1. Environmental Public Health Indicators: The CDC Approach Michael A. McGeehin, Ph.D., M.S.P.H. Director Division of Environmental Hazards and Health Effects National Center for Environmental Health Centers for Disease Control and Prevention (CDC)

2. Introduction Development project conducted by NCEH/CDC in collaboration with: –Council of State and Territorial Epidemiologists –Environmental Protection Agency –Agency for Toxic Substances and Disease Registry –Public Health Foundation –National Association of County and City Health Officials –Association of Public Health Laboratories

3. EPHI Proposed Uses Surveillance of status and trends –Assess patterns of acute respiratory disease Program and policy development/evaluation –Assess how programs address motor vehicle emissions Build core capacity to respond to problems –Can states identify increased occurrence of acute respiratory events related to changes in ambient air quality?

4. Environmental Public Health Indicator Provides information about a population’s exposure and health status in relationship to environmental factors Summarizes large amounts of complex information in a concise, easily understood

5. An “Ideal” Indicator Is: Measurable, quantifiable, utilizes data Possible to track over time Based on demonstrated linkages between environment and health Usable, useful, and understandable at different levels and to diverse populations Informative to the public and to responsible agencies

6. Building on Past Efforts WHO Environmental Health Indicators Healthy People 2010 CSTE Chronic Disease Indicators: http://www.cste.org/CDindicators.pdf EPA State Environmental Goals and Indicators State Health and Environmental Agency Projects NACCHO PACE-EH Project

7. EPHI Categories Hazard: –a condition or activity that identifies the potential for exposure Exposure: –biological marker in tissue or fluid Health Effect: –occurrence of an adverse effect from exposure to a known or suspected environmental hazard Intervention: –Implementation of program that minimizes or prevents a hazard, exposure, or health effect.

8. EPHI Examples Hazard: –Monitored contaminants in water supplies Exposure: – Blood lead levels Health Effect –Unusual patterns of acute respiratory disease Intervention: –Compliance with operations and maintenance standards for drinking water systems

9. Environmental Public Health Indicators Topic Areas Air, Ambient (Outdoor) Air, Indoor Disasters Lead (Pb) Noise Pesticides Sentinel Events Sun and Ultraviolet Light Toxics and Waste Water, Ambient Water, Drinking

10. EPHI: Hazard Indicators (1) Criteria pollutants in ambient air Hazardous substances or air toxics released in ambient air Residence in non- attainment areas for criteria pollutants Motor vehicle emissions Tobacco smoke in homes with children Residence in a flood plain

11. EPHI: Hazard Indicators (2) Pesticide use patterns Pesticides or toxic contaminants in food UV radiation Chemical spills Monitored contaminants in ambient water Point-source discharges into ambient water Contaminants in shellfish and sport and commercial fish

12. EPHI: Exposure indicators Blood lead level (in children)

13. EPHI: Health Effect Indicators (1) CO poisoning Deaths attributed to extremes in ambient temperature Lead poisoning in children Hearing loss in adults who have no occupational exposures Pesticide-related poisoning and illness Individual cases of: –Asthma death –Methemoglobinemia Unusual patterns with suspected/confirmed environmental contribution: –Acute asthma events –Cardiovascular and respiratory events

14. EPHI: Health Effect Indicators (2) Melanoma Possible child poisoning resulting in consultation or ER visit Outbreaks attributed to ambient water contaminants Outbreaks attributed to seafood consumption Outbreaks attributed to drinking water contaminants

15. EPHI: Intervention Indicators (1) Programs that address motor vehicle emissions Alternative fuel use in registered vehicles Availability of mass transit Policies that address indoor air hazards in schools Laws pertaining to smoke-free indoor air Complaint-related indoor air inspections Emergency preparedness training programs, plans, and protocols Annual multi- institutional exercises to prepare for response to disasters

16. EPHI: Intervention Indicators (2) Compliance with training standards among pesticide workers Health-based activity restrictions in ambient water Implementation of sanitary surveys Compliance with operational and maintenance standards for drinking water systems Boil-water advisories

17. Indicator Types “Core” Indicators –Generally data is available or in the process of development and relevant nationally “Optional” Indicators –Information may not be relevant nationally and/or available in all states “Developmental” Indicators –Will require extensive developmental effort

18. Next steps …. Summarize information needs for each indicator Inventory and evaluate state level health and environmental data systems Pilot projects: state and local health and environment agencies