ENVIRONMENTAL HEALTH DATA NEEDS
An Action Plan for Federal Public Health Agencies

EXECUTIVE SUMMARY

The fragmentation of environmental health information systems has directly impacted the ability of our public health and environmental agencies to protect the communities they serve. The enormity of available data, but paucity of usable information, is a paradox that often frustrates state and local environmental health officials. The barriers to accessibility and usability of environmental health and related data (e.g., regulatory and Census data) restrict the ability to address emerging health problems, educate decision makers and the public on the full impact of specific environmental hazards, and evaluate the effectiveness of interventions.

With the assistance of the Public Health Foundation, the Federal Government convened a workshop March 3-5, 1997, to assess environmental health information needs of state and local governments and begin laying the groundwork for potential solutions to these problems. Approximately 25 individuals from local, state, and federal public health and environmental agencies, schools of public health, and national public/environmental health associations attended and shared their expertise in public and environmental health surveillance and information systems. During the workshop, held at the Maritime Institute in Linthicum Heights, Maryland, participants were asked to identify types and sources of existing environmental health information, identify and prioritize information needs for the protection of the public's health, and formulate suggested actions. Accessibility, availability, and utility of data were also discussed.

This report provides background information on this effort and highlights of the workshop discussion, and proposes actions for consideration by federal public health agencies.

KEY FINDINGS

  • Environmental health resources should be directed toward improving existing data collection systems (including the capture of missing data) and increasing data accessibility and usability, rather than for creating new data collection systems.
  • Traditional models used to analyze public health information should be expanded to include important determinants of health such as: economic, educational, and social status indicators; the relative condition of environmental infrastructures; and changes in local demographics.
  • Integration of activities and electronic information (with a commitment to addressing confidentiality issues) among public health, environmental health, and environmental protection agencies, representing all levels of government, is vital for addressing national information needs, as well as individual agency needs.
  • Multidisciplined teams, representing all levels of government, with hands-on public health experience are needed for the design or redesign of information systems used for environmental health data collection and analysis.
  • The utility of environmental health information systems can be enhanced through: common data architecture; delineation of core baseline and sentinel data; and a comprehensive, central environmental health data repository which includes regulatory, risk, hazard, exposure, disease/outcome, health status, demographic, socio-economic, and geographic variables (including Census data).
  • Agreement on the essential competencies within environmental health roles and programs will aid in defining and promoting continuing education programs currently needed by environmental health and environmental protection practitioners.
  • Environmental health information systems need to be evaluated based on their usefulness to state and local agencies in responding to community demands for timely, accurate, and reliable information; and in achieving their research, surveillance, intervention, and health education goals.
  • Localities need assistance in building their capacity to use raw data they provide to state and federal agencies.
  • Creative partnerships and resource sharing should be encouraged and facilitated among all levels of government, academic institutions, and the private sector.
  • High priority should be given to fully funding the development of public/environmental health surveillance and information systems that are capable of being integrated into a national network.
  • A national environmental health research agenda should be adopted specifying the goals of states and localities as the number one priority.

SUGGESTED ACTION

Workshop discussions were focused on the gaps and barriers in fulfilling state and local environmental health information needs. These discussions led to the development of potential solutions, with an emphasis on actions that the Federal Government, through its Environmental Health Policy Committee (EHPC), could be taken to improve state and local environmental health information and surveillance capabilities. These broad-based solutions were organized around seven roles, or functions, of the Federal Government with respect to its relationship with states and localities. Examples of solutions ranked as high priority by participants are outlined below, according to the seven functions.

  1. As a facilitator of consensus: Develop minimum standards and variables for data collection as an aid to making data compatible across sites and jurisdictions.
  2. As a program manager: Ensure that newly-developed federal software is compatible with multiple operating systems, including commercial systems, and allows for exporting and importing data with commercial applications.
  3. As a source of resources: Implement a block grant approach to funding state and local environmental health programs, similar to the EPA performance partnership program.
  4. As a technical expert: Continue to update and expand information made available through the Internet.
  5. As a leader: Encourage and facilitate stronger ties between environmental protection and public health agencies, perhaps by strengthening organizational links and coordinating funding programs at the federal level (i.e., EPA and HHS).
  6. As an integral part of the public health system: Create opportunities for public health experts from the federal agencies and academia to work for specified periods of time at the state and local levels (and vice-versa) to enhance public health programs.
  7. As a Congressional liaison: To help meet its Congressional mandates, (GPRA), the Federal Government should reaffirm on behalf of localities the need for comprehensive demographic information, developed by the U.S. Census, for environmental health planning and program development.

IMPLEMENTATION STRATEGIES

The final charge to the workshop participants was to identify potential short-term strategies for consideration by the Environmental Health Policy Committee in moving these issues forward. One such opportunity identified by workshop participants was the national objectives-setting process for Healthy People 2010, which could facilitate development of new baselines and tracking data for monitoring progress on environmental health. Healthy People Objective 11.16, "Establish and monitor in at least 35 states plans to define and track sentinel environmental diseases," could be set as a top priority. Another suggestion was development of a white paper based on the workshop findings, endorsed by national public and environmental health associations, and adopted by the EHPC.

By expanding traditional models of risk, networking environmental health information with all stakeholders, increasing locally-focused research, and addressing the education needs of practitioners and decision-makers through innovative training programs, staff sharing programs, internships, and scholarships, the public health community can more effectively and proactively address emerging health problems, educate the public, choose appropriate interventions, and evaluate the effectiveness of interventions.

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