1. Environmental Health and Emergency Preparedness: Disparate or Desperate? Blueprint for Rural Environmental Health Reslience

2. Presentation Goals 1. Background on the NACCHO APC Program 2. Provide examples of initiatives and resources in the area of EH/EP 3. Explain Environmental Health Resilience in the context of national guidance 4. Gather feedback and needs regarding the possibilities and realities of addressing EH/EP

3. Disparate- the accepted definition Preparedness: emergency, disaster, recovery, possible/infrequent, planning, response, risk, all hazard, interdisciplinary, tactical, TERRORISM, mitigation… Environmental Health: Regulatory, compliance, standards, assessment, recovery, management, inspection, promotion, enforcement, consultation, sanitation, control…

4. Desparate- the unacceptable definition “Alamosa” STEC in childcare center Boulder Fires Annual Flooding, Pennsylvania, Memphis Rocky Ford melons Mundane- fires, water contamination (Hotchkiss, CO) Mine water releases/contaminants Oil and gas exploration

5. The Devils Advocate approach: What is needed? Who says? How do they say it? What do they expect us to do? Why is it valuable for us to do it? How can we get it done in light of everything else we have to do? What can happen if we don’t? What will that mean?

6. Do YOU feel the movement? The Mesa County APC recognizes that there is a national movement taking place to address the integration of Environmental Health and Emergency Preparedness. At its core, this movement seeks to address a community plan for resilience in the face of environmental hazards and emergencies. The Mesa APC has been working to assure that quality improvement tools and resources are available to local public health agencies.

7. Movement? What Movement? National Environmental Health Promotion Network (NEHPN): Society for Public Health Education (SOPHE),  http://www.sophe.org/environmentalHealth/NEHPN.cfm http://www.sophe.org/environmentalHealth/NEHPN.cfm National Conversation on Public Health and Chemical Exposures,  http://www.atsdr.cdc.gov/nationalconversation/ http://www.atsdr.cdc.gov/nationalconversation/ EPA's Community-Based Water Resiliency (CBWR) initiative,  http://water.epa.gov/infrastructure/watersecurity/communities/index.cfm http://water.epa.gov/infrastructure/watersecurity/communities/index.cfm

8. The National Environmental Health Promotion Network (NEHPN) is a group created through a cooperative agreement between SOPHE and CDC/ATSDR.  It is comprised of professionals from the fields of environmental health, public health preparedness, and health education.  One of its major goals is to develop training and resources regarding environmental threats and emergency preparedness for consumption by health educators.

9. National Environmental Health Promotion Network http://www.sophe.org/EHEP/index.cfm This project will establish a network of subject matter experts in environmental health and emergency preparedness. The role of these network members includes but is not limited to:  Assisting with development of trainings and resources for use by public health professionals in environmental health response and all-hazards emergency preparedness  Receiving training in environmental health, all-hazards emergency preparedness, risk communication and outreach to vulnerable Populations  Serving as a liaison to the ATSDR regional offices, offering training and technical assistance as deemed necessary

10. The National Environmental Health Promotion Network (NEHPN) Past data collected by SOPHE has shown that health educators lag behind in terms of level of training and knowledge regarding issues in environmental health and emergency preparedness. This is not for lack of desire to be informed, but a lack of available training opportunities and resources.

11. National Conversation on Public Health and Chemical Exposures Recommendations for the local level:  http://www.nationalconversation.us/sectors/government/local http://www.nationalconversation.us/sectors/government/local Highlights:  2.4 Expand environmental public health tracking and occupational health surveillance  4.6 Provide training to all relevant parties to maximize the success of community-engaged projects  5.3 Develop current and comprehensive environmental and occupational health education for grades K-16  6.5 Expand professional development opportunities for the environmental public health workforce  7.8 Develop capacity of Emergency Support Function (ESF) #8 – Health and Medical Service planners and responders

