Abstracts

THE COMMON GROUND: THE CRITICAL ROLE OF INDICATORS AND TRACKING IN SHAPING THE FUTURE OF ENVIRONMENTAL HEALTH

Thomas A.Burke

These are difficult times for environmental protection. In recent years there has been growing opposition to many of the regulatory approaches that are the foundation of the nation’s environmental policies. At the core of much of this opposition is the call for “sound science” to strengthen the basis for environmental decisions. Recent controversies surrounding the arsenic in drinking water rule and ongoing debates concerning the scientific basis for Clean Air Act standards underscore a critical challenge for the future of environmental health. Fundamental questions concerning the public health benefits of environmental policies must be addressed: Do these policies really work? Are there measurable public health benefits? Are they worth the costs?

The past 30 years have brought substantial gains for environmental protection. We have addressed many major problems ranging from water pollution control to hazardous waste management. During this time an extensive regulatory infrastructure has evolved at both the federal and the state levels. Unfortunately, the very laws that drove this progress neglected to support the critical role of public health. As regulatory requirement burgeoned, the public health capacity to identify, track, and respond to environmental hazards eroded. This presentation examines the historical and evolving relationship between public health and environ-



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Environmental Health Indicators: Bridging the Chasm of Public Health and the Environment, Workshop Summary Abstracts THE COMMON GROUND: THE CRITICAL ROLE OF INDICATORS AND TRACKING IN SHAPING THE FUTURE OF ENVIRONMENTAL HEALTH Thomas A.Burke These are difficult times for environmental protection. In recent years there has been growing opposition to many of the regulatory approaches that are the foundation of the nation’s environmental policies. At the core of much of this opposition is the call for “sound science” to strengthen the basis for environmental decisions. Recent controversies surrounding the arsenic in drinking water rule and ongoing debates concerning the scientific basis for Clean Air Act standards underscore a critical challenge for the future of environmental health. Fundamental questions concerning the public health benefits of environmental policies must be addressed: Do these policies really work? Are there measurable public health benefits? Are they worth the costs? The past 30 years have brought substantial gains for environmental protection. We have addressed many major problems ranging from water pollution control to hazardous waste management. During this time an extensive regulatory infrastructure has evolved at both the federal and the state levels. Unfortunately, the very laws that drove this progress neglected to support the critical role of public health. As regulatory requirement burgeoned, the public health capacity to identify, track, and respond to environmental hazards eroded. This presentation examines the historical and evolving relationship between public health and environ-

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Environmental Health Indicators: Bridging the Chasm of Public Health and the Environment, Workshop Summary mental protection, and describes the critical role of environmental health tracking in bridging the common goals of these disparate worlds. Environmental health tracking provides a framework for identifying and monitoring sources of harmful pollutants, measuring population exposures, and assessing key health indicators in the population. Results from the work of the Pew Environmental Health Commission are presented, including findings regarding key measures of health and environment. This work has provided support for current legislative efforts to establish a national tracking network. Additional approaches to the development of health and environment indicators for tracking also are examined. Contemporary issues including mercury exposure, brownfields’ redevelopment, and recent terrorist events are examined to illustrate the role of tracking in addressing critical environmental health issues. The horrible events of September 2001 have brought an unprecedented awareness of the need for a strong public health capacity, as well as unprecedented investment in the public health infrastructure. We now have a responsibility to build on this investment and an opportunity to apply new approaches to evaluating hazards, strengthening the scientific basis for policy, and preventing disease. Building upon the improved national capacity for disease surveillance and public health preparedness, environmental health tracking can provide essential support for our environmental protection efforts, while improving our understanding of the relationship between the environment and health. ENSURING USABILITY IN ENVIRONMENTAL HEALTH MONITORING Baruch Fischhoff and Henry Willis One of the challenges of environmental health monitoring is that these data will be used at a number of levels—local, state, national, and international. Creating databases and summaries that will be usable and meaningful to the diverse intended audience will require careful thought and advance planning. As the plan for a national monitoring system moves forward, one can use a social and behavioral science perspective to present the information in a way that is consistent with the underlying science of physiology and environment. The National Academies and others have published a number of reports on risk delineating subjectivity of scientific risk estimates, which

