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