1. Healthy People 2010 Focus Area 8 : Environmental Health Progress Review March 19, 2003

2. Key Components of Environmental Health Source: Department of Health and Human Services. Healthy People 2010. 2 nd edition. With understanding and improving health and objectives for improving health. Vol. 1. Washington: U.S. Government Printing Office. November 2000. Water Quality Toxics and Waste Outdoor Air Quality Healthy Homes and Healthy Communities Global Environmental Health Infrastructure and Surveillance Health of Individuals & Communities

3. 8-1.Harmful air pollutants 8-2. Alternative modes of transportation 8-3. Cleaner alternative fuels 8-4. Airborne toxins Outdoor Air Quality

4. 8-1a. Persons living in areas that do not meet EPA standards † for ozone Source: Aeromatic Information Retrieval System (AIRS), EPA/OAR. Total American Indian/ Alaska Native only White only, not Hispanic Black only, not Hispanic HispanicAsian only Percent2010 target ‡ = 0%19972001 Native Hawaiian/ Other Pacific Islander only † National Ambient Air Quality Standards for ozone. Target set to be consistent with the Clean Air Act (Public Law 101-549). ‡

5. 8-1b. Persons living in areas that do not meet EPA standards † for particulate matter TotalAmerican Indian/ Alaska Native only White only, not Hispanic Black only, not Hispanic HispanicAsian only Percent 2010 target ‡ = 0%19972001 Native Hawaiian/ Other Pacific Islander only Source: Aeromatic Information Retrieval System (AIRS), EPA/OAR. † National Ambient Air Quality Standards for particulate matter. Target set to be consistent with the Clean Air Act (Public Law 101-549). ‡

6. 8-1c. Persons living in areas that do not meet EPA standards † for carbon monoxide Source: Aeromatic Information Retrieval System (AIRS), EPA/OAR. 2010 target ‡ = 0% 19972001 Percent American Indian/ Alaska Native only White only, not Hispanic Black only, not Hispanic HispanicAsian only Total † National Ambient Air Quality Standards for carbon monoxide. Target set to be consistent with the Clean Air Act (Public Law 101-549). Native Hawaiian/ Other Pacific Islander only ‡

7. 8-1d. Persons living in areas that do not meet EPA standards † for nitrogen dioxide Source: Aeromatic Information Retrieval System (AIRS), EPA/OAR. 2010 target ‡ = 0% Percent American Indian/ Alaska Native only White only, not Hispanic Black only, not Hispanic Hispanic Asian only Total 19972001 † National Ambient Air Quality Standards for nitrogen dioxide. Target set to be consistent with the Clean Air Act (Public Law 101-549). Native Hawaiian/ Other Pacific Islander only ‡ 2010 target met * * ***** *

8. 8-1e. Persons living in areas that do not meet EPA standards † for sulfur dioxide Source: Aeromatic Information Retrieval System (AIRS), EPA/OAR. 2010 target ‡ = 0% 19972001 Percent American Indian/ Alaska Native only White only, not Hispanic Black only, not Hispanic HispanicAsian only Total † National Ambient Air Quality Standards for sulfur dioxide. Target set to be consistent with the Clean Air Act (Public Law 101-549). Native Hawaiian/ Other Pacific Islander only ‡

9. 8-1a-f. Persons living in areas that do not meet EPA standards † for criteria pollutants, 2001 Source: Aeromatic Information Retrieval System (AIRS), EPA/OAR. 2010 targets ‡ = 0% Percent OzoneSulfur dioxide Nitrogen dioxide Carbon monoxide Particulate matter 2010 target met * * * Lead Outside MSAWithin MSA Total † National Ambient Air Quality Standards Targets set to be consistent with the Clean Air Act (Public Law 101-549). ‡ MSA: Metropolitan Statistical Area

10. 8-1g. Persons living in areas that do not meet EPA standards † for criteria pollutants, by race/ethnicity Source: Aeromatic Information Retrieval System (AIRS), EPA/OAR. American Indian/ Alaska Native only White only, not Hispanic Black only, not Hispanic Hispanic Asian only Number (thousands) 2010 target = 0 19972001 † Persons living in areas that exceed the National Ambient Air Quality Standards for one or more criteria pollutants: ozone, carbon monoxide, nitrogen dioxide, sulfur dioxide, particulate matter, or lead. Native Hawaiian/ Other Pacific Islander only

