INPHET Network
P. Lauriola* & G. Leonardi** *ARPA Emilia-Romagna, Italy **Public Health England, UK
CEOM plenary meeting LUXEMBOURG
Friday, 12 June 2015
What is Surveillance?
Surveillance is the systematic process of collection, transmission, analysis and feedback of public health data
for decision making
Could you drive without looking at the traffic?
Can you make public health decisions in the absence of data?
Information Loop of Public Health Surveillance
Summaries, Interpretations,
Recommendations
Reports
Health Agencies
Health Care Providers
Public
In 2000, the Pew Environmental Health Commission detailed an "environmental health gap," a lack of basic information needed to document links between environmental hazards and chronic diseases.
Some features
• A key distinction between EPHT and traditional surveillance, is the emphasis on data integration across health, human exposure, and hazard information systems
• Environmental Public Health Tracking (EPHT) may be seen as an approach to facilitate translation of evidence into routine practice, rather than an approach towards the construction of evidence on environmental public health
EPHT Can Be Used to Explore
Time trends and geographical patterns in: Environmental hazards Human exposure Disease occurrence
Surveillance of health outcomes by environmental
gradient Organizing and linking health and environmental
information Comparison of disease or exposure rates among areas
aggregated according to levels of an environmental hazard
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Hazard databases: Air toxicants, water quality measures, etc.
Exposure databases: Biomonitoring information- Blood lead, arsenic, mercury, etc.
Data linkage strategies
Environmental Public Health Tracking Network: Data Acquisition and Linkage: The Challenge
Health outcomes databases: Mortality, morbidity (admissions, ED visits, office visits, medication usage, etc)
Evaluate associations
Direct Research and Interventions
Can the Concept of Environmental Public Health Tracking Work in a Real Life Setting?
The question remains, at the end of this major effort, will the Environmental Public Health Tracking Network be able to track and link hazards, exposures and outcomes in a way that will have real life effects and impact on the public health of our communities?
Examples of Public Health Tracking in a Real Life Setting
• One example is the famous decrement in blood lead levels in the late 1970’s as a result of the removal of lead from gasoline.
• The EPA ruling in 1975 resulted in the removal of lead in gasoline for all noncommercial vehicles
• The result of this removal was 37% decrease in average blood levels in the U.S. from February l976 through February l980.
Examples of Public Health Tracking
in a Real Life Setting
Examples of
Public Health Tracking in a Real Life Setting
An additional example is related to aeroallergens and pollen counts in a defined area as related to childhood asthma exacerbations. Such evidence can provide an intervention strategy in a defined neighborhood or municipality.
Risk Ratios of asthma attendance and admissions visits by level / type of pollen
Clinical and Experimental Allergy, 2000, Volume 30, 1724-1732
Success stories
1.Emergencies: Deep water Horizon Oil Spill, heat waves 2. Policy : CO detectors are required in all rental and single family homes (Maine). 3. Prevention: Tracking identified increase of heat-related ER visits during heat events City leaders approved cooling centers to open
4. Education: The Health Department used the information to provide extra prenatal care resources and education . 5. Health alert and advisories: linked demolition with childhood blood Pb . Now issue neighborhood alert if demolition is scheduled
Environmental Public Health Tracking in England
Aim:
• Identify populations at risk from exposure to
significant environmental hazards • Review/establish relationships between hazard
and disease • Inform public health policy making
• Optimise intervention and prevention strategies
• Generate hypotheses for further research.
Environmental Public Health Tracking projects
1. Carbon monoxide poisoning in private dwellings
2. Arsenic in private drinking water supplies
3. Laboratory-based Surveillance of Lead in Children study
4. Risk prioritisation: Multi Criteria Decision Analysis and other risk priority setting methods.
5. Development of guidance for management of investigation for clusters of disease
6. Development of the national Environmental Public Health Surveillance System
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Heat waves A Heat Health Watch Warning System was developed in France starting in 2003
Rhones-Alpes (August 2012) The epidemiological surveillance of heat waves is a component of France’s national heat wave plan, and is closely associated with the surveillance of meteorological forecasts. Its objectives are to evaluate the health situation, to alert, and to recommend preventive measures. It focuses on a small number of near-real time health indicators based on data from networks of emergency hospital services (OSCOUR®) and emergency medical visits at home (SOS doctors), as well as on registered fatalities. Additional epidemiological and sociological studies are needed to identify new kinds of vulnerabilities, and the adaptation measures needed to ensure the continued efficiency of preventive actions in the future.
Carbon Monoxide (CO) surveillance In the early 2000s, InVS created a surveillance system that monitors CO poisoning. The system, extended to the whole country in 2005, uses specific and syndromic surveillance to:
- measure the extent of CO poisoning
- describe its spatio-temporal dynamics
- describe the clinical characteristics, severity and medical care of cases
- identify circumstances of occurrence that may be subject to regulatory or preventive measures at regional or national levels
Regional distribution of the incidence of CO poisoning (2011) Regional distribution of the incidence of CO poisoning (2011)
E3
Inte- grate
Inter-pret
Analyse Merge
European Environment and Epidemiology : E3 network
Epidemic intelligence and surveillance (ECDC, WHO)
Environmental and land-use data (EEA, SEIS, EDEN,...)
