center's China Environment Forum provided an opportunity for the partners to discuss their individual work, the genesis of their combined work, the nature of the problems they aim to address, and the potential benefits of the environmental research centers for both China and the United States.

Water Challenges in China's Karst Region
For Chris Groves, southwest China, though far from his home in south central Kentucky, was an obvious location to continue his research on the effect of natural geological conditions on water quality; the tall, slender mountains that have made regions like Guizhou famous were formed through the geologic process known as "karst," which is also responsible for much of the landscape in the southeastern United States. Very simply, karst refers to areas in which erosion has significantly dissolved rock in the subsurface resulting in large underground streams and caverns. In China this geographic phenomena created the magnificent mountains depicted in many traditional Chinese landscape paintings. There are some obvious benefits to areas that boast karst landscape; beyond the aesthetic beauty, karst mountains and caves serve as popular tourist sites, providing significant income to regions that often lack other means of economic development. The downside of karst is harder to see—indeed, it is under the surface.

Though water is often plentiful in karst regions, its groundwater debunks the widely accepted assumption that underground water is always clean and pure. Karst areas, accounting for nearly ten percent of the world's land surface, inherently have contaminated groundwater. Most groundwater is clean simply because it travels underground at a very slow pace—often only a few feet a year. This slow progress allows the time necessary for bacteria in the water to die off; whereas karst water often moves through massive subterranean rivers and caves at the breakneck pace that can exceed several miles a day. Consequently, this water is easily contaminated.

Chris Groves was drawn to southwest China not only because of water quality issues—within 500,000 square kilometers of karst areas 80 million people are drinking unclean groundwater—but also because of the general problems of water quantity in the region. In southwest China drilling for the limited clean groundwater is made difficult by the mountainous landscape, while significant rain falls for only four months of the year, during monsoon periods. Groves, along with his colleagues at Western Kentucky University's Hoffman Environmental Research Institute, ventured into Guangxi province in hopes of understanding these water problems and devising viable solutions.

The Consequences of Residential Coal Use
At the invitation of the Institute of Geochemistry in Guizhou, the U.S. Geological Survey (USGS) and the Armed Forces Institute of Pathology (AFIP) began a research project in 1996 to study the elevated levels of arsenic and fluorine in southwest China. While their research highlights that environmental health problems in China are severe, widespread, and complex, Robert Finkelman noted if all members of the scientific and policy communities (e.g., geoscientists, public health officials, sociologists, and politicians) work together, feasible solutions can be developed and implemented to mitigate these health threats.

While arsenic and fluorine-related health problems are present worldwide (including the United States), China's problems with these toxins are particularly acute. Arsenic exposure in China is pervasive; sources include drinking water, foodstuff, industrial smelting, pesticides, and natural geological conditions. The health effects from these exposures are particularly disturbing: According to José Centeno, in addition to cardiovascular disease, peripheral diabetes, hearing loss and developmental effects, arsenic exposure has been linked to cancers of the skin, lung, bladder, liver, kidney, and uterine. These effects are so numerous and critical that one of the first missions of Centeno and Finkelman's research in southwest China was to conduct an extensive study looking at pathological problems from arsenic. USGS and AFIP have initially focused on domestic coal burning.

Health effects from the combustion of biomass fuels including coal represent a crisis affecting more people worldwide than HIV/AIDS, cancer, and heart disease combined. An estimated 3.5 billion people worldwide suffer from the effects of carbon-based fuel burning; this figure includes Native Americans, proving that no country is immune from the problem.

Regions in southwest China, like Guizhou, have not felt the economic upturn experienced in the eastern coast. While the growing Chinese middle class in coastal areas slurp Starbucks and have central gas heating, many in China's inland drink contaminated water and rely on coal for heat, cooking, and light. Forests have been denuded—harvested in the past for fuel and greater agricultural space—which has made reliance on coal the only option for many residents of southwest China. This principle fuel may not be simply dirty, but toxic.

While coal burned in the United States and China contains an average arsenic content of about 10 parts per million (ppm), some coal in southwest China has the world's highest levels, as high as 35,000 ppm—in addition, high concentrations of mercury are found in Chinese coal, as much as 50 ppm compared to U.S. levels of about 0.1 ppm. Much of the harmful arsenic exposure is inhaled from burning coal for heat—winter nights are cold on the high plateaus in southwest China, so to keep in heat homes are built without chimneys or other ventilation. The damp autumns in the region also make it necessary for farmers to bring crops inside to dry over coal fires. Consequently, another means of arsenic exposure arises when chili peppers, a staple of the regional diet, are hung over the burning coals, absorbing as much as 500 ppm of arsenic. Human bodies are rather efficient at moving arsenic away from vital organs, therefore inhaled and ingested arsenic is sent to skin, usually the hands and feet forming crusty lesions (a condition known as hyperkeratosis). These lesions can crack creating open wounds that may lead to fatal infections for Chinese farmers working in rice patty fields.

