From: Rollin Hu

RE: Mercury exposure from magico-religious rituals and folk medicines is a serious public health threat in many ethnic communities.

Long-term exposure to mercury can damage the respiratory system, cause irreversible kidney injury, and increase the risk for birth defects, among other detrimental effects. Even very small amounts of metallic mercury (for example, a few drops) can raise air concentrations of mercury to levels that may be harmful to health. Mercury is easily vaporized, and its vapors are capable of persisting in an indoor environment for months. Children who play near the floor and carpeting are especially vulnerable, as mercury is heavier than air and sinks.

Many religions practiced by individuals of Hispanic and Caribbean descent include use of metallic mercury, often referred to as "azogue." These include but are not limited to Santeria (a Cuban-based religion), Voodoo (Haitian), Palo Mayombe (Caribbean), and Espiritismo (Puerto Rican). Practitioners of these religions often recommend that mercury be sprinkled in dwellings or automobiles, or mixed with oil, wine, or perfume in open containers. Mercury is also vaporized in devotional candles, creating a substantially more troubling public health problem, as inhaled vapor is capable of causing more damage than exposure to the liquid form.

• Of ritual experts consulted by public health officials, 29% recommended mercury be sprinkled in the home, 2% that it be sprinkled in cars, and 2% that it be ingested.
• Mercury is often sold in stores called botanicas located in areas with large Hispanic and Caribbean populations. A 1996 survey of New York City botanicas found 35 such stores selling an average of 150 9 g units per day, amounting to sales of greater than 420 kg yearly.
• A 1997 study commissioned by the Environmental Protection Agency (EPA) found that 44% of New Yorkers of Caribbean descent used mercury "in their homes, cars, or carried on their person." 27% of New Yorkers of Hispanic descent reported the same.
• Based on a 1995 analysis of botanicas, officials calculate that as many as 13,800 homes in New York City alone may be contaminated with mercury every year.

Some folk medicines used by Mexican-Americans and many Asian-Americans also utilize mercury to treat a variety of conditions, including fever, rheumatism, apoplexy, and cataracts. 8 out of 9 Chinese herbal medicine balls imported into the United States tested positive for high levels of mercury. Ingesting the recommended dose of two balls per day could theoretically expose individuals to up to 1.2 g of mercury daily.

Governments at the federal, state, and local levels have done little to address the problem of mercury use in religious and ethnomedical practices.

• The EPA has the authority to regulate the sale and use of mercury under the Toxic Substances Control Act, but has to date not invoked that authority.
• The Agency for Toxic Substances and Disease Registry (ATSDR) has ignored domestic mercury exposure and has focused on the arguably less widespread effects of mercury exposure from Superfund sites and methylmercury exposure from contaminated fish. Lack of effective studies from ATSDR has helped perpetuate inaction from the EPA.
• The Consumer Product Safety Commission’s regulations dictate that all toxic substances must bear warning and identification labels. However, more than 90% of mercury sold for magico-religious purposes and almost all ethnic folk medicines are unlabeled.

The ability of government agencies to reduce the religious and ethnomedical use of mercury hinges upon not alienating the very populations these measures are intended to help. Individuals who feel that public health institutions are impinging on their right to practice religious beliefs may lose trust in these institutions and ignore the legitimate health concerns that are brought up. As a result, we recommend the following actions be pursued through an interdepartmental effort:

• Fund clinical studies through HHS and ATSDR to convince mercury users that magico-religious use of mercury is hazardous to human health.
• Initiate public health education/advertising programs targeted toward ethnic communities that utilize mercury.
• Initiate a dialogue with religious practitioners.
• Inform community health care providers of the hazards of mercury use, and remind them to remain vigilant for symptoms of mercury poisoning.
• Enforce current mercury labeling requirements in botanicas and ethnic herbal remedy markets to make sure purchasers are aware of the health risks.
• Begin regulating the sale of mercury through the EPA by instituting reporting requirements for botanicas and folk medicine markets that wish to sell the substance.

It costs an estimated $20,000 to decontaminate an apartment that has been exposed to high levels of mercury. If the EPA were to decontaminate every dwelling that is exposed to mercury from magico-religious practices each year, it would have to spend $276,000,000 annually just to clean New York City. It costs far less to initiate public health education and advertising programs, and enforce existing labeling and sales regulations.