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Environmental Health Indicators: Bridging the Chasm of Public Health and the Environment, Workshop Summary often rely on the perception of the experts laden with uncertainty reflecting their extrapolations from imperfect data sets and theories. As a result, the Academy has advocated that scientists and government officials have an obligation to communicate with the public throughout the process of managing environmental risk. The public needs candid communication about the state of science so that it can feel respected and empowered. Central to the issue before us today, is the definition of terms, including “risk.” Fundamental terms such as risks are in reality political judgments, and because of this, citizens have a right to be involved in the process. They have a right to determine what is measured; if they are not involved, the measures will not have credibility. This involvement has grown over the last 20 years, which has resulted in increasing citizen participation. The Institute of Medicine’s report on environmental justice argued that if you want credibility for the results of research that affects a community—then it is to the researcher’s advantage to involve the community in the research process (IOM, 1999). In the past 20 years, respecting the intellect and the interest of local communities has increasingly become the norm not only in this country but in Canada, the United Kingdom, and elsewhere. The Canadian Standards Organization’s guide to risk management is particularly good at showing how to make communication integral to the process. In the United States, EPA has conducted many comparative risk projects demonstrating how science can be put at the service of citizens so that they can better understand the risks that they are facing and set appropriate priorities. Scientifically sound risk prioritization must meet both content and process criteria. In terms of content, the indicators to be used ideally should be exhaustive of the things that the community cares about, standardized so that people can pool and compare their results. The path to such content could begin at the national level, as a point of departure for different states. In situations where people are unfamiliar with the issues a constructive evaluation process is needed. People need to see the issues in a comprehensible way, then have a chance to reflect on them so that they know what they are talking about when they set priorities. Often when people are faced with new problems, they don’t know what they want. Therefore, it is important for the process to help them construct values that are relevant to a particular situation. People’s values and priorities can be measured; the science for that measurement is psychometrics. It provides detailed guidance for the following steps: (1) categorizing risk, i.e., identifying things one cares about; (2) identifying the indicators to be considered; (3) ranking the summaries in a re-

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Environmental Health Indicators: Bridging the Chasm of Public Health and the Environment, Workshop Summary sponsible way. In order to ensure the usability of environmental health monitoring, it would be helpful to create standing advisory committees, similar to the risk comparison ones in order to provide the public diverse input into the formation of the environmental monitoring system. ENVIRONMENTAL HEALTH MONITORING: A VIEW FROM INDUSTRY Carol J.Henry Knowledge of the causes of chronic illnesses and diseases and trends in occurrence is currently insufficient, as is the public health infrastructure to track and work on these issues. Government and the private sector have developed diverse initiatives to address these insufficiencies. All of the initiatives recognize the need for a comprehensive public health surveillance or health tracking system to aid in understanding disease trends in the United States. The American Chemistry Council (ACC) recognizes the importance of these issues and offers its support for the concept of a comprehensive public health surveillance system, further recognizing that it would improve the ability of local, state, and federal public health agencies to track priority chronic diseases and risk factors for disease, as well as aid in generating hypotheses for research on disease causation. Such a system also could provide a link between improved homeland security and advancement in public health. However, there are several areas of concern with the current proposals, including a too-narrow definition of environmental factors that emphasizes chemicals, without acknowledging or including physical, biological, or societal factors that have major roles in human disease. The ACC is committed to continuous environmental, health, and safety performance improvements by its member companies through its Responsible Care program and to support research on the effects of chemicals on health and the environment. Through its Long Range Research Initiative, the ACC supports research in some areas that could result in aiding surveillance or tracking systems. It is suggested that the Department of Health and Human Services (DHHS) convene a commission to identify the needs for a public health surveillance system in the twenty-first century. There are opportunities for various organizations, including the ACC, to partner with other organizations to build broad-based stakeholder support and promote better

