What is EPHT and why is it important?How is the environment related to our health?How do we study connections between health and the environment?What is the history of EPHT?Vision, Mission, and Goals of EPHTWhat kind of information will the EPHT network contain?
What is EPHT and why is it important?
Americans are concerned about hazards and health impacts related to environmental exposures. Citizens and policy makers want access to current, relevant, and accurate information about environmental exposures and health outcomes to facilitate individual, community, state, and national decision-making about adopting strategies to reduce the burden of disease attributable to the environment.
Environmental Public Health Tracking, or EPHT, is the ongoing collection, integration, analysis, and interpretation of data about: Environmental hazards , exposure to environmental hazards
- and health effects potentially related to exposure to environmental hazards.
The goal of environmental public health tracking is to protect communities by providing information to federal, state, and local agencies. These agencies, in turn, will use this information to plan, apply, and evaluate public health actions to prevent and control environmentally related diseases.Only by systematically measuring environmental insults, tracing their geographic distribution, documenting their residues in human tissues, and understanding their connection with illness can that information help prevent suffering and disease. Integrating all of these elements sets environmental public health tracking apart from traditional disease surveillance.Key benefits of the Environmental Public Health Tracking Network include:
- The ability to provide timely information to all users
- Integrating local, state, and national databases of environmental hazards, environmental exposures, and health effects
- Allowing analysis across geographic and political boundaries
- A focus on the environmental triggers of chronic disease.
How is the environment related to our health?
Every day we encounter chemicals, physical agents, and other substances in the air, water, and soil around us, as well as in the food we eat. Research shows a connection between our environment and our health, but we still have a long way to go in understanding what links the two.
We need better information and more sophisticated tools to understand the causes of these diseases if we are to prevent them.At the beginning of the 20th century, the American population faced significant health challenges from continued outbreaks of infectious diseases that ravaged the population. Much of the dramatic decrease in mortality from infectious disease in Western civilization was attributable to environmental public health measures such as disinfection of water, food safety regulations, and housing improvements, among others.
The second half of the 20th century witnessed a dramatic shift in the health burden of the U.S. population from infectious diseases to diseases such as cancer, birth defects, and asthma. During the same period, advances in industrial science and technology led to the development and use of many new chemical compounds. Unheard of 50 years ago, these chemical compounds are now found throughout our air, water, food, workplaces, and homes. Other environmental hazards have also affected the health of Americans, including pollution from increasing traffic and social implications from urban sprawl.
Today, chronic illnesses—like birth defects, developmental disabilities, asthma, cancers, heart disease, and neurological diseases—are responsible for 70 percent of deaths in the United States and affect over 100 million men, women, and children. These diseases cost our country more than $325 billion a year in health care and lost productivity and account for 60 percent of personal health care costs. The World Health Organization estimates that poor environmental quality may be responsible for one fourth of all preventable illness in the world, and that 50,000 to 100,000 people die prematurely each year as a result of air pollution alone. Illnesses stemming from air pollution cost about $100 billion annually in the United States, according to the American Lung Association. The Environmental Protection Agency (EPA) estimates that reducing air pollution to levels required by the 1990 Clean Air Act Amendments will prevent more than 1.7 million asthma attacks.
How do we study connections between health and the environment?
Environmental hazards have subtle effects on human health. They rarely cause immediate illness the way epidemic disease germs do. Their effect on the human body can go unnoticed, and years or decades may pass before symptoms appear. A single exposure or a single chemical may not trigger an illness, but an accumulation of exposures over time can take its toll. Effects are complicated. Many hazards may influence the appearance of one disease, while a single hazard may influence many outcomes.
Genes and behavior may also affect how environmental pollutants cause disease in individuals.Researchers have linked exposures to some environmental hazards with specific diseases. One example is the link between exposure to asbestos and lung cancer. Another example is the link between exposure to lead and decreased mental function in children. However, other links remain unproven, such as the suspected link between exposure to disinfectant byproducts (for example, chlorine from showerheads) and bladder cancer.
Much of the public health surveillance currently in place in the United States focuses on infectious diseases. An urgent need exists for a more comprehensive national approach to collecting and analyzing data on noninfectious diseases and to integrating that information with environmental hazard and exposure data.
Surveillance systems that capture data on public health effects and monitoring systems that capture environmental data currently exist. They are, however, separate systems, often developed by different agencies and for different purposes, making it difficult to track environmental hazards and investigate possible associated health effects. The environmental monitoring and health/exposure surveillance systems that exist currently are generally not compatible with each other because of differences in the purposes of the systems. There is a lack of common standards in how data are collected, including where data are collected, frequency of collection, characteristics collected, and data formats. Because existing systems are not linked, it is difficult to study and monitor relationships among hazards, exposures, and health effects. The availability of these types of data in a standardized Tracking Network will enable researchers, public health authorities, healthcare practitioners, and the public to begin to understand the possible associations between the environment and adverse health effects.
What is the history of EPHT?
Connecting hazardous substances in the air or water to illness might seem an obvious step, but its application has been spotty. Environmental and public health units at all levels of governments were once united. After creation of the EPA in the 1970s, however, health and the environment often became separate realms with separate administrative structures, separate funding, and separate legal authorities for action.
In 2000, the Pew Environmental Health Commission detailed an "environmental health gap," a lack of basic information needed to document links between environmental hazards and chronic disease. The commission found that the environmental public health system was fragmented, neglected, and ineffective, and does not have the capability to respond adequately to environmental threats. Without a tracking system, environmental causes of chronic diseases are hard to identify.
Over the last decade, CDC has laid the foundation of a national Environmental Public Health Tracking system to link environmental hazards and the diseases they cause. In FY 2006, CDC funded 17 state and 1 local health departments to build and implement state-based tracking networks. In 2009, the CDC funded an additional 5 states. The state and local data systems will feed into the National tracking network.Oregon started with an EPHT planning grant in August 2002. Over a three-year period, we planned activities to lay the foundation for establishing a State EPHT Network. In 2006, Oregon was funded to create and implement the network. This Network intends to serve the needs of stakeholders as well as interface with the National EPHT Network. Major activities of the planning and implementation grants include:
- Building relationships with those who will provide and use the data
- Providing capacity building, technical assistance, and environmental health training
- Developing a plan to implement a state EPHT Network
- Gathering input from stakeholders and agency partners through surveys and meetings around the state to assess environmental health priorities and needs
- Generating core measure data for the network (e.g. asthma and myocardial infarction hospitalizations, ozone and particulate matter levels, drinking water contaminants, blood lead levels, vital statistics, birth defects and cancer)
- Developing, implementing and assessing an outreach plan and risk communication strategy
- Establishing a State Technical Advisory Group
- Conducting a comprehensive assessment of all tracking activities in Oregon
Vision, Mission, and Goals of EPHT
Vision: Healthy, Informed Communities
The vision of Oregon Environmental Public Health Tracking program is to provide a resource of information about health and the environment for our partners, stakeholders and the concerned public leading to actions to improve the health of Oregon communities.
Mission: To Provide Information that Drives Actions to Improve Health
The mission of the Oregon Environmental Public Health Tracking program is to develop information systems, analytical tools, staff expertise, and an internet-accessible library of integrated environmental hazard, environmental exposure, and human health outcome data and information. We will share this resource with partners and stakeholders to raise awareness of environmental health concerns and drive actions to improve public health.Goals:
1) Build a sustainable Environmental Public Health Tracking network
2) Enhance Environmental Public Health Tracking workforce and infrastructure
3) Disseminate information to guide policy, practice, and other actions to improve health
4) Advance environmental public health science and research
5) Foster collaboration among health and environmental programs
What kind of information will the EPHT network contain?
The EPHT network utilizes existing hazard, exposure, and health effect data.Hazards include chemical agents, physical agents, biomechanical stressors, and biologic toxins that can be found in air, water, soil, food, and other environmental media.
Exposure tracking is the monitoring of individuals, communities, or population groups for the presence of an environmental agent or its metabolite. Exposure data can also include biomonitoring of hazardous agents in the human body such as childhood lead poisoning surveillance of blood lead levels. Biomonitoring is the direct measurement of people's exposure to environmental contaminants by measuring substances or their metabolites in blood, urine, or other specimensHealth effects tracking represents traditional public health surveillance efforts. Disease registries, vital statistics data, annual health surveys such as the National Health Interview Survey, and administrative data systems, such as hospital discharge data, are sources that have been used for tracking health conditions.
A key distinction between EPHT and traditional surveillance is the emphasis on data integration across health, human exposure, and hazard information systems. This Program to build a National EPHT Network is the first national effort to provide the United States with standardized data from multiple health, exposure, and hazard information systems that includes linkage of these data as part of regular surveillance activities.
Oregon EPHT has collected information about several environmental hazards, exposures and health effects, including blood lead, birth, death, birth outcomes, air quality, hospitalizations for asthma and heart attack, and drinking water.In the next few years, Oregon EPHT will add information about birth defects, cancer, and hospitalizations for carbon monoxide poisoning to the network.In the future, the needs of stakeholders will help determine what information would be important to add to the Oregon EPHT network. Some potential ideas include information about pesticide exposures, the built environment, climate change, harmful algal blooms, newborn metabolic screenings, multiple sclerosis, breastmilk contaminants and juvenile diabetes.