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Faculty of Public Health
Of the Royal Colleges of Physicians of the United Kingdom
Working to improve the public’s health
OSPHE 099
Land contamination in a residential area
OSPHE 099
QUESTION 6
Land contamination in a residential area
CANDIDATE PACK
OSPHE 099
Candidate task
You are working in the public health department of your local health commissioning
organisation1. You will meet with the Chair of a local residents’ group and brief him/her of your
assessment of the risks to the health of the residents and what further actions (if any) are
required to obtain further information.
You have 8 minutes to prepare for the station. You are not required to prepare any visual aids.
You will then spend 8 minutes discussing the task with an actor. You may use paper notes to
aid your verbal briefing.
Outline of situation
A residential area within your locality was built in the late 1980s on a “brownfield site2” formerly
occupied by a textile factory. Production ceased more than 25 years ago and the textile
company is no longer in existence. Its assets are now owned by a large multinational
corporation which, as a gesture of corporate responsibility, has informed the local Council that it
is concerned that the land might be heavily contaminated with high levels of carbon disulphide
which was extensively used in the manufacturing process. In 1985 the land was sold to a
developer and subsequently to private home-owners, most of whom moved in from other
districts and many of whom have lived in the area since. There are over 200 dwellings in the
development, none of which are built directly over the former factory area which is located at
the highest part of the site. A major investigation will be carried out over the next three
months to determine the level of contamination in the land.
The residents have been informed of the situation. As a representative of the Public Health
Department the local Council has asked for your help in determining the risks to the health of
the residents in the area. The Public Health Department has not been aware of any increased
levels of ill health in the area and the briefing pack contains some information from the Census
and the local Cancer Registry.
Candidate guidance
You should begin by briefing the Chair, focussing on the main risks, and then answer their
questions which will mainly centre on health risks to local residents and what should happen
next.
At the station
You will be greeted by a marker examiner who will take your candidate number and name, and
then hand over to the actor by saying:
“This is the Chair of the local residents’ group. They will now start the station”
1
A Primary Care Organisation (PCO) is an NHS organisation that provides community and primary health care
and commissions health care from community and hospital services. In England these are called Primary Care
Trusts (PCTs). A Health Board in Scotland performs some similar functions. PCTs and Health Boards generally
cover designated areas and populations within those areas.
2
A brownfield site is any land, which has previously been used for any purpose and is no longer in use for that
purpose. A site does not have to be contaminated, although contaminated land will automatically be brownfield.
OSPHE 099
Candidate Briefing Pack
Item 1 From Cancer Registry to Director of Public Health
Cancer Registrations in the local housing development 1993 - 2003
16 Persons diagnosed - 1 person had 2 tumours
3
3
2
1
1
1
1
1
1
1
1
non-melanoma skin cancers,
breast,
testis (a relatively rare tumour) and
lung,
oesophagus,
prostate,
kidney,
ovary,
leukaemia in a child,
larynx,
rectum.
These are prevalence figures but work out at less than two new diagnoses per year (19932003).
We had done some calculations in the Registry to estimate the number of cancers expected for
different populations. If we have a population of 1,000 people we would expect 2 cancers per
year with the lower incidence of 1 per year and the upper of 10 per year without there being
undue alarm. Lower and upper incidence for populations of 2,000 had been calculated at 4 and
17 persons respectively.
Item 2 From 2001 Census – self reported health status
Question
Limiting Long term Illness
General Health
Good Health
Fairly Good Health
Not Good Health
Area of the
local
Development
%
13.8
78.4
15.0
6.6
Locality
District
National
%
23.3
%
22.8
%
25.6
70.4
19.6
10.1
70.9
19.4
9.7
70.0
19.3
10.7
OSPHE 099
Item 3 BRIEFING NOTE ON HEALTH EFFECTS OF CARBON DISULPHIDE
 What are the contaminants?
The Department of the Environment have informed us that the possible contaminants on the
site are carbon disulphide, sulphuric acid and various hydrocarbon compounds. Of these, the
main chemical for possible concern is carbon disulphide.
 What is carbon disulphide?
Carbon disulphide is a compound that is commonly used in the textile industry in the
manufacture of rayon and other synthetic materials. In its physical state it is a colourless liquid
with a characteristic odour.
 What are the possible risks to health of carbon disulphide?
It should be emphasised that the most dangerous side effects of carbon disulphide are seen
when there is acute exposure to very large amounts such as chemical incidents/accidents, or
with occupational exposure (effects on people who are directly handling and working with the
chemicals for considerable periods of time). In these circumstances the effects of short term
exposure include irritation of the eyes, the skin and the respiratory tract. The substance may
also affect the central nervous system.
