Living with PFAS ‘forever chemicals’ can be distressing. Not knowing if they’re making you sick is just the start

When we talk about the health effects of PFAS, we commonly think about any physical effects on the body.

For instance, does exposure to these long-lasting, per- and polyfluoroalkyl chemicals increase our risk of cancer, liver disease or pregnancy complications?

What’s less talked about is the psychological distress of living in a community affected by PFAS pollution – the uncertainty of whether your sickness is down to PFAS or something else, the stigma of living there, or the financial stress of watching property values drop, among other factors.

Later today, a Senate select committee is set to release its final report on the extent, regulation and management of PFAS in Australia.

Here’s what we know about the psychological impact of living with PFAS pollution.

What are PFAS chemicals?

Since the 1950s, companies have used PFAS chemicals in consumer goods from non-stick pans through to makeup and fast-food wrappers. Firefighters have used PFAS-based foams to put out high-temperature industrial fires, particularly at airports and during fire training.

These chemicals persist in the environment and accumulate in animals and humans. In humans, PFAS are mainly present in the blood and blood-rich organs, such as the liver.

There are thousands of different PFAS chemicals. However, health authorities have focused on three common ones: perfluorooctanesulfonic acid (PFOS),
perfluorooctanoic acid (PFOA) and perfluorohexanesulfonic acid (PFHxS).

The average time it takes for them to be eliminated from the human body by 50% is 2.7–5.3 years, depending on the chemical.

Their extensive use in consumer goods now means most people have low levels in their blood, even in remote parts of Australia.

But health effects are uncertain

Health researchers have conducted hundreds of studies into the health effects of PFAS. However, the results are difficult to interpret and sometimes contradictory. This has led to uncertainty about their health effects.

Health authorities consider exposure to PFAS is potentially associated with:

• elevated cholesterol levels
• lowered antibody responses to some vaccines
• changes in liver enzymes (evidence of liver inflammation or damage)
• pregnancy-induced hypertension (high blood pressure) and preeclampsia (a pregnancy complication that can be life-threatening for mother and baby)
• small decreases in birth weight
• kidney and testicular cancer.

The International Agency for Research on Cancer concluded that PFOA is a human carcinogen (meaning it can cause cancer) and PFOS is possibly carcinogenic. This was not based on human epidemiological studies due to lack of evidence, but on experimental studies in animals and the potential mechanisms of action in humans.

An expert panel convened by NSW Health concluded earlier this year that most health effects from PFAS are likely to be small.

How PFAS affects communities

Some communities have become contaminated with PFAS, usually due to firefighting activities around airports, defence force bases and firefighting training grounds.

That’s because PFAS from firefighting foams can leach into ground water and surrounding waterways. If people drink this water or eat food grown with it PFAS may accumulate in their blood.

This has led to community members becoming concerned about the potential health effects, and telling us they were distressed.

My research team conducted the PFAS Health Study between 2018 and 2021 in three affected communities: Williamtown in New South Wales; Oakey in Queensland; and Katherine, in the Northern Territory.

Residents and workers who had higher levels of PFAS in their blood also had higher cholesterol levels. However, we found limited evidence of other health effects despite an extensive investigation.

We found evidence of psychological distress among community members due to a range of reasons, including:

• uncertainty about the health effects
• not understanding what high PFAS levels in the blood means
• being exposed to larger amounts of PFAS at work
• financial pressures from property losses, either from having to sell up and move away or falling property values in affected areas
• interactions with government agencies responding to the contamination
• stigma from living in a contaminated area.

In a survey we conducted, one in three participants in these towns were “very” or “extremely” concerned about their health. One in five said they were “very” or “extremely” concerned about their mental health.

One resident told us about the psychological distress associated with uncertainty about the health effects of PFAS exposure:

you get sick and you don’t know whether to [attribute] it to the pollution here […] is what I’ve got caused by this or is it something else?

Another told us about a worrying decline in property prices:

20 acres, $100,000 four bedroom house. I don’t know anywhere else in Australia that you’d get something like that, maybe [the other PFAS-affected sites].

Many residents talked about feeling stuck. One told us:

We’ve been there 30 years and you can’t walk away and where do you live?

How to respond?

We found the effects of PFAS contamination on communities go far beyond any physical impact on the body. So any response needs to also factor in the psychological impact of living with PFAS if we are to support communities immediately after contamination is recognised, and into the future.

Government agencies are often responsible for dealing with these “slow-moving disasters”. So it is important they ask communities what they need so support them, beyond addressing the source of contamination and their physical needs, such as providing uncontaminated drinking water. This may be the support of counsellors, psychologists or other services.

The response to these events can occur over many years. So we may also need to factor in longer-term psychological consequences of PFAS contamination when planning health services and providing support.