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      Indo-US nuclear deal: A challenge for occupational health

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          With the nuclear deal with US, the country is poised towards investing in nuclear power. However, there are concerns stemming from the track record of nuclear installations in the past regarding the safety aspects. The present editorial discusses the connected issues and reviews India's preparedness towards meeting the occupational hazards posed by nuclear power. INTRODUCTION The nuclear deal between US and India has been approved, only some formalities are remaining. This might be counted as an achievement of this government, but this also poses several challenges regarding a safe nuclear occupational environment. The much publicized government's view points and media hype, largely based on optimism that energy needs of our country can be met with if we resort to nuclear energy for power generation has to be tempered with the track record of nuclear installations. Concerns are coming forward from different quarters.[1] Several issues need to be addressed such as whether this a safe and economically viable proposition? What about the health hazards of radioactive material and even the radioactive wastes on the workers and on the entire community. HISTORICAL ASPECT In spite of marked improvement in radiation protection, some 285 nuclear reactor accidents have been reported in various countries between1945-1987.[2] Two major nuclear reactor plant accidents are: 1. Chernobyl nuclear disaster:[3] On April 25th-26th, 1986 the World's worst nuclear power accident occurred at Chernobyl in the former USSR (now Ukraine). The Chernobyl nuclear power plant located 80 miles north of Kiev had 4 reactors and whilst testing reactor number 4 numerous safety procedures were disregarded. At 1:23 am the chain reaction in the reactor became out of control creating explosions and a fireball which blew off the reactor's heavy steel and concrete lid. The Chernobyl accident killed more than 30 people immediately and as a result of the high radiation levels in the surrounding 20-mile radius, 135,00 people had to be evacuated. 2. Three mile island: On an island 10 miles from Harrisburg Pennsylvania resides the Three Mile Island nuclear power Station. There are two reactors at the plant, dubbed Unit 1 and Unit 2. One of them is inoperable. Unit 2 experienced a partial reactor meltdown on March 28, 1979. A partial nuclear meltdown is when the uranium fuel rods start to liquefy, but they do not fall through the reactor floor and breach the containment systems. The accident which occurred at Unit 2 is considered to be the worst nuclear disaster in US history. Although surveillance within the Three Mile Island cohort between 1979-1998 (n = 32, 1350), provided no consistent evidence that radioactivity released during the nuclear accident had a significant impact on the overall mortality of these residents, several concerns persist and certain dose - response relationships cannot be definitely excluded.[4] SAFETY CHALLENGES FOR INDIA India is not immune to the nuclear reactor plants accidents. So far we experienced two such kind of accidents fortunately they were not major accidents. JAN-1-1992: Four tons of heavy water spilt at Rajasthan nuclear power plant.[5] MAY-13-1992: Tube leak causes a radioactive release of 12 Curies of radioactivity from Tarapur nuclear power station.[5] Apart from accidents, there is a major problem of radioactive waste management. There is no full proof method of disposal of radioactive waste.[1] As we engage in nuclear enterprise on a large scale we should gear up our nuclear safety protocols to avoid major nuclear disasters. OCCUPATIONAL HEALTH HAZARDS OF RADIATIONS[6–11] The radiation related diseases in population around uranium mines and nuclear facilities are well known. Health hazards of radiation have wide spectrum ranging from acute radiation syndrome to carcinogenesis (major cause of occupational carcinogenesis of thyroid, skin, breast,lungs and salivary glands). Radiation may act to enhance the effect of another carcinogen i.e. they may act as co-carcinogens. Radiation dermatitis is also very common amongst the laborers. Long-term exposure to radiation also related with chromosomal mutations. Long-term exposure known to be associated with the foetal abnormalities for eg. An excess of leukemia and non-Hodgkin's lymphoma in young people residing in village of Seascale, England was caused by occupational irradiation of their fathers at Sella-field nuclear installation as suggested by case control study.[12] According to studies conducted by International Physicians for Prevention of Nuclear war (IIPNW) and German Society for Radiation Protection, 50000 to 100,000 liquidators (clean-up workers) died in the year up to 2006 since Chernobyl. Between 540,000 and 900,000 liquidators have become invalids, 12,000 and 83,000 children born with congenital deformation in region of Chernobyl. In Belarus alone over 10,000 people developed thyroid cancer since catastrophe.[1] Till date there is no such method to safely dispose the nuclear waste products. The threat posed by dumping wastes into a storage pond is already causing grave environmental concerns. Its is important to note here that half-life of Uranium is 760 million years and that of Plutonium is 24,100 years. This means that after so many years half of the radioactive substance will remain around us.[1] Insurance costs in case of accidents of nuclear reactor are so high that no private company came forward to cover the insurance cost of these facilities in U.S. Ultimately government had to pay insurance cost. It is going to be repeated here in India.[1] In India the traditional public health concerns likes communicable diseases, malnutrition, poor environmental sanitation and reproductive health care get emphasis and priorities in the health policy. Recent industrialization and globalizations is changing the occupational morbidity drastically, the new pathologies like cancers, stress, AIDS, geriatrics, psychological disorders and heart diseases are on rise. The transition pose challenges to health care system with new concepts of environmental legislation, ethical issues, new safety regulations, insurance and high costs of healthcare.[13] Due to lack of education, unawareness of the hazards of the occupations, general backwardness in sanitation, poor nutrition and climatic proneness of this geographic region to epidemics aggravate the health hazards from work environment.[14] CONCLUSION Though India is showing signs of becoming a major economic power, the state of public health is not up to the mark. We still have large burden of communicable diseases and increasing trends of non-communicable diseases. So far occupational health as a part of public health is somewhat neglected sector due to lack of policy making and research. As already discussed due to many lacunae in basic infrastructure in occupational health, India is ill prepared for new occupational hazards like nuclear radiation hazards. The overall improvement in the occupational health infrastructure is needed to initiate any new projects particularly hazardous ones dealing with nuclear power. It is emphasized by some experts in the power sector and government that nuclear power is only option which can fulfill the power requirement of the country, but many experts think that more safe and economic options are available like non-conventional energy resources. We should concentrate more on this type of resources to protect our labourers, their families and on large extents entire community. To conclude government must think in all directions over this Indo-US nuclear deal.

