CA ENVIRONMENTAL HEALTH TRACKING PROGRAM

Technical Team PresentationPaul English, PhD, MPH

Environmental Health Investigations Branch

Division of Environmental and Occupational Disease Control

CA Dept. of Health Services

Acknowledgements

Centers for Disease Control and Prevention California Wellness Foundation

Pew Environmental Health Commission Report

“America’s Environmental Health Gap: Why the Country Needs a Nationwide Health Tracking Network”

Highlights lack of public health infrastructure and leadership to track chronic diseases and environmental exposures

Pew Recommendations

Build State and Local Capacity for Defending Against Environmental Health Threats

Create a nationwide environmental health tracking network

Pew Environmental Health Commission:Goals of Tracking Network

Identify populations at risk and respond to outbreaks, clusters and emerging threats;

Establish the relationships between environmental hazards and disease;

Guide intervention and prevention strategies, including lifestyle improvements;

Pew Environmental Health Commission:Goals of Tracking Network (cont.)

Identify, reduce and prevent harmful environmental risks;

Improve the public health basis for policymaking;

Enable the public’s right to know about health and the environment; and

Track progress towards achieving a healthier nation and environment.

State & National Environmental

Health Tracking Systems

Population

DiseaseTrackingPopulation

Demography

Health Outcomes Tracking*

•Administrative Data Systems•Birth Defects Registries •BRFSS•Cancer Registries•Health Surveys•Vital Statistics

Population Demographics*

•Census Data

Exposure Tracking*

•Blood Lead Poisoning (child & adult)•National Report on Human Exposure to Environmental Chemicals•Toxic Exposure Surveillance System

HazardsTracking*

•Emergency Response Notification System•Hazardous Substances-Emergency Event Surveillance System •Toxic Release Inventory

Health OutcomesExposure Profile

Biomonitoring

InterventionGuidelines

Hazard

HazardousMaterial Profile

Exposure

Data Linking/IntegrationMetadata Data Standardization Data Quality Assurance

GIS Data Presentation Data Mining & Knowledge DiscoveryStatistical Models Privacy

InformationExtraction &

Transformation

Integrated Environmental

Health Tracking Data Warehouse

InformationAnalysis &

Dissemination

Public Health Actions

(*) Selected Data Sources

State & National Environmental

Health Tracking Systems

Population

DiseaseTrackingPopulation

Demography

Health EffectsTracking*

•Administrative Data Systems•Birth Defects Registries •BRFSS•Cancer Registries•Health Surveys•Vital Statistics

Population Demographics*•Census Data

Exposure Tracking*

•Blood Lead Poisoning (child & adult)•National Report on Human Exposure to Environmental Chemicals•Toxic Exposure Surveillance System

HazardsTracking*

•Emergency Response Notification System•Hazardous Substances-Emergency Event Surveillance System •Toxic Release Inventory

Health EffectsExposure Profile

Biomonitoring

InterventionGuidelines

Hazard

HazardousMaterial Profile

•Track health, disease, and risk trends•Establish program priorities•Develop, implement, and evaluate public health policies and program strategies

•Develop rapid-response mechanisms to investigate outbreaks and clusters •Develop guidelines/standards•

•Track health, disease, and risk trends•Establish program priorities•Develop, implement, and evaluate public health policies and program strategies

•Develop rapid-response mechanisms to investigate outbreaks and clusters •Develop guidelines/standards•

Exposure

Data Linking/IntegrationMetadata Data Standardization Data Quality Assurance

GIS Data Presentation Data Mining & Knowledge DiscoveryStatistical Models Privacy

InformationExtraction &

Transformation

Integrated Environmental

Health Tracking Data Warehouse

InformationAnalysis &

Dissemination

Public Health Actions

(*) Selected Data Sources

•Track health effects, exposures, hazards and target interventions•Monitor effects of interventions and policies

•Raise awareness of environmental health issues•Guide research initiatives

Environmental Public Health Tracking: Complexity

Tracking Frameworks:Questions

EnviroHazard

HealthOutcome

Basic Distribution Questions: Right-to-Know Function

• What hazards are we exposed to?• In what amount or concentration?• Are exposures changing?• How does my (community) exposure

compare to others?• Did the environmental policy prevent or

control the hazard?

• What is the rate of disease X in my community?

• Is this high or low?• Is the disease rate changing? • How does my (community) disease rate

compare to others?• Did the health policy prevent disease?

Linkage Questions: Hypothesis Formulation

• Does a change (+/-) in a health outcome correspond in time & place to changes in hazards?• Does a change in hazards correspond in time & place to changes in health outcomes?

Hypothesis Testing Investigation: Controlled Study

• Is the observed association in time and place valid? Can it be replicated? Note basic distribution data can inform where to look to perform case-control study.

Tracking Frameworks:Value of Linkage

Amount & Location /TimeNew Cases &

Prevalence / Time

OutcomeHazard

Value of linking information increases with (1) time and (2) changes in hazard loading and outcome rates. Collecting hazard and outcome information over time provides better information about population health thus addressing social, scientific and policy questions.

