Introduction to Environmental Health Public Health Tracking

7/28/2019 Introduction to Environmental Health Public Health Tracking

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Introduction to EnvironmentalPublic Health Tracking


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Objectives

Increase knowledge of the NationalEnvironmental Public Health TrackingNetwork

Develop skills in using the TrackingNetwork to mine data and identify trendsto address public health problems


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Preview

About National Environmental PublicHealth Tracking Network

Using the Tracking Network Tracking in Action: Success Stories


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NATIONAL ENVIRONMENTAL PUBLIC

HEALTH TRACKING NETWORK


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What is the National EnvironmentalPublic Health Tracking Network?

CDC's Tracking Network: Working Toward aHealthier Planet for Healthier People

http://www.youtube.com/watch?v=J42CLZH1NlE
http://www.youtube.com/watch?v=J42CLZH1NlEhttp://www.youtube.com/watch?v=J42CLZH1NlE


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What is the Tracking Network?

A system of integrated health, exposure, andhazard information and data from a variety ofnational, state, and city sources


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Building the Tracking Network


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Why is the Tracking NetworkImportant?Before Tracking With Tracking

Simple questions could take months to

answer

Can respond quickly-often within hours-to

locate hazard sources or answer concerns

Environmental and health fields were

often separated

These two worlds are brought together to

the benefit of all

Focused mainly on acute events such as

hazardous chemical releases or point-

source pollution

Ability to trace amounts and geographic

spread of pollutants over time, allowing

monitoring of long-term trends and place

those acute events in context

Environmental health surveillance wasmore difficult than infectious disease

surveillance

The same "disease detective" skills can beapplied to finding environmental causes of

illnesses and then take preventive measures

to protect the public's health


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Why is the Tracking Network Important?

The Tracking Network canhelp: Determine areas with at-

risk populations Leverage resources anddevelop partnerships

Evaluation of control and

prevention measures Facilitate policydevelopment
http://ephtracking.cdc.gov/showBiomonitoringLanding.action


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TRACKING NETWORK DATA


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Tracking Network Data Sources

Grantees Health departments in 23 states and 1 city(NYC)

Partners CDC programs

Federal agencies


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Data on the Tracking Network

Visit: http://ephtracking.cdc.gov/docs/EPHTDataSources.pdf

EnvironmentalHazard

Health

PopulationExposures and

Characteristics
http://ephtracking.cdc.gov/docs/EPHTDataSources.pdfhttp://ephtracking.cdc.gov/docs/EPHTDataSources.pdf


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ENVIRONMENTAL HAZARD DATA


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Environmental Hazard Data

Air quality

Water quality

Climate change Community design

Homes
http://ephtracking.cdc.gov/showWaterLanding.actionhttp://ephtracking.cdc.gov/showCommunityDesign.actionhttp://ephtracking.cdc.gov/showClimateChangeLanding.action


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Environmental Hazard Data: Air

Visit: http://ephtracking.cdc.gov/showAirLanding.action
http://ephtracking.cdc.gov/showAirLanding.actionhttp://ephtracking.cdc.gov/showAirLanding.action


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ACTIVITYEnvironmental Hazard Data: Air

Air qualityMonitored data

Modeled data


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Environmental Hazard Data: Water

Water quality

Community water


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ACTIVITYEnvironmental Hazard Data: Water

How is community drinking watertracked?

What contaminants are being monitored?

What are the data sources?


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Environmental Hazard Data:Climate Change

Extreme heat Weather and health data can be used toidentify patterns in extreme heat and theirassociated health effects.

These indicators use data from the past toidentify extreme temperatures, deaths thatmight be related to heat, and conditions thatmake people vulnerable to heat.


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Environmental Hazard Data:Community Design

Types of transportation to work

Air quality (ozone and PM2.5)

Childhood lead poisoning Motor vehicle-related fatalities


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Environmental Hazard Data: Homes

Homes Childhood lead poisoning

Age of housing

Carbon monoxidepoisoning


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Environmental Hazard Data Limitations

Coverage

Spatial characteristics Temporal characteristics


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HEALTH DATA


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Health Data

Asthma

Birth defects

Cancer Carbon monoxide poisoning
http://ephtracking.cdc.gov/showCancerMain.action


