Well Documented Relationship Between Health Environmental Public Health Tracking Effect and Environmental Factor § Lead – Impaired cognitive development in children; nervous system dysfunction in adults § Arsenic – Skin cancer Judith R. Qualters, Ph.D. Acting Branch Chief, Environmental Health Tracking Branch § Methyl mercury – Adverse reproductive outcomes Division of Environmental Hazards and Health Effects National Center for Environmental Health § Asbestos – Lung cancer; mesothelioma Centers for Disease Control and Prevention (CDC) Suspected Relationship Between the Health Effect and Environmental Factor § DBP’s – Bladder Cancer § Aluminum – Alzheimer’s disease § Endocrine disruptors – Fertility § ? – Cancer clusters Public Perceptions of Environmental Health Risks The Future of Public Health (IOM, 1988) “How important are environmental factors Don't know “The removal of Not important 1% in causing disease?” environmental health 9% authority from public health agencies has led to Very Important fragmented responsibility, 53% lack of coordination, and Somewhat inadequate attention to the important health dimensions of 37% environmental problems.” Princeton Survey Research Associates, 2000; Margin of error: +3% 1 The Future of Public Health Pew Environmental Health Commission (IOM, 1988) Environmental Health Review § Environmental health system was inadequate and “Wherever organizational separation takes fragmented place…desirable program coordination is impeded. Data systems are fragmented, impeding broad § Responsibilities scattered among agencies assessment and surveillance that makes possible § Unable to link environmental and health databases comparisons of program impacts on the health of the public and policy formulation based on comparable analysis and risk assessment.” Recommended a “Nationwide Health Tracking Network for diseases and exposures” Environmental Public Health Tracking CDC Program Goal Develop and implement Exposure Hazards comprehensive programs in all 50 states, DC, the U.S. State and National Public Health Actions territories, and among tribal Data Collection Systems •Track health, disease, and risks to target interventions •Environmental Hazards nations. Tracking •Detect new health events and unusual occurrences associated with § A coordinated, integrated, •Environmental Exposure environmental exposures Tracking Monitor effects of interventions and standards –based Tracking •Health Outcomes Tracking • policies Network •Raise awareness of environmental health issues § •Guide research initiatives Improved, sustainable public Integrated health resources Environmental Health Tracking, Analysis, Evaluation § Mechanisms for data And Dissemination dissemination Program Priorities CDC Activities Obtain input from stakeholders / develop partnerships § Chronic diseases and other health effects with possible environmental etiology § Environmental Health Tracking Workgroups § § Chemicals, physical agents, biomechanical stressors, Meetings with State/local health and environmental biological toxins agency staff § EPA § Focus determined by HP 2010, Pew Report, State § Other Government and NGO meetings priorities § CDC coordinating workgroup § Compatible with NEDSS, BT, EPA’s National Environmental Information Exchange Network. 2 CDC Activities (cont’d) CDC Activities (cont’d) Funding 20 state/local pilot projects Funding 3 Centers of Excellence for Environmental Public Health Tracking § Components: § Schools of Public Health •Coordination and collaboration between state/local health and environmental agencies required § Support state/local pilot projects •Evaluation of existing databases § Select project topics: •Assessment of existing legislation/regulations •Linkage issues •Development/enhancement of surveillance systems •Using environmental public health indicators •Statistical algorithms •Linkage of health and environmental databases •Market research: audience profiles, needs, communications strategies Building the Network Challenges How does this fit with other CDC surveillance efforts? §Expectations: utility of § Supplements, does not supplant existing resources surveillance data •E.g. broadening scope of Public Health Domain Information §Competing local/state/national Model and Public Health Logical Data Model priorities § Identifies needs/gaps/priorities §Cost § Increases interoperability through use of standards §Existing capacity §Data compatibility § Builds the bridge between health and environmental data §Risk: cumulative; attributable • MOU with EPA §Right to know / Right to privacy Conclusion § Significant challenges § Bottom up AND top down effort § Collaboration and innovation essential § Staged approach § One component of a bigger picture 3.