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

2. 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

3. 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’

5. 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

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

8. 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

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

10. 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.

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

12. 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

13. 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: /pubmed/fdw130
Environmental Public Health Tracking in Sandwell. Report of First’s Pilot. Oldbury: Sandwell Metropolitan Borough Council, ISBN number: