Presentation on theme: "CA ENVIRONMENTAL HEALTH TRACKING PROGRAM Technical Team Presentation"— Presentation transcript:
1CA ENVIRONMENTAL HEALTH TRACKING PROGRAM Technical Team Presentation Paul English, PhD, MPHEnvironmental Health Investigations BranchDivision of Environmental and Occupational Disease ControlCA Dept. of Health Services
2Acknowledgements Centers for Disease Control and Prevention California Wellness Foundation
3Pew 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
4Pew RecommendationsBuild State and Local Capacity for Defending Against Environmental Health ThreatsCreate a nationwide environmental health tracking network
5Pew 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;
6Pew 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; andTrack progress towards achieving a healthier nation and environment.
8Environmental Public Health Tracking: Complexity Track health effects, exposures, hazards and target interventionsMonitor effects of interventions and policiesRaise awareness of environmental health issuesGuide research initiatives••Track health, disease, and risk trendsTrack health, disease, and risk trends••Develop rapidDevelop rapid--response mechanisms toresponse mechanisms toPublic HealthPublic Health••Establish program prioritiesEstablish program prioritiesinvestigate outbreaks and clustersinvestigate outbreaks and clusters••••ActionsActionsDevelop, implement, and evaluate public healthDevelop, implement, and evaluate public healthDevelop guidelines/standardsDevelop guidelines/standards••policies and program strategiespolicies and program strategiesInformationInformationAnalysis &Analysis &GISGISData PresentationData PresentationData Mining & Knowledge DiscoveryData Mining & Knowledge DiscoveryStatistical ModelsStatistical ModelsPrivacyPrivacyDisseminationDisseminationIntegratedIntegratedHazardHazardPopulationPopulationEnvironmentalEnvironmentalExposureExposureBioBioInterventionInterventionExposureExposureHealth EffectsHealth OutcomesHealth TrackingHealth TrackingHazardousHazardousProfileProfilemonitoringmonitoringGuidelinesGuidelinesData WarehouseData WarehouseDiseaseDiseaseMaterialMaterialPopulationPopulationTrackingTrackingProfileProfileDemographyDemographyInformationInformationExtraction &Extraction &MetadataMetadataData StandardizationData StandardizationData Linking/IntegrationData Linking/IntegrationData Quality AssuranceData Quality AssuranceTransformationTransformationHazardsExposurePopulationHealth EffectsHazardsExposurePopulationHealth OutcomesTracking*Tracking*TrackingTracking*Tracking**Demographics*Demographics*Tracking*State & NationalState & National••Census DataCensus Data••Administrative DataAdministrative Data••Emergency ResponseEmergency Response••Blood Lead PoisoningBlood Lead PoisoningSystemsSystemsEnvironmentalEnvironmentalNotification SystemNotification System(child & adult)(child & adult)••Birth Defects RegistriesBirth Defects RegistriesHealth TrackingHealth Tracking••Hazardous SubstancesHazardous Substances--••National Report onNational Report onEmergency EventEmergency EventHuman Exposure toHuman Exposure to••BRFSSBRFSSSystemsSystemsSurveillance SystemSurveillance SystemEnvironmentalEnvironmental••Cancer RegistriesCancer Registries••Toxic ReleaseToxic ReleaseChemicalsChemicals••Health SurveysHealth SurveysInventoryInventory••Toxic ExposureToxic ExposureSurveillance SystemSurveillance System••Vital StatisticsVital Statistics(*) Selected Data Sources(*) Selected Data Sources
9Tracking Frameworks: Questions EnviroHazardHealthOutcomeBasic Distribution Questions: Right-to-Know FunctionWhat 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 FormulationDoes 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 StudyIs 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.
10Tracking Frameworks: Value of Linkage HazardOutcomeNew Cases & Prevalence / TimeAmount & Location /TimeValue 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.
