Ministry of Public Health, Montevideo 5 March 2009 ELECTROMAGNETIC FIELDS AND HEALTH: EFFECTS, PERCEPTION, PROTECTION Paolo Vecchia National Institute

Ministry of Public Health, Montevideo5 March 2009

ELECTROMAGNETIC FIELDS AND HEALTH:ELECTROMAGNETIC FIELDS AND HEALTH:

EFFECTS, PERCEPTION, PROTECTIONEFFECTS, PERCEPTION, PROTECTION

Paolo Vecchia

National Institute of Health, Rome, Italy

Chairman of ICNIRP



THE INTERNATIONAL COMMISSION ONTHE INTERNATIONAL COMMISSION ONNON-IONIZING RADIATION PROTECTIONNON-IONIZING RADIATION PROTECTION

ICNIRP is an independent scientific organization that:

• provides guidance and advice on the health hazards of non-

ionizing radiation

• develops international guidelines on limiting exposure to non-

ionizing radiation that are independent and science based

• provides science based guidance and recommendations on

protection from non-ionizing radiation exposure


ICNIRP’S PARTNERSICNIRP’S PARTNERS

WHO

ILO

WMO

CIE

ICOH

IEC

IRPA

EC

ICNIRP


ICNIRP Statement

GENERAL APROACH TO PROTECTIONAGAINST NON-IONIZING RADIATION

Health Physics 82:540-548 (2002)www.icnirp.org


STEPS IN THE DEVELOPMENTSTEPS IN THE DEVELOPMENTOF GUIDELINESOF GUIDELINES

Critical review of the literature

Identification of health and biological effects relevant for health

Identification of the critical effect

Establishment of basic restrictions

Derivation of reference levels


APPROACH TO HEALTH RISK ASSESSMENTAPPROACH TO HEALTH RISK ASSESSMENT

Any single observation or study may indicate the possibility of a health risk

related to a specific exposure.

However, risk assessment requires information:

● From studies that meet quality criteria

● From the totality of science


EVALUATION PROCESSEVALUATION PROCESS

The evaluation process used by ICNIRP consists of three steps:

● Evaluating single studies in terms of their relevance

● Reviewing all the information for each health effect

● Combining the outcomes into an overall evaluation


Biological modelsDosimetry

Biological modelsDosimetry

animalsanimals

cellscells

epidemiologyepidemiology

humanshumans

RANKING OF EVIDENCERANKING OF EVIDENCE

EVIDENCEEVIDENCE≠≠

PROOFPROOF BIOLOGICAL EFFECTBIOLOGICAL EFFECT≠≠

HEALTH EFFECTHEALTH EFFECT

ASSOCIATIONASSOCIATION≠≠

CAUSALITYCAUSALITY

Courtesy of B. Veyret


ESTABLISHED EFFECTSESTABLISHED EFFECTS

Effects are considered as established based on:

Quality of the studies (peer review)

Consistency

Replicability

Cause-effect relationship (for epidemiology)


THE CRITICAL EFFECTTHE CRITICAL EFFECT

If several effects occur, it may be possible to rank them

according to the exposure level at which each effect becomes

relevant.

The critical effect is the established adverse health effect that

is relevant at the lowest level of exposure


ESTABLISHED EFFECTS FOR ELF FIELDSESTABLISHED EFFECTS FOR ELF FIELDS

Induction of internal electric fields and currents

Stimulation of electrically excitable tissues

The effects are related to the internal electric field

(V/m) or the internal current density (A/m2)


ESTABLISHED EFFECTS FOR RF FIELDSESTABLISHED EFFECTS FOR RF FIELDS

Absorption of electromagnetic energy

Increase of body temperature (general or local)

Thermal effects

Thermal effects are related to SAR, i.e. to to the energy

absorbed per unit time and per unit body mass (W/kg)

What about non-thermal, long-term effects?


