A Vision for Environmental Public Health Tracking
From the earliest days of organized public health, understanding environmental hazards and exposures has been critical to protecting the health of communities. As the national infrastructure for environmental protection evolved since the creation of the U.S. Environmental Protection Agency (U.S. EPA) in 1970, there has been an emphasis on controlling pollution sources and monitoring environmental quality. While these efforts have helped improve environmental quality, the creation of environmental agencies contributed to a fragmentation of environmental public health efforts among environmental and health agencies (Burke, Shalauta, Tran, & Stern, 1997; Institute of Medicine, 1988). To address the uncoordinated patchwork of environmental public health in the U.S., the Pew Foundation established the Pew Environmental Health Commission at Johns Hopkins University in 1998. The commission found that as a result of decades of neglect, the nation's public health system was operating without basic information about chronic disease and related potential environmental factors (Environmental Health Tracking Project Team, 2000; Litt et al., 2004). To address this gap, the commission developed a blueprint for environmental public health tracking (EPHT) summarized in this overarching recommendation:
Create a federally supported Nationwide Health Tracking Network that informs consumers, communities, public health practitioners, researchers, and policymakers on chronic diseases and related environmental hazards and population exposures. This will provide the capacity to better understand, respond to, and prevent chronic disease in this country. In response to the commission recommendations, in 2002 the National Center for Environmental Health of the Centers for Disease Control and Prevention (CDC) established the Environmental Public Health Tracking Program. Since then, the Tracking Program has supported and worked with agency, community, and academic partners to develop the necessary systems, training, expertise, and capacity to address the vision of the commission. The Tracking Program has spawned many successful projects from the first years of work, including funding tracking programs in state and local agencies in 25 states, exposure prevention and community environmental health assessments, and new policies and research (Kearney, Namulanda, Qualters, & Talbott, 2015; Litt et al., 2007).
Renewing the Vision: Tracking Program Progress and Next Steps
Environmental public health science has advanced with new understandings of population exposures and recognition of a broader range of health impacts (Gibb et al., 2015). The increased recognition of the public health importance of climate change, the emergence of the health impact assessment (HIA) as a core tool for public health decision making, and vast improvements in health information technology and availability--all present great opportunities for the future of tracking (Mueller et al., 2015; U.S. Global Change Research Program, 2014). Recognition of and attention to the link between environment and health has never been greater. Public health policy decisions ranging from transportation to community development are increasingly dependent upon strong public health information (National Association of Chronic Disease Directors [NACDD], 2015). Despite these successes, in the 12 years since its inception, the Tracking Program has been hampered by continued fragmentation in the field, scientific uncertainties, and limited resources.
Considering the successes and challenges that remain, this project provided recommendations for the future of tracking, building upon the progress made and continuing to work toward the vision of a nationwide network and related public health capacity to better understand, respond to, and prevent environmental hazards, exposures, and diseases. The discussion and recommendations below are the result of an expert panel workshop that included persons with expertise in community health, emergency preparedness, environmental health sciences, epidemiology, and public administration. Agencies and organizations represented on the panel included: the Association of Public Health Laboratories; U.S. EPA; U.S. Geological Survey; and state health and environment agencies from Massachusetts, Michigan, New Jersey, Oregon, and Washington. Also represented were academic institutions: Colorado School of Public Health, City University of New York School of Public Health, and Johns Hopkins School of Nursing. The panel convened at a workshop in Baltimore, Maryland, in March 2015. The recommendations were designed to inform strategic planning for the Tracking Program as it seeks to enhance the utility of efforts to develop and sustain program activities to build a nationwide network, as well as advance environmental public health capacity at all levels to better protect the nation's communities.
Results: Expert Panel Discussion
At the start of the workshop, participants engaged in an assessment, each providing their perspectives on the Tracking Program's accomplishments and challenges, as well as participants' suggestions for next steps. Following the assessment exercise, the discussion turned to practical ways to enhance the Tracking Program and implement the next steps.
Assessment Activity: Accomplishments
The Tracking Program has enhanced and sustained environmental public health capacity, which was particularly critical during the recent recession years when, without the Tracking Program, such capacity would have been minimal or even nonexistent. Additionally, the Tracking Program was lauded for enhancing technical expertise, creating access to data, facilitating the development of a multidisciplinary "people" network of grantees and federal partners across the nation, as well as partnerships and data sharing across agencies and community organizations within states. These infrastructure supports, data sharing activities, and partnerships were identified as fundamental to achieving the vision of the commission. Participants felt that these fundamental features must be sustained and, if possible, expanded as the program moves forward.
For example, the Tracking Program has helped U.S. EPA to be accountable for both policy actions and inactions by highlighting the links between environmental exposures and health--and, in turn, the resulting health protection afforded by improved environmental quality. The primary example for U.S. EPA has been related...