11. 8-1g. Persons living in areas that do not meet EPA standards † for criteria pollutants, by age and geographic location Source: Aeromatic Information Retrieval System (AIRS), EPA/OAR. Less than 1065 and over10-64 Number (thousands) Age in years.………………. ……………….. WithinOutside....………...………… MSA 2010 target = 0 19972001 † Persons living in areas that exceed the National Ambient Air Quality Standards for one or more criteria pollutants: ozone, carbon monoxide, nitrogen dioxide, sulfur dioxide, particulate matter, or lead. MSA: Metropolitan Statistical Area

12. EPA-designated nonattainment areas, 1990 and 2000 Source: Aeromatic Information Retrieval System (AIRS), EPA/OAR. 1990 2000 * Criteria pollutants are ozone, carbon monoxide, nitrogen dioxide, sulfur dioxide, particulate matter, and lead. *

13. EPA-designated nonattainment areas for criteria pollutants †, September 2001 Source: Aeromatic Information Retrieval System (AIRS), EPA/OAR. Criteria pollutants are ozone, carbon monoxide, nitrogen dioxide, sulfur dioxide, particulate matter, and lead. † Alaska Eagle River JuneauAnchorage Fairbanks Puerto Rico Guaynabo County Guam Piti Power Plant Tanguisson Power Plant

14. 8-5.Safe drinking water 8-6. Waterborne disease outbreaks 8-7. Water conservation 8-8. Surface water quality (developmental) 8-9. Beach closings (developmental – proposed baseline data shown) 8-10. Fish contamination (developmental) Water Quality

15. Number of beaches in the 2001 National Health Protection Survey of Beaches Source: EPA/OW. BEACH Watch Program: 2001 Swimming Season. May 2002.

16. 8-9. Beaches experiencing one or more advisories or closings, 1997-2001 Source: National Health Protection Survey of Beaches, EPA/OW. NumberBeaches surveyedBeaches experiencing > 1 advisories/closings 23% 25% 24% 27% Note: This objective is developmental. A 2010 target has not yet been set.

17. Sources of pollution causing beach advisories and closings, 2001 Source: EPA/OW. BEACH Watch Program: 2001 Swimming Season. May 2002. Unknown 52% Storm water runoff 20% Other 3% Wildlife 10% Combined sewer overflow 3% Boat discharge 2% Sanitary sewer overflow 2% Sewer line blockage or break 4% Publicly owned treatment works 1% Septic system 3%

18. 8-11. Elevated blood lead levels in children 8-12. Risks posed by hazardous sites 8-13. Health care visits due to pesticide exposure 8-14. Toxic pollutants generated for energy recovery (developmental) 8-15. Recycled municipal solid waste Toxics and Waste

19. 8-11. Children ages 1-5 years with elevated blood lead levels † Source: National Health and Nutrition Examination Survey (NHANES), CDC/NCHS. Percent 1988-19911999-20001976-19801991-1994 88.2% 8.9% 4.4% † Elevated blood lead level is defined as > 10 ug/dL. Data for 1999-2000 are statistically unreliable (relative standard error > 30%). ** 2.2% **

20. Mean blood lead concentration in children ages 1-5 years Source: National Health and Nutrition Examination Survey (NHANES), CDC/NCHS. † Geometric mean Mean † blood lead concentration (ug/dL) I 95% Confidence Interval 1976-1980 1988-1991 1999-20001991-1994

21. Mean blood lead concentration in children ages 1-5 years, by race/ethnicity Source: National Health and Nutrition Examination Survey (NHANES), CDC/NCHS. † Geometric mean Mexican American* White, not Hispanic Mean † blood lead concentration (ug/dL) I 95% Confidence Interval Black, not Hispanic * Can be of any race Total 1991-19941999-2000

22. 8-16. Indoor allergens 8-17. Office building air quality 8-18. Homes tested for radon 8-19. Radon-resistant new home construction 8-20. School policies to protect against hazards 8-21. Disaster preparedness plans and protocols 8-22. Lead-based paint testing in pre-1950s homes 8-23. Substandard housing Healthy Homes and Communities

