Environmental Public Health Tracking Program
Building a Network
Without question environmental contaminants are affecting people’s health. Environmental hazards are among parents’ top health concerns for their children, according to the American Academy of Pediatrics. Understanding how these contaminants and other environmental factors are linked to chronic disease is essential to disease prevention—and to protecting the health of our communities.
The Centers for Disease Control and Prevention (CDC) is leading the initiative to build the National Environmental Public Health Tracking Network. The Tracking Network is being developed in response to calls for better understanding of how the environment can affect people’s health. This Web-based system will integrate health and environmental data and provide information to address public health concerns, educating the public about ways to protect themselves from possible contamination and disease.
States and communities can act upon data generated through tracking. Today, because of tracking, public health officials in Washington State can do more than determine mercury levels in fish. They can also compile information from many sources and use the data to educate citizens about healthy fish choices with greater speed and accuracy. In Maine, tracking has allowed researchers to examine high arsenic levels in well water and its effects on reproduction. Consequently, state public health officials can now warn well users about the hazards of exposure to arsenic during pregnancy.
Tracking Network will enable and encourage communities, health care providers, state and local health departments and others to take control of their health. The building blocks of this network are grants to state and local health departments and universities around the country to build capacity and demonstrate just what tracking can do.
Building the Foundation: Pennsylvania (2002 – 2006)
In 2002, the Pennsylvania Department of Health received funding from CDC to plan for a statewide Environmental Public Health Tracking Network that will be part of the national tracking network. Pennsylvania used the funding to build capacity, enhance infrastructure, and complete data linkage projects. The results range from improving surveillance to faster responses to environmental public health questions.
Why Tracking Matters to Pennsylvania:
Work has begun, in collaboration with the University of Pittsburgh’s Graduate School of Public health to (1) work on a conceptual framework to model and characterize the temporal and spatial sequence of events that predict asthma exacerbations and (2) use preliminary results from ongoing research to model and then predict asthma exacerbation at small area level using near-real time ambient air pollution and asthma emergency department (ED) visits in Allegheny County, PA as well as the whole state of Pennsylvania. This modeling effort takes advantage of a syndromic surveillance system that monitors daily ED visits by the Allegheny County Health Department and a similar system called Real-time Outbreak and Disease Surveillance (RODS) that is maintained by University of Pittsburgh, Department of Biomedical Informatics. RODS provides asthma surveillance data for all counties in Pennsylvania down to zip code level. The initial exploratory model includes analyses of past weather, air pollution data, and asthma ED visits. The main air pollutants of interest are particulate matter less than 2.5 μm (PM2.5) and ozone.
It is expected that the prediction model, once validated, will run every night on the EPHT system to produce a prediction model map. Members of the public will be encouraged to look at the prediction map to look for the probabilities of particulate matter and ozone induced asthma for their location(s) of interest. A more technically sophisticated approach is also contemplated.
Health Assessment Program (HAP)
Since 1989, the PADOH Health Assessment Program (HAP) has partnered with the federal Agency for Toxic Substances and Disease Registry (ATSDR) to protect the public health of residents from exposure to toxic substances near hazardous waste sites. The goals of the HAP are to: 1). Prevent or reduce exposure and illnesses resulting from exposure to hazardous waste sites. 2). Determine the human health effects associated with exposures to hazardous waste sites. 3). Mitigate the risks of harmful human health effects at toxic waste sites in Pennsylvania and 4). Provide health education to community members and health care professionals about the health effects of hazardous substances and how to reduce their exposure. To that end, the HAP addresses public health issues near hazardous waste sites (including Pennsylvania Department of Environmental Protection (PADEP) sites, Environmental Protection Agency (EPA) Resource Conservation and Recovery Act (RCRA) sites, and EPA Superfund sites also called National Priority List (NPL)) by producing documents in the form of health consultations, public health assessments, technical assists, and fact sheets. Given Pennsylvania’s vast industrial history, it consistently ranks among the top states in the nation in the number of EPA NPL sites. The Pennsylvania Environmental Public Health Tracking (PA EPHT)program, in partnership with the HAP, plans to use its geo-spatial infrastructure to enable spatial and text search and display of the HAP documents. The website will enable users to search multiple documents using common data variables including, but not limited to, location; exposure pathway; contaminant; NPL or non-NPL site; air, water or soil contamination; concern; requester type (agency or individual petitioner); and sites with quality of life issues (e.g., odor or sound).
Arsenic Concentrations in Groundwater
Pennsylvania has a large rural population dependent on private wells for drinking water. Some of these wells pull groundwater that contain elevated levels of arsenic, a known carcinogen widely dispersed in the groundwater of Pennsylvania. Many studies indicate that long-term ingestion of arsenic through groundwater increases the risk of developing bladder, kidney, liver, bronchus and lung, and prostrate cancer.
Currently (2007-2011) the U.S. Geological Survey, Pennsylvania Department of Health, and Pennsylvania Department of Environmental Protection have begun construction of several geochemical and spatial models. These models will evaluate groundwater quality, well, geology, hydrology, soils, topography, and land use variables at statewide and regional scales. The goal is to develop a model that predicts the probability of encountering arsenic at levels of 4 parts per billion or greater and map the resulting predicted probabilities for the state.
The resulting models and spatial representation of predicted probabilities will reveal those areas in Pennsylvania where elevated arsenic concentrations have the highest predicted probabilities of occurring, and they can be used by health officials to direct resources towards additional sampling and education programs in those areas. These modeling maps can also be used by members of the public to know for themselves about the probablilistic distribution of Arsenic in groundwater in their environment.
In 2007, residents of the Tri-county (Carbon, Luzerne, and Schuylkill) area of northeast PA voiced concerns about elevated incidence rates of Polycythemia vera (PV) identified by ATSDR and PADOH. They asked whether this might be caused by extensive pollution in the area including from one Superfund site – or by genetic/inherited factors or a combination of these.
PA EPHT realized the importance of updating case ascertainment in the Tri-county from the Pennsylvania Cancer Registry for not only PV – but also for other Myeloproliferative Neoplasms (MPNs):
· Essential thrombocythemia (ET)
· Primary Myelofibrosis (PMF)
· Chronic Myelocytic Leukemia (CML)
PA EPHT played a key role in preparing to update the previous 2007 MPN study of PV by ATSDR and PADOH through contracting with the University of Pittsburgh School of Public Health who will conduct new MPN case ascertainment in the Tri-county.
PA EPHT has been instrumental in fostering public health education and awareness of PV in the Tri-county through supporting:
· Community Meetings
· Distribution of Fact Sheets to the Public and Physicians
· Meetings with the Community Action Committee sponsored by ATSDR
Data and information obtained through these extensive studies will be made available at various levels of security to various levels of end users on the PA EPHT public and secure portals.