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CA ENVIRONMENTAL HEALTH TRACKING PROGRAM Technical Team Presentation Paul English, PhD, MPH Environmental Health Investigations Branch Division of Environmental.

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Presentation on theme: "CA ENVIRONMENTAL HEALTH TRACKING PROGRAM Technical Team Presentation Paul English, PhD, MPH Environmental Health Investigations Branch Division of Environmental."— Presentation transcript:

1 CA ENVIRONMENTAL HEALTH TRACKING PROGRAM Technical Team Presentation Paul English, PhD, MPH Environmental Health Investigations Branch Division of Environmental and Occupational Disease Control CA Dept. of Health Services

2 Acknowledgements Centers for Disease Control and Prevention California Wellness Foundation

3 Pew Environmental Health Commission Report Americas 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

4 Pew Recommendations Build State and Local Capacity for Defending Against Environmental Health Threats Create a nationwide environmental health tracking network

5 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;

6 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 publics right to know about health and the environment; and Track progress towards achieving a healthier nation and environment.

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8 State & National Environmental Health Tracking Systems Population Disease Tracking Population 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 Hazards Tracking * Emergency Response Notification System Hazardous Substances- Emergency Event Surveillance System Toxic Release Inventory Health Outcomes Exposure Profile Bio monitoring Intervention Guidelines Hazard Hazardous Material Profile Exposure Data Linking/IntegrationMetadataData StandardizationData Quality Assurance GISData PresentationData Mining & Knowledge DiscoveryStatistical ModelsPrivacy Information Extraction & Transformation Integrated Environmental Health Tracking Data Warehouse Information Analysis & Dissemination Public Health Actions (*) Selected Data Sources State & National Environmental Health Tracking Systems Population Disease Tracking Population Demography Health Effects 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 Hazards Tracking* Emergency Response Notification System Hazardous Substances- Emergency Event Surveillance System Toxic Release Inventory Health Effects Exposure Profile Bio monitoring Intervention Guidelines Hazard Hazardous Material 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/IntegrationMetadataData StandardizationData Quality Assurance GISData PresentationData Mining & Knowledge DiscoveryStatistical ModelsPrivacy Information Extraction & Transformation Integrated Environmental Health Tracking Data Warehouse Information Analysis & 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

9 Tracking Frameworks: Questions Enviro Hazard Health Outcome 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.

10 Tracking Frameworks: Value of Linkage Amount & Location /Time New 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.

11 SB 702 Senate Bill 702 (Escutia) signed by Gray Davis in Oct mandates that CDHS lay the groundwork to establishing a Environmental Health Tracking Network Collaborative project with UC, and Cal/EPA

12 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

13 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

14 WA OR MTND WY SD ID MN IA NE CO UT NV CA AZ NM TX WI MO IL KS OK AR MI LA MS ALGA FL AK TN KY NC SC VA IN OH PA WV NY ME The National Environmental Public Health Tracking Program 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 RI MA CTCT

15 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 States public health and environmental agencies Improve dissemination of environmental health data to policy decision-makers and other stakeholders

16 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

17 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

18 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.

19 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

20 California Environmental Health Tracking Program SB 702 Working Group Planning Consortium CA Dept. of Health/OEHHA Tracking Program Staff/Co-Investigators Teams Technical Needs Assessment Evaluation Outreach Education UC Tracking Center of Excellence

21 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.

22 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.

23 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.

24 CA Env. Health Tracking Pilot Goals 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

25 CA Env. Health Tracking Pilot Goals 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

26 CA Env. Health Tracking Program Pilot (Alameda County) Asthma ER & Hosp, Physician Visits, Medication Use (Medi-Cal & Kaiser) Adverse Pregnancy Outcomes (IUGR & Preterm) Traffic Exposure (Traffic counts, Meteorology, Point Sources, Emissions, Land use, DEMs) Stakeholder Web Access - Visualization Geocoding, Analysis, & Mapping for Hot-Spot Identification Modeling & Contour Mapping Healthy Home Inspections of Hot Spots (In-Home Asthma Triggers) Linkage Case/Control Analysis (GIS Buffer Proximity Analysis) Evaluation Routinely Generated Data Stakeholder Web Access - Visualization

27 Smoothed Low Birthweight Rates, San Diego County, CA, 1990

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

29 Data linkage for case/control analyses

30 Evaluation Completeness of Reporting Representativeness Usefulness – Targeting areas for in-home inspections? – Useful for accessing env. health burden? Cost

31 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


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