use of indicators to monitor the status and trends of health, to develop the interventions to protect and promote health, and to build a core capacity to respond to environmental health problems. They explored frameworks for developing indicators and methods for ranking environmental health risks. They also discussed the criteria for establishing the national environmental health monitoring system, the potential benefits and limitations of the system, privacy issues raised by the system, the scientific underpinnings of the system, and the funding required. They discussed how to elicit the participation of health professions, industry, community groups, and the general public. Further, they considered how workers will collect and analyze information and the specialized education and training that they will need.
Tord Kjellstrom of the Australian National University stated that a main aim of an environmental health indicator is to provide an easily interpretable measure of the state of the environment or the health of a defined population (e.g., an urban air quality variable, or the life expectancy of a population). He suggested that creating indicators that can be interpreted in terms of linkages between environmental quality and public health may be difficult. Thomas Burke of Johns Hopkins University noted that environmental health indicators fall into four categories: hazard indicators (for example, motor vehicle emissions), exposure indicators (blood lead levels), health outcome indicators (lead poisoning), and intervention indicators (programs that address motor vehicle emissions). Burke remarked that indicators must be measurable (comparable and quantifiable), understandable to policy makers and the public, and defensible (that is, they must support a relationship between environmental factors and health status). They also must allow trends to be examined over time. Further, they must be linked to public health goals.
Several overarching themes emerged during the workshop. First, the concept of establishing a national system to monitor environmental health, and eventually all of public health, received consistent support. This support came from federal, state, and local government agencies; from leadership within the administration; from private organizations; and from the public. Senator Hillary Rodham Clinton cited a growing concern among the public about the effects of environmental exposures on health and noted strong congressional support for a national monitoring system. These views were echoed by Eve Slater of the Department of Health and Human Services and Paul Gilman of the Environmental Protection Agency, who represented the current administration. Carol Henry of the American Chemistry Council suggested that opportunities exist for