In terms of long term exposure in people working with the substance, there have been reports
of skin conditions such as dermatitis, effects on the cardiovascular and nervous system. Carbon
disulphide is not believed to cause cancer in exposed individuals.
OSPHE 099
Land contamination in a residential area
MAIN MARKER
EXAMINER PACK
OSPHE 099
Examiner situation
You will greet the candidate and record their candidate number and name and then hand over
to the actor by saying:
“This is the chair of the local residents’ association. They will now start the station”
Examiner Answer guidance
The candidate is expected to be able to communicate approaches to describing the causation of
disease, identify the characteristics of the local area, explain how prospective monitoring may
be approached in this situation and describe the contribution health service public health teams
can make in following up residents’ concerns. A detailed knowledge of the agencies and
processes involved is not required.
Examiner briefing pack (these will be inserted by the Faculty office)
Candidate pack, Actor briefing pack
OSPHE 099
Marking Guide for Examiners
1.
Has the candidate appropriately demonstrated presenting skills in a typical public health
setting (presenting to a person or audience)?
Avoids jargon. Is clear. Appropriate language for the audience. Maintains eye contact.
Appropriate manner for the situation. Shows empathy.
2.
Has the candidate appropriately demonstrated listening skills in a typical public health
setting (listening and responding appropriately)?
Ensures actor questions are answered appropriately. Answers totality of the question. Manner
of response appropriate to actor scenario.
3.
Has the candidate demonstrated ascertainment of key public health facts from the
material provided and used it appropriately?
Risks inherent in geographical location of site, downhill and possibly downstream from old
factory site.
Facts on carbon disulphide – occupational v environmental exposure risks - not always possible
to extrapolate from one to the other.
Health of local population compared with local/national picture – lower levels of ill health than
surrounding population, lower cancer incidence, higher socio-economic profile.
Lack of evidence of increased ill health not necessarily proof that risk is absent.
4.
Has the candidate given a balanced view and/or explained appropriately key public
health concepts in a public health setting?
Puts information in context of limited knowledge of environmental risk.
Points out long history of habitation on site without apparent ill effects.
Discusses multi-factorial causation of conditions such as cancer, heart disease etc.
Recognises that mental distress over the situation may in itself be a direct or indirect
contributory factor in future ill health.
5.
Has the candidate demonstrated sensitivity in handling uncertainty, the unexpected,
conflict and/or responding to challenging questions?
Sensitive and empathic to real concerns of residents and the uncertain situation in which they
find themselves.
Mentions uncertainty in relation to environmental effects, level of contaminant (if any) present
on site.
Keeps to health remit, recognising that property values and possible litigation issues are best
dealt with by other agencies.
Outlines role of Public Health department in following up information from investigation and
taking necessary action, working with local and national partners e.g. Council, HPA1 (Chemical
Hazards and Poisons Division). Specifically outlines what happens next and a commitment to
keep the residents informed and offer contact details and a timetable of next steps.
1
HPA: Health Protection Agency: a national body of experts who advise healthcare organisations and others on
public heath protection issues around infectious and environmental hazards.
OSPHE 099
Land contamination in a residential area
ACTOR BRIEFING PACK
OSPHE 099
Station background
As candidate briefing.
Actor Brief
You are the Chair of the local “residents association” and have lived in the area for 15 years.
You are concerned about the effect on the value of your house, but more importantly about
possible adverse health effects. You are aware of two local people who have died of cancer in
the past five years – one had a brain tumour and another lung cancer. Your son looked up
carbon disulphide on the internet and told you that it causes “nerve and heart damage”.
Start the meeting by introducing yourself and prompting the candidate to begin:
“Thanks very much for agreeing to meet with me. We are all very worried
about this situation. How big a risk is there to our health?”
Depending on the initial summary ask:
“Well what do the local statistics tell us?”
At the earliest opportunity raise the issue of your two neighbours with cancer. Ask:
“Is there a connection between the two cases of cancer in my neighbours?”
“What are you going to do to monitor the situation?”
“They must have known about this for years – why weren’t we told anything?”
Before the end of the station ask:
“What about property values - who is responsible for compensating the
residents for physical and mental distress?
Any ‘no go’ areas
Do not discuss complex toxicological or clinical issues. If candidate raises these say “I’m just an
ordinary person. What’s the bottom line here”.
Level of conflict
High at first, in keeping with level of anxiety about situation. If candidate addresses concerns
appropriately conflict level lowered to reflect this. Maintain high level of suspicion about
government and multinationals.