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Health Data

Childhood lead poisoning

Developmental disabilities

Heart attacks Reproductive and birth outcomes
http://ephtracking.cdc.gov/showHeartAttack.actionhttp://ephtracking.cdc.gov/showDevelopmentalDisabilitiesLanding.actionhttp://ephtracking.cdc.gov/showHeartAttack.actionhttp://ephtracking.cdc.gov/showRbMain.action


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POPULATION DATA


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Population Data: Characteristics

Data that can provide context aboutrelationships between exposures andhealth effects Information about age, sex, race, and behavioror lifestyle may help us understand why aperson has a particular health problem


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Population Data:Biomonitoring/Population Exposures

Measures human exposure to environmentalchemicals, national estimates only

Visit: http://ephtracking.cdc.gov/showBiomonitoringTracking.action

Eleven Chemicals:

ArsenicBenzene

Cadmium

Chloroform

Cotinine

Lead

MercuryNaphthalene

Pyrene

Toluene

Uranium
http://ephtracking.cdc.gov/showBiomonitoringTracking.actionhttp://ephtracking.cdc.gov/showBiomonitoringTracking.action


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USING THE TRACKING NETWORK


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Using the Tracking Network

Queries

Maps, charts, and tables

Share, and export


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Indicators and Measures

i.e. Heart Attacks

i.e. Hospitalizationsfor Heart Attacks

i.e. Number ofHeart Attacks

Content AreaIndicator

Measure


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Indicators and MeasuresContent Area Indicator Measure

Heart Attacks Hospitalizations for Heart Attacks Number of Heart Attacks

Asthma Asthma Prevalence among Children Percent of Children Ever Diagnosed

with Asthma

Asthma Hospitalizations for Asthma Crude Rate of Hospitalizations for

Asthma per 10,000 population

Cancer Incidence of Bladder Cancer Annual Number of Cases of Bladder

Cancer

Population

Characteristics

Demographic Measures Number of People

Climate Change Heat-Related Mortality Number of Deaths due to Heat

Stroke/Exhaustion by state, by

month, by yearHomes Blood Lead Testing and Age Housing Number of Homes Built Before

1950 (2000 census)

Visit: http://ephtracking.cdc.gov/showIndicatorsData.action
http://ephtracking.cdc.gov/showIndicatorsData.actionhttp://ephtracking.cdc.gov/showIndicatorsData.actionhttp://ephtracking.cdc.gov/showIndicatorsData.action


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Air Quality Data Query

Visit: http://ephtracking.cdc.gov/showAirIndicators.action
http://ephtracking.cdc.gov/showAirIndicators.actionhttp://ephtracking.cdc.gov/showAirIndicators.actionhttp://ephtracking.cdc.gov/showAirIndicators.action


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Air Quality Data Query

Year Number of Days Above Ozone

Air Quality Standard, San

Bernardino County

2003 125 counts

2004 118 counts

2005 110 counts

2006 116 counts

About the Indicator: Ozone - Days Above

Regulatory StandardThe number of days in which the daily

maximum 8-hour average ozone concentrationexceeds a standard provides an indication of

short-term spikes in ozone concentrations. This

may give you an idea of how many days per

year you may be exposed to unhealthy levels of

ozone.

Podcast: Asthma Rates and Air Quality
http://www2c.cdc.gov/podcasts/player.asp?f=5883117http://www2c.cdc.gov/podcasts/player.asp?f=5883117


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Health Data Query


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Health Data Query

Year Number of Days Above Ozone Air

Quality Standard, San Bernardino

County

Number of Heart

Attack Cases, CA

2003 125 counts 63,064

2004 118 counts 59,514

2005 110 counts 57,157

2006 116 counts 54,729


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Health Data Query


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Year Number of Days

Above Ozone Air

Quality Standard,

San Bernardino

County

(VERY HIGH)

Number of Heart

Attack Cases, CA

(HIGH nationally)

Number of Heart

Attack Cases, San

Bernardino

2003 125 counts 63,064 3,418

2004 118 counts 59,514 3,189

2005 110 counts 57,157 3,1692006 116 counts 54,729 2,886

Health Data Query


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ACTIVITY: Query


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Using the Tracking Network


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Map


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Chart


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Table


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Metadata


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Additional Features

Resources

Grantee tracking networks Secure portal Contextual information


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Why Use the Tracking Network?

Quantify the magnitude of a public health problem Detect unusual trends in health, exposures, and hazards

Identify populations at risk of environmentally relateddiseases or of exposure to hazards

Generate hypotheses about the relationship between healthand the environment

Direct and evaluate control and prevention measures andindividual actions

Facilitate policy development

Guide public health actions Educate the public so they can take action to protect their

health and the health of their families


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TRACKING IN ACTION: SUCCESS STORIES


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Success Story Saving Lives

Identifying the increases in preterm birth rates in Fresno County, CaliforniaWhat is the problem? Research shows preterm birth is associated with the mother's exposure to traffic pollutants

and lead. A routine review of data on the California Environmental Health Tracking Networkrevealed a pattern in the risk of preterm birth in Fresno County, one of the major populationcenters in the state's Central Valley area.What did Tracking do?

California's Tracking Program informed the Fresno Department ofPublic Health of the trends. The local health department askedthe Tracking Network for more data about: Preterm birth trends reported by race and ethnicity Maternal Infant Health (MIH) indicators, including very preterm birth

(less than 32 weeks gestation) Rates by census tractsImproved public health

Fresno County used the information to identify locations for targeting activities that arerelated to childhood lead poisoning, air quality, and asthma. Fresno County officials reportedthat the data and assistance from the tracking network were very helpful to the localchildhood lead poisoning prevention program.


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Success Story Protecting People

Answering community concerns about cancer in MarylandWhat is the problem? Community concerns about cancer and potential links to environmental hazards occur relatively

frequently in Maryland. Before the Maryland Tracking Program began in 2002, most concerns aboutcancer and the environment were addressed only by the Maryland Cancer Registry and possibly localhealth departments. Maryland had no systematic way to respond to frequently asked questions fromindividuals, groups, and communities about cancer and the environment.

What did Tracking do? The Tracking Program, working with the Maryland Cancer Registry, geocoded all residential addressesin the Registry. Now the Maryland Cancer Registry can accurately show cancer data in maps andcarry out geospatial analyses of cancer information. Also, for the first time, there is an establishedprocess for evaluation of cancer concerns in Maryland. The new process involves a coordinatedresponse that includes the Maryland Cancer Registry, the Center for Environmental HealthCoordination, the Maryland Department of the Environment (MDE), and local health departments andis now available on the Tracking Program's Web site.Improved public health

The Tracking Program has worked with the Maryland Cancer Registry on two major cancerinvestigations, one in Poolesville and another in Frederick. The first looked at concerns about cancerand drinking water; the second involved concerns about cancer in a community. In both cases, theMaryland Tracking Program provided maps showing the geographic distribution of cancer and geo-statistical analyses of the cancer cases. The results of these two investigations were presented atcommunity meetings. To date, there is no evidence of cancer clusters, but experts were able toanswer questions from community residents.


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Success Story Protecting People

Lowering exposure to arsenic fromprivate well water in UtahWhat is the problem? Some Millard County residents use private wells for cooking and drinking

water. The Health Hazard Assessment team of the Utah Department ofHealth confirmed that in the Delta Conservation Districts, many of theprivate wells had arsenic concentrations high enough to be an urgent

public health hazard.What did Tracking do? The Health Hazard Assessment team used drinking water data from the

Utah Tracking Network to assess health effects in residents of MillardCounty caused by drinking arsenic-contaminated water from private wells.Improved public health

Due to the high levels of arsenic found in this study, the Health HazardAssessment team recommended that well water in this area not be used fordrinking or cooking. They also suggested that residents of the areapurchase and install water systems to reduce arsenic exposure in thecommunity. Arsenic levels in water will be monitored until amounts are atlevels that are not harmful to human health.


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Success StoryProtecting PeopleHeat Wave PreparednessWhat is the problem? During the California 2006 heat wave, there were 140 confirmed deaths and an additional 515 suspected

deaths due to extreme heat. An estimated $133 million in health-related costs was attributed to the heatwave, along with an estimated $500 million in agriculture-related costs from the loss of livestock. Heatwaves have and will continue to impact all regions of California, including urban, rural, inland, and coastalareas. In California, heat waves are expected to become longer and more frequent over time.

What did Tracking do? The California Tracking Program worked with the Bay Area National Weather Service (NWS) regional office toconduct a study to determine if heat alerts accurately predicted times when people suffered the most heat

illness. NWS monitors temperature and issues heat alerts. The heat alerts serve as triggers for cities andcounties to take preventative action, such as opening cooling centers where the public can gather for life-saving relief from the heat. The California Tracking Program showed that heat-related emergency room visitspeaked immediately following heat alerts for the San Jose area and subsided when the heat alerts werediscontinued. Due to budget cuts, the City of San Jose wanted scientific evidence from NWS to show therewas a need for cooling centers during heat waves. Without this proof, decision-makers would not approvethe opening of cooling centers as part of the city's heat alert response plan for the upcoming summer.

