Success Stories from Environmental Public Health Tracking (Part 1 of 2)

August 31, 2016|11:28 a.m.| Samantha Williams

This is the first of a two-part interview with Fuyuen Yip, PhD, MPH, acting branch chief for the Environmental Public Health Tracking Program at the National Center for Environmental Health at CDC. [Click here to read part two]

In the wake of major environmental public health emergencies such as the Zika virus and the contamination of drinking water in Flint, Mich., the need for evidence-based tools is more critical than ever. To this end, CDC’s Environmental Public Health Tracking Program (often referred to simply as the Tracking Program) has been instrumental in providing state health officials with a tool to inform public health practice and policy.

Since 2002, CDC’s Tracking Program has provided grants to 25 states and one city health department to build and maintain tracking networks. These networks feed into a National Tracking Network that provides users with access to exposure information, hazard monitoring, and health effects data in one convenient location. ASTHO supports the expansion of the Tracking Network through its State-to–State Peer Fellowship program, which has helped 23 non-funded states build tracking capacity since 2009.

The benefits of tracking extend beyond environmental health surveillance. A tracking program enables health departments to identify vulnerable communities, promote timely outreach strategies, and create efficiencies in public health service delivery. State tracking teams (often interdisciplinary in nature) have also been the starting point of collaborative public health initiatives.

I recently had the pleasure of interviewing Dr. Fuyuen Yip, acting branch chief for CDC’s Environmental Public Health Tracking Program. In part one of our interview, Yip shared success stories from the tracking program as well as ways that health departments have used tracking to advance health equity goals.

For our readers who aren't as familiar, could you please explain environmental public health tracking and why the Tracking Network was formed?

Environmental public health tracking is a type of surveillance where we collect and integrate environmental and health data for analysis and reporting. How we got our start was in 2000, when the Pew Environmental Health Commission wanted to establish a nationwide environmental health tracking network. The network would focus on reducing and also preventing health problems, and increase the understanding of the relationships between the environment and the health. 

CDC responded to this need by creating our program, the National Environmental Public Health Tracking Program, and the Tracking Network is its cornerstone. It is a web-based system that brings together data concerning health and environmental problems and our goal is to provide information to help improve and understand where we live, work, and play. 

The program not only includes the Tracking Network, but the people, resources, and the program managers involved in building the network. We currently fund 26 state and local health departments to develop local tracking networks, and these networks feed into the National Tracking Network.

The program has achieved numerous successes by state agencies to guide city and state planning, target prevention efforts, and raise awareness about public health threats. Could you describe an example of how a health agency has used the Tracking Network to protect communities from these threats?

Sure. Three examples include activities that took place in Maine, Vermont, and Florida.  I'll start with Maine. Maine’s state tracking program identified three deaths from carbon monoxide poisoning, and learned that the poisonings were from off-roading, a new risk from carbon monoxide. The team worked with local news media and educated residents about safe off-roading practices and prevention tips. And now these messages are part of the annual health advisories that are issued each spring—a nice addition to their carbon monoxide prevention efforts.

Another example is Vermont, who partnered with the CDC Climate and Health Program and developed a web-based blue-green algae portal. Their motivation was to be able to provide timely information on blue-green algae conditions in lakes throughout the state. They used a network of more than 100 volunteers trained by a local conservation group to add data to the Vermont Health Department's blue-green algae web-map. This allowed alerts for conditions of concern to be shared more quickly with the public.

The third example I wanted to share is from Florida. Their tracking team led a well water study to examine if using filters on kitchen water faucets could help to reduce a person's exposure to arsenic in their drinking water. They were involved in designing the study, collecting samples, and analyzing data in one specific county with help from the department of health. Results from the study showed that indeed using the filters was an effective way to reduce exposures to high levels of arsenic. They developed factsheets and educational materials for well water owners, helping raise awareness about arsenic exposure, the need for testing wells, and ultimately reducing exposure to arsenic in drinking water.

So those are just three examples of how tracking data and the Tracking Network have been able to contribute to community-level or public health protection.

Those really speak to the diversity of topics under environmental health tracking and the range of outcomes. Are there any examples where tracking data were used to influence policy or measure its influence?

