The fundamental issues of monitoring are the basic aspects of public health and environmental protection, and the establishment of this program should have occurred 25 years earlier, noted Burke. The concept of linking environment and health dates back to the Council on Environmental Health in the 1970s and was again noted in the Institute of Medicine (1988) report The Future of Public Health, which communicated that “the removal of environmental health authority from public health agencies has led to fragmented responsibility, lack of coordination, and inadequate attention to the health dimensions of environmental problems.” The Pew Environmental Health Commission continued the discussion and recommended that the nation’s environmental health defense system be strengthened, that the environmental precursors of disease be identified and controlled, and that public health’s readiness to respond be improved, noted Burke. The commission’s recommendations included establishing:

  • a national baseline tracking network for diseases and exposures;

  • a nationwide early-warning system for critical environmental health threats;

  • state pilot tracking programs to test diseases, exposures, and approaches for national tracking;

  • federal investigative response capability; and

  • tracking links to communities and research.

Acting on these recommendations, the Centers for Disease Control and Prevention (CDC) set up four environmental health monitoring workgroups to obtain input from those interested in working together with the agency, noted Michael McGeehin, the National Center for Environmental Health, CDC. The National Center for Environmental Health (NCEH) held three meetings in which 75 people from across the country—from the states, academic institutions, and nongovernmental organizations—worked within the workgroups to advise the CDC on the best way to set up a national monitoring system. They specified six requirements for the system; the nationwide monitoring system must:

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