public health assessment process jack hanley, m.p.h. environmental health scientist agency for toxic...
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Public Health Assessment Process
Jack Hanley, M.P.H.
Environmental Health Scientist
Agency for Toxic Substances and Disease Registry
Superfund Amendments and Reauthorization Act - 1986
• ATSDR mandated to perform a public health assessment for each facility listed on the Environmental Protection Agency’s National Priorities List
• An analysis and statement of the public health implications posed by the release of hazardous substances
Public Health Assessment
Purpose of a Public Health Assessment
• Identify the public health impact on off-site populations from releases of hazardous substances
• Determine the need for follow-up public health actions or studies
Possible Recommendations
Public Health Assessment Process
Step 1: Evaluate site informationStep 2: Identify health concernsStep 3: Determine contaminants of concernStep 4: Identify and evaluate exposure pathwaysStep 5: Determine public health implicationsStep 6: Determine conclusions and
recommendationsStep 7: Develop a public health action plan
Evaluate Site Information
• Background information• Community health concerns• Demographics• Land use and natural resources use• Environmental data• Environmental pathways
Identify Community Health Concerns
• Identify involved community members• Involve the community in the public health
assessment process• Maintain communication with the community
and other involved parties throughout the process
Determine Contaminants of Concern
• Identify significant releases of contaminants
• Determine which contaminants may have contributed significantly to the off-site health hazard posed by the site
• Identify contaminants used at the facilities
Identify and Evaluate Exposure Pathways
• Identify each of the five elements of an exposure pathway
• Categorize an exposure pathway as completed or a potential
• Determine whether these elements form a past, present, or future exposure pathway
• Determine whether the exposure pathway should be eliminated
Elements of an Exposure Pathway
• Contaminant Source
• Environmental media
• Exposure Point
• Exposure Route
• Receptor population
Exposure Pathway Potential Pathway
Contaminant Source
Environmental Media
Exposure Point
Exposure Route
Receptor Population
Contaminant Source
Environmental Media
Exposure Point
Exposure Route
Receptor Population
Completed Pathway
Importance of Exposure Pathway Analysis
• Enables the health assessor to focus on completed pathways
• Provides a systematic methodology for identifying receptors
• Lays the foundation for evaluating the public health implications
Determine Public Health Implications
Evaluation Occurs in Three Areas:
• Toxicological• Health outcome data • Community health concerns
Toxicological Evaluation
• Estimate media-specific exposures• Compare exposure estimates with health
guidelines• Determine exposure-related health effects• Evaluate other factors that influence
adverse health outcomes
Health Outcome Data Evaluation
• Evaluate available health outcome data for all identified plausible health outcomes associated with contaminants determined to be of public health concern
Community Health Concerns Evaluation
• Address site-related health concerns expressed by the community using environmental data, exposure pathways analysis, toxicological evaluation, and health outcome data evaluation
Community Health Concerns Evaluation
• Determine whether the outcome is plausible
• If the outcome is not plausible, identify other data and information to explain the likelihood of the outcome
• Address other issues related to environmental and other concerns
Determine Conclusions
• Assign a public health hazard category to the site
• Identify health implications from completed exposure pathways
• Identify plausible community health concerns
• Identify insufficient information
ATSDR Hazard Categories
A. Urgent public health hazard
B. Public health hazard
C. Indeterminate public health hazard
D. No apparent public health hazard
E. No public health hazard
Determine Recommendations
ATSDR makes recommendations for:
• Protecting public health • Follow-up public health actions• Additional environmental information
Develop Public Health Action Plan
• Identify actions undertaken or planned
• Identify the agencies that conduct the actions
Oak Ridge Reservation Public Health Assessment
• ATSDR, with the assistance of the Subcommittee, will analyze and evaluate the information, data, and findings from previous studies and investigations on the radiological and chemical contaminants released from the Oak Ridge Reservation
Oak Ridge Reservation Public Health Assessment
• Identify and characterize exposures of off-site populations
• Identify populations exposed at levels of health concern• Evaluate health outcome data associated with
exposures of concern• Address community health concerns• Recommend follow-up public health actions or studies