Nationwide environmental tracking effort shares data with public: Health data online
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* Kim Krisberg

In late July, the Utah Department of Health received a phone call from a resident concerned that a local school was being exposed to perchlorate, a chemical that poses health risks in high doses. Usually, it would take some time to answer such a query, but in this case, it did not even require a call back.

With the resident still on the phone, Sam Lefevre, MS, program manager for the department’s Environmental Epidemiology Program, accessed Utah’s Environmental Public Health Tracking Network, gathering data on whether the region in question was experiencing disease trends that would point to perchlorate contamination. Luckily, no trend was found, but without the tracking network, finding that answer would have taken quite a bit longer.

“People are increasingly interested in the environmental effects on health, and one of the best ways to help people protect their own health is to inform them,” Lefevre told *The Nation’s Health*. “So, by making this data available (through the tracking network) and helping people make healthy and informed decisions…it’s probably the best way I know to help people protect themselves.”

Lefevre is part of a nationwide effort to improve environmental public health tracking and surveillance — an initiative that reached a major turning point in early July when the Centers for Disease Control and Prevention launched the national version of the Web-based Environmental Public Health Tracking Network. For the first time, the public can access the CDC network and track trends between environmental conditions and disease incidence by geographic location. The network tracks data for seven health areas — asthma, birth defects, cancer, carbon monoxide poisoning, childhood lead poisoning, heart attacks, and reproductive and birth outcomes — as well as by three environmental indicators — outdoor air quality, water quality and safe housing. According to CDC, the network “unites vital environmental information from across the country.”

“While there are different systems out there, they were fragmented, they didn’t interact with each other,” said Judy Qualters, PhD, chief of the Environmental Health Tracking Branch within CDC’s National Center for Environmental Health. “Now, we’re bringing the data together in a one-stop shop, having it easily available and consistently formatted…it’s really been a boon to folks we work with in improving our ability to respond to concerns of the public.”

The network’s beginnings can be traced back to a 2000 report from the Pew Environmental Health Commission, which found that the nation was facing a significant environmental health gap — “a gap in critical knowledge that hinders our national efforts to reduce or eliminate diseases that might be prevented by better managing environmental factors.” The report called for the creation of a national tracking network to more clearly illustrate exactly how known pollutants were affecting chronic disease rates.

In 2002, CDC directed newly appropriated funds to 16 state health departments as well as the New York City health department to conduct pilot projects and lay the foundation for such a nationwide tracking system. After years of successful work, CDC launched the network’s implementation phase in 2006. Just as the state-based networks depend on cooperation from local health departments, fellow state agencies, universities and other organizations in collecting data, CDC’s national tracking network combines data from the state-based networks as well as from federal agencies, such as the National Cancer Institute. In August, CDC used additional federal funds to expand the tracking network to six more states — Colorado, Kansas, Louisiana, Minnesota, South Carolina and Vermont. Qualters noted that the “ultimate goal and vision” is to bring every state into the fold.

“We always envisioned a network that will grow over time,” Qualters told *The Nation’s Health.* “We look forward to really moving this forward and to making this something that’s useful for public health practitioners and that can help them in their everyday jobs.”

Back in Utah, one of the 16 pilot states, Lefevre said the environmental tracking network not only helps inform residents, but allows public health workers to better inform policy and funding decisions.

For example, he said, every year the health department publishes and sends an “e-book” to members of the state legislature and other health policy-makers that details the latest environmental tracking data on health topics such as asthma, birth defects and low birthweights, helping policy-makers steer public health funding where it is needed. The media also takes heed of the Utah tracking network, Lefevre said, with calls from reporters coming in within hours after a new health indicator is uploaded.

“The local newspapers watch this pretty closely, and it’s a great asset in helping us get the message out and starting a dialogue with communities,” he said.

## States’ tracking work pays off for residents

Raising environmental public health awareness is a goal in Florida as well, where work on tracking led to one of the largest data linkage studies involving childhood lead poisoning to date, according to APHA member Greg Kearney, DrPH, MPH, principal investigator for environmental public health tracking programs in the Florida Department of Health.

Involved with the CDC tracking project since 2003, Florida health workers used the opportunity to examine the relationship between developmental disabilities and childhood blood lead levels, finding that children who were screened for lead poisoning were more likely to receive needed services for issues such as mental retardation and speech problems than children who did not get tested. According to the study, which was published in the November/December 2008 issue of the *Journal of Public Health Management and Practice,* the results served as an “example for future partnerships for linking biomarker data from environmental exposures such as lead with health data.”

“The potential for tracking is really unlimited,” Kearny told *The Nation’s Health,* noting that health workers are trying to build a “Florida flavor” into their state tracking project, identifying more Florida-specific concerns such as radon poisoning, which Florida officials have been particularly aggressive in confronting, as well as health hazards linked to poor-quality imported drywall that was sold in the state after hurricane damage.

As in Utah, Kearney said he hopes the tracking network will shape better public health policy — “we really need to get these messages to legislators so that we can start taking public health action,” he said.

![Figure1](http://www.thenationshealth.org/http://www.thenationshealth.org/content/nathealth/39/7/1.1/F1.medium.gif)

[Figure1](http://www.thenationshealth.org/content/39/7/1.1/F1)

The Environmental Public Health Tracking Network includes data from environmental measures such as air quality.

Photo by Dave Herriman, courtesy iStockphoto

Taking action is exactly what happened in Massachusetts, where a tracking project linking the presence of mold and moisture inside schools to childhood asthma prevalence has led to partnerships confronting the problem.

One of the first demonstration sites funded by the CDC environmental tracking project, Massachusetts already had some capacity to link environmental and health data, said Suzanne Condon, MS, director of the Bureau of Environmental Health at the Massachusetts Department of Public Health. And with an added boost from the CDC project, Massachusetts health workers found a significant tie between high rates of pediatric asthma and the presence of mold and moisture in school settings throughout the state. As a result of the project, Condon said, state and local public health workers have been distributing guidance to officials on how to remedy mold and moisture problems. The state health department has now entered its seventh year of pediatric asthma data collection, and this year received 100 percent compliance across the state — meaning that every schoolchild in Massachusetts diagnosed with asthma is accounted for in the tracking network, Condon said.

“It certainly raised awareness…and really empowered local officials to take action,” Condon told *The Nation’s Health.*

Massachusetts’ environmental public health tracking portal, which opened to the public in June, allows visitors to track health indicators, such as cancer rates, at the community, census tract and neighborhood levels, and then search for geographic overlaps with possible contaminant sources, such as landfills or hazardous waste sites. Future tracking plans include examining drinking water supplies, incidence of birth defects, and the link between chemical exposures and low birthweight, Condon noted.

“To sit down at a computer today and to be able to answer a question in a matter of minutes…that historically would have taken weeks or months, at best, to answer is really moving environmental public health forward in a way that has been long coming,” Condon said.

For more information on the Environmental Public Health Tracking Network, of which APHA is an official partner, visit [www.cdc.gov/ephtracking](http://www.cdc.gov/ephtracking).

*   Copyright The Nation’s Health, American Public Health Association