2. PACE-EH SUMMIT Louisville KY March 28 & 29, 2006 Alan Kalos Northern Kentucky Health Department alan.kalos@ky.gov www.nkyhealth.org

3. Genetics BehaviorEnvironment Determinants of Health

4. What is Environmental Health?

5. Environmental Health A definition: Environmental health is the complex relationship among people, the physical environment and the health of our population. Kentucky Environmental Indicators Committee, July 8, 1999.

6. What is an Indicator?

7. Indicator Definition: Indicators are direct or indirect measures of some valued component or quality of a defined system, used to assess and communicate the status and trends of that systems health. Green Mountain Institute for Environmental Democracy, September 1997

8. Indicator Definition (2): Indicator: A measurement that reflects the status of a system. Indicators reveal the direction of a system (a community, the economy, the environment), whether it is going forward or backward, increasing or decreasing, improving or deteriorating, or staying the same. National Public Health Performance Standards, CDC July 2005

9. Indicator Definition (3): Indicators are tools for quantifying, through direct or indirect measures, a significant aspect of an environmental issue. They can be used to assess and communicate the status of and trends in overall environmental health. Protocol for Assessing Community Excellence in Environmental Health, NACCHO, May 2000.

10. Indicator Definition (4): Indicator: a pointer, a sign, a symptom or an index; a suggestion Websters New Ideal Dictionary, 1984

11. Sources, Exposures & Outcomes

19. Levels of Indicators Tertiary Infrastructure, sources and activities Samples – Percent population on public water systems Percent population on public sewer systems Smoke-free workplaces

20. Levels of Indicators Secondary Environmental stressors, exposures, and pathways Samples – Air Quality Index Hazardous waste generated Radon exposure Agricultural chemicals

21. Levels of Indicators Primary Outcome Indicators – Human and environmental health Samples – human health: Birth defects Blood lead levels in children Childhood cancers Samples – environmental health: Surface water not meeting use standards Endangered species Acres of wetlands

22. Comparative Risk Which has a higher priority? One child develops cancer and dies? or 5,000 adults and children go to the doctor with gastrointestinal distress?

23. Ranking and Priority Setting Magnitude of the Issue Size of the jurisdiction (community) Number affected Percent of the population affected

24. Ranking and Priority Setting

26. Severity of the issue Who is affected High mortality or morbidity Irreversible harm

27. Ranking and Priority Setting Death Childhood cancer Mercury poisoning Stomach ache Severity

28. Ranking and Priority Setting Forces of Change Is there the political will to make changes What is the economic impact Is there public demand for change

29. Ranking and Priority Setting How many jobs lost if plant closes? How much will it cost to stop discharges? Do the people believe the plan is responsible for illness?

30. PACE-EH SUMMIT Louisville KY March 28 & 29, 2006 Alan Kalos Northern Kentucky Health Department Alan.Kalos@ky.gov www.nkyhealth.org