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Environmental Public Health Tracking Program

Dr. Greg Kearney

This is a full transcript of the online presentation. For the presentation itself (it will open in a new window), go here.

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Hello, my name is Dr. Greg Kearney. I am an Environmental Epidemiologist with the Florida Dept of Health, Division of EH, and Principal Investigator for the EPHT program. My office is located with the BCEH, under the supervision of Dr Carina Blackmore. In this presentation, I would like to provide you with some background about EPHT, and describe some our work efforts towards helping CDC to create a national environmental public health tracking network.

At the turn of the 20th Century, the American population faced significant health challenges. The recent shift from rural to urban that accompanied industrialization resulted in overcrowding in dilapidated houses, served by inadequate water supplies and non-existent waste disposal systems, virtually no septic tanks or waste water systems. This led to continued outbreaks of infectious diseases. In the 1900's, one-third of all deaths were caused by pneumonia, TB or diarrhea, and 40% were among children less than 5 years of age. The later half of the century witnessed a dramatic shift in the health burden of the population from infectious disease to chronic diseases such cancer, asthma, birth defects, many of which may be associated with environmental exposures. During the same period, advances in industrial science and technology led to the development of tens of thousands of chemicals compounds. Unheard of 50 years ago, these chemicals are now ubiquitous in air, water, food, workplaces and homes. Mankind has benefited tremendously from these products, however, the long term exposure, particularly to low levels in not well understood.

The environment plays an important role in human development and health. Researchers have linked exposures to some environmental hazards with specific diseases. One example is the link between exposure to asbestos and mesothelioma exposure to lead and decreased mental function in children. However, other links remain unclear, such as the suspected link between exposure to disinfectant byproducts (for example, chlorine from showerheads) and bladder cancer, Electromagnetic fields and cancers. Many links are complicated by lifestyle and behavioral choices that folks make.

The general public feel strongly that the environment plays a role in their health. A poll taken in 1999 by the Pew Charitable Trusts found that 87% of Americans believed environmental factors such as pollution, cause increase rates of diseases and health problems.

In September 2000, after 18 months of the review the Pew EHC released a report on the state of environmental public health in the United States. The report outlined the steady increase of chronic diseases in the U.S. and that birth defects are the number one cause of infant mortality, behavioral and developmental disabilities are rising to over 50% in the past 10 years, and a 75% increase in the asthma rate, and significant increases in the incidence of selected cancers. Overall, the report found the environmental public health system was inadequate, fragmented and ineffective. Despite increasing rates of chronic disease and environmental links, a coordinated system to track many of the exposures related to environmental hazards, simply did not exist.

The Pew Environmental Commission Report: Recommendations from the report were to establish a national environmental public health tracking network (EPHT) to link information on environmentally related diseases, human exposures and environmental hazards. The purpose of the program would be to provide information that would be used to respond to, and eventually reduce the burden of disease. The utility of EPHT Network would provide timely surveillance for public health authorities to determine disease impacts, trends, clusters, outbreaks, identify pop. and geographic areas most affected. Also assess the effectiveness of the public health interventions and allow researchers and PH authorities to begin to understand the possible associations between environment and adverse health.

So, is EPHT a concept, is it a program or is it a network? It is all of the above. Well, it’s a concept aimed at integrating environmental hazard data with health outcome data. It is also, a federally funded program to build capacity among state health agencies and stakeholders And, when completed, will be an information Network, using GIS and other statistical tools designed to connect state health agencies and the CDC together to provide the general public the health status of their communities on the World Wide Web.

The Vision of the program is quite simple, to provide information from a nation-wide network of integrated environmental monitoring and public health data systems so that all sectors may take action to prevent and control environmentally related health effects. When completed EPHT, will 1) Integrate environmental health data with public health data into meaningful information and 2) Inform communities and empower them to take action for healthier communities

The primary focus of the program is on chronic diseases and adverse health outcomes with environmental hazards. Other funding Tracking state’s works, including Florida are evaluating tracking other factors related to environmental health including: Built environment, Global Climate Change, Mercury levels and fish consumption, Traffic and Birth defects and others.

So who is involved in EPHTN development? EPHT is a collaborative effort and includes, CDC, 17 funded State & City Health Depts., State Environmental Agencies, Universities, NGO’s, State Health Registries, and many federal partners (US EPA, USGS, NASA).

Much of our EPHT efforts included partnership development, and required getting stakeholders and partners involved, or keeping them informed with the national EPHT effort. Tracking formulated an Advisory committee which consisted of primary stakeholders and partners, such FDEP and AHCA; people that were vitally important to helping develop the program. In addition to our Advisory Committee we created workgroup committees which provided technical expertise on data issues such as office of Vital Statistics and the Registries including Florida Cancer Data System and the Florida Birth Defects Registries.

From an epidemiological standpoint, there are many types of risk factors and limitations to consider when conducting this type of an assessment. With so many limitations, such as the ones listed here, it can oftentimes be very difficult to interpret the findings. Therefore, one must use caution, exercise good professional judgment, and gather all facts before making a final determination of results.

The CDC and Florida Department of Health would like for people to learn more about Environmental Public Health Tracking. As a FDOH employee, you can access this information on the Division of Environmental Health’s internal Sharepoint site.

To find out more information about the EPHT program at the National level, you may visit www.cdc.gov/nceh/tracking or in Florida at www.doh.state.fl.us/environment/programs.