23. 8-16. Indoor allergens: Dust mite and cockroach allergens in bed dust Source: National Survey of Lead and Allergens in Housing, NIH/NIEHS; and U.S. Department of Housing and Urban Development (HUD). Group 1 dust mite > 2 ug/g Millions of homes 1998-99 level 2010 target Direction desired Group 1 dust mite > 10 ug/g German cockroach > 0.1 unit/g Allergen concentration in bed dust ……………………… ………………………. 44.3 23.2 5.8

24. Homes with group 1 dust mite allergen concentrations at or above threshold, 1998-1999 Source: Arbes SJ, Cohn RD, Yin M, et al. House dust mite allergens in US beds: Results from the first National Survey of Lead and Allergens in Housing. Journal of Allergy and Clinical Immunology. February 2003. > 0.025 ug/g Percent of homes > 2.0 ug/g> 10.0 ug/g Allergen concentration in bed dust …………………… …………………… Lower limit of detection Threshold for allergic sensitization Threshold for asthma sensitization I 95% Confidence Interval* of any race. 84.2% 46.2% 24.2%

25. Mean dust mite concentrations, by housing unit characteristics, 1998-1999 Source: Arbes SJ, Cohn RD, Yin M, et al. House dust mite allergens in US beds: Results from the first National Survey of Lead and Allergens in Housing. Journal of Allergy and Clinical Immunology. February 2003. Construction Year < 1939 1940-1959 1960-1977 1978-1998 1990 census region West Midwest South Northeast Household income < $20,000 $20,000-39,999 $40,000-59,999 > $60,000 Mean concentration (ug/g) I 95% Confidence Interval* of any race.

26. 8-24. Exposure to pesticides 8-25. Exposure to heavy metals and other toxic chemicals (developmental – proposed baseline data shown) 8-26. Information systems used for environmental health 8-27. Monitoring environmentally related diseases 8-28. Local agencies using surveillance for vector control Infrastructure and Surveillance

27. 8-24a-d. Pesticide metabolites in the urine, persons ages 6 and over Source: National Health and Nutrition Examination Survey (NHANES), CDC/NCHS. Data reported in the Second National Report on Human Exposure to Environmental Chemicals, CDC/NCEH (January 2003). 1-Napthol (carbaryl) Paranitrophenol (methyl parathion/ parathions) 3,5,6-Trichloro-2-pyridinol (chlorpyfifos) Metabolite (pesticide) Isopropoxyphenol (propoxur) Note: 1988-1994 data are for persons ages 6 and over. 1999-2000 data are for persons ages 6-59 years. < LOD † 95 th percentile I 95% Confidence Interval LOD: Limit of detection Urine concentration (ug/g creatinine) † 1988-941999-20002010 target 2010 target met * *

28. 8-24a-c. Pesticide metabolites in the urine, persons ages 6-59 years, by race, 1999-2000 Source: National Health and Nutrition Examination Survey (NHANES), CDC/NCHS. Data reported in the Second National Report on Human Exposure to Environmental Chemicals, CDC/NCEH (January 2003). 1-Napthol (carbaryl) Paranitrophenol (methyl parathion/ parathions) 3,5,6-Trichloro-2-pyridinol (chlorpyfifos) Metabolite (pesticide) † 95 th percentile ** Can be of any race. Urine concentration (ug/g creatinine) † Mexican American** Black, not Hispanic 2010 target White, not Hispanic 2010 target met * *

29. 8-24a-c. Pesticide metabolites in the urine, persons ages 6-59 years, by age, 1999-2000 Source: National Health and Nutrition Examination Survey (NHANES), CDC/NCHS. Data reported in the Second National Report on Human Exposure to Environmental Chemicals, CDC/NCEH (January 2003). 1-Napthol (carbaryl) Paranitrophenol (methyl parathion/ parathions) 3,5,6-Trichloro-2-pyridinol (chlorpyfifos) Metabolite (pesticide) † 95 th percentile Urine concentration (ug/g creatinine) † 6-11 years12-19 years 2010 target 20-59 years * 2010 target met *

