Introduction to Environmental Public Health Tracking

Objectives
Increase knowledge of the National Environmental Public Health Tracking Network Develop skills in using the Tracking Network to mine data and identify trends to address public health problems

Preview
About National Environmental Public Health Tracking Network Using the Tracking Network Tracking in Action: Success Stories

NATIONAL ENVIRONMENTAL PUBLIC HEALTH TRACKING NETWORK

What is the National Environmental Public Health Tracking Network?

CDC's Tracking Network: Working Toward a Healthier Planet for Healthier People
http://www.youtube.com/watch?v=J42CLZH1NlE

What is the Tracking Network?

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

Building the Tracking Network

Why is the Tracking Network Important?

Before Tracking Simple questions could take months to answer Environmental and health fields were often separated With Tracking Can respond quickly-often within hours-to locate hazard sources or answer concerns These two worlds are brought together to the benefit of all

Focused mainly on acute events such as Ability to trace amounts and geographic hazardous chemical releases or pointspread of pollutants over time, allowing source pollution monitoring of long-term trends and place those acute events in context Environmental health surveillance was more difficult than infectious disease surveillance The same "disease detective" skills can be applied to finding environmental causes of illnesses and then take preventive measures to protect the public's health

Why is the Tracking Network Important?

The Tracking Network can help:
Determine areas with atrisk populations Leverage resources and develop partnerships Evaluation of control and prevention measures Facilitate policy development

TRACKING NETWORK DATA

Tracking Network Data Sources

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

Partners
CDC programs Federal agencies

Data on the Tracking Network

Environmental Hazard

Health

Population Exposures and Characteristics

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

ENVIRONMENTAL HAZARD DATA

Environmental Hazard Data

Air quality Water quality Climate change Community design Homes

Environmental Hazard Data: Air

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

ACTIVITY Environmental Hazard Data: Air

Air quality
Monitored data Modeled data

Environmental Hazard Data: Water

Water quality
Community water

ACTIVITY Environmental Hazard Data: Water

How is community drinking water tracked? What contaminants are being monitored? What are the data sources?

Environmental Hazard Data: Climate Change

Extreme heat
Weather and health data can be used to identify patterns in extreme heat and their associated health effects. These indicators use data from the past to identify extreme temperatures, deaths that might be related to heat, and conditions that make people vulnerable to heat.

Environmental Hazard Data: Community Design

Types of transportation to work Air quality (ozone and PM2.5) Childhood lead poisoning Motor vehicle-related fatalities

Environmental Hazard Data: Homes

Homes
Childhood lead poisoning
Age of housing

Carbon monoxide poisoning

Environmental Hazard Data Limitations

Coverage Spatial characteristics Temporal characteristics

HEALTH DATA

Health Data
Asthma Birth defects Cancer Carbon monoxide poisoning

Health Data
Childhood lead poisoning Developmental disabilities Heart attacks Reproductive and birth outcomes

POPULATION DATA

Population Data: Characteristics

Data that can provide context about relationships between exposures and health effects
Information about age, sex, race, and behavior or lifestyle may help us understand why a person has a particular health problem

Population Data: Biomonitoring/Population Exposures

Measures human exposure to environmental chemicals, national estimates only
Eleven Chemicals: Arsenic Benzene Cadmium Chloroform Cotinine Lead Mercury Naphthalene Pyrene Toluene Uranium

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

USING THE TRACKING NETWORK

Using the Tracking Network

Queries Maps, charts, and tables Share, and export

Indicators and Measures

Content Area
Indicator
Measure

i.e. Heart Attacks

i.e. Hospitalizations for Heart Attacks

i.e. Number of Heart Attacks

Indicators and Measures

Content Area Heart Attacks Asthma Asthma Cancer Population Characteristics Climate Change Indicator Hospitalizations for Heart Attacks Asthma Prevalence among Children Hospitalizations for Asthma Incidence of Bladder Cancer Demographic Measures Heat-Related Mortality Measure Number of Heart Attacks Percent of Children Ever Diagnosed with Asthma Crude Rate of Hospitalizations for Asthma per 10,000 population Annual Number of Cases of Bladder Cancer Number of People Number of Deaths due to Heat Stroke/Exhaustion by state, by month, by year Number of Homes Built Before 1950 (2000 census)

Homes

Blood Lead Testing and Age Housing

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

Air Quality Data Query

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

Air Quality Data Query

Year Number of Days Above Ozone Air Quality Standard, San Bernardino County 125 counts 118 counts 110 counts 116 counts
About the Indicator: Ozone - Days Above Regulatory Standard
The number of days in which the daily maximum 8-hour average ozone concentration exceeds 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.

