Health In Vieques: A Crisis and its Causes
By Cruz Maria Nazario, John Lindsay-Poland, and Déborah Santana
Media coverage of the controversy in Vieques frequently states that opponents of the US Navy’s bombing “allege health and environmental damage from military practices” and that “the Navy denies those claims.” Yet the critical health situation in Vieques is at the heart of why more than two- thirds of the island’s residents voted for an immediate cessation of naval bombing and a full environmental cleanup.
This Issue Brief explores health conditions in Vieques and what is known about the possible causes of health problems there. It concludes by calling for the immediate cessation of military activities in the island, full environmental decontamination, thorough evaluation of the health situation and improvement of the health care services in Vieques.
Children at risk? When she was just two years old, Milivy Adams’ parents, José and Zulayka, noticed a bulge on the child’s head. It was diagnosed as a tumor and removed, but there were other tumors — in her kidney, her left hand and leg, and shoulders. José had been a baker in Vieques, but brought the family to New Jersey, where Milivy received chemotherapy and radiation treatment at nearby Philadelphia Children’s Hospital; at present her condition is deteriorating.
For many Puerto Ricans, Milivy Adams’ struggle to live has become symbolic of the many people in Vieques who have contracted cancer and other serious diseases during the years that the Navy has used the eastern end of the island as a bombing and training area. This was demonstrated in a Puerto Rico Department of Health publication (November, 1997), which showed that Vieques had a 27% higher cancer rate than the rest of Puerto Rico from 1985 to 1989. Subsequent studies and observation have confirmed the excessive risk of developing and dying from cancer among viequenses. From 1995 to 1998, viequenses under 50 years old had 56% greater risk of dying from cancer than Puerto Ricans of the same age living in the main island. The increased risk of viequenses of developing and dying from cancer since 1970 is significant.
While every cancer death affects the family, in a small community the impact is multiplied. Therefore, when in a single week in February 2002, six viequenses died of cancer, not only the immediate family was affected, but a distressing signal also reached the entire community: Who will be next?
The poor health situation in Vieques is not limited to cancer. In 1998, the crude death rate from heart disease in Vieques was 251.6 per 100,000, compared to 157.5 in Puerto Rico. Vieques has no long-term or heavily contaminating industries, except for the military. Other towns in Puerto Rico with evident environmental contamination or with limited access to health care experienced lower mortality rates from heart disease during that year. For example, the town of Cataño is contaminated from many industries in the vicinity, yet has a death rate from heart disease of 163.9 per 100,000. In addition, rural Las Marías also had lower rates (172.7) even though, like Vieques, a large proportion of the population lives in remote areas with poor access to specialized health services.
Between 15 — 32% of Vieques public school students reported respiratory ailments in the annual health report of the Puerto Rican Department of Education from 1995 to 1999. During 1998 the Puerto Rico Health Department conducted two health surveys using a sample of 215 households in Vieques. One of the surveys, sponsored by the federal Centers for Disease Control, is known as the Behavior Risk Factor Surveillance Survey (BRFSS). The BRFSS is a survey designed to gather information from a representative sample of the population on their habits as they affect health, such as cigarette smoking (considered the most important risk factor for developing cancer) and measures for early detection of disease (a positive factor for a better quality of life).
The official report from the Department of Health reported that while there were no significant (p>0.05) differences between those living in Vieques and the main island regarding physical activity, cigarette smoking, vitamins and supplement consumption, and many demographic characteristics, the reporting of premature sexual development (telarchia) in girls under eight years old was significantly (p=0.005) higher in Vieques (7.2%) than the rest of Puerto Rico, which already has extremely high rates (3.0%). Puerto Rico’s high rates most likely stem from the presence of high levels of phthalates from manufacturing. Phthalates are chemical compounds which mimic hormones. The most probable sources of phthalates and other ecoestrogens in Vieques are military explosives components.
Infant mortality in Vieques is decreasing more slowly than in Puerto Rico: in Puerto Rico a 71% decrease was observed when infant mortality rates from 1960-1964 were compared to 1990-1994, while it only decreased 27% in Vieques during the same 30 years. In fact, between 1990 and 1997 the risk of a baby dying before his or her first birthday was about 25% higher for babies born from women living in Vieques than one born in Puerto Rico.
Cancer risk. Many years before David Sanes was killed by two off-target bombs in Vieques in 1999 —the tragic event that reignited a massive protest movement — the people of Vieques were already dying of catastrophic illnesses such as cancer at a higher rate than expected for a population of less than 10,000. In fact, when cancer rates in Vieques during 1970-1974 are compared to their cancer rates from 1985-1989, the risk of viequenses contracting cancer was 66% higher than in the previous period. This means that the cancer risk in Vieques has been increasing steadily in statistically significant proportions since the early 1970s, when bombing and military practices in Vieques also intensified.
