Environmental Public Health Tracking: a cost-effective system for characterising the sources, distribution and impacts of environmental hazards Patrick Saunders

Introduction What it is Why we should do it How to do it How’s it being done How the outputs can be used CDC definition: the ongoing collection, integration, analysis, and interpretation of data about environmental hazards, exposure to environmental hazards, and human health effects potentially related to exposure to environmental hazards

Why Environment impacts on individual and community health negatively & positively Disproportionately affects the poor But still major gaps in our understanding Statutory and implicit requirements Increased public concerns Prevent inappropriate epidemiological studies ‘We can track flu, West Nile virus, and mad cow disease but not enough of the chronic illnesses that are the biggest killers…because we just don’t have enough of that basic information’

What Hazards Goods Exposures Diseases Contaminated sites Source of pollution Nuisance complaints Access to goods Unhealthy foods Air quality Housing Crime Goods Green space, healthy foods, cycling Exposures Largely use proxies Diseases Specific cancers, reproductive outcomes, hospital admissions

Black Country Night, with foundry Edwin Butler Bayliss Wolverhampton Art Gallery

Having now created some relative risk surfaces, we need to assess how significant they are. Essentially, what we want to know is whether the white peaks and black troughs in the previous slides are statistically significant. One way to test this is to use Monte-Carlo simulation techniques to test the Random labelling hypothesis. Basically this involves pooling all the case patients and their matched controls and then randomly selecting a new set of cases from this pool. If we then Create 99 simulated relative risk surfaces in this manner, we can compare our observed or real surface with the 99 simulated surfaces to see how unique the observed pattern is. 8

Bringing Things Together Tracking links different dimensions applying methods from one setting to another

Over 20,000 complaints Using the population weighted method 37 different LSOAs had significantly higher levels of total nuisance two for four years, two for three years and five for two years 18 areas showed a significant increase in complaints over the period with four areas deteriorating from being average or better to poor On the other hand, 25 areas including some that had been very poor had seen significant decline in complaints The control chart analysis identified all the high complaint areas as above and also captured a further 24 as having excessively elevated complaint levels (see figure 5). These additional areas were all close to significance using the indirect method. 15 areas were consistently poor over the period.

Partners Local authority NHS Police Environment Agency Public health Environmental health Housing Transport Planning NHS Police Environment Agency Local action groups Universities PHE

How Establish a multi-agency group Think in terms of well being as well as health Integrate into business plans Align to business objectives of participants Make it as easy as possible for participants Add value and generated products Share success Recruit political support Establish a mechanism for the public to register concerns Establish active horizon scanning Persevere

Conclusion Cost effective? US budget in 2015 $35m UK budget? Sandwell budget? Further reading: Saunders PJ, Middleton JD, Rudge G. Environmental Public Health Tracking: a cost-effective system for characterizing the sources, distribution and public health impacts of environmental hazards. Journal of Public Health 2016; doi: 10.1093/pubmed/fdw130 Environmental Public Health Tracking in Sandwell. Report of First’s Pilot. Oldbury: Sandwell Metropolitan Borough Council, 2013. ISBN number: 9781900471114.