Improved public health NWS presented the California Tracking Program study findings to City of San Jose decision-makers. Based

on this evidence, the city decided to allow cooling centers to open as part of the city's heat alert response.The California Tracking Program is partnering with NWS to conduct similar studies for other regions inCalifornia, including Los Angeles. This information will help cities to make decisions about heat wavepreparedness policies and help NWS refine its heat alert system for each region.

S S S i M


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Success Story Saving MoneyThrough Prevention

Informing health care providers about asthma in NYCWhat is the problem? Each Fall NYC sees a large increase in hospital stays and in emergency

department visits for asthma, especially among children. Illness ratesin the fall can be three times higher than rates during the summer.Possible reasons include infections among children returning to school,seasonal pollen, and cooler weather.What did Tracking do?

The NYC Tracking Program analyzed childhood asthma data. It usedthe results to write messages for health care providers. Themessagessent through the city's Health Alert Networkurgedproviders to update patients' asthma management plans in time forschool year start.Improved public health

In the last few years, the seasonal fall mailing to health care providersand other asthma prevention activities have coincided with a decreasein rates of NYC hospital stays among children. Because of theprogram's success, advisories to health care providers have become astandard practice at the beginning of each school year in NYC.


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Success Story Educating Communities

Louisiana - Deepwater Horizon (British Petroleum) Oil SpillWhat is the problem? On April 20, 2010, a drill rig explosion caused about 4.9 million barrels of oil to spill into the

Gulf of Mexico. The explosion killed 11 platform workers and injured 17. Marine and wildlifehabitats were severely affected, and the fishing and tourism industries of U.S. coastal stateswere devastated.

What did Tracking do? The Louisiana Tracking Program has been developing an oil spill response plan in

collaboration with CDC/ATSDR*, CDC/NIOSH+, and agencies from other affected Gulf Coaststates. Survey- and map-based tracking systems were developed to capture and track healthcomplaints and environmental monitoring results. In addition, the Louisiana Tracking Programworked with the Occupational Safety and Health Administration (OSHA) to make sure thatoutreach materials were available in several languages and available to people with limitedInternet access.

Improved public health The Louisiana Tracking Program worked with the state health department to notify OSHA

about workplace exposures and health complaints from emergency response workers.Interventions were held to educate response workers, residents, and health care providers ontopics such as personal protective equipment, seafood safety, chemicals of concern, potentialroutes of exposure, and associated health effects.


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More Success Stories

Tracking in Action: Interactive Map
http://www.cdc.gov/nceh/tracking/flashmap.html


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Group Activity

Scenario You are a student intern working for the Wisconsin Department of

Health Services Program and Planning Office. The departments HeartDisease and Stroke Prevention Program wants to increase the publicsawareness about womens risks for heart disease and stroke.

Your task You are asked to develop educational materials that highlight key

points that women need to know about risks for heart disease andheart attacks. The fact sheet will be distributed to three counties inWisconsin for which heart attack hospitalization rates are higher thanthe state rate. Use data and information from the National andWisconsin Tracking Networks

(http://www.dhs.wisconsin.gov/epht/index.htm) to identify the threecounties in Wisconsin where educational efforts will be targeted. Youreducational materials may include a poster, a fact sheet, or any otheritems you think would best convey your message.
http://www.dhs.wisconsin.gov/epht/index.htmhttp://www.dhs.wisconsin.gov/epht/index.htmhttp://www.dhs.wisconsin.gov/epht/index.htm


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Homework: Scenarios

Chose and complete one scenario


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Homework: Queries

Conduct three queries on the TrackingNetwork, choosing a contentarea/indicator/measure of your choice,

and turn in the following for each: Health: Output data in a chart

Environment: Output data in a table

Population characteristics: Output data in amap


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For additional details on CDCsNational Tracking Network, visit

www.cdc.gov/eph tracking

The findings and conclusions in this presentation have not been

formally disseminated by the CDC and should not be construed to

represent any agency determination or policy.

Thank You!
http://www.cdc.gov/ephtrackinghttp://www.cdc.gov/ephtracking

Documents

Introduction to Environmental Health Public Health Tracking