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Environmental Health Indicators: Bridging the Chasm of Public Health and the Environment, Workshop Summary public and political understanding of the value of a public health surveillance system. THE LOCAL COMMUNITY: ENVIRONMENTAL CHALLENGES AND RECOMMENDATIONS Mark B.Horton The following scenarios typify the challenges that health officers and environmental health officials face at the local level: Increased bacterial levels are detected along a popular ocean beach in a resort community in Southern California. What is the source of pollution? Should the beaches be posted or closed and for how long? As the result of an energy crisis, a local electric power plant, natural gas powered, doubled its energy production. There is community concern about the environmental consequence. How will public health monitor this effect? A local tire fire has caused a huge smoke plume over an inland community for a period of several weeks. What surveillance mechanisms should be put in place to monitor the health effects? The local vector control district discovers antibodies for West Nile virus in its sentinel bird surveillance program. What information should be shared with the public? Whose role is it to inform the public? Extensive mold is discovered in multiple units of a multifamily condominium structure in the local community. The homeowners association is suing the developer. The homeowners association also is raising association fees to cover the cost of vacated residences, sending delinquent owners to collections agencies and considering default. What is the role of local public health? A local community group is organizing to protest dust and air pollution emanating from a large construction site near a residential area. Anecdotal illness reports have been received. What surveillance mechanisms should be put in place? Who is responsible for surveillance of health effects? The challenges to local public health and environmental health in dealing with issues such as the above are considerable and include the following:

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Environmental Health Indicators: Bridging the Chasm of Public Health and the Environment, Workshop Summary Organizational and coordination issues—different agencies at different levels of government are responsible for various aspects of environmental monitoring and regulation. The relationship between environmental health and public health at the local level varies considerably from county to county. Funding for environmental regulatory activities is fee based and categorical. Very few resources are available for new and different challenges. Data and connectiveness of databases are lacking. Local surveillance and analysis capacity is limited. Environmental health at the local level is limited in its ability to prioritize issues. Community engagement or support for establishing environmental priorities is lacking. To address the above concerns and challenges, several essential steps should be considered: A new paradigm for leadership and coordination of responsibilities at the federal, regional, state, and local levels. A coordinated and consistent set of environmental objectives applicable at the federal, state, and local levels, with appropriate indicators and data elements defined. A process for comprehensive strategic planning, prioritization, and community involvement. A significant investment in epidemiological capacity at the local level. New sources of funding to support the above, and additional resources available to support local innovative projects to address community priorities. A consistent set of performance standards and capacities for environmental health at the state and local levels. THE INTERACTION WITH THE GLOBAL COMMUNITY Tord Kjellstrom Each country is facing problems similar to those of the United States when it comes to assessing the health effects of environmental hazards

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Environmental Health Indicators: Bridging the Chasm of Public Health and the Environment, Workshop Summary and monitoring progress toward reducing or preventing negative environmental health effects. The hazard panorama in different countries is more dependent on the level of a country’s economic development than on its geographical location. In recent decades, issues of chemical pollution have been in the forefront in most developed countries, including urban air pollution from motor vehicles and industry, exposures to chemicals in agriculture, and long-distance pollution from coal- and oil-powered electricity production. In addition, the threats of catastrophic radiation pollution from nuclear power plants and the new challenges brought by greenhouse gas emissions require foresighted prevention and monitoring systems. In developing countries, the major environmental concerns remain the biological hazards of unsafe drinking water and unsatisfactory sanitation, as well as the hazards of poor housing and worker health and safety. Problems of such poverty-related environmental health hazards also remain in the deprived parts of developed countries. Environmental health thus has many facets, and there is no one global solution to finding meaningful indicators. The notion of “indicators” in this field was inspired by the common use of indicators of economic development, such as the gross domestic product (GDP). In the early 1990s the Organization for Economic Cooperation and Development (OECD) published its PSR (Pressure-State-Response) framework in order to promote a common set of environmental performance indicators. This framework is still used by ministries for the environment in many countries as a basis for their environmental reporting, and indicators within this framework were used for international comparisons at the World Summit on Sustainable Development in Johannesburg, September 2002. A major aim of an indicator is to provide an easily interpretable measure of the state of our environment or the health of a defined population. There are a number of indicators that serve this purpose, such as the commonly monitored urban air quality variables or the commonly reported life expectancies of populations. These “one-dimensional” indicators that describe only the state of the environment or our health have been widely adopted internationally (or “globalized”), and they are of great importance for describing time trends and geographic variations. U.S. government agencies, academic institutions, industry, and other interested parties have taken active part in the development of such indicators. These include sets of indicators from the United Nations Commission for Sustainable Development (CSD), the United Nations Environment Programme (UNEP), the World Bank, and the World Health Organization (WHO). The

