Dunlop, Thomas S. MPH, REHS; Porter, Denisha MPH, HHS, RS; Washam, Robert RS, MPH; Li, Jennifer MHS; Ho, Jessica RD, MSPH; Johnson, Rebecca MPH
Pitkin County, Colorado (Mr Dunlop); Creating Healthy Communities Program, Cincinnati Health Department, Cincinnati, Ohio (Ms Porter); Martin County Health Department, Florida (Mr Washam); and Environmental Health and Health and Disability (Ms Li and formerly Ms Johnson), National Association of County & City Health Officials, Washington, District of Columbia.
Correspondence: Jennifer Li, MHS, National Association of County & City Health Officials, 1100 17th Street NW, Suite 700, Washington, DC 20036 (firstname.lastname@example.org).
The authors declare no conflicts of interest.
Disclosure of funding received for this work from the Centers for Disease Control and Prevention and the Florida Department of Health.
Strong state-local relationships within the Environmental Public Health Tracking Program (Tracking Program) can enhance the ability of the Centers for Disease Control and Prevention and state and local health departments to collect and analyze data that would help determine links between environmental exposure and health. Since the National Association of County & City Health Officials is particularly interested in how local-state partnerships could benefit the Environmental Public Health Tracking Network, this article features strategies to engage local health departments. First, state-local facilitated discussions have been shown to positively impact the public's health. Second, Martin County conducted a program that taught women to avoid overconsumption of high-mercury seafood, which was also implemented in other Florida counties. Finally, the Cincinnati Health Department initiated a project that promoted data sharing with the state, and the results have also been promising. Such efforts indicate that state-local partnerships have the potential to support and enrich the Tracking Program.
The Centers for Disease Control and Prevention established the Environmental Public Health Tracking Program (Tracking Program) in 2002 to collect, analyze, and disseminate data and information about environmental exposures and the health effects that are linked with those environmental hazards.1,2 It funds 23 states and 1 city health department to develop state and city networks, which feed into the Environmental Public Health Tracking Network (Tracking Network).3 The National Association of County & City Health Officials, a national partner of the Tracking Program, promotes increased engagement of local health departments (LHDs) in the Tracking Program, and this article highlights the benefits of having LHDs be more involved in efforts to support the Tracking Program.
Linking Local Public Health With the Tracking Program
The National Association of County & City Health Officials partnered with the Centers for Disease Control and Prevention, the Association of State and Territorial Health Officials, and state health departments (SHDs) to convene state and local health officials to discuss how LHDs and SHDs can work together to use Tracking Network data and resources to address various forms of illness and disease resulting from environmental stressors. The driving force behind these facilitated discussions was the idea that data and resources from state programs could more easily be applied to benefit local communities, and, in turn, LHDs are more likely to seek scientific support from the SHD data system to answer difficult public health questions.
For LHDs, some benefits of having strong relations with their state tracking programs include the following:
* The ability to link environmental and public health data.
* The ability to compare data at local, state, regional, and federal levels.
* Increased environmental public health advocacy with policy makers.
* Improved community education, empowerment, and mobilization.
* Increased communication and coordination among agencies.
Overall, these discussions have helped increase communication among various stakeholders in the environmental and public health disciplines, which, it is hoped, will encourage a more robust public health system.
One way to increase LHD engagement in tracking is to involve LHDs in the collection of biomonitoring data, which is something that often requires obtaining data from local communities. For example, the Florida Tracking Program provided mini-grants to 3 LHDs, including Martin County, to conduct a local mercury biomonitoring study. The Florida Tracking Program and Martin County were interested in the biomonitoring study because residents of south Florida have easy access to fresh seafood and much of the local seafood is known to have high mercury content. Since consumption of fish with elevated mercury levels is associated with mercury poisoning, researchers in Martin County were especially concerned with at-risk populations such as women of childbearing age, given the effects of mercury on infants, unborn fetuses, and young children. Martin County recruited 408 young women and tested their hair for mercury and administered a short questionnaire about fish consumption. The study found that 25% of women tested had elevated mercury levels compared with 12%, which is the national average.4,5
In response to these findings, Martin County health officials educated local medical providers and created a recipe booklet with information on how to select and prepare low-mercury fish, with the idea that these local medical providers would then educate local women about mercury poisoning. Thus, while SHDs are able to aggregate large quantities of data to identify broad trends, LHDs are invaluable for understanding nuances of the data at the local level as seen in this mercury biomonitoring study.
Development of a Local Network
Another way to increase LHD engagement is to provide LHDs with the resources and support to help them establish their own local networks. The Cincinnati Health Department (CHD), for instance, was able to build upon its public health tracking capacity by being chosen as an Association of State and Territorial Health Officials fellow in 2011. Through the Peer-to-Peer Fellowship Program, CHD was paired with New York City's Department of Health and Mental Hygiene to complete a pilot project that would display vital statistics data. The Cincinnati Health Department worked with internal programs as well as external database managers to reformat the vital statistics data for presentation consistent with the Tracking Network. Special emphasis was placed on developing the information technology infrastructure, the design/look for the portal, orienting and training advisory committee members, and forging strong relationships with state and local agencies. Some tracking pilot project activities included evaluating the many CHD databases, assessing ways to build new data sets and to present data, and analyzing compatibility of data with the Tracking Network. The Cincinnati Health Department used 2010 US Census population data for analysis of the 48 neighborhoods that comprise the city of Cincinnati. In addition, the CHD worked closely with New York City's Department of Health and Mental Hygiene to ensure that they were reaching Tracking Network standards.
Through this project, CHD integrated environmental health, public health, and clinical care services to improve the health of the Cincinnati community and promote data sharing between the CHD Vital Records Department, City of Cincinnati Information Technology Centers, and the Ohio Department of Health. Moreover, by comparing maternal, child health, and vital statistics data between neighborhoods, CHD was able to develop a Web site that displays vital statistics data. In fact, this project can inform future LHD projects that hope to link geographic data on exposures to environmental hazards related to maternal, child health, and chronic disease data and share that data among internal programs and external database managers to reformat the data for presentation through the Tracking Network.
Local health departments can better understand issues in their local communities and are thus able to use data to drive community-specific interventions at the local level. Therefore, it is imperative that LHDs are actively engaged in state and national tracking efforts. The Centers for Disease Control and Prevention and SHDs can engage LHDs by convening facilitated discussions, funding specific projects, and providing support for the development of local networks, which can then improve their capacity to ensure that environmental risk factors are minimized to reduce the impact of chronic disease.
2. McGeehin MA, Qualters JR, Niskar AS. National Environmental Public Health Tracking Program: bridging the information gap [published online ahead of print August 3, 2004]. Environ Health Perspect. 2004;112(14):1409–1413. doi:10.1289/ehp.7144.
4. Karouna-Reiner N, Rao R, Lanza J, et al. Mercury levels and fish consumption practices in women of childbearing age in the Florida Panhandle. Environ Res. 2008;108(3):320–326.
5. McDowell MA, Dillon CF, Osterloh J, et al. Hair mercury levels in U.S. children and women of childbearing age: reference range data from NHANES 1999-2000. Environ Health Perspect. 2004;112(11):1165–1171.
biomonitoring; environmental public health; local health department; network; tracking
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