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          Most cited references 15

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          Results of case-control study of leukaemia and lymphoma among young people near Sellafield nuclear plant in West Cumbria.

          To examine whether the observed excess of childhood leukaemia and lymphoma near the Sellafield nuclear plant is associated with established risk factors or with factors related to the plant. A case-control study. West Cumbria health district. 52 Cases of leukaemia, 22 of non-Hodgkin's lymphoma, and 23 of Hodgkin's disease occurring in people born in the area and diagnosed there in 1950-85 under the age of 25 and 1001 controls matched for sex and date of birth taken from the same birth registers as the cases. Antenatal abdominal x ray examinations, viral infections, habit factors, proximity to and employment characteristics of parents at Sellafield. Expected associations with prenatal exposure to x rays were found, but little information was available on viral illnesses. Relative risks for leukaemia and non-Hodgkin's lymphoma were higher in children born near Sellafield and in children of fathers employed at the plant, particularly those with high radiation dose recordings before their child's conception. For example, the relative risks compared with area controls were 0.17 (95% confidence interval 0.05 to 0.53) for being born further than 5 km from Sellafield 2.44 (1.04 to 5.71) for children of fathers employed at Sellafield at their conception, and 6.42 (1.57 to 26.3) for children of fathers receiving a total preconceptual ionising radiation dose of 100 mSv or more. Other factors, including exposure to x rays, maternal age, employment elsewhere, eating seafood, and playing on the beach did not explain these relationships. Focusing on Seascale, where the excess incidence has predominantly been reported, showed for the four out of five cases of leukaemia and one case of non-Hodgkin's lymphoma whose fathers were employed at Sellafield and for whom dose information was obtained that the fathers of each case had higher radiation doses before their child's conception than all their matched control fathers; the father of the other Seascale case (non-Hodgkin's lymphoma) was not employed at the plant. These results seem to explain statistically the geographical association. For Hodgkin's disease neither geographical nor employment associations with Sellafield were found. The raised incidence of leukaemia, particularly, and non-Hodgkin's lymphoma among children near Sellafield was associated with paternal employment and recorded external dose of whole body penetrating radiation during work at the plant before conception. The association can explain statistically the observed geographical excess. This result suggests an effect of ionising radiation on fathers that may be leukaemogenic in their offspring, though other, less likely, explanations are possible. There are important potential implications for radiobiology and for protection of radiation workers and their children.
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            Long-term follow-up of the residents of the Three Mile Island accident area: 1979-1998.

            The Three Mile Island (TMI) nuclear power plant accident (1979) prompted the Pennsylvania Department of Health to initiate a cohort mortality study in the TMI accident area. This study is significant because of the long follow-up (1979-1998), large cohort size (32,135), and evidence from earlier reports indicating increased cancer risks. Standardized mortality ratios (SMRs) were calculated to assess the mortality experience of the cohort compared with a local population. Relative risk (RR) regression modeling was performed to assess cause-specific mortality associated with radiation-related exposure variables after adjustment for individual smoking and lifestyle factors. Overall cancer mortality in this cohort was similar to the local population [SMRs = 103.7 (male); 99.8 (female)]. RR modeling showed neither maximum gamma nor likely gamma exposure was a significant predictor of all malignant neoplasms; bronchus, trachea, and lung; or heart disease mortality after adjusting for known confounders. The RR estimates for maximum gamma exposure (less than or equal to 8, 8-19, 20-34, greater than or equal to 35 mrem) in relation to all lymphatic and hematopoietic tissue (LHT) are significantly elevated (RRs = 1.00, 1.16, 2.54, 2.45, respectively) for males and are suggestive of a potential dose-response relationship, although the test for trend was not significant. An upward trend of RRs and SMRs for levels of maximum gamma exposure in relation to breast cancer in females (RRs = 1.00, 1.08, 1.13, 1.31; SMRs = 104.2, 113.2, 117.9) was also noted. Although the surveillance within the TMI cohort provides no consistent evidence that radioactivity released during the nuclear accident has had a significant impact on the overall mortality experience of these residents, several elevations persist, and certain potential dose-response relationships cannot be definitively excluded.
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              An overview of occupational health research in India


                Author and article information

                Indian J Occup Environ Med
                Indian Journal of Occupational and Environmental Medicine
                Medknow Publications (India )
                May-Aug 2007
                : 11
                : 2
                : 47-49
                Department of Community Medicine, Pad Dr. D Y Patil Medical College, Pune - 411 018, India
                Author notes
                For correspondence: Dr. Amitav Banerjee, Department of Community Medicine, Pad Dr. D Y Patil Medical College, Pune - 411 018, India. E-mail: amitavb@
                © Indian Journal of Occupational and Environmental Medicine

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


                Occupational & Environmental medicine


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