Importance of an Envoronmental Public Health Tracking Program

Importance of an Environmental Public Health Tracking Program

      Throughout the twentieth century, industrialization was a key factor for the shift in the way Americans lived. The shift to a more urban population came with its advantages and disadvantages. A lot of negative impacts came up in the health field due to overcrowding, scarce water resources, and a no effective waste disposal system (McGeehin, Qualters, & Niskar, 2004, p. 1409). These inadequate supplies led to infectious diseases that scoured the country. McGeehin et al. (2004) stated that one-third of all deaths were caused by pneumonia, tuberculosis, and diarrhea with forty percent of the deaths being children under the age of five. Much of the deaths during this time had relation with environmental public health issues: water and food regulations, and housing improvements. Advances in the scientific field have led to more chemicals being found in food, water, and air, which could attribute to the shift of health disparities in communicable diseases to cancer, asthma, and birth defects (McGeehin et al., 2004)
           
     Unlike in the beginning of the twentieth century, the people in the United States believe that the environment has an effect on one’s health (McGeehin et al., 2004). However, as Seachrist (2012) noted, there is an “environmental health gap” in today’s society, meaning there is not a clear understanding how the environment affect an individual or population’s health. The increased interest in the relationship between health and the environment has only helped fuel the need for some action to be taken in finding the answer.
        
     The Pew Environmental Health Commission(PEHC)  assessed the environmental public health in 1999, and found the environmental public health system did not have the capability to respond to environmental threats effectively (McGeehin et al., 2004) The PEHC recommended there be a developmental system to track exposures, environmental agents, and diseases, and then take action when necessary (Kyle, Balmes, Buffler, & Lee, 2006, p. 980). This led the Centers for Disease Control and Prevention (CDC) to launch the Environmental Public Health Tracking (EPHT) Network in 2001. The CDC then selected 24 state and local health departments, and three schools to participate (Kyle et al., 2006) The Missouri Department of Health and Senior Services was selected in 2002, and launched the Missouri Tracking Network in 2008.

      The EPHT is a free system put in place to provide user-friendly health and environmental data in the forms of graphs, charts, maps, and tables. The ultimate goal of EPHT is to improve health and reduce disease (Kyle et al., 2006) To do this, the CDC decided on the three surveillance elements and how to define them: health, exposure, and hazard. Hazard surveillance is the “assessment of the occurrence of, distribution of, and secular trends in levels of hazards (toxic chemical agents, physical agents, biomechanical stressors, or biological agents)” (Kyle et al., 2006)  Exposure surveillance is defined as the “monitoring of individuals, communities, or population groups for the presence of an environmental agent or its metabolite” (McGeehin et al., 2004) Health is considered the” traditional public health surveillance efforts” used for tracking gathered from vital statistics data or health surveys(McGeehin et al., 2004) Through the use of EPHT it allows users to be able to “generate hypotheses, identify patterns and trends, facilitate education and outreach efforts, and develop and evaluate public health actions” (Seachrist, 2012, p. 11).The development of this system has been the first effort of taking multiple standardized data sets and linking them for the betterment of overall health made by the United States.

      The tracking system is one that is multi-tiered at the federal, state, and local levels. While providing confidentiality to individual records, it allows for linking and analyzing data for the three elements: health, hazard, and exposure (McGeehin et al., 2004) Each tier has to do its part in supporting EPHT for it to be effective. The EPHT is useful at all tiers in the system. The policy makers can use it when deciding where to target the resources and intervention in the environmental public health field (Centers for Disease Control and Prevention, 2012). Health practioners and nurses can find it beneficial by using the data to research environmental health risk factors, plan treatments, and meet their educational needs as well as their patients (Seachrist, 2012, p. 11). Environmental Public Health Tracking is beneficial to anyone to find out how the environment may be affecting their self, family, or community. It is a tracking program that is in use every day for the betterment of the communities. The areas covered by the EPHT include: air quality measures; containments in drinking water; carbon monoxide, asthma and myocardial infarction hospitalizations; birth defects/premature births; childhood blood lead data; vital statistics/birth outcomes;  and type of cancer (current and future datasets) (Seachrist, 2012, p. 11).  All areas covered by the EPHT are useful to the different tiers.

        Missouri could be looked at as an ideal location for the developmental stages of EPHT. It has both rural farming and industrial settings that come with their own public health challenges (CDC, 2012). Elevated blood lead levels and extreme heat are two challenges faced and improved with the help of EPHT. Both of these challenges are important not only to public health officials and health practioners, but to parents and the elderly as well. While using EPHT, one can pull up an interactive map on where the closest cooling center is in cases of extreme heat, or where cases of elevated blood lead levels have been to see if your children are at risk (CDC, 2012).

           With a project this big and new, it does not come without limitations. The linkage of environmental and health data is limited to only those effects with scientific evidence that the health effect has possible environmental etiology (McGeehin et al., 2004) Because of the fact that there is not already a surveillance system existing at the national, state, and local levels using standard questions to assess the exposures and health effects of environmental hazards, there may be a lot of building necessary (McGeehin et al., 2004) There may also be some misunderstanding towards the general public and media on what EPHT is actually offering. Although it can help one formulate a hypothesis on the etiology of an outbreak, it cannot directly answer questions about diseases (McGeehin et al., 2004) Putting a specific cause to an outbreak through the EPHT may never be possible due to imperfections in the diseases themselves. There may be some lag time between a health effect associated with an environmental hazard of possibly months or years, and most health effects have multi-casual pathways that cannot be narrowed down into one specific cause for a disease (McGeehin et al., 2004) In the development of a National EPHT Program, there are going to be limitations and setbacks, but the benefits outweigh the disadvantages when looking at it from a public health point of view.

        With the ultimate goal of Environmental Public Health Tracking being to improve health and reduce disease, moving it from the developmental stages to a national tracking system is necessary. In order to do this, the citizens at the national, state, and local levels need to be held accountable for the job provided to them in terms of EPHT. When looking at the benefits in a place like Missouri, which has both urban and rural settings, it is hard to say that it is not for the betterment of the communities. With time, there can only be improvements made.

  WORKS CITED
Center for Disease Control and Prevention. (2012). CDC’s National Environmental and Public Health Tracking Network, Missouri. Retrieved from             http://ephtracking.cdc.gov/docs/State_Tracking_2012_MO.pdf.

Kyle, A. D., Balmes, J. R., Buffler, P. A., & Lee, P. R. (2006). Integrating Research, Surveillance, and Practice in Environmental Public Health Tracking. Environmental Health Perspectives, 114(7), 980-984. doi:10.1289/ehp.8735

McGeehin, M. A., Qualters, J. R., & Niskar, A. (2004). National Environmental Public Health Tracking Program: Bridging the Information Gap. Environmental Health Perspectives, 112(14), 1409-1413. doi:10.1289/ehp.7144

Seachrist, N. H. (2012). Environmental Public Health Tracking Program. Pennsylvania Nurse, 67(1), 11-13.