EPHT Planning Activities New Mexico Department of Health Office of Epidemiology Santa Fe, New Mexico

1. EPHT Planning ActivitiesNew Mexico Department of Health Office of EpidemiologySanta Fe, New Mexico 2003 CSTE Conference June 23-25, 2003 Presenter: Barbara Malczewska-Toth, Ph.D., DABT

2. Program Announcement 02179 Requirements • Collaborative project • Local, tribal, state, federal, and academic agencies and organizations • Letters affirming collaboration and support • Formal partnership between the state health and environmental agencies for development of the EPHT System • Formal collaborative agreement • Liaisons in both agencies identified

3. What is to be covered? • Environmental Public Health Indicators • Prioritization of EPH Indicators • Inventory of EPH data systems

4. Environmental Public Health Indicators New Mexico History • Health Milestones Project (1996) • New Mexico Turning Point Initiative (1998-1999) • Environmental Health Report Card (2000) • Environmental Health Indicators for the United States-Mexico Border Area (2001) • Environmental Health Capacity Building (CA between CDC and NMDOH) (2001)

5. Environmental Public Health Indicators Definitions http://www.cste.org/pdffiles/Environmentalpublichealthindicators.pdf Environmental public health indicators provide information about a population’s health status with respect to environmental factors. Hazard Indicator: A condition or activity that identifies the potential for exposure to a contaminant or hazardous condition. Exposure Indicator: A biological marker in tissue or fluid that identifies the presence of a substance or combination of substances that may potentially harm the individual. Health Effect Indicator: A disease or condition that identifies the occurrence of an adverse effect from exposure to a known or suspected environmental hazard. Intervention Indicator: A program or official policy that minimizes or prevents an environmental hazard, exposure, or health effect.

6. Environmental Public Health Indicators Role of Indicators for the EPHT • Establish priorities for tracking environmental exposures and related diseases in New Mexico communities • Guide development of EPHT system in New Mexico • Identify environmental conditions and health outcomes of greatest relevance • Identify best available data • Develop most informative measures • Identify limitations, data needs, future directions • Drive data collection, although data collection also can drive the selection and use of indicators

7. Environmental Public Health Indicators Role of Indicators for the EPHT (concluded) • Monitor current status or trends of environmental and health conditions in New Mexico in order to prevent adverse health effects related to environmental conditions • Provide a basis for building environmental health capacity within state and local environmental, health, and related agencies

8. Environmental Public Health Indicators Process for Developing the EPHIs • CSTE/CDC Environmental Public Health Indicators (2002) http://www.cdc.gov/nceh/indicators/default.htm • EPHI framework • Topics • Core EPHIs • Other EPHIs and other indicator projects • Measures

9. Environmental Public Health IndicatorsFramework Human Exposure Environmental Hazard Health Effect Intervention

10. EXAMPLETopic: Ambient (Outdoor) Air Quality • Rationale and Role: Air quality affects people’s health. Certain air pollutants can cause or exacerbate certain diseases. • This indicator may be used to: • Monitor trends in air pollution; • Map levels of air pollution to identify hotspots or areas in need of special action; • Estimate how many people are exposed to excess levels of air pollution; • Monitor levels of compliance with air quality standards; • Assess the effects of air quality policies; • Help investigate associations between air pollution and health effects.

11. EXAMPLETopic: Ambient (Outdoor) Air Quality(continued) Linkage with Other Indicators: This indicator represents one in a suite of indicators that together describe the effects of air pollution on health: Indoor Air Quality; Ambient Water Quality; Fish Safety

12. EXAMPLEEnvironmental Hazard

13. EXAMPLEHealth Effect

14. EXAMPLE:Intervention

15. Prioritizing EPHIs • Develop preliminary list of priority indicators through collaboration of EH professionals and other citizens • EPH program priorities • Stakeholder priorities • Survey EPH programs, professionals, and scientists to identify data sources for indicators • Select these indicators for which data are available and can be linked on an ongoing basis • Select these indicators for which interventions are available to remove the hazard or prevent the exposure • Identify limitations, data needs, future directions/activities

16. Inventory of EPH Data Systems Purpose • Identify, describe, and evaluate available ongoing environmental hazard, human exposure, and health outcome data systems in New Mexico, and • Integrate/link environmental exposure and health effect data and monitor EPH conditions

17. Inventory of EPH Data Systems History Initial inventories of EH data systems developed through compilation of results from previous surveys (prior to the start of the project) • Health data system elements: • Name of dataset/data system • Owner/location • Description/purpose/content • Major indicator/variables • Geographic area

18. Inventory of EPH Data Systems History (concluded) • Environmental data system elements: • Database name & business purpose • Technology • Major inputs • Major outputs • Users

19. Inventory of EPH Data Systems • Updated initial inventory of EPH data systems through • Internet searches • Telephone interviews with data owners • Current inventory includes more than 100 datasets and data systems • Disseminated among members of the EPHT Planning Consortium

20. Inventory of EPH Data Systems • Phased survey of EPH datasets and data systems • Three phases/levels • Each phase includes evaluation component

21. Inventory of EPH Data Systems • Phase I: • Initial survey to identify and describe the variables, geographic and temporal coverage of each dataset and other basic information

22. Inventory of EPH Data Systems • Phase II: • Focus on data quality, timeliness, and completeness issues • Phase III: • Focus on technology considerations

23. Inventory of EPH Data Systems • Prioritized datasets and data systems for the initial survey • Criteria: • Information on one or more indicator category • Health outcome data or information that can be related to one or more indicator category • Developed a draft questionnaire, including glossary of EH terms to conduct initial survey of EH datasets and data systems identified in the prioritized inventory

24. Inventory of EPH Data Systems • Next step: Conduct initial survey

25. Challenges & Opportunities • Establishing the EPHT Planning Consortium and workgroups and maintaining interest of all stakeholders • Developing data sharing agreements • Developing data linkage methods • Assuring consistency with other systems such as NEDSS that are not fully defined yet • Other

26. Acknowledgements • CSTE/CDC Indicator Projects http://www.cste.org This presentation is supported by Cooperative Agreement U50/CCU522441-01 from CDC. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the CDC.