Demographic and socioeconomic data (Eurostat, ...)
Cam
biam
enti
clim
atic
i ed
effe
tti su
lla s
alut
e Bioclimatic discomfort and ambulance dispatches
Strong relationship between ambulance dispatches and bioclimatic discomfort
Alessandrini E; Zauli Sajani S et al. Emergency ambulance dispatches and apparent temperature: a time-series analysis in Emilia-Romagna, Italy, Environmental Research (2011) 111: 1192–1200
Map of Municipalities with confirmed WNV circulation and localization of Human WNND cases by probable infection site.
Emilia-Romagna 2008-2009.
2008
Environmental and Public Health Tracking: practical
methods for priority setting and evaluation
Overall outcome
Delegates from seventeen countries took part, eight European (UK, Italy, France, Belgium, The Netherlands, Sweden, Finland, Latvia as well as the European Commission) and nine from other continents (USA, India, Japan, South Korea, UAE, Mongolia, Nigeria, Australia and New Zealand).
Overall outcome
Authoritative officials from national public health organisations and researchers in the field were Over 70 participants attended the workshop, from 38 different organisations, coming from 10 countries, including Israel, the US, Spain, Sweden, Denmark, France, the UK, Italy, Belgium and the Netherlands.
www.epiprev.it/INPHET/home
Initiatives towards the EU Parliament
Last February 4th MEP Cécile Kyenge, in collaboration with the CPME, supported the position that health and sustainability are pillars of wellbeing and productivity, especially in a time of socio-economic and cultural crisis. Issues concerning the environment and health can and must be taken into proper account especially since the European vision of society is based on sustainability, equity and wellbeing, which should be the reference point for the new idea of Europe
• COST aims to enable breakthrough scientific developments leading to new concepts and products. It thereby contributes to strengthening Europe’s research and innovation capacities.
• Since 2011, COST has been shaping its future and preparing for the new challenges to be taken up under Horizon 2020.
• Albania: Dr Ariana Zeka (National Institute of Public Health - Albanian National Institute of Public Health); Prof Enver Roshi (ISHP - Medical University)
• Belgium: Dr An Van Nieuwenhuyse (Scientific Institute of Public Health Belgium WIV-ISP) • Switzerland: Dr Kees de Hoogh (Swiss Tropical and Public Health Institute) • Denmark: Prof Elisabeth Knudsen (University of Copenhagen - Faculty of Health and Medicine
Sciences) • Spain: Dr Piedad Martin-Olmedo (Escuela Andaluza De Salud Pública) • United Kingdom: Dr Giovanni Leonardi (Public Health England [Centre for Radiation,
Chemical, and Environmental Hazards]) • Hungary: Dr Anna Paldy (National Institute of Environmental Health) • Croatia : Dr Aleksandra Fucic (Institutute for Medical Research and occupational Health -
Institute for Medical Research and Occupational Health) • Israel: Dr Isabella Karakis , (Ministry of Health) • Italy: Dr Paolo Lauriola, (ARPA Emilia-Romagna • Netherlands: Ms Brigit Staatsen (National Institute for Public Health and the Environment -
National Institute for Public Health and the Environment) • Poland: Prof Cezary Palczynski (Medical University of Lodz) • Romania: Prof Eugen Gurzau (Environmental Health Center) • Sweden: Dr Karin Björklund (The Public Health Agency of Sweden) • Turkey: Prof Hilal Ozcebe (University of Hacettepe) • International Organisations: Dr Lina Balluz (US- Centers for Disease Control and
Prevention)
EPHET-EUROPE CONSORTIUM
• Development of a systematic and integrated EPHT practice in Europe • Integration/exchange of knowledge and information regarding the main
environmental - health concerns in Europe; • To facilitate multidisciplinary collaboration between environmental, natural
and social science, and health disciplines, institutions and professionals; • To stimulate exchange and collaboration between the various networks
dealing with environment and health to develop an overall EPHT network; • To facilitate capacity-building making available methods and tools on all
relevant topics to institutions in all participating countries; • Building blocks for an international clearinghouse in the field of
environmental hazards, exposure and health data; • To identify critical information gaps in EPHT directed at improving transfer
of intelligence between science and policy; • To improve communication channels among different stakeholders involved
in the EPHT process or interested in its outputs
Objectives
• Definition and development of projects dealing with EPHT: pilot initiatives, databases and their use (such as congenital anomalies, housing - related hazards to health), environmental drivers of infectious diseases, small area health studies (eg near polluted sites);
• Exchange of experiences/expertise, staff, trainees; • Development of guidelines, standards (e.g. INSPIRE
Directive); • Benchmarking; • Development of training and education; • Piloting the network in a few countries.