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Environmental Health Indicators: Bridging the Chasm of Public Health and the Environment, Workshop Summary latter has promoted a set of 47 Health-for-All Indicators since the early 1980s that all 190 member states have agreed to monitor. So, there is no lack of indicators, and there has been strong interaction between the United States and other countries in developing them. However, to create indicators that can be interpreted in terms of linkages between environmental quality and public health has been a major challenge. Such indicators need to present a message of how much ill-health is related to a specific environmental hazard or how much of the health effects has been reduced by a specific policy or practice. A true “environmental health indicator” must express the linkage between environmental quality and health in a specific situation. A series of activities was started in 1992 at the WHO, partly funded by the U.S. Environmental Protection Agency (EPA), to try to establish a method for the development and testing of such indicators. A number of reports were published, in which a new framework was presented: the DPSEEA framework, which incorporates transparent linkages between different one-dimensional environment or health indicators and puts public health in the focus. DPSEEA stands for Driving force-Pressure-State-Exposure-Effect-Action. D and P combine into P in the OECD framework; S, E, and E are the S in the OECD framework; and action is the term favored by the WHO over response (which sounded too passive). The DPSEEA framework acknowledges that for pressures on the environment to be created there are usually driving forces of policy, technological change, or economic circumstances. When public health is the focus, the state of the environment has to be recorded separately from health itself (the effects). In addition, for an environmental hazard to cause health effects, people must actually be exposed. Thus, the split into S, E, and E. Numerous case studies have tested the framework developed at the WHO, and it has proven to be a helpful aid to indicators development (examples are given during the presentation). It is interesting to note that when trying to put the OECD PSR framework into practice, the U.S. EPA decided to add an “exposure” dimension into the framework. When the CSD tried to use the PSR framework it decided to add the “driving force” dimension. When the UNEP tried to use the PSR framework in its Global Environmental Outlook reports, it was found necessary to add two dimensions and led to DPSIR (Driving force-Pressure-State-Impact-Response). The slow progression toward a DPSEEA-type framework may be seen as a slow merging of ideas between the environmental and economics experts and the consequence (or public health) experts.

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Environmental Health Indicators: Bridging the Chasm of Public Health and the Environment, Workshop Summary This indicator framework truly has the potential to “bridge the chasm between public health and the environment.” It is interesting to note that the Australian Commonwealth government’s primary health agency (the Commonwealth Department of Health and Aging) has recently decided to promote the DPSEEA framework as its preferred basis for environmental health indicators development. Collaboration with the environment agency has been ensured, and the ongoing process may provide useful experiences for U.S. agencies in these fields. Another country with quite advanced developments in this area is Sweden. The struggle to find information systems that give the public and decision makers interpretable indicators of the health benefits of environmental policies and practices is not confined to the United States. International sharing of experiences and collaborative research will lead to more cost-effective solutions and to harmonized sets of common indicators. As the concern for local environmental issues broadens to global environmental threats such as global warming and transboundary pollution by persistent organic pollutants, a common understanding between the environmental and health sectors within and between different countries on the issue of environmental health indicators is increasingly needed. WHAT EARTH SCIENCE TECHNOLOGY CAN DO TO ASSIST PUBLIC HEALTH P.Patrick Leahy Many aspects of natural science that the U.S. Geological Survey (USGS) addresses have links or potential links to public health issues. USGS investigations that contribute toward a better understanding of public health and the environment span a range of scales from the planetary to the molecular and atomic. Whether the concern is transport of microbes or anthropogenic materials on dust particles that travel large distances around the earth or the spread of wildlife and human disease in a more localized area, the USGS applies a wide variety of expertise in natural sciences and state-of-the-art technology where needed. Historically, USGS science has contributed significantly to understanding the relation of asbestos mineralogy to mesothelioma, of selenium toxicity to wildlife health, and of geology to nutrition. However, the linkage of findings from natural science to the public health community has not been as

