Environmental Public Health Indicators: Update on CDC Activities
Ecoinformatics, Environmental Research: Current progress, Ecoinformatics, Environmental Research: Current progress, research strategies and needs research strategies and needs
Ispra, ItalyIspra, ItalyJan 17 – 20, 2006Jan 17 – 20, 2006
Judith R. Qualters, Ph.D.Chief, Environmental Health Tracking Branch
Division of Environmental Hazards and Health EffectsNational Center for Environmental Health
Centers for Disease Control and Prevention (CDC)404-498-1815
Background: Environmental Public Health Indicator Development
• Collaborative process• Built on previous efforts of
WHO and others• External review by health
and environmental professionals
• Adopted by Council of State and Territorial Epidemiologists (CSTE) – June, 2001
Goals
• Provide information about a population’s exposure and health status in relationship to environmental factors
• Guide state public health agencies in developing a comprehensive environmental public health surveillance system
EPHI Framework Adapted from WHO “DPSEEA” (Pressure State) Model
Source: Environmental Health Indicators: Framework and Methodology; prepared by David Briggs
Connecting the Dots: Indicator Suites Example - Lead
• Hazard: Lead contamination in the environment– Measure: Proportion of housing stock built before 1950
• Exposure: Blood lead level in children– Measure: Proportion of high-risk children with elevated blood lead
levels
• Health Effects: Lead poisoning in children– Measure: Number of hospitalizations from lead poisoning in children
• Intervention: Lead elimination programs– Measure: Number of completed lead abatements
Current Indicator Development Activities
• Assessment projects – Environmental Public Health Tracking Program
• State Environmental Health Indicators Collaborative
• Coordination across indicator efforts
CDC’s EPHT Program Grantees - 2006
Indicators and Tracking
• State/ local projects evaluating proposed EPHIs
• EPHI framework guides tracking development
• Objective: meaningful data for inter-state, regional, national assessment
• 17 states and 3 local health departments
• Questions: – Does the EPHI address your priority information needs?– Are they realistic in terms of available data and integration of these
data?– What is the utility of selected measures in program/policy planning? – Does the measure selected accurately reflect the environmental public
health issue of concern?
“Examine the feasibility of using the EPHI Project for surveillance”
EPHI Assessment
Example: Maine
IndicatorIndicator Project: Carbon Monoxide / Power Outages
HAZARD
Hazardous or toxic
substance in indoor air
Measure
Data Source
1.Percent of the population and geographical distribution of power outages on a given day
Power Utility Commission
Measure
Data Source
2. Percent of households where someone owns a generator
BRFSS
Measure
Data Source
3.Percent of adults who report usually running their generator in an enclosed structure
BRFSS
Example: Maine (cont’d)
IndicatorIndicator Project: Carbon Monoxide / Power Outages
EXPOSURE
Biological Marker of
human exposure to
CO
Measure
Data Source
Level of carboxyhemoglobin in blood (% saturation)
Hospital laboratories
HEALTHEFFECT
CO poisoning (not fire-related)
Measure
Data Source
1. Incidence of CO poisonings among Maine residents
Maine Health Data Organization
Measure
Data Source
2. Incidence of occupationally-related CO poisonings
Maine Health Data Organization
Example: Maine (cont’d)
Indicator Indicator Project: Air/Asthma
Intervention
Programs that address hazardous
substance in ambient air
Measure
Data Source
1. Percent of households with CO monitors
BRFSS
Measure
Data Source
2. Number of Health Alerts for CO poisoning sent through Maine Health Alert Network (HAN)
Maine HAN
State Environmental Health Indicators Collaborative (SEHIC)
• Collaborators– State health departments– CSTE – CDC– EPA
• Goal: develop and pilot EPHI in multiple states that can be used for state-level information dissemination and policy making
SEHIC Activities
• Review state experiences with EPHI• Develop common set of definitions • Develop template for Indicator Profiles• Draft “How-To Guides”• Initial priority areas: Outdoor air,
asthma, drinking water• Pilot indicators in multiple states and
evaluate• Identify 10 leading EPHI and develop
indicator suites
Preliminary Indicators
• Air– Ambient concentrations of PM 2.5
– Ambient concentrations of ozone
• Asthma– Unusual pattern of asthma events
• Drinking Water– Population served by community water supplies (CWS) by
TTHM levels– Population served by CWS by arsenic levels– Distribution of arsenic in groundwater used for drinking
Template
INDICATOR:
Measurement Unit
Geographic Area
Measures Of Frequency
Time Period
Significance & Background
Rationale
Limitations Of Measure
Data Resources
Limitations Of Data Resources
Related Sets Of Indicators
Additional Data To Collect
Notes
Indicator Coordination
• CDC - CSTE
• CDC – EPA
CDC & CSTE Partnership on Indicators
CDC & EPA CollaborationFirst step: indicator cross-walk
CDC• EPHI• Occupational
Health Indicators• Chronic Disease
Indicators• Injury Indicators
EPA• Report on the
Environment 2006• America’s
Children and the Environment
• Border 2012 Indicators
For More Information…..
• www.cdc.gov/nceh/indicators
• www.cste.org