SB 702

Senate Bill 702 (Escutia) signed by Gray Davis in Oct. 2001 mandates that CDHS lay the groundwork to establishing a Environmental Health Tracking Network

Collaborative project with UC, and Cal/EPA

Bill Mandates

Creation of an expert working group to develop possible approaches to establishing tracking network (including estimated costs)

Prepare report to DHS, Cal/EPA, and legislative committees

Develop health and environmental measurements for tracking

CDC National Environmental Public Health Tracking Cooperative Agreement

Funded to CA Dept. of Health Services, in partnership with Office of Environmental Health Hazard Assessment, Cal/EPA

Three years, $791,000 annually

WA

OR

MT ND

WY

SDID

MN

IANE

COUT

NV

CA

AZNM

TX

WI

MO

IL

KS

OKAR

MI

LA

MSAL GA

FL

AK

TN

KY

NC

SC

VA

IN

OH

PA

WV

NY

ME

The National Environmental Public Health Tracking Program - 2002

VT

NH

Centers of Excellence

Enhancement and Demonstration Project

Planning and Capacity Building

JOHNS HOPKINS UNIVERSITY

TULANE UNIVERSITY

UNIVERSITY OF

CALIFORNIA, BERKELEY

HOUSTON, TX

WASHINGTON, D.C.

NEW YORK CITY, NY

NJ

DE

MD

RIMA

CT

CDC Agreement Goals

Begin process of implementing a standards-based health and environment tracking network

Increase state, local, and national capacity for environmental health tracking

Improve collaborations between State’s public health and environmental agencies

Improve dissemination of environmental health data to policy decision-makers and other stakeholders

CDC Agreement Objectives (6)

1. Involve stakeholders by convening a Planning Consortium for program planning, implementation, and evaluation.

2. Identify and prioritize state and local needs to develop a tracking network

Needs assessments Feasibility of using indicators for surveillance Prioritizing informational, hardware, software needs

CDC Agreement Objectives (6)

3. Collaborate with UC in developing training programs.

4. Develop technical plans for an electronic standards-based tracking network

Data transfer Data linkage Security Dissemination Integration with other systems

CDC Agreement Objectives (6)

5. Develop an outreach and education strategy for communicating information

Developing and evaluating communication strategies

6. Conduct a pilot project that will track asthma prevalence and adverse pregnancy outcomes and link to hazard data on traffic exhaust exposures.

Planning Consortium

Composed of representation from:– U.S. EPA, UC, Cal/EPA, CDHS technical experts

(e.g. CCR, EHL)– County/tribal health/environmental officials– Health care providers– Environmental Groups– NGOs, CBOs

California Environmental Health Tracking Program

SB 702 Working Group

Planning Consortium

CA Dept. of Health/OEHHATracking Program

Staff/Co-InvestigatorsTeams

TechnicalNeeds

Assessment

EvaluationOutreach Education

UC TrackingCenter of Excellence

Recommendations of CDC Technical Workgroup

1. Env. Health Surveillance System (EHSS) should be developed in cooperation with NEDSS

2. EHSS should consist of a network of distributed data sources, which could send or receive data.

3. EHSS should adopt metadata standards that permit standardized search for all sourced info.

Recommendations of CDC Technical Workgroup

4. Architects of EHSS should work with federal partners and private standard-setting organizations to share, create, modify data, and develop process, performance and technology standards.

5. Architects should adopt a formal technology neutral methodolgy for modeling, analysis and design of the EHSS.

6. EHSS should identify, integrate, and make available tools for data analysis, interpretation, and presentation.

Recommendations of CDC Technical Workgroup

7. Architects should explore developing relationship with private providers to gain access to non-traditional surveillance/tracking sources.

8. Architects should ensure that there are data sharing agreements between relevant agencies at state and federal levels.

9. Architects should develop a comprehensive IT security plan and include technical specifications.

CA Env. Health Tracking PilotGoals

To examine the feasibility of tracking routinely available data on asthma and adverse pregnancy outcomes

To identify elevated “hotspot” areas of concern of these health outcomes and traffic-related pollutants

CA Env. Health Tracking PilotGoals

To explore GIS methods of mapping and linking pollution and health data for health communication and data dissemination for local stakeholders (i.e. Pacific Institute, West Oakland, Alameda County)

To assist local health departments in planning and allocation of resources

CA Env. Health Tracking ProgramPilot (Alameda County)

Asthma ER & Hosp, Physician Visits,Medication Use

(Medi-Cal & Kaiser)

Adverse PregnancyOutcomes

(IUGR & Preterm)

Traffic Exposure(Traffic counts,

Meteorology,Point Sources,

Emissions, Land use,DEMs)

StakeholderWeb Access -Visualization

Geocoding,Analysis, &

Mappingfor “Hot-Spot”Identification

Modeling&

Contour Mapping

Healthy Home Inspections of “Hot Spots”

(In-Home Asthma Triggers)

Linkage

Case/ControlAnalysis

(GIS BufferProximity Analysis)

Evaluation

Routinely Generated Data

StakeholderWeb Access -Visualization

“Smoothed” Low Birthweight Rates, San Diego County, CA, 1990

Modeled Total NOx from line and pointsources in southern San Diego County, 2000, ADMS-Urban software

Data linkage for case/control analyses

Evaluation

Completeness of Reporting Representativeness Usefulness

– Targeting areas for in-home inspections?– Useful for accessing env. health burden?

Cost

Key Challenges/Opportunities

Strategies to expand/build tracking network in era of severe state budget cuts

Need to produce timely information on hazards/health outcomes that are useful to local stakeholders

How to engage/involve local communities on tracking activities

How to promote closer involvement/collaboration of environmental agencies