Judith R. Qualters, Ph.D. Chief, Environmental Health Tracking Branch

1. Environmental Public Health Indicators: Update on CDC Activities Ecoinformatics, Environmental Research: Current progress, research strategies and needs Ispra, ItalyJan 17 – 20, 2006 Judith R. Qualters, Ph.D. Chief, Environmental Health Tracking Branch Division of Environmental Hazards and Health Effects National Center for Environmental Health Centers for Disease Control and Prevention (CDC) 404-498-1815

2. Background: Environmental Public Health Indicator Development • Collaborative process • Built on previous efforts of WHO and others • External review by health and environmental professionals • Adopted by Council of State and Territorial Epidemiologists (CSTE) – June, 2001

3. Goals • Provide information about a population’s exposure and health status in relationship to environmental factors • Guide state public health agencies in developing a comprehensive environmental public health surveillance system

4. EPHI FrameworkAdapted from WHO “DPSEEA” (Pressure State) Model Source: Environmental Health Indicators: Framework and Methodology; prepared by David Briggs

5. Connecting the Dots: Indicator Suites Example - Lead • Hazard: Lead contamination in the environment • Measure: Proportion of housing stock built before 1950 • Exposure: Blood lead level in children • Measure: Proportion of high-risk children with elevated blood lead levels • Health Effects: Lead poisoning in children • Measure: Number of hospitalizations from lead poisoning in children • Intervention: Lead elimination programs • Measure: Number of completed lead abatements

6. Current Indicator Development Activities • Assessment projects – Environmental Public Health Tracking Program • State Environmental Health Indicators Collaborative • Coordination across indicator efforts

8. CDC’s EPHT Program Grantees - 2006

9. State/ local projects evaluating proposed EPHIs EPHI framework guides tracking development Objective: meaningful data for inter-state, regional, national assessment Indicators and Tracking

10. EPHI Assessment “Examine the feasibility of using the EPHI Project for surveillance” • 17 states and 3 local health departments • Questions: • Does the EPHI address your priority information needs? • Are they realistic in terms of available data and integration of these data? • What is the utility of selected measures in program/policy planning? • Does the measure selected accurately reflect the environmental public health issue of concern?

11. Measure Measure Measure 1.Percent of the population and geographical distribution of power outages on a given day 2. Percent of households where someone owns a generator 3.Percent of adults who report usually running their generator in an enclosed structure Data Source Data Source Data Source Power Utility Commission BRFSS BRFSS Example: Maine Indicator Indicator Project: Carbon Monoxide / Power Outages HAZARD Hazardous or toxic substance in indoor air

12. HEALTH EFFECT CO poisoning (not fire-related) Measure 1. Incidence of CO poisonings among Maine residents Data Source Maine Health Data Organization Measure 2. Incidence of occupationally-related CO poisonings Data Source Maine Health Data Organization EXPOSURE Biological Marker of human exposure to CO Measure Level of carboxyhemoglobin in blood (% saturation) Data Source Hospital laboratories Example: Maine (cont’d) Indicator Indicator Project: Carbon Monoxide / Power Outages

13. Indicator Indicator Project: Air/Asthma Intervention Programs that address hazardous substance in ambient air Measure Measure 1. Percent of households with CO monitors 2. Number of Health Alerts for CO poisoning sent through Maine Health Alert Network (HAN) Data Source Data Source BRFSS Maine HAN Example: Maine (cont’d)

14. State Environmental Health Indicators Collaborative (SEHIC) • Collaborators • State health departments • CSTE • CDC • EPA • Goal: develop and pilot EPHI in multiple states that can be used for state-level information dissemination and policy making

15. SEHIC Activities • Review state experiences with EPHI • Develop common set of definitions • Develop template for Indicator Profiles • Draft “How-To Guides” • Initial priority areas: Outdoor air, asthma, drinking water • Pilot indicators in multiple states and evaluate • Identify 10 leading EPHI and develop indicator suites

16. Preliminary Indicators • Air • Ambient concentrations of PM 2.5 • Ambient concentrations of ozone • Asthma • Unusual pattern of asthma events • Drinking Water • Population served by community water supplies (CWS) by TTHM levels • Population served by CWS by arsenic levels • Distribution of arsenic in groundwater used for drinking

17. Template

18. Indicator Coordination • CDC - CSTE • CDC – EPA

19. CDC & CSTE Partnership on Indicators

20. CDC EPHI Occupational Health Indicators Chronic Disease Indicators Injury Indicators EPA Report on the Environment 2006 America’s Children and the Environment Border 2012 Indicators CDC & EPA CollaborationFirst step: indicator cross-walk

21. For More Information….. • www.cdc.gov/nceh/indicators • www.cste.org