11SB 702Senate Bill 702 (Escutia) signed by Gray Davis in Oct mandates that CDHS lay the groundwork to establishing a Environmental Health Tracking NetworkCollaborative project with UC, and Cal/EPA
12Bill MandatesCreation of an expert working group to develop possible approaches to establishing tracking network (including estimated costs)Prepare report to DHS, Cal/EPA, and legislative committeesDevelop health and environmental measurements for tracking
13CDC National Environmental Public Health Tracking Cooperative Agreement Funded to CA Dept. of Health Services, in partnership with Office of Environmental Health Hazard Assessment, Cal/EPAThree years, $791,000 annually
14The National Environmental Public Health Tracking Program - 2002 WAMEMTNDORMNVTNHIDNYSDWIMACenters of ExcellenceEnhancement and Demonstration ProjectPlanning and Capacity BuildingJOHNS HOPKINS UNIVERSITYTULANE UNIVERSITYUNIVERSITY OFCALIFORNIA, BERKELEYHOUSTON, TXWASHINGTON, D.C.NEW YORK CITY, NYNJDEMDRIWYMICTIAPANENVOHUTILINCOCAWVKSVAMOKYNCTNAZOKNMARSCMSALGATXLAFLAK
15CDC Agreement GoalsBegin process of implementing a standards-based health and environment tracking networkIncrease state, local, and national capacity for environmental health trackingImprove collaborations between State’s public health and environmental agenciesImprove dissemination of environmental health data to policy decision-makers and other stakeholders
16CDC Agreement Objectives (6) Involve stakeholders by convening a Planning Consortium for program planning, implementation, and evaluation.Identify and prioritize state and local needs to develop a tracking networkNeeds assessmentsFeasibility of using indicators for surveillancePrioritizing informational, hardware, software needs
17CDC Agreement Objectives (6) Collaborate with UC in developing training programs.Develop technical plans for an electronic standards-based tracking networkData transferData linkageSecurityDisseminationIntegration with other systems
18CDC Agreement Objectives (6) Develop an outreach and education strategy for communicating informationDeveloping and evaluating communication strategiesConduct a pilot project that will track asthma prevalence and adverse pregnancy outcomes and link to hazard data on traffic exhaust exposures.
19Planning Consortium Composed of representation from: U.S. EPA, UC, Cal/EPA, CDHS technical experts (e.g. CCR, EHL)County/tribal health/environmental officialsHealth care providersEnvironmental GroupsNGOs, CBOs
20California Environmental Health Tracking Program SB 702 Working GroupPlanning ConsortiumCA Dept. of Health/OEHHATracking ProgramStaff/Co-InvestigatorsTeamsEvaluationOutreachEducationUC TrackingCenter of ExcellenceTechnicalNeedsAssessment
21Recommendations of CDC Technical Workgroup Env. Health Surveillance System (EHSS) should be developed in cooperation with NEDSSEHSS should consist of a network of distributed data sources, which could send or receive data.EHSS should adopt metadata standards that permit standardized search for all sourced info.
22Recommendations of CDC Technical Workgroup 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.Architects should adopt a formal technology neutral methodolgy for modeling, analysis and design of the EHSS.EHSS should identify, integrate, and make available tools for data analysis, interpretation, and presentation.
23Recommendations of CDC Technical Workgroup Architects should explore developing relationship with private providers to gain access to non-traditional surveillance/tracking sources.Architects should ensure that there are data sharing agreements between relevant agencies at state and federal levels.Architects should develop a comprehensive IT security plan and include technical specifications.
24CA Env. Health Tracking Pilot Goals To examine the feasibility of tracking routinely available data on asthma and adverse pregnancy outcomesTo identify elevated “hotspot” areas of concern of these health outcomes and traffic-related pollutants
25CA 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
26CA Env. Health Tracking Program Pilot (Alameda County) Routinely Generated DataStakeholderWeb Access -VisualizationHealthy Home Inspections of“Hot Spots”(In-Home Asthma Triggers)Asthma ER & Hosp,Physician Visits,Medication Use(Medi-Cal & Kaiser)Geocoding,Analysis, &Mappingfor “Hot-Spot”IdentificationLinkageCase/ControlAnalysis(GIS BufferProximityAnalysis)EvaluationAdverse PregnancyOutcomes(IUGR & Preterm)Modeling&ContourMappingTraffic Exposure(Traffic counts,Meteorology,Point Sources,Emissions, Land use,DEMs)StakeholderWeb Access -Visualization
27“Smoothed” Low Birthweight Rates, San Diego County, CA, 1990
28Modeled Total NOx from line and point sources in southern San Diego County, 2000,ADMS-Urban software
30Evaluation Completeness of Reporting Representativeness Usefulness Targeting areas for in-home inspections?Useful for accessing env. health burden?Cost
31Key Challenges/Opportunities Strategies to expand/build tracking network in era of severe state budget cutsNeed to produce timely information on hazards/health outcomes that are useful to local stakeholdersHow to engage/involve local communities on tracking activitiesHow to promote closer involvement/collaboration of environmental agencies