REVIEW OF THE LITERATUREREVIEW OF THE LITERATURE

All published studies are taken into consideration

The evidence is weighted based upon:

• Scientific quality

• Replicability

• Consistency


IARC 2002 ICNIRP 2003 WHO 2007


EPIDEMIOLOGICAL STUDIES ON EPIDEMIOLOGICAL STUDIES ON CHILDHOOD LEUKAEMIACHILDHOOD LEUKAEMIA


POOLED ANALYSIS - AHLBOM ET AL.POOLED ANALYSIS - AHLBOM ET AL.

3247 cases, 10400 controls

“The 99.2% of children residing in homes with exposure levels <

0.4 T had estimates compatible with no increased risk, while

the 0.8% of children with exposures > 0.4 T had a relative risk

estimate of approximately 2, which is unlikely to be due to

random variability.”


CRITERIA FOR CAUSALITYCRITERIA FOR CAUSALITY

A cause-effect relationship is recognised if the statistical association is supported

by the following (Hill’s criteria):

• Strength of the association

• Consistency, with reference to replicability

• Specificity

• Time directionality

• Biological gradient

• Biological plausibility

• Coherence, with reference to the natural history of the illness

• Experimental confirmation

• Analogy


WHICH SUPPORT FOR EPIDEMIOLOGY?WHICH SUPPORT FOR EPIDEMIOLOGY?

Ahlbom et al. 2000

“The results of numerous animal experiments and laboratory studies examining

biological effects of magnetic fields have produced no evidence to support an

aetiologic role of magnetic fields in leukaemogenesis. Four lifetime exposure

experiments have produced no evidence that magnetic fields, even at exposure

levels as high as 2000 T, are involved in the development of lymphopoietic

malignancies. Several rodent experiments designed to detect promotional effects of

magnetic fields on the incidence of leukaemia or lymphoma have also been negative.

There are no reproducible laboratory findings demonstrating biological effects of

magnetic fields below 100 T.”


ANIMAL STUDIESANIMAL STUDIES(LEUKAEMIA AND LYMPHOMA)(LEUKAEMIA AND LYMPHOMA)


CLASSIFICATION OFCLASSIFICATION OFELF MAGNETIC FIELDS ELF MAGNETIC FIELDS

IARC concluded in 2001 that ELF magnetic fieds are possibly

carcinogenic to humans (Group 2B) based on limited

epidemiological evidence of childhood leukaemia


THE IARC CLASSIFICATIONTHE IARC CLASSIFICATION

1 The agent is carcinogenic to humans

2A The agent is probably carcinogenic to humans

2B The agent is possibly carcinogenic to humans

3 The agent is not classifiable as to its carcinogenicity to humans

4 The agent is probably not carcinogenic to humans


MEANING OF CATEGORIESMEANING OF CATEGORIES

1 Consistent evidence for carcinogenicity

2 Data limited or inconsistent

2A Carcinogenicity is presumed, but non-

carcinogenicity cannot be excluded

2B Non-carcinogenicity is presumed, but


3 Inadequate evidence

4 Consistent evidence against carcinogenicity


CRITERIA FOR THE CLASSIFICATONCRITERIA FOR THE CLASSIFICATON

1 Consistent evidence for carcinogenicity

2 Data limited or inconsistent

2A Carcinogenicity is presumed, but non-carcinogenicity

cannot be excluded

2B Non-carcinogenicity is presumed, but


3 Inadequate evidence

4 Consistent evidence against carcinogenicity


POSSIBLY OR PROBABLY CARCINOGENIC?POSSIBLY OR PROBABLY CARCINOGENIC?

100

500

0 50

100

Probably carcinogenic

0 10050

0 10050Possibly carcinogenic

On a scale 0 to 100, how do you estimate ELF magnetic fields to be a cause of cancer?


WHAT IS IN GROUP 2B? WHAT IS IN GROUP 2B?

● DDT

● Atrazine

● Coffee

What have Governments (and individuals) done about these agents?


THE DIMENSION OF RISKTHE DIMENSION OF RISK

In the absence of any special effect of magnetic fields 2 of the 500 cases of

childhood leukaemia a year would be associated with exposures of 0.4 µT

or more; if there were an effect of magnetic fields, a further 2 cases might

be produced, 1 case every 2 years being possibly due to proximity to

power lines. This would imply an increase in the annual risk of leukaemia in

childhood from about 1 in 20,000 to 1 in 10,000 and would correspond to

an increase in the overall risk of leukaemia to age 15 years from 1 in 1400

to 1 in 700 for the 0.5% of children who were highly exposed.