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Environmental Health Indicators: Bridging the Chasm of Public Health and the Environment, Workshop Summary robust as desirable, and science-based policy making and decision making have suffered. Partnerships and collaborative efforts between the natural science community and the public health community must be strengthened. An example of such a partnership is the one recently established between the USGS and the National Institute of Environmental Health Sciences (NIEHS). Current USGS activities that are contributing or have the potential to contribute to bridging the chasm between public health and the environment include studies on: (1) trace element exposure, (2) dust, (3) anthropogenic organic materials, (4) radionuclides, (5) microbes and pathogens, and (6) global climate change. Advancing the state of knowledge from association or correlation between environmental factors and public health requires in-depth understanding of the exposure pathways, hazard assessment, and process studies. USGS science is providing ways to better understand the processes and pathways between and among the abiotic and the biotic realms. CENTERS FOR DISEASE CONTROL AND PREVENTION’S APPROACH TO DISEASE SURVEILLANCE Michael A.McGeehin The greatest environmental health success of the last 30 years is the National Health and Nutrition Examination Survey (NHANES) data for lead poisoning—blood lead levels in children in the United States. This success was achieved by collaboration between EPA and various health agencies. It was done primarily by an intervention that was environmental (i.e., removal of lead from gasoline). Lead has gone from a universal problem to a problem that is primarily a health disparity issue. If you are an African-American child living in older housing in the United States, your chance of having an elevated blood lead level is 22 times as likely as that of a white child in newer housing. We wouldn’t have this information if we didn’t have good surveillance data. One of the Healthy People 2010 goals is to eliminate childhood lead poisoning in the United States. The only way we can do this is by basing our programs on good surveillance data and modifying them in the next 10 years to make sure we go after the population that is most effective. Surveillance data in public health help us determine the magnitude of a problem. Whenever we try to estimate what the asthma prevalence or

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Environmental Health Indicators: Bridging the Chasm of Public Health and the Environment, Workshop Summary incidence is in a community or a state, or even for the nation, we end up having to go to about eight different sources and put this together. With a good, strong national network of surveillance, we have a single source collected in the same way, and the data are much better. The best way to make our decisions based on good, sound data is to have good surveillance. Currently, we do not have good surveillance data on chronic diseases. Surveillance data—the national health tracking network—are the backbone of good public health. We need uniform criteria for the reporting of all diseases. Each disease has certain criteria such as data that are collected, their timeliness, and when they are submitted. All of this disparate, fragmented reporting puts the burden on our public health system and our private health care industry. There are a lot of different diseases that are reportable, and we have a lot of different surveillance systems at the Centers for Disease Control and Prevention (CDC), such as childhood blood lead surveillance, the national report on human exposure, the Behavioral Risk Factor Surveillance System (BRFSS), the National Health and Nutrition Examination Survey, and National Health Interview Survey (NHIS). The CDC faces some problems with the different surveillance systems, one of them being that because of the fragmentation and the fact that they were designed in response to outbreaks, they are not utilizing the most advanced information technology that is available right now. To deal with the problem, CDC created a new initiative—the National Electronic Disease Surveillance System (NEDSS). NEDSS is trying to take all of the surveillance systems that are currently at CDC, and all that will be developed, and put them into a system that is uniform efficient, and standards-based. It is important that the system be standards-based, so that it integrates with private industry and other public health care agencies. UNDERSTANDING THE STATE OF THE ENVIRONMENT: MOVING BEYOND THE PROCESS TO TRUE OUTCOME INDICATORS Kimberly Nelson There are far greater numbers of unanswered questions about the linkages and the connections between human health and the environment

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Environmental Health Indicators: Bridging the Chasm of Public Health and the Environment, Workshop Summary than there are answered questions. At the EPA, we are trying to better understand the environmental condition and make the links to human health, in part by compiling a state of the environment report and by supporting partnerships between agencies. Our goal is to move beyond narrowly defined traditional clean air, water, waste, and land-use issues to more broadly encompass ecosystems and human health; it is these complex relationships that drive many of today’s hard questions. The EPA’s State of the Environment Report will focus on the relationship of ecological and human health to our air, water, and land-related programs and will consist of two phases. In the short term, our goal is to increase public understanding of the state of our environment. In the longer term, we hope to foster in-depth dialogue with respect to the relationships between environmental and health conditions, current ecological and health assessments, and methods to build linkages between the two. With respect to both phases, we must identify data gaps and recognize that most of the data required to define the state of the environment are not available from the EPA. Ninety to ninety-five percent of the data we require come from our state partners. Our goal is to define a methodology to align and present the information in a rational and understandable format while driving the EPA to dismantle the barriers that currently exist in environmental protection. To facilitate data collection and sharing, as well as innovative means to address environment and health links, the Office of Environmental Information both encourages the formation of and supports existing partnerships between agencies. The EPA sponsors a $25 million grant program to states to support the collection of high-quality environmental information. One of the categories is a challenge grant to facilitate states’ efforts to partner with other organizations within the state or with environmental agencies from other states. In the past, more states were likely working independently than they were to partner with each other; currently, states are much more willing to form partnerships. I believe people have finally recognized that the ability to leverage information collectively is many times greater than that of a single effort. Our office promotes partnerships to foster more efficient flows of information between our state partners, the tribes, and the EPA and to reduce reporting burdens placed on industry and states. Most important, I believe partnership building is going to improve access to environmental information by citizens, states, and health professionals as well as many others and lead us into productive environmental and health problem solving in the twenty-first century.

