Information on environmental health services for kids can be hard for parents to find: APHA review ================================================================================================== * Julia Haskins Since Aluveller Perkins’ son was diagnosed with asthma, she has been dogged about finding environmental health services to manage his illness. It has been a long ordeal, but she eventually found services in Washington, D.C, where she lives: Through the Impact DC Asthma Clinic, Perkins connected with assistance from the Children’s Law Center and the DC Partnership for Healthy Homes, helping her access services to reduce in-home asthma triggers. She has also made lifestyle changes to control her son’s asthma, such as banning smoking in her home and car. “I’m learning as I go along, making sure I’m doing everything possible to be proactive and (support) his health,” Perkins told *The Nation’s Health.* Environmental health services, from asthma home visiting programs to lead testing, can help protect children from the dangerous environmental exposures they encounter every day. But the problem for parents and caregivers is accessing such services, a new analysis from APHA’s Center for Public Health Policy shows. To be released this month, “Protecting the Health of Children: A National Snapshot of Environmental Health Services” details the barriers that parents face when seeking information on environmental health services for their children. Over the past two years, the APHA policy center has studied the public availability of information on environmental health services, using community forums and a national scan of websites representing state health and environmental quality agencies. In its review, APHA looked at access to environmental health services from the perspective of a parent or caregiver, as opposed to a public health worker. “Our scan found that states do a really good job of providing information about environmental health issues and even some of the services they provide, but not necessarily how to access those services,” Tia Taylor Williams, MPH, director of APHA’s Center for Public Health Policy and Center for School, Health and Education, said at a Nov. 12 session at APHA’s 2018 Annual Meeting and Expo. ![Figure1](http://www.thenationshealth.org/http://www.thenationshealth.org/content/nathealth/48/10/1.1/F1.medium.gif) [Figure1](http://www.thenationshealth.org/content/48/10/1.1/F1) A new review from APHA asssesed whether caregivers can find information on children’s environmental health services. Photo by Nikhil Patil, courtesy Wavebreakmedia To conduct the scan, APHA made a list of 210 baseline services divided into five categories: informing the public, surveillance and diagnosis, training and technical assistance, policy development and enforcement, and linking to needed services. Each service was matched with one of 27 corresponding health conditions or environmental health issues, such as asthma and endocrine disruptors — chemicals that can interfere with the body’s hormone systems. Among the categories of services, the one that health and environmental agencies performed best was informing the public, with 60 percent of states providing information online about environmental health issues. The lowest category was surveillance and diagnosis, with just 36 percent of states offering the information online to the public. The scan showed that states are more likely to provide information about services required under federal environmental laws and policies. The federal government supports states in regulating both treatment and storage of hazardous waste, monitoring drinking water quality through enforcement of the Safe Drinking Water Act and displaying current air quality on websites — all of which fall under the six highest-scoring services. Because of their size, physiology and behavior, kids are particularly vulnerable to environmental toxins. They breathe more air, drink more water and eat more food relative to adults, and also risk exposure to potentially harmful toxins when they play on the floor or put non-food items in their mouths. “Our children need our protection, and our environmental health services offer protection for our children’s health,” Natasha DeJarnett, PhD, then an environmental policy analyst at APHA and contributor to the report, said at the Annual Meeting session. However, some of the information that would be most beneficial to children’s health was lacking. State websites overall provided little information about environmental health services in schools and child care facilities, where children spend much of their time. A shortage of information on endocrine disruptors is troubling for children’s health, “as certain stages in childhood — the prenatal, perinatal and puberty stages — are most susceptible to endocrine disruptors across their entire lifespan,” according to the report. Accessing environmental health services can be challenging for a number of reasons. Families may not know that the services exist, and if they do, health departments often do not make clear what services are available. People may also be limited by barriers such as physical access or language. And because there is no single agency dedicated to environmental health services, families looking for support may not know where to go. The report provided recommendations on the federal and community levels to ensure that families can easily access environmental health services for their children. Coordination is one factor in improving access, with the report calling for educating state departments of health and environmental quality on environmental health. It also called for promoting collaboration among health departments, health care providers and payers. Federal leadership and funding are also critical to help departments carry out environmental health services for children and families, the report said. In addition, numerous improvements can be made to state websites, such as indicating which environmental health services are actually available, linking to other health-related programs, providing information in languages other than English and optimizing websites for mobile and tablet use. ## Working closely with communities crucial A key report takeaway was the need for community engagement to understand people’s ability to access environmental health services. As part of the project, APHA met with communities in Flint, Michigan, and Washington, D.C., to gather insights on environmental health services that residents knew about. The community conversations also shed light on the systemic barriers to accessing environmental health services that intersect with race, socio-economic status and other social determinants of health. Surili Patel, MS, deputy director of APHA’s Center for Public Health Policy, pointed to community members’ distrust of authority figures in the wake of Flint’s water crisis — in which a change to the city’s water supply contaminated its drinking water with lead — and confusion over where to seek help. “There is some level of disconnect, especially in vulnerable communities where services are available for environmental health, but folks don’t know where to go (or) who to ask” for assistance, Patel told *The Nation’s Health.* E. Yvonne Lewis, founder and CEO of the National Center for African American Health Consciousness, worked with APHA in facilitating the community forum in Flint. During the Annual Meeting session, she noted that in times of crisis, academics and researchers often go to communities to investigate a situation without considering the people enduring the adversity. It was critical that APHA work alongside community members in Flint to gain their trust and keep them informed about results from the scan, said Lewis, an APHA member. In addition, Lewis said that she hopes the participation of Flint community members in APHA’s project will be helpful to other communities that have suffered mistreatment. “If we can consider that this is an opportunity for us to speak a larger message with a louder voice because of the spotlight (on Flint), that will ensure that these kinds of things don’t continue to happen,” she told *The Nation’s Health.* Another benefit of speaking with community members is understanding how they want to receive information. Some people may prefer to learn about environmental health services for children through state websites, such as those included in APHA’s scan. But there are many other means of communication that could be explored, providing culturally competent, simple messaging to people needing straight answers. By working directly with community members, as the report recommended, people can be set apart to relay information about environmental health services. It is a strategy that Perkins, a participant in the Washington, D.C., focus group, supports. Perkins said she wants to help other parents connect to environmental health services for their children, and believes other parents could also serve in peer education roles. “Word-of-mouth is the most powerful form of education that there is because people talk all the time,” she said. “People share some of the same experiences. It’s how you handle them and who you reach out to.” Input from community members was integral to the report and will continue to help APHA understand how people learn about and access environmental health services. “The scan is just the tip of the iceberg to understand the reality of environmental health services available versus accessible,” Patel said. For more information and to access the new report, visit [bit.ly/aphaenvironment](http://bit.ly/aphaenvironment). * Copyright The Nation’s Health, American Public Health Association