NRPB (UK), 2002


Annual cases of leukaemia (bars) and gross consumption of electric energy (line) in Sweden

1960 1965 1970 1975 1980 1985 19900

20

40

60

80

100

120

140

160

Cases/year TWh/year

0

20

40

60

80

100

120

140

160


LONG-TERM EFFECTS OF RF FIELDS?LONG-TERM EFFECTS OF RF FIELDS?

A scientific review by WHO, held under the International EMF Project (Munich, November, 1996), concluded that, from the current scientific literature, there is no convincing evidence that exposure to RF shortens the life span of humans, induces or promotes cancer

Fact Sheet # 183, May 1998


LONG-TERM EFFECTS OF RF FIELDS?LONG-TERM EFFECTS OF RF FIELDS?(WHO 1998)(WHO 1998)

A scientific review by WHO, held under the International EMF Project (Munich, November, 1996), concluded that, from the current scientific literature, there is no convincing evidence that exposure to RF shortens the life span of humans, induces or promotes cancer

Fact Sheet # 183, May 1998


LONG-TERM EFFECTS OF RF FIELDS?LONG-TERM EFFECTS OF RF FIELDS?(WHO 2006)(WHO 2006)

Over the past 15 years, studies examining a potential relationship between RF transmitters and cancer have been published. These studies have not provided evidence that RF exposure from the transmitters increases the risk of cancer.

Likewise, long-term animal studies have not established an increased risk of cancer from exposure to RF fields, even at levels that are much higher than produced by base stations and wireless

networks. Fact Sheet # 304, May 2006


ALL TUMOURS (JOHANSEN ET AL 2001)ALL TUMOURS (JOHANSEN ET AL 2001)


EXPOSURES NEAR BASE STATIONSEXPOSURES NEAR BASE STATIONS


Levels of RF radiation in the proximity of a base station in the UK

EXPOSURE TO BASE STATIONSEXPOSURE TO BASE STATIONS


NEW ZEALANDNEW ZEALAND

The National Radiation Laboratory has measured exposures around many operating cellsites.

Maximum exposures in publicly accessible areas around the great majority of sites are less than 1% of the public exposure limit in the Standard.

Exposures are rarely more than a few percent of the limit, and none have been above 10%.


COMMON APPROACH COMMON APPROACH OF NORDIC AUTHORITIESOF NORDIC AUTHORITIES

The exposure to the general public from base stations is

extremely low, normally 100 to 10 000 times lower than the

ICNIRP guidelines and very much lower than the exposure

from the handsets.


THE NETHERLANDSTHE NETHERLANDS

The Committee considers the likelihood of health problems

arising in work and residential areas near GSM 900 and DCS

1800 base stations due to exposure to electromagnetic

fields originating from the antennas, extremely small.

The field strengths are always considerably lower than the

health-based exposure limits proposed by the Health

Council and other organizations.

GSM Base Stations, June 2000


FRANCEFRANCE

Overall, there is no evidence, at the date, of increase in cancer incidence around high-power emitters and, a fortiori, around base stations

French Senate, 2001


SPAINSPAIN

In accordance with previous conclusions, this Board

considers that, at current emission strengths, at the

distances calculated according to criteria of the EU

Recommendation and on the basis of current available

scientific evidence, cell phone antennas do not

represent a public health hazard.

Electromagnetic Fields and Public Health


AUSTRALIAAUSTRALIA

No adverse health effects are expected from

continuous exposure to radiofrequency radiation

emitted by the antennas on mobile telephone base

station towers

Mobile Telephone Communication Antennas: Are They a

Health hazard? Fact Sheet No. 4


NEW ZEALANDNEW ZEALAND

Is it safe to live near a cellsite?