Far more pervasive than arsenic in southwestern China are elevated levels of fluorine that affect the health of more than 10 million people. Much of the coal that is contaminated with arsenic is also laced with high concentrations of fluorine (as is the clay soil often mixed with coal to create briquettes). Thus, much like the chain of exposure to arsenic, toxic levels of fluorine are ingested with food, inhaled in homes, and consumed with water. The health effects of fluorine exposure are similarly disturbing. Centreno and Finkelman offered photographic evidence of the debilitating effects—notably, dental fluorosis, that is characterized by stained, wrinkled and missing teeth and skeletal fluorosis that results in bone deformities and joint and spine problems.

Linking Separate Projects
While USGS and AFIP were investigating the presence of fluorine and arsenic in coal, Chris Groves approached Finkelman and Centeno to explore whether combining their respective resources and experiences could provide synergy to enhance the research of all three groups. A particular scientific link immediately realized was that the formation of the karst landscapes Groves and his Chinese colleagues in Guangxi have long studied could result in residual clays that are a major source of high fluorine exposure.

The research interests of Finkelman, Centeno, and Groves merged well together; the three acknowledged the potential of combining their expertise and experience to more quickly find and implement solutions to what has become a health crisis in some areas of southwestern China. Unlike other environmental challenges across the globe, there is no government or corporation to blame for these problems; issuing fines to corporations or forcing businesses to clean up cannot solve these unique challenges. The consortium of research groups (USGS, AFIP, and WKU, as well as some Chinese research centers) is not overwhelmed by the enormity of the problems, and has opted to implement a "triage" strategy for the region. Instead of concentrating their efforts on long-term and expensive solutions (like previous Chinese government efforts to replace coal with what turned out to be socially unacceptable stoves), the consortium is devoted to implementing quick solutions to stop exposure.

Coal testing is but one example of a fast, easy, and inexpensive means to mitigate exposure to toxic chemicals: Working with a chemical company, the USGS and AFIP developed inexpensive test kits for villagers to bring into the field and test arsenic levels. The mechanism of the test is simple—the darker the color produced by chemical reaction of the coal, the higher the concentration of arsenic in the coal. At less than $1 for each sample analysis, this is an affordable solution for areas lacking money to pay for larger, more elaborate projects.

The consortium has learned that locally based research is imperative to arrive at feasible solutions. One obvious solution is to identify coal that is particularly toxic. However, this is not as simple as Robert Finkelman once assumed. Before investigating the situation in southwest China, he suggested that coal cleaning, done worldwide, would be an easy answer; by separating visible pyrite grains that are often high in arsenic, the coal is made significantly less toxic. After working in southwest China, Finkelman discovered that the region's coal was the exception to this rule. Arsenic was not in the pyrite, but in the organic material itself. Using a cookie-cutter solution to the problem would have, in effect, led to higher exposure to toxins by burning coal more highly concentrated with arsenic.

The value of locally based research is just one motivation behind the consortium's plan to create two self-sustaining environmental health research centers in China—the centers would bring together a large community of health, environment, science, and cultural experts to devise practical solutions. Based in Guilin and Guiyang, the initial plan is to enhance preexisting research centers with new equipment and training. José Centeno also suggested the possibility of creating telemedicine facilities so that specialists from around the world could study and assist in preventing future health effects. In addition, the centers will put to use Geographic Information Systems (GIS) technology that has been invaluable in the United States. Along with equipment, the centers would provide training both at Western Kentucky University and in southwestern China. Enhancing the scientific capacity of Chinese scientists is imperative to make the centers truly self-sustaining.

The benefits of these environmental research centers could be numerous, according to Robert Finkelman. These comprehensive centers could lead to improved health and welfare in southwestern China, helping to promote economic and social stability. Moreover, the centers would assure training for local experts and even provide many with invaluable international experience.

While this proposed project is more economical than previous proposals in the region (e.g., coal washing, solar energy, communal clean energy crop drying facilities), the centers still need significant funding to implement their solutions. The consortium members are seeking support from the U.S. Congress and other agencies for the centers could also significantly benefit the United States:

  • The centers would create an environmental sentinel—a global environmental warning system—that could monitor changing health issues and alert U.S. officials to shifting patterns in environmental health. The crucial need for such a center in China and other countries is apparent by recent events such as the "brown cloud" of pollution that made its way from China to the North America and the fast spread of the West Nile virus.
  • Funding requests for the centers also include bringing highly qualified interns from China to spend a year working with various federal agencies—and sending U.S. students to southwest China.
  • The research conducted on China's acute manifestations of arsenic and fluorine exposure could help U.S. health researchers and agencies better understand and recognize more subtle exposures in the U.S. population.

    This tragic health crisis in southwest China demands creative and easily implemented solutions. By combining forces, Western Kentucky University, the U.S. Geological Survey, and the Armed Forces Institute of Pathology have initiated a consortium that could bring new resources and experience to develop feasible solutions to immediately curtail the crisis of exposure to naturally occurring toxins. Just as a partnership was necessary to arrive at some solutions, so are partnerships necessary to fully implement the work—this meeting at the Wilson Center provided an opportunity for some U.S. government agency representatives, nongovernmental organizations, and research centers to learn about the proposal and offer their own suggestions for funding and collaboration.