Some example initiatives to be carried out by the EPHT-EUROPE
• Policy makers: EPHT can create opportunities to reduce the multiplicative impacts associated with rapid urbanization, globalization and climate/social/economical change. Findings of the EPHT network will be discussed with European officials involved in the implementation and evaluation of the 7th Environmental Action Plan (EAP) of the EU.
• The public: EPHT will provide information to support individual attitudes and collective actions. In the latter case it could provide definite and rigorous reference materials for public pressure and advocacy towards policy makers to take into account robust environmental health evidence.
• Professionals and stakeholders: in particular, land planners, managers, and researchers.
Special attention will be paid to young researchers
Expected impacts
As some of the Proposers are already involved in other COST Action networks and EU-projects (ESCAPE, INTARESE, ERA-ENVHEALTH..) dealing with environment and health, EPHT-EUROPE will be the first step towards a network of networks in this field.
• Working Group 1 – EPHT - EUROPE MANAGEMENT AND NETWORK COORDINATION: Coordination of the project implementation. It will promote exchange experiences on risk governance and risk literacy improvement.
• Working Group 2 – CAPACITY BUILDING AND TRAINING: To review and identify needs for capacity-building and create guidelines for an EPHT training curriculum across Europe.
• Working Group 3 – NETWORK DEVELOPMENT AND STRENGHTENING Development of a common framework for research and response on environmental health issues related to public health.
• Working Group 4 - SCIENCE AND DATA: To identify and share the scientific issues and methodology pertaining to EPHT.
• Working Group 5 – ETHICS AND CONFIDENTIALITY : To consider the ethics/confidentiality concerns: such as the use of data for advocacy, political statements; suggestions for risk communication strategy and tools. Guidelines on security of individual information, including relationships with industry,
Work Plan
• CEOM collaboration is clearly mentioned and envisaged in the proposal.
• Particular care will be given to the collaboration with Medical Doctors organisations (such as with CEOM, European Medical Orders Council), which are crucial stakeholders in the overall process.
CEOM
EIT Climate-KIC Pathfinder project application
Innovation is the application of new or more effective ideas, knowledge, technologies, processes, services or products to new, existing or latent market needs
ADVERSE
ADVERSE Consortium • ARPA Emilia-Romagna, I, Paolo Lauriola • PANNON Pro Innovations Ltd, RIC Central Hungary, HU, Miklós Gyalai -Korpos • Imperial College London, UK, Tracy Irvine, (Representative of the Oasis+ Consortium
(made up of Climate-KIC members) • AUSL Modena, I Carlo Goldoni • Public health England (PHE), UK, Giovanni Leonardi • Municipality of Modena, I, Giulio Guerzoni • University of Modena, I, Marco Sola • Scientific Institute of Public Health Belgium WIV-ISP, BE Tom DeSmedt • Swiss Tropical and Public Health Institute, CH Dr Kees de Hoogh • Medical University of Lodz , PL, Cezary Palczynski • Environmental Health Center, RO, Eugen Gurzau, • National Institute of Public Health - Albanian National Institute of Public Health, AL, • Ariana Zeka • Institute for Medical Research and occupational Health - Institute for Medical
Research and Occupational Health – HR, Aleksandra Fucic • Ministry of Health, Israel Isabella Karakis • London School of Hygiene and Tropical Medicine and University Federico II – Napoli,
UK, I,Carla Guerriero
Natural Climate Extreme Events
• Climate change is likely to have serious and significant impacts on human population health;
• Patterns of extreme events is less understood despite that extreme events have the potential to disrupt community and economic functions of a society;
• Between 1960 and 2014, 1.590 natural events-disasters and crises-have caused 191.839 deaths, and affected more than 45 million human beings in the wider Europe;
• With the frequency and severity of natural disasters increasing, the cost of catastrophe loss is soaring;
• Integrating health and environmental risks in an overarching model can lead to a reduction of societal costs.
INPHET and ADVERSE • According to the INPHET this project aims to shape a
support service in facing disaster events either before or during or after the events;
• The EPHT procedure and “Disaster risk assessment” will lead: link risk to economic policy, promote participatory development, promote risk sharing and transfer of interventions;
• Delays in responding to climate related events and lack of coordination of the different organizations increase the economic damage associated but also to loss of competiveness.
Objectives • Provide expertise and data to include the "health
factor" in cost models, planning activities, etc. related to extreme events;
• Provide ex ante risk assessment models , ex post events data and tracking modeling approaches in occasion of extreme natural events;
• Provide health impact assessment and implementing an organizational framework to face such events.
On-line Plattform
On-line Plattform (cont’d)
• health effects; • environmental effects; • overall and analytic economic impact
evaluation; • interventions put in action to face the
environmental –health emergency before/during/after the event
• investigations carried out.
Organisation of the Project
THANK YOU FOR YOUR ATTENTION
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