Yes. Measurements carried out by NRL around several

dozen cellsites have shown that maximum exposures are

typically about 1 or 2% of the exposure limit recommended

in New Zealand and international exposure standards. In

most areas they are less than that. No health effects are

anticipated at such low exposures.

www.nrl.moh.govt.nz/faq.html


SWEDENSWEDEN

To summarize, mobile telecommunications base stations do not constitute a risk regarding radiation protection.

Radiation from Mobile Telecommunications Base Stations, SSI, 2001


NORDIC COUNTRIESNORDIC COUNTRIES(Denmark, Finland, Iceland, Noway, Sweden)(Denmark, Finland, Iceland, Noway, Sweden)

The Nordic authorities agree that there is no scientific

evidence for any adverse health effects from mobile

telecommunication systems, neither from the base

stations nor from the handsets, below the basic

restrictions and reference values recommended by the

International Commission on Non-Ionizing Radiation

Protection (ICNIRP).

Mobile Telephony and Healt: A Common View, 2004


SYSTEMS OF PROTECTIONSYSTEMS OF PROTECTION

• Health threshold based systems

Adequate for well established, threshold effects

• Optimization systems

Adequate for no-threshold known hazards

• Precautionary measures

Adequate for suspected, not established hazards


THE TWO-LEVEL SYSTEMTHE TWO-LEVEL SYSTEM

Basic restrictions

in terms of biologically effective quantities

Reference levels

in terms of an external exposure metric

Exposure below reference levels ensures compliance with basic

restrictions, since the relations between them have been developed

under worst-case conditions.

If the reference level is exceeded, the basic restriction is not necessarily

exceeded.


THRESHOLDS FOR EFFECTSTHRESHOLDS FOR EFFECTS

Guidelines are developed based upon a quantitative relationship

between exposure and adverse effect

If the relationship takes the form of a threshold, it may be

possible to state a level of exposure below which the adverse

effect may be avoided


SETTING BASIC RESTRICTIONSSETTING BASIC RESTRICTIONSE

xpos

ure

leve

l Established health effects

Reduction factor

“Safe” exposure

Threshold of effects

Exposure limit


BASIC RESTRICTIONSBASIC RESTRICTIONSAND REFERENCE LEVELSAND REFERENCE LEVELS

● Basic restrictions (limits of exposure) are set in terms of the

biologically effective quantity, below the threshold for effects

● Reference levels in terms of measurable quantities are

derived by the basic restrictions assuming conditions of

maximum coupling


BASIC LIMITS AND REFERENCE LEVELSBASIC LIMITS AND REFERENCE LEVELSELFELF

Basic limits

workers 10 mA/m2

general public 2 mA/m2

Reference levels – electric field

workers 10 kV/m

general public 5 kV/m

Reference levels – magnetic flux density

workers 500 µT

general public 100 µT


Basic limits: workers 0.4 W/kg

general public 0.08 W/kg

BASIC LIMITS AND REFERENCE LEVELSBASIC LIMITS AND REFERENCE LEVELSRFRF


WHY HARMONISATION?WHY HARMONISATION?

There are many benefits to having harmonised standards for EMF exposures.

• Increased public confidence that governments and scientists agree on health risks

• Reduced debat and fears about EMF

• Health protection for everyone at the same high level

• Avoid confusion in the public mind and stress about health effects from EMF exposure when there are different EMF limits required by different authorities


THE EU RECOMMENDATIONTHE EU RECOMMENDATION

“Provisions by Member States in this area should be based on a

commonly agreed framework, so as to ensure consistency of

protection throughout the Community.”

“The existing variations and gaps in provisions and guidelines

contribute to a sense of confusion and insecurity felt by many

Community citizens and undermines confidence in health

protection authorities.”


BASES FOR THE EU RECOMMENDATIONBASES FOR THE EU RECOMMENDATION

• The common framework for standards should be based on the

best scientific knowledge available

• Advice on this regard has been provided by the International

Commission on Non Ionizing Radiation Protection (ICNIRP)


ICNIRP ON LONG-TERM EFFECTSICNIRP ON LONG-TERM EFFECTS

ELF

In the absence of support from laboratory studies, the epidemiological studies are insufficient to allow an exposure guideline to be established.

