Environmental Public Health Tracking

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EPHT focuses on our ability to learn more about important patterns and trends in environmental health. By reviewing how hazards, exposures, and diseases change over time or across regions of the state, questions can be generated about whether those trends are meaningful. These questions, or their answers, may direct future research, public health interventions, or other activities that might prevent or control environmentally related health problems. Exploring these trends also might help us to improve the types of data collected, how data are managed and how we share data with other agencies and data users.

NYS DOH received a grant from the federal Centers for Disease Control and Prevention (CDC) to conduct environmental public health tracking projects. CDC awarded grants to state and local health departments around the country as well as to schools of public health. New York City was also awarded an EPHT grant.

CDC’s goal is to develop a national environmental public health tracking network. The eventual goal would be to have all public health systems able to share data and analyze trends across the nation. The network can help to support joint decision-making, professional collaboration, and rapid flow of information between public health and environmental agencies.

Highlights

  • A review of hazard, exposure and health data sets. This is an important part of the EPHT program, as it helps us decide which data are currently most useful for environmental public health tracking.
  • A new environmental health surveillance system. This system will help DOH researchers plug in specific hazard, exposure and health data sets to look for unusual geographic or population trends. Potentially, the system could be useful for many purposes, such as checking the effectiveness of interventions; generating hypotheses or identifying research needs.
  • Surveillance projects. These projects are intended to explore our ability to link environmental and health data sets and to identify patterns, clusters, or trends.
  • PHASE. The Public Health Air Surveillance Evaluation is a special project with other states and the federal government that focuses on the best approach to characterize air quality data.
  • Epidemiological investigations. These investigations involve taking a closer look at some of the patterns or trends we see in health or environmental data.
  • The data exchange project. This project focuses on creating a technological framework for sharing data between agencies.
  • Outreach and Education. These activities support all the components of the EPHT project. They include gaining feedback from the Planning Consortium, conducting focus group sessions to get input on the surveillance system, involving public audiences in the design and development of EPHT materials and improving public access to EPHT activities on the Web.

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Evaluating Data Sets

Our ability to track environmental hazards, exposures, and health effects is directly related to the type of data that are collected and the quality and completeness of the data sets. By evaluating environmental and health outcome databases, we can determine what enhancements are needed. We can also identify additional data needs and assess the possibility of filling data gaps. This evaluation includes a review of our current databases and identification of actions to improve them. We are looking at the content, format, and design of data systems, and the extent to which they are compatible.

The EPHT Surveillance System

Both the State Health Department and the State Department of Environmental Conservation are responsible for managing and developing environmental and public health information systems. The State Health Department is building a surveillance system that will provide data about environmental hazards, exposures and health effects throughout New York State over time. Methods are being developed that can be used to automate the secure exchange of data. The surveillance system will be used to examine environmental and health data sets and to identify unusual geographic patterns and time trends.

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Surveillance Projects

The New York State Department of Health is conducting several projects. These projects test our ability to link environmental and health data sets and to identify unusual geographic patterns, clusters, or trends over time. Some of these projects were designed to help address an important State Health Department goal: enhancing our capability to track the public health significance of environmental exposures (air pollution and drinking water contaminants) to children.

With these projects, we hope to learn more about how to link environmental and health data to explore possible relationships between environmental hazards and health effects. What we learn will help to improve our ability to track other environmental exposures and possibly related health outcomes, and will also prompt additional investigations to explore the findings in more detail.

Asthma and Air Quality. One part of this project explores trends for measured and estimated levels of air pollutants within air quality regions of NY State and childhood hospitalizations for asthma. The project also includes a series of epidemiological investigations examining the relationship between air pollution and asthma and other respiratory diseases. The investigations use different measures of air quality, such as 8-hour daily maximum ozone levels or daily average levels of small particulate matter. One investigation is examining the daily childhood hospital admissions in New York State and ozone levels for 1991-2001. Another investigation focuses on the chronic effects of ozone on the first hospital admission for respiratory disease for children born in New York State from 1995 through 1998. The studies use analytic and statistical methods that can take into account other factors, such as seasonal patterns, meteorological conditions, population density, or lag time between exposure and effect.

Air Quality and Birth Outcomes. This project is a series of epidemiological investigations of the relationship between air pollution and reproductive outcomes conducted in conjunction with the University at Albany School of Public Health. In one investigation, birth weight and prematurity among infants born in New York State between 1995 and 2001 are being examined in relation to levels of ozone and particulate matter of less than 10 microns. The study methods take into account other maternal factors that have been reported to be associated with low birth weight or prematurity, such as early prenatal care. Another investigation will focus on infant mortality and air pollution.

Drinking Water and Birth Outcomes. We are developing a surveillance system to track birth outcomes, such as birth defects, low birth weight, and prematurity, and levels of contaminants called disinfection by-products in public drinking water supplies. Levels of disinfection by-products are measured in public water supplies on a regular basis to make sure they comply with state and federal standards. The levels vary depending on characteristics of the source of the water, treatment process and time of year. The surveillance system will examine patterns and trends in the levels of these contaminants and birth outcomes and will assess their possible relationship. Data on birth weight, prematurity, and birth defects are being obtained from the NYSDOH Vital Statistics office and the NYSDOH Congenital Malformations Registry.

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Evaluation of Air Quality Characterizations - PHASE

NYSDOH is working with the US Centers of Disease Control and Prevention and US EPA, as well as Maine and Wisconsin, on an EPHT project called PHASE (Public Health Air Surveillance Evaluation). Different approaches to characterizing air quality are being evaluated for how well they allow researchers to estimate individual exposures to ozone or particulate matter less then 2.5 microns. Each of the air quality characterizations have been temporally and spatially linked with hospitalization data for asthma and myocardial infarction, which is one form of cardiovascular disease, to better understand their strengths and limitations. Of particular interest is the usefulness of each method for conducting routine surveillance and epidemiological analyses. More in-depth investigation is planned for the relationship between air quality and hospitalization for myocardial infarction.

Who Are Our EPHT Partners?

EPHT is a multidisciplinary partnership program. Teams have been formed that include epidemiologists, toxicologists, information technology specialists, environmental scientists, statisticians, educators, and others from New York State Department of Health, the New York State Department of Environmental Conservation, and the University at Albany's School of Public Health.

CDC and other federal agencies such as the United States Environmental Protection Agency are providing data, technical guidance, and assistance. These partnerships are key to the success of the EPHT program.

A number of key people are also participating in a planning consortium that provides advice and recommendations about the design and execution of the EPHT program. This consortium includes individuals representing community and advocacy groups, as well as academics, and professionals with a wide range of experience and expertise. It has provided input on many of the technical aspects of the program. Members also provide advice on strategies for outreach and communication.

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Where Can I Get More Information?

New York State Department of Health
Center for Environmental Health
EPHT Project
1-800-458-1158, extension 27950

Centers for Disease Control and Prevention
National Center for Environmental Health
1-888-232-6789
http://www.cdc.gov/nceh/tracking
epht@cdc.gov

New York City Department of Health and Mental Hygiene
Bureau of Environmental Disease Prevention
253 Broadway, 12th Floor, Box CN58
New York, NY 10007