It is important to note that among viequense children up to nine years old, the risk of developing cancer was double the risk for children of the same age in the rest of Puerto Rico from 1985 to 1989. Even more significant is the fact that during the same time period children in Vieques from 10 to 19 years old had 3.5 times the risk of developing cancer, compared with children of the same age in Puerto Rico. In 1999 — the year David Sanes died — the risk of dying of cancer in Vieques was 61% higher than in Puerto Rico. These statistics represent the reality of the health situation in Vieques, according to official data from the Puerto Rico Department of Health.
In Vieques, cancer deaths are under-reported, because many cancer patients move to other municipalities to receive treatment and are thus more likely to die away from their residence.
How can we explain the elevated risks of developing cancer in Vieques? Why do viequenses have a higher risk of developing and dying from cancer ? Are the people living in Vieques different from Puerto Ricans on the big island? Are the living habits of viequenses less healthy than those living in Puerto Rico? Is it because of the contamination on Vieques? What are the most probable sources of contamination in Vieques?
Health surveys show that socioeconomic differences, lifestyle, or even age distribution among viequenses compared to Puerto Ricans in the main island do not account for the high risk of developing cancer in Vieques. Epidemiological studies are required to further evaluate the influence of such factors in cancer etiology. But based on the official data available from scientific studies, the evidence points elsewhere.
A very few small industries have been established in Vieques for short periods, none of which have been large enough or operated long enough to account for the serious and widespread health crisis in Vieques. By contrast, for more than 60 years the US Navy has actively bombed and openly burned conventional weapons in Vieques, fired unconventional weapons, and experimented with unknown materials and substances.
It is reasonable to focus on the activities and wastes of industries with a high potential for contaminating the environment where they are located. This is why regulatory and environmental agencies are charged with actively monitoring such activities and wastes. Any industry not complying with these laws and regulations is subject to fines, as well as requirements to clean up the contamination and compensate for damages.
Navy activities, cancer and other diseases in Vieques. Toxic wastes produced by military activities have been verified by information provided by the Navy and manufacturers of weapons components such as explosives, propellants, and munitions casings. The available information usually does not include the weapons used in an experimental stage, or those used by other nations’ militaries that rent the impact area in Vieques. The limits on available information further indicates the need to investigate the links between health problems and environmental contamination in Vieques, using sound scientific methods.
The Navy has argued that there are no links between military practices and health problems in Vieques. Yet as environmentalist Peter Montague points out, “Science will never provide definitive answers to some of the most important questions that we face.” Absolute proof that a person became sick from a specific source of environmental contamination is almost never possible. “There is always room,” Montague continues, “for a researcher employed by Philip Morris or the Crop Protection Association (the pesticide trade group) to say, ‘Could not this disease be partly caused by some factor that you haven’t taken into consideration?’ And the honest answer must always be, ‘Yes, there’s a slim chance that it could be.’”
Yet the precautionary principle argues that identifiable sources of health hazards must be controlled, even in the absence of “absolute proof.” If we value the health of the people living on Vieques, then “absolute proof” is not necessary. Among the factors that might explain the high cancer rate and other health problems in Vieques, environmental contamination appears to be most important. There already is enough evidence to conclude that naval bombing has imposed and continues to impose enormous risks on the health of islanders.
What we know. The information currently available allows us to discuss the biological plausibility that contamination from naval activities can cause many health problems in Vieques. For example, some explosives — such as TNT and RDX — are classified by the Environmental Protection Agency (EPA) and by the International Agency for Research on Cancer (IARC) as possible carcinogens. RDX contamination only results from military activities, and traces of this toxic element have been detected in Vieques. Even bombs that do not contain large amounts of explosives use propellants such as DNT, which is also a probable carcinogen. Studies of animal exposure to DNT have shown that a reduction in the numbers of red blood cells, nervous system disorders, and liver and kidney damage can occur .
The structural parts of munitions also have components such as arsenic, cadmium and lead, which the EPA has classified as carcinogenic, based on studies showing that humans and animals exposed to these substances have an increased risk of developing cancer. Other carcinogens related to military activity are: pyrotechnic products (hexachloroethane and lead, both probable carcinogens), and combustion products (Nitrosodiphenylamine, classified as a probable carcinogen by EPA). Military training also destroys vegetation using chemical compounds such as dioxins, which have toxic effects on humans. Exposure to dioxin increases the risk of autoimmune diseases such as diabetes, as reported by a e recent Air Force Health Study (2001).