RF

Although there are deficiencies in the epidemiological work, [...] the studies have yelded no convincing evidence that typical exposure levels lead to adverse reproductive outcomes or an increased cancer risk in exposed individuals.

ICNIRP Guidelines, 1988


WHAT IS THE PRECAUTIONARY PRINCIPLE?WHAT IS THE PRECAUTIONARY PRINCIPLE?

The precautionary principle is an approach to risk management that

is applied in circumstances of scientific uncertainty, reflecting the

need to take action in the face of a potentially serious risk without

awaiting the results of scientific research.

EC - DG XXIV, 1998


WHEN IS THE PP APPLIED?WHEN IS THE PP APPLIED?

Recourse to the precautionary principle presupposes:

• Identification of potentially negative effects resulting from a

phenomenon, product or procedure

• A scientific evaluation of the risk which because of the

insufficiency of the data, their inconclusive or imprecise

nature, makes it impossible to determine with sufficient

certainty the risk in question


HOW IS THE PP APPLIED?HOW IS THE PP APPLIED?

Measures adopted should be:

• Proportional to the desired level of protection

• Not discriminatory in their application

• Consistent with others adopted in similar circumsatnces

• Based on cost/benefit analysis

• Provisional

• Able to assign responsibility for providing the scientific evidence

for a comprehensive risk evaluation


IS THE RECOURSE TO THE PP IS THE RECOURSE TO THE PP JUSTIFIED FOR EMF?JUSTIFIED FOR EMF?

A cautionary policy for EMF should be adopted only with great

care and deliberation. The requirements for such a policy as

outlined by the European Commission do not appear to be met

in the case of either power or radio frequency EMF; however

other related policies, such as Prudent Avoidance, may be

justified

WHO, Backgrounder on Cautionary Policies, March 2000


MOTIVATION FOR CAUTIONARY MOTIVATION FOR CAUTIONARY MEASURESMEASURES

Are precautionary measures adopted in some countries at either

national or local level motivated by

• Adverse effects on health?

or

• Public anxiety and protest?



Public protection against EMFRecommendations to Member States

Facing Health issues

• Compulsory standards• Science-based measures

Facing public concern

• Separate voluntary standards• Precautionary measures

WHO RECOMMENDATIONSWHO RECOMMENDATIONS


SCIENCE AND CAUTIONARY MEASURESSCIENCE AND CAUTIONARY MEASURES

A principle requirement is that such [precautionary] policies be

adopted only under the condition that scientific assessments of

risk and science-based exposure limits should not be undermined

by the adoption of arbitrary cautionary approaches. That would

occur, for example, if limit values were lowered to levels that bear

no relationship to the established hazards or have inappropriate

arbitrary adjustments to the limit values to account for the extent of

scientific uncertainty.

WHO 2000


EFFECTIVENESS OF MEASUREMENTSEFFECTIVENESS OF MEASUREMENTS

Any measure adopted, including precautionary measures, must be

effective for its specific purpose.

• Measures aimed at reducing health risks must be evaluated

based on the health benefit

• Measures aimed setting down public concern must be

evaluated based on the reduction of controversies


PRECAUTIONARY LIMITSPRECAUTIONARY LIMITSAND WORRIESAND WORRIES

• Adoption of very restrictive and arbitrary EMF exposure limits

by countries tends to increase public concern rather than

reducing worries and controversies.

• Difference betwen limits tends to create confusion and

mistrust of authorities.

• Choosing exposure limits that cannot be justified, either

scientifically or logically, have already created some mistrust

of the science, and in the authorities.

Cognetti Commission (Italy), 2002


THE VICIOUS CIRCLETHE VICIOUS CIRCLE

Perception

Precaution


CAUTIONARY EVALUATION OF DATACAUTIONARY EVALUATION OF DATAAND CAUTIONARY MEASURESAND CAUTIONARY MEASURES

The Precautionary Principle should not be confused with the

need to make a cautious interpretation of scientific data on

established effects.

The latter leads to the use of reduction factors when deriving

guidelines for limiting exposure.