Yes. One example is the Minnesota Tracking Program, which maintains data on second-hand smoke amongst nonsmokers in the state. In 2007, Minnesota passed Freedom to Breathe legislation motivated by the need to help reduce residents' exposures to second-hand smoke. Because tracking collects data on second-hand smoke, they could look at their data over time to analyze the impact of this legislation. They found children's exposure decreased by 20 percent since the passing of that legislation. So that's one nice example of using this tracking data to see if a policy has worked over time, or had influence on public health.

Another example is Utah, which was concerned about radon exposure and wanted to encourage home testing. In 2015 Utah’s tracking staff attended a ‘Maps on the Hill’ event, which highlighted the utility of mapping technology for policy making. Their participation increased the visibility of their program and they contributed to a white paper that was used to inform policy makers about radon. In this paper, they generated estimates of the economic burden of radon-related lung cancers for the state. They estimated it could cost Utah residents between $2.7 million to $3 million in the first year alone for medical treatment related to radon exposure. This led to an increase in funding for radon awareness efforts, and this year they successfully obtained funding for radon education and awareness activities around the state, which was wonderful to hear. 

Those are some great examples of tying policy and practice and in fact, they lead into my next question about ASTHO’s 2016 President’s Challenge: advancing health equity and optimal health for all. Tracking is an activity that can help achieve the three objectives of health equity: implementing a health in all policies approach; strengthening community capacity; and expanding the understanding of health, which is by its nature cross-disciplinary. Could you please explain how environmental health tracking could be a useful tool for states interested in implementing a health in all policies approach?

That's a wonderful question and I really like this concept of advancing health equity and optimal health. The Tracking Network can be a valuable resource to help identify people at risk of a health problem that environmental exposures can exacerbate. It could also be used to help protect public health through education, interventions or policies, because the information can help inform all these. We also view it as an opportunity to help save money by improving the speed and also the accuracy of public health activities and responses. Having data at your fingertips makes decision making a little bit more efficient.

We also have ready-to-use data and innovative tools that can help interpret the data, such as maps that show where environmental health problems are taking place. States can use this information to target vulnerable populations or audiences who may find the information most useful. One example of this is the California tracking program. They were able to map breast cancer data at the census tract level for the entire state. They identified geographic areas that were previously not known to have elevated rates of invasive breast cancer, which helped local hospitals focus their efforts on outreach, education, and screening for women in surrounding communities.

But the Tracking Network can also be used to monitor long-term health trends and take a closer look at how the environmental factors correlate to health data to inform prevention efforts and policies. I think those are some aspects of the Tracking Network that can be useful to help states implement the health in all policies approach.

The example of California’s breast cancer project is a great example of how tracking is a great foundation for future partnerships. Was that unique to California, or are there other states where tracking proved a vehicle for new partnerships or activities?

That’s a good point about California and we hope that the information can help communities come into contact with each other and share information. But I think one good example to your question is the way New York State has used tracking to build capacity. New York State’s Prevention Agenda: 2013 to 2018 is a call to action, mandating local public health units to work with local hospitals and health care partners to complete a community health improvement plan (CHIP), which include an environmental health report. 

When Madison County in New York State was directed to submit an environmental health report, they addressed water quality issues in the area and in the county; air quality issues; and healthy community design, like walkability, access to parks, and transportation. To gather even more information for this assessment, the county used New York State tracking network data such as state climate change and disease indicators, which are typically not included in these types of reports. As a result, Madison County compiled a very comprehensive report for inclusion in the CHIP.

They got a lot of visibility for this report and as they move forward in implementing this community health assessment, the county health department staff now use state tracking network data to assess connections between the environment and chronic disease at the county level. They're also promoting the use of the state and national tracking networks with all of their partners to get a better context of environmental health in their communities.

Read part two of this interview »

Samantha Williams

Samantha Williams is an analyst for environmental health at ASTHO. She coordinates ASTHO's Environmental Public Health Tracking: Peer-to-Peer Fellowship Program and supports projects related to environmental surveillance data. Samantha received a Master of Science degree in environmental health from Macquarie University in Sydney, Australia.