Using Environmental Public Health Tracking to Improve Health in Colorado: An Interview with Martha Rudolph

October 25, 2017|11:56 a.m.| ASTHO Staff

Martha RudolphEnvironmental health issues are as varied as states themselves. The way an issue is addressed in one state could be markedly different in another due to population size, geography, and resources available to the state or local health agency. CDC’s National Environmental Public Health Tracking Program provides state health officials with tracking and networking tools to inform public health practice and policy, enhance collaborative initiatives, and create efficiencies in public health service delivery.

CDC’s tracking program currently funds 25 states and one city health department to build and maintain environmental public health tracking programs. Each health department hosts its own unique data portals that feed into a national tracking portal that provides users with access to exposure information, hazard monitoring, and health effects data in one convenient location. In support of this program, ASTHO helped 23 non-funded states build tracking capacity.

ASTHO recently spoke with Martha Rudolph, director of environmental programs at the Colorado Department of Public Health and Environment (CDPHE), about how environmental public health tracking program has helped protect Colorado communities. 

What are Colorado’s major environmental health issues?

Colorado’s unique geology and rural areas present some beautiful landscapes, as well as some environmental health challenges. For example, all of Colorado’s 64 counties are at high risk for radon levels in exceedance of the EPA action level of 4 pCi/L. More of Colorado’s water bodies are becoming susceptible to Harmful Algal Blooms (HABs) with the warm weather season and increasing nutrient levels. Also, in some of Colorado’s more rural areas, citizens depend on private wells for drinking water, which can contain high levels of arsenic, uranium, nitrates, bacteria and other contaminants.

How has environmental public health tracking data helped protect Colorado communities from major environmental threats?

In November 2016, a citizen from Boulder County called CDPHE’s “Toxcall” hotline for environmental exposure concerns to report high uranium levels in his private well after testing. Uranium levels are reported to the tracking network as elevated levels of uranium from any source, including drinking water, are known to increase the risk of kidney damage. This concern was elevated; the environmental epidemiology program and the water quality program at CDPHE met with Boulder County Public Health to discuss next steps. The Colorado Environmental Public Health Tracking Program collaborated with these groups, drawing on several years of Colorado tracking work that compiled disparate private well water and radon data sets. Radon is the result of decomposing uranium and may be an indicator of uranium presence in an area. Tracking staff used the data to create maps of private well water quality and surrounding environmental conditions in the area that helped the local environmental health agencies develop effective sampling and outreach plans for the community. Boulder County used the maps and data to further investigate and sample the citizen’s private well water as well as the water from surrounding neighbors. In light of this, Boulder County has established better communication with extension offices and community associations in general about water in mountain communities and how it should be tested.

Environmental public health tracking collects and analyzes data from partner agencies within or outside of public health. In your view, how have these relationships benefited different divisions in the Colorado Department of Public Health and Environment?

With the expansion of an environmental epidemiology program and expertise in the department, Colorado has been better able to rapidly respond to emerging environmental health threats. Programs such as indoor air quality, water quality and the radon program have access to the tracking program’s public health expertise and resources when needed. In turn, the tracking program has relied on technical assistance from these environmental specialists in developing messaging. The team collaboration has resulted in successful public meetings, factsheets, data visualizations and other communication tools. With the team present at public meetings, resources available online, and the “Toxcall” public hotline, community members have better access to information about their environmental health-related concerns than ever before.

Tracking is a cost-effective and impactful tool for decision-making at the population and individual level. Can you give us an example of how tracking data was used to influence policy or change behavior? What have been the economic or social benefits of this?

The Colorado tracking program collaborated with the radon program at CDPHE to analyze tracking data available on Colorado’s EPHT portal. This data was used to write a legislative bill, HB 16-1141, for financial assistance to low-income families who need testing and, most importantly, a mitigation system installed in their homes. The Colorado tracking program also provided assistance in writing a data sharing agreement for point-level data with labs receiving results from the low-income radon assistance grants in Colorado. The resulting bill, initiated by CDPHE, was signed by Gov. John Hickenlooper in 2016. The bill provides funding of a radon education and awareness program at CDPHE and provides $100,000 for CDPHE to assist low-income individuals with the installation of radon mitigation systems in their homes. Starting Jan. 1, 2017, CDPHE established the radon mitigation assistance program. CDPHE will also establish a radon education and awareness program and will work collaboratively with radon contractors and citizens to help answer questions and concerns about radon mitigation. The funding will result in 100 households receiving testing and mitigation per year.

In order to assist states that are not funded by CDC’s Tracking Network, ASTHO’s EPHT Fellowship offers these state health agencies with an opportunity to undertake a pilot project, mentored by a CDC grantee state. Can you or a member of your state’s tracking team speak to your experience as a mentor and the value that you see in ASTHO’s fellowship?

To date, Colorado has hosted ASTHO fellows from Wyoming and Texas. The most recent fellowship experience with Texas allowed for the exchange of information and ideas, such that Texas was able to quickly position themselves to apply for CDC’s open competitive grant to expand the Tracking Network that same year (2017). True to its name, the fellowship opportunity allows us to build camaraderie with other states and learn from their successes and lessons learned regarding environmental health issues we share. This presents opportunities for collaboration, shared resources, and expertise in areas that may be new in Colorado, but familiar elsewhere.

(A list of CDC grantee states can be found on their website).

What are the most valuable lessons you have learned through environmental public health tracking?

Regardless of funding, all states can benefit from the lessons learned through collaboration. As mentioned, fostering collaboration and building relationships across programs and states is one of the most beneficial outcomes of the environmental public health tracking program. This program has cultivated and prioritized the linking of environmental exposures and health outcomes. Highlighting these linkages has facilitated new collaborations between public health practitioners, environmental protection specialists, community planners and others to develop data-driven solutions to improve the health of communities.

What are the most important skills, tools, or resources that public health leaders need to have in order to successfully track environmental health progress in their states?

As long as resources and programs continue to be designated as either specific environmental or health-related, and not both, effective skills in collaboration and communication between environmental and health professionals is paramount in responding to environmental health concerns. Additionally, these partnerships offer benefits of early notification opportunities, and a collective problem-solving response to the emerging issues often encountered in our rapidly changing field. 



Martha E. Rudolph serves as the Director of Environmental Programs for the Colorado Department of Public Health and Environment, providing oversight to the Air Pollution Control, Hazardous Materials and Waste Management, Water Quality Control, and Environmental Health and Sustainability divisions. Rudolph is a member of ASTHO’s Environmental Health Policy Committee, which provides unique, state-based expertise and leadership for environmental health policy and practice.

Mike Van Dyke, PhD, CIH, Branch Chief, Environmental Epidemiology, Occupational Health and Toxicology Branch (EEOHT) at Colorado Department of Public Health and Environment.

Stephanie Kuhn, MSPH, Environmental Epidemiology Program Manager at Colorado Department of Public Health and Environment.