Using Public Health Data to Assess Vulnerability and Cumulative Impacts to Health Jerald A. Fagliano, M.P.H., Ph.D. Environmental and Occupational Health Surveillance Program New Jersey Department of Health and Senior Services April 13, 2011 Clean Air Council

Outline What public health data sets are available? Data resources: –Environmental Public Health Tracking – –NJ State Health Assessment Data (NJ SHAD) – Using public health data to assess cumulative impacts

Key Data Sets Relevant to Environmental Public Health Vital Events –Births –Deaths –Infant and fetal deaths Health Outcome Registries –Cancers –Birth defects Administrative Data –In-patient hospitalization and emergency department Laboratory Reports on Exposure –Childhood blood lead

EPHT and NJ SHAD State Health Assessment Data (NJ SHAD) system, a public health data resource –Includes custom data query, public health indicators, and links to reports NJ Environmental Public Health Tracking program supports and uses NJ SHAD as its data portal –Part of national EPHT Network with CDC, 25 States, and New York City

Health Disparity Priority Areas: Asthma Cancer Heart Disease Kidney Disease Diabetes HIV/AIDS Immunization Infant Mortality Obesity Injuries Violence

Environmental Public Health Tracking: Air Quality Drinking Water Lead Exposure Birth Outcomes Infant Outcomes Cancers CO Poisoning Asthma Heart Attack Occup. Injuries

Age-Adjusted Death Rate due to Heart Disease, NJ and US,

Age-Adjusted Death Rate due to Heart Disease, by Race/Ethnicity, 2006

Percent of Live Births with Low Birth Weight, Percent of Children Under Age 5 Years of Age Living in Poverty, 2000

Percent of Infants with Low Birth Weight, by Mother’s Education and Prenatal Care,

Diseases of the heart Malignant neoplasmsCerebrovascular diseases All causes of death Age-Adjusted Death Rates by Race/Ethnicity, State of NJ,

Age-Adjusted Death Rate due to Cancers, by County and Race/Ethnicity,

Planned Improvements to NJ SHAD Dynamic mapping of query output Additional data sets: –Hospitalization and emergency department –Childhood lead exposure –Cancer Secure portal for access to data at finer geographic and temporal scales

Public Health Measures as Cumulative Impact Measures Public health measures are measures of “cumulative impact” from: –Heritable risk factors –Personal behaviors –Community/social stressors –Environmental and occupational exposures Challenge is in understanding how these factors interact to produce health impacts May indicate degree of potential vulnerability to added environmental stressors

Health Outcome Indicators of Vulnerability to Environmental Impact General measures of health –Mortality (age-adjusted rates) Overall, cardiovascular, cancer –Infant and fetal mortality –Low birth weight among singleton, term births More specific measures –Childhood lead exposure –Hospitalization and emergency department use due to asthma or heart attack –Cancer incidence Leukemia, lymphoma, bladder, lung –Birth defects Clefts, neural tube defects, heart anomalies

For more information: Environmental Public Health Tracking – – NJ State Health Assessment Data – Strategic Plan to Eliminate Health Disparities in New Jersey –