THE FRENCH EXPERIENCETHE FRENCH EXPERIENCE

The group of experts recommend that ‘sensitive’ buildings

(hospitals, day care centers, and schools), located less than 100

metres from a base station, should not be directly in the path of the

transmission beam.

This recommendation is not incompatible with the installation of a

base station antenna on the roofs of buildings in this category, as

the incident beam has little or no effect on the area immediately

below it ("fountain" effect).

Zmirou Report, 2001


EXPECTED EFFECTS ON RISK PERCEPTIONEXPECTED EFFECTS ON RISK PERCEPTION

The group of experts feel that, if operators apply these measures,

public fears, especially those of parents concerned by their

children's exposure in school, will be allayed, especially keeping in

mind that, in view of the exposure levels observed, the group of

experts does not back the hypothesis that there is a health risk for

populations living in the vicinity of base stations.

Zmirou Report, 2001


OBSERVED EFFECTS ON RISK PERCEPTIONOBSERVED EFFECTS ON RISK PERCEPTION

The recommendation of the 2001 Report, aiming at reassuring,

resulted in the opposite effect.

Therefore, the expert group does not maintain the need for this

concept of “sensitive site” for base stations.

Such conclusion specially applies to schools, where the risk

perception is the highest.

AFSSE 2003


WHERE IS THIS ANTENNA?WHERE IS THIS ANTENNA?

In Stockholm

Inside the Karolinska Hospital


AND THIS ANTENNA?AND THIS ANTENNA?

On the roof

of WHO Headquarters

In Geneva



CONCLUSIONS ON HYPERSENSITIVITYCONCLUSIONS ON HYPERSENSITIVITY

• The majority of studies indicate that “hypersensitive” individuals cannot detect EMF exposure any more accurately than others.

• Controlled double-blind studies have shown that symptoms are not correlated with EMF exposure.

• Symptoms may be due to pre-existing psychiatric conditions as well as stress reactions as a result of worrying about believed EMF health effects, rather than the EMF exposure itself.

• Hypersensitivity should not be used as a medical diagnosis since there is presently no scientific basis to link symptoms to EMF exposure.

• The term “hypersensitivity” should be dismissed.


RISKS IN PERSPECTIVERISKS IN PERSPECTIVE

Susceptibility towards EMF is very high because alleged risks concern:

• A pathology particularly dread such as cancer

• A category particularly protected such as children

What is the relevance of EMF in the general context of cancer and in

the general context of children’s health?


2003, 351 pages

Electromagnetic fields

Some studies have shown a risk of childhood leukaemia with exposure to high level residential extremely low frequency electromagnetic fields, but causality has not been established

(p. 243)


2002, 222 pages

Electromagnetic fields

Assuming that the association is causal, the number of cases in excess would be in the order of 1%. […]

Whether or not this is to be considered acceptable (keeping in mind that the association is not proven) is an ethical matter, requiring a thorough and transparent discussion among different stakeholders.

(p. 89)


BALANCING RISKS AND BENEFITSBALANCING RISKS AND BENEFITS

Actions on limiting the exposure of the general public to

electromagnetic fields should be balanced with the other

health, safety and security benefits that devices emitting

electromagnetic fields bring to the quality of life, in such

areas as telecommunications, energy and public security.

EU Recommendation, 1999


BALANCING RISKS AND BENEFITSBALANCING RISKS AND BENEFITS

Key issues for the European region

2. European population development, economic growth and health status improvement are strongly dependent on clean, reliable and affordable

6. Health impacts from the lack of continuous and affordable energy available are broad, ranging from increased winter mortality, air pollution related morbidity and mortality to higher risks of psychological stress

17. The exposure of local populations to power lines is minimal.

WHO Workshop “Energy and Health” - Rome, 30-31 May 2005 (Draft)


THE FINAL GOAL OF THE FINAL GOAL OF PROTECTION POLICIESPROTECTION POLICIES

To develop a policy that realizes the

protection of human health in its broadest

sense …


Documents

Ministry of Public Health, Montevideo 5 March 2009 ELECTROMAGNETIC FIELDS AND HEALTH: EFFECTS, PERCEPTION, PROTECTION Paolo Vecchia National Institute