12. EPA's Community-Based Water Resiliency (CBWR) initiative aims to: Increase overall community preparedness by raising awareness of water sector interdependencies and enhance integration of water sector into community emergency preparedness and response efforts; and Increase preparedness and resiliency of drinking water and wastewater utilities by delivering tools and information to increase community collaboration and bolster security practices. Water Contaminant Information Tool:  http://water.epa.gov/scitech/datait/databases/wcit/index.cfm http://water.epa.gov/scitech/datait/databases/wcit/index.cfm

13. National Health Security Strategy The National Health Security Strategy (NHSS) 1 states that communities will work to “Ensure prevention or mitigation of environmental and other emerging threats to health” by:  Enhanced risk analysis and research to improve understanding and anticipation of environmental and emerging threats;  Improved mechanisms to prevent and mitigate existing and novel environmental and emerging threats, including those relating to food safety and resulting from the misuse of life sciences information and technology;

14.  Enhanced ability to detect and report environmental and emerging threats early and to characterize them fully;  Improved ability to effectively and efficiently respond and recover from health incidents caused by environmental and emerging threats. Sources: National Health Security Strategy, HHS, http://www.phe.gov/Preparedness/planning/authority/nhss/strategy/Documents/nhss- final.pdf ; Biennial Implementation Plan, HHS, http://www.phe.gov/Preparedness/planning/authority/nhss/strategy/Documents/nhss- final.pdf. National Health Security Strategy (cont.)

15. Background on PHEP In December 2009, the U.S. Department of Health and Human Services released the National Health Security Strategy (NHSS) followed by its companion document, the Biennial Implementation Plan (BIP) to “galvanize efforts” for achieving the vision of complete national health security. The NHSS compliments and supports the implementation of strategies developed by the Department of Homeland Security’s (DHS) National Response Framework which assist in addressing the 10 Essential Public Health Services. These strategies culminate in the Centers of Disease Control and Prevention’s (CDC) 15 Public Health Emergency Preparedness (PHEP) target capabilities. The PHEP capabilities provide a framework to help rural communities prepare for, protect against, respond to, and recover from incidents with potentially negative environmental health consequences.

16. CDC’s Public Health Emergency Preparedness (PHEP) Capabilities  Public Health Laboratory Testing  Public Health Surveillance and Epidemiological Investigation*  Community Preparedness  Community Recovery  Responder Safety and Health *The biosurveillance aspects of animal disease and emergency support, food and agriculture safety and defense, and environmental health were incorporated into the public health surveillance and epidemiological investigation capability. 2 PHEP Capabilities: National Standards for State and Local Planning, March 2010, www.cdc.gov/phpr/capabilities.

17. The RAND Report: “Community resilience or the sustained ability of a community to withstand and recover from adversity (e.g., economic stress, influenza pandemic, man- made or natural disasters)”, is an intrinsic goal of the efforts that guide environmental health actions.  Building Community Resilience to Disasters: A Way Forward to Enhance National Health Security, RAND Corporation, 2011. ISBN 978-0-8330-5195-0

18. Adapt Withstand Rapidly Recover The Basic Resilience Model

19. Resilience-Workforce Tasks:  Perform exercises and drills  Provide training in environmental health response  Conduct inspections and plan reviews  Create/Implement plans for mitigation and recovery

20. Resilience-Partnership Tasks:  Solicit community input and awareness  Support collaboration and execute agreements  Enforce laws and compliance measures  Inform community of disaster management services

21. Mesa APC’s role In the fall of 2009 the Mesa County Health Department was selected as an APC by the National Association of County and City Health Officials (NACCHO.) Over the past 7 years APC sites around the nation have created 130 toolkits. Of those, 19 address issues related to environmental health emergencies.

22. Mesa APC’s role The first step in the construction of community resilience is identifying the places within local environmental health programs where knowledge, support, and resources are lacking. Filling these environmental health planning and preparedness gaps is foundational to the overall sustainability of rural community resilience, and central to the mission of the NACCHO Advanced Practice Center (APC) program.