Are people in Vieques exposed to these compounds? In the 1978 the Navy conducted a study of water wells in Vieques aimed at measuring the presence of materials from explosives in the island’s water sources. The study found RDX (0.00004 parts per million) in all samples except one, and also found the explosive Tetryl in a water tank in Isabel Segunda, the island’s main town. The amount of contaminants measured is not as important as what they establish: that there exists an exposure pathway between the toxic materials used in munitions in the impact area and people’s water in the civilian area of the island. It should be noted that naval bombing intensified in the years following the 1978 well study.
When civil disobedience camps were established in the bombing zone of eastern Vieques (between May 1999 and May 2000), several researchers (Jorge Fernández Porto, Neftalí García Martínez and others) took soil samples that provided scientific evidence of the presence of toxic substances in the Vieques firing range. Biologist Dr. Arturo Massol and his colleagues from the University of Puerto Rico-Mayaguez have published several studies establishing that these toxic substances have entered the food chain and are present in dangerous levels in vegetation (squash, peppers, pigeon peas, and others) in the civilian lands of Vieques. A research group from the University of Puerto Rico School of Public Health (Nazario et al) found cadmium, arsenic and lead in the surface dust accumulated inside homes in Vieques. Hair samples of viequenses taken in 1999 and 2000 showed high levels of cadmium, lead and mercury.
Such findings indicate an urgent need for comprehensive and complete studies of potential exposure and contamination of the people living in Vieques, who have apparently been exposed to carcinogenic and toxic substances for decades.
What do health professionals say? In 2001, the American Public Health Association adopted a resolution calling on the President to order a permanent cessation of military exercises on Vieques and to establish a cleanup program to restore the island’s environment. The resolution pointed out that cancer rates for Vieques “exceed the alert levels adopted by the surveillance system as defined by the Agency for Toxic Substances and Disease Registry.” Moreover, in June 2000, 21 Puerto Rican physicians were arrested for entering the firing range in Vieques. They announced that byengaging in peaceful civil disobedience, they observed their Hippocratic Oath in an act of concern for the health of soldiers as well as of islanders.
1. As a public health measure for controlling the most probable source of exposure of viequenses to harmful substances, the United States should permanently end naval bombing, as well as open burning and detonation, in Vieques.
2. The federal executive should initiate — and Congress should fully fund — removal of the existing contaminants to which people in Vieques are exposed, with a complete cleanup program of the island’s lands and waters.
3. A complete and up-to-date epidemiological study of the causes of cancer and other health problems in Vieques should be initiated as soon as possible. Whether the study is underwritten by an international organization such as the Pan-American Health Organization, the U.S. government, the Puerto Rican government, or another party, it is crucial for viequenses to be integrally involved in the study’s design and execution.
4. It is critical that health care services in Vieques be improved and made comprehensive. For example, while a planned new birth center is a good step, pre-natal services are even more important and urgently needed.
Dr. Cruz Maria Nazario is a cancer epidemiologist at the University of Puerto Rico Graduate School of Public Health. She coordinated the professional group assigned by the Puerto Rican legislature to study the incidence and causes of cancer in Vieques in 2001. John Lindsay-Poland is director of the Fellowship of Reconciliation Task Force on Latin America and the Caribbean in San Francisco, CA. Dr. Déborah Santana is Professor of Ethnic Studies at Mills College.
This Vieques Issue Brief is one of a series published by the Fellowship of Reconciliation.
Sources for more information:
Air Force Health Study, available at:
Resolution of American Public Health Association, American Journal of Public Health, March 2001, p. 514.
Military Toxics Project, “Toxic Hazards of Practice Ammunition,” available at:
Arturo Massol, Casa Pueblo, “Studies on Vieques Flora and Fauna: Summary of Findings,” available at: http://www.viequeslibre.addr.com/articles/articles.htm
Peter Montague, Rachel’s Environmental and Health Weekly #726, “Science, Precaution and Pesticides,” June 7, 2001.
Jorge L. Colón, Cruz Maria Nazario, Himilce Vélez, Rafael Guerrero, Vieques: Situación Actual de la Salud, Grupo de Apoyo Técnico y Profesional para el Desarollo Sustentable de Vieques, April 2000.
“Focused Petitioned Public Health Assessment: Drinking Water Supplies and Groundwater Pathway Evaluation, Isla de Vieques Bombing Range, Vieques, Puerto Rico,” Agency for Toxic Substances and Disease Registry, available at:
Erick Suárez, “Incidencia y Mortalidad de Cáncer en Vieques,” presentation to First Puerto Rican Conference on Public Health, San Juan, April 10, 2002.