2003 2004 2005 2006

Podcast: Asthma Rates and Air Quality

Health Data Query

Health Data Query

Year Number of Days Above Ozone Air Quality Standard, San Bernardino County 125 counts Number of Heart Attack Cases, CA 63,064

2003

2004
2005 2006

118 counts
110 counts 116 counts

59,514
57,157 54,729

Health Data Query

Health Data Query

Year Number of Days Above Ozone Air Quality Standard, San Bernardino County (VERY HIGH) 125 counts 118 counts 110 counts Number of Heart Attack Cases, CA (HIGH nationally) Number of Heart Attack Cases, San Bernardino

2003 2004 2005

63,064 59,514 57,157

3,418 3,189 3,169

2006

116 counts

54,729

2,886

ACTIVITY: Query

Using the Tracking Network

Map

Chart

Table

Metadata

Additional Features
Resources Grantee tracking networks Secure portal Contextual information

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 related diseases or of exposure to hazards Generate hypotheses about the relationship between health and the environment Direct and evaluate control and prevention measures and individual 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

TRACKING IN ACTION: SUCCESS STORIES

Success Story Saving Lives

Identifying the increases in preterm birth rates in Fresno County, California
What 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 Network revealed a pattern in the risk of preterm birth in Fresno County, one of the major population centers in the state's Central Valley area. What did Tracking do? California's Tracking Program informed the Fresno Department of Public Health of the trends. The local health department asked the 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 tracts

Improved public health Fresno County used the information to identify locations for targeting activities that are related to childhood lead poisoning, air quality, and asthma. Fresno County officials reported that the data and assistance from the tracking network were very helpful to the local childhood lead poisoning prevention program.

Success Story Protecting People

Answering community concerns about cancer in Maryland
What 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 about cancer and the environment were addressed only by the Maryland Cancer Registry and possibly local health departments. Maryland had no systematic way to respond to frequently asked questions from individuals, groups, and communities about cancer and the environment. What did Tracking do? The Tracking Program, working with the Maryland Cancer Registry, geocoded all residential addresses in the Registry. Now the Maryland Cancer Registry can accurately show cancer data in maps and carry out geospatial analyses of cancer information. Also, for the first time, there is an established process for evaluation of cancer concerns in Maryland. The new process involves a coordinated response that includes the Maryland Cancer Registry, the Center for Environmental Health Coordination, the Maryland Department of the Environment (MDE), and local health departments and is 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 cancer investigations, one in Poolesville and another in Frederick. The first looked at concerns about cancer and drinking water; the second involved concerns about cancer in a community. In both cases, the Maryland Tracking Program provided maps showing the geographic distribution of cancer and geostatistical analyses of the cancer cases. The results of these two investigations were presented at community meetings. To date, there is no evidence of cancer clusters, but experts were able to answer questions from community residents.

Success Story Protecting People

Lowering exposure to arsenic from private well water in Utah
What is the problem? Some Millard County residents use private wells for cooking and drinking water. The Health Hazard Assessment team of the Utah Department of Health confirmed that in the Delta Conservation Districts, many of the private 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 Millard County 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 Hazard Assessment team recommended that well water in this area not be used for drinking or cooking. They also suggested that residents of the area purchase and install water systems to reduce arsenic exposure in the community. Arsenic levels in water will be monitored until amounts are at levels that are not harmful to human health.

Success StoryProtecting People

Heat Wave Preparedness
What 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 heat wave, along with an estimated $500 million in agriculture-related costs from the loss of livestock. Heat waves have and will continue to impact all regions of California, including urban, rural, inland, and coastal areas. 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 to conduct 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 and counties to take preventative action, such as opening cooling centers where the public can gather for lifesaving relief from the heat. The California Tracking Program showed that heat-related emergency room visits peaked immediately following heat alerts for the San Jose area and subsided when the heat alerts were discontinued. Due to budget cuts, the City of San Jose wanted scientific evidence from NWS to show there was a need for cooling centers during heat waves. Without this proof, decision-makers would not approve the 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 in California, including Los Angeles. This information will help cities to make decisions about heat wave preparedness policies and help NWS refine its heat alert system for each region.

Success Story Saving Money Through Prevention

Informing health care providers about asthma in NYC
What is the problem? Each Fall NYC sees a large increase in hospital stays and in emergency department visits for asthma, especially among children. Illness rates in 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 used the results to write messages for health care providers. The messagessent through the city's Health Alert Networkurged providers to update patients' asthma management plans in time for school year start. Improved public health In the last few years, the seasonal fall mailing to health care providers and other asthma prevention activities have coincided with a decrease in rates of NYC hospital stays among children. Because of the program's success, advisories to health care providers have become a standard practice at the beginning of each school year in NYC.

Success Story Educating Communities

Louisiana - Deepwater Horizon (British Petroleum) Oil Spill
What 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 wildlife habitats were severely affected, and the fishing and tourism industries of U.S. coastal states were 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 Coast states. Survey- and map-based tracking systems were developed to capture and track health complaints and environmental monitoring results. In addition, the Louisiana Tracking Program worked with the Occupational Safety and Health Administration (OSHA) to make sure that outreach materials were available in several languages and available to people with limited Internet 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 on topics such as personal protective equipment, seafood safety, chemicals of concern, potential routes of exposure, and associated health effects.

More Success Stories

Tracking in Action: Interactive Map

Group Activity
Scenario
You are a student intern working for the Wisconsin Department of Health Services Program and Planning Office. The departments Heart Disease and Stroke Prevention Program wants to increase the publics awareness 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 and heart attacks. The fact sheet will be distributed to three counties in Wisconsin for which heart attack hospitalization rates are higher than the state rate. Use data and information from the National and Wisconsin Tracking Networks (http://www.dhs.wisconsin.gov/epht/index.htm) to identify the three counties in Wisconsin where educational efforts will be targeted. Your educational materials may include a poster, a fact sheet, or any other items you think would best convey your message.

Homework: Scenarios
Chose and complete one scenario

Homework: Queries
Conduct three queries on the Tracking Network, choosing a content area/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 a map

Thank You!
For additional details on CDCs National 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.