23. Mesa APC’s role The Mesa County APC, in partnership with the Toledo-Lucas County (Ohio) APC, began an environmental health toolkit evaluation process that includes “usability” reviews, subject matter expert (SME) analysis, toolkit user input, and a quality improvement review.

24. Mesa APC’s role In order to identify these gaps, the Mesa County APC launched an Environmental Health Gaps survey to gather feedback from environmental health professionals regarding the programmatic gaps in their jurisdiction. This data was compared to the 19 environmental health toolkits produced by the NACCHO APC program.

25. In a survey administered by the Mesa County Advanced Practice Center (APC) through the National Environmental Health Association and the Colorado Environmental Health Association, the following categories were identified as gaps by local environmental health professionals. Ambient Air Quality Noise80.0% Greenhouse Gases80.0% Vehicle Emissions66.7% Disease Control Environmental (cancer, asthma, lead, etc.) 64.3% Solid Waste Management Pharmaceutical/Bio-Medical57.1% Household Hazardous (paint, oils, batteries, etc.) 52.9% Water Quality Urban Runoff (pesticides, fertilizers, chemicals, animal waste) 86.7% Agricultural Runoff78.6% Environmental Health Gaps http://www.surveymonkey.com/s/ehgaps

26. Indoor Air Quality Ventilation (Public/Work Places) 64.7% Mold/Mildew56.3% Food safety Allergens80.0% Internet Sales66.7% Home Preparation60.0% Delivery Services60.0% Green Initiatives Design Walkable Communities85.7% Alternate Energy66.7% Energy Efficiency 66.7% Alternative Transportation66.7% Environmental Health Gaps

27. What is an Advanced Practice Center (APC)? The National Association of County and City Health Officials (NACCHO) Advanced Practice Centers (APC) Program is a network of local health departments that exist to serve the public health community, developing resources and training on topics such as:  Bio-surveillance  Vulnerable populations  Risk communication  Countermeasure distribution  Workforce development Visit http://apc.naccho.org for more information on the APC mission, other APC sites, and other resources.

28. Barriers: Budget offers and Contracts Compliance/Regulation vs Education/Outreach- perceived 80/20 rule. If its not part of the budget (as determined by what is offered by CDPHE or other) then we CAN’T do it (unless we truly care about it.) Status quo- we’ve always done it this way- or eveyone else does it this way…or it is someone else’ responsibility. Clearly defined objectives- linked to contract outcomes, and measureables. Data/Indicators…have they been identified locally? Can they be ascertained?

29. What would make our (rural) environmental health jobs easier Workload analysis- risk based vs. routine- a different strategy or a more outcome-based strategy  Foodborne illness risk factors (FDA): “number of hits” Quality Improvement: Contract Outcome Data Assessment (CODA) Creating a local system of “consumable” data/information base for EH that is not reliant on personality or experience. Reducing the drags on effectiveness: effect of funding and programmatic direction from the area of EH.

30. Getting involved in future developments The Mesa County APC launched an Environmental Health Gaps survey to gather feedback from environmental health professionals regarding the programmatic gaps in their jurisdiction. You are encouraged to take the survey by visiting: http://www.surveymonkey.com/s/ehgaps to help us produce a strong dataset. http://www.surveymonkey.com/s/ehgaps Environmental Health Response Toolkits are always available at the NACCHO APC website (www.apc.naccho.org) and by linking to them from the Mesa APC page, which contains a list of the Environmental Health toolkits. NACCHO and the Mesa County APC is in need of subject matter expert (SME) feedback from environmental health professionals that have used the APC toolkits. Please contact the Mesa County APC to get involved.www.apc.naccho.org

31. Contact: Mesa County Advanced Practice Center:  http://health.mesacounty.us/APC2 http://health.mesacounty.us/APC2  mesaapc@mesacounty.us mesaapc@mesacounty.us Greg Rajnowski, Health Informatics  Greg.Rajnowski@mesacounty.us Greg.Rajnowski@mesacounty.us  970-248-6929