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America's Environmental Health Gap: Why the Country Needs a Nationwide Health Tracking Network

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America's Environmental Health Gap: Why the Country Needs a Nationwide Health Tracking Network America's Environmental Health Gap: Why the Country Needs a Nationwide Health Tracking Network Technical Report September 2000 Sponsored by: The Pew Environmental Health Commission At the Johns Hopkins School of Hygiene and Public Health Report by: Environmental Health Tracking Project Team Johns Hopkins School of Hygiene and Public Health Department of Health Policy and Management 1 Foreword by Commission Chairman Lowell Weicker, Jr. With the mapping of the human genome, we are on the verge of a new wave of advances in health. With this remarkable achievement, researchers will be able to shed new light on the links between genetic predisposition and such factors as behavior and exposures to pollutants in the environment in order to prevent many of the chronic diseases that today cause so much suffering. But there is a catch. We must have the basic information about the health of Americans and our environment before we can make the fullest use of this exciting genetic knowledge. The way to get this basic data is to track it—systematically, comprehensively, on a coordinated basis at all levels from the local community to the nation as a whole. We have to track what and where the hazards are in the environment, whether people are at risk from exposures to these hazards, and the health of our communities. Our information about environmental factors must run as deep and be as comprehensive as our knowledge of the genome. This report examines our current public health response capabilities to environmental threats, and recommends the establishment of a Nationwide Health Tracking Network. The Pew Environmental Health Commission was charged with developing a blueprint to rebuild the nation’s public health defenses against environmental threats. We know there are pollutants entering our air and water each year with suspected or known adverse effects on the health of our communities. What we are limited in knowing is if there is a link between that pollution and the increases we are seeing in chronic diseases because we aren’t tracking environmental health factors. We need to gather the facts now. Americans have a right, and the need, to know. 2 TABLE OF CONTENTS TECHNICAL REPORT OVERVIEW..................................................................................................................... 5 CHAPTER 1. EXECUTIVE SUMMARY OF COMMISSION RECOMMENDATIONS.............................. 7 THE GRIM PICTURE – AN ENVIRONMENTAL HEALTH AND PREVENTION GAP ....................................................... 8 THE PUBLIC’S EXPECTATIONS ................................................................................................................................10 THE PEW ENVIRONMENTAL HEALTH COMMISSION’S RECOMMENDATION – A RIGHT TO KNOW OUR ENVIRONMENTAL HEALTH ..................................................................................................................................... 10 ACTION STEPS NEEDED TO DEVELOP THE NETWORK............................................................................................ 13 THE COMMISSION’S HEALTH TRACKING ANALYSIS.............................................................................................. 17 A LOOK AT NATIONAL CAPACITY FOR TRACKING ................................................................................................ 18 Hazard Tracking................................................................................................................................................ 19 Exposure Tracking............................................................................................................................................. 20 Health Outcome Tracking ................................................................................................................................. 20 A LOOK AT STATE AND LOCAL CAPACITY FOR TRACKING................................................................................... 21 THE TIME IS RIGHT.................................................................................................................................................. 22 WHY WE NEED A HEALTH TRACKING NETWORK NOW ........................................................................................ 23 CHAPTER 2. BACKGROUND ON ENVIRONMENTAL HEALTH TRACKING ...................................... 25 DEFINING "ENVIRONMENTAL HEALTH TRACKING"............................................................................................... 27 The Goals of Environmental Health Tracking ................................................................................................. 27 The Components of Environmental Health Tracking....................................................................................... 29 HISTORICAL PERSPECTIVES ON PUBLIC HEALTH SURVEILLANCE (TRACKING).................................................... 36 TRACKING TODAY................................................................................................................................................... 37 RECOGNIZING THE ENVIRONMENTAL HEALTH GAP .............................................................................................. 39 TRACKING DATA AND COORDINATION NEEDS ...................................................................................................... 39 CONCLUSIONS ......................................................................................................................................................... 41 CHAPTER 3. AN EXAMINATION OF THE NATIONAL INFRASTRUCTURE FOR ENVIRONMENTAL HEALTH TRACKING............................................................................................................................................. 42 FEDERAL ENVIRONMENTAL HEALTH TRACKING INTERVIEWS.............................................................................. 42 Synthesis of Federal Interviews ........................................................................................................................ 43 STATE ENVIRONMENTAL HEALTH TRACKING INTERVIEWS .................................................................................. 45 The Approach..................................................................................................................................................... 45 Synthesis of State Interviews ............................................................................................................................. 45 LOCAL TRACKING INTERVIEWS.............................................................................................................................. 53 The Approach..................................................................................................................................................... 53 Synthesis of Local Interviews ............................................................................................................................ 54 CONCLUSIONS ......................................................................................................................................................... 56 CHAPTER 4. SELECTION OF HEALTH ENDPOINTS FOR TRACKING: AN EXAMINATION OF AVAILABLE INFORMATION .............................................................................................................................. 57 INTRODUCTION........................................................................................................................................................ 57 AN EXAMINATION OF ENVIRONMENTAL RELEASES: THE TOXICS RELEASE INVENTORY .................................... 57 IDENTIFICATION OF HEALTH ENDPOINTS ............................................................................................................... 58 A LOOK AT NATIONAL HEALTH OUTCOME DATABASES ...................................................................................... 61 EXAMINATION OF THE NATIONAL HEALTH INTERVIEW SURVEY.......................................................................... 64 CONCLUSIONS FROM THE EXAMINATION OF AVAILABLE TRACKING DATA......................................................... 72 CHAPTER 5. THE ENVIRONMENTAL HEALTH TRACKING SUMMIT ................................................. 73 INTRODUCTION........................................................................................................................................................ 73 GOALS OF THE SUMMIT........................................................................................................................................... 73 PARTICIPATION........................................................................................................................................................ 73 3 KEY RECOMMENDATIONS....................................................................................................................................... 73 Developing Leadership...................................................................................................................................... 74 Strengthening Environmental Health Science.................................................................................................. 74 Improving Capacity for Reporting and Response ............................................................................................ 75 SELECTING ENDPOINTS FOR TRACKING: TOWARD A TIERED APPROACH ............................................................ 75 CONCLUSIONS ........................................................................................................................................................
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