30. 8-25b,c,e. Heavy metals in the blood, persons ages 1 year and over, 1999-2000 Source: National Health and Nutrition Examination Survey (NHANES), CDC/NCHS. Data reported in the Second National Report on Human Exposure to Environmental Chemicals, CDC/NCEH (January 2003). Note: This objective is developmental. A 2010 target has not yet been set. † 95 th percentile I 95% Confidence Interval Cadmium Lead Blood concentration (ug/dL) † Females & Males 1-5 years Females 16-49 years ………. Mercury

31. 8-25c. Mean blood lead concentrations, persons ages 1 year and over, 1999-2000 Source: National Health and Nutrition Examination Survey (NHANES), CDC/NCHS. Data reported in the Second National Report on Human Exposure to Environmental Chemicals, CDC/NCEH (January 2003). Total 1-5 years Mexican American* Male Female Black, not Hispanic White, not Hispanic 6-11 years 12-19 years 20 years and over * Can be of any race I 95% Confidence Interval* Mean blood lead concentration (ug/dL) Note: This objective is developmental. A 2010 target has not yet been set.

32. 8-25f,g,i. Pesticide metabolites in the urine, persons ages 6-59 years, 1999-2000 Source: National Health and Nutrition Examination Survey (NHANES), CDC/NCHS. Data reported in the Second National Report on Human Exposure to Environmental Chemicals, CDC/NCEH (January 2003). LOD: Limit of detection. Note: This objective is developmental. A 2010 target has not yet been set. 2,4-Dichlorophenoxyacetic acid ortho -Phenlyphenol 2-Isopropyl-4-methyl- 6-hydroxypyrimidine (Diazinon) Metabolite (pesticide) Urine concentration (ug/g creatinine) † < LOD † 95 th percentile

33. 8-25m,o,p. Organochlorine compounds in the blood serum, persons ages 12 years and over, 1999-2000 Source: National Health and Nutrition Examination Survey (NHANES), CDC/NCHS. Data reported in the Second National Report on Human Exposure to Environmental Chemicals, CDC/NCEH (January 2003). Note: This objective is developmental. A 2010 target has not yet been set. Oxychlordane Dichlorodiphenyltrichloroethane (DDE) Beta-hexachlorocyclohexane Organochlorine compound Serum concentration (ng/g lipid) † † I 95 th percentile 95% Confidence Interval*

34. 8-25o. Dichlorodiphenyltrichloroethane (DDE) in the blood serum, persons ages 12 and over, 1999-2000 Source: National Health and Nutrition Examination Survey (NHANES), CDC/NCHS. Data reported in the Second National Report on Human Exposure to Environmental Chemicals, CDC/NCEH (January 2003). Total 12-19 years Mexican American* Serum concentration (ng/g lipid) † 20+ years MalesFemalesBlack, not Hispanic White, not Hispanic 95% Confidence Interval* 95 th percentile † I * Can be of any race Note: This objective is developmental. A 2010 target has not yet been set.

35. 8-29. Global burden of disease due to poor water quality, sanitation, and hygiene 8-30. Water quality in the U.S.-Mexico border region Global Environmental Health

36. U.S.-Mexico border region Source: U.S.-Mexico Border Health Commission

37. 8-30a-f. Wastewater sewer service in selected U.S.-Mexico border communities Sources: EPA; Mexico’s Comision Nacional de Agua; State and local health departments; American Water Works Association; Rural Water Association; U.S.-Mexico Border Health Association. Ciudad Acuna Percent 1997 2002 2010 target MexicaliPiedras Negras Matamoros Nogales, Sonora Reynosa NA NA: Data not available. * * * 2010 target met *

38. 8-30g-l. Wastewater receiving treatment in selected U.S.-Mexico border communities Sources: EPA; Mexico’s Comision Nacional de Agua; State and local health departments; American Water Works Association; Rural Water Association; U.S.-Mexico Border Health Association. Ciudad Acuna Percent 1997 2002 2010 target MexicaliPiedras Negras Matamoros Nogales, Sonora Reynosa NA NA: Data not available. NA * * * 2010 target met *

39. For more information Progress Review data and slides can be accessed on the web at: http://www.cdc.gov/nchs/hphome.htm