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Environmental Health Indicators: Bridging the Chasm of Public Health and the Environment, Workshop Summary ENVIRONMENTAL HEALTH INDICATORS AND WEB-BASED INFORMATION SERVICES Bill Pease Consumer users of environmental health indicators want information that is credible, relevant, and actable. Satisfying these criteria is often quite difficult because many indicators lack the scientific consensus required to be credible, the resolution required to be useful to specific audiences, and/or any linkage to opportunities for action. By reviewing several successful examples of web-based information services, guidelines for attaining these criteria can be identified. For example, relevance can be delivered if indicators are designed to provide personalized, localized, or domain-specific information. Useful environmental health indicators confront a number of implementation challenges if they are to be provided as web-based services, including the following: integrating ontologies and data sources across knowledge domains, developing privacy protections, and supporting information intermediaries that are less subject to scientific and regulatory constraints. ENVIRONMENTAL HEALTH MONITORING IN THE WORKPLACE: SAFEGUARDING WORKERS AND ADVANCING PUBLIC HEALTH Kathleen Rest The work environment is a critical public health interface and integral to discussions of environmental health. Indeed, the use of toxic substances in the workplace and their release into the air, water, and soil can be the source of environmental pollution, community contamination, and their appearance in human tissue. Moreover, there are a host of overlapping concerns in occupational and environmental health, related to both exposures and health effects. For example, workers and the public share concerns about asbestos, lead and other heavy metals, pesticides, radon, fine particulates, formaldehyde, and other chemicals. Diseases with potential occupational and environmental contributions include asthma,

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Environmental Health Indicators: Bridging the Chasm of Public Health and the Environment, Workshop Summary COPD (chronic obstructive pulmonary disease), sick building syndrome, and low-level chemical sensitivity, as well as concern about cancer, birth defects and developmental disabilities, neurological and autoimmune disease, and other ailments. Many of these issues reflect the growing concerns about the indoor environment—be it the home, school, office, or other work environment. Yet despite the many direct and indirect links between occupational and environment health, the work environment is generally overlooked in conversations and initiatives related to environmental health and environmental health tracking. In the United States, over 135 million workers spend a large proportion of their daily lives in work environments. In most cases, no fence line exists between the workplace and the community, and workers are generally exposed first and worse. They often serve as sentinels for others; they can carry home exposures that pose risk to family members. In 2002, 5,524 non-fatal injuries and illnesses occurred in the private sector alone. In addition to their enormous human toll, the economic burden of workplace illness and injury is substantial. The Liberty Mutual 2002 Workplace Safety Index estimates that the direct costs of occupational injuries and illnesses in 1999 rose to $40.1 billion, with indirect costs reaching over $200 billion. The Pew Commission highlighted substantial inadequacies in environmental health tracking at the state and local level due to limited resources as well as lack of federal leadership. Occupational health surveillance faces many of the same challenges. Resources for state-based surveillance are limited, and many states have little if any capacity to monitor and track occupational health indicators. The National Institute for Occupational Safety and Health (NIOSH) has supported state-based surveillance efforts through such programs as SENSOR (the Sentinel Event Notification System for Occupational Risks), FACE (Fatality Assessment and Control Evaluation), and ABLES (Adult Blood Lead Epidemiology Surveillance). But gaps remain. The Pew Commission also noted the nation’s failure to explore the potential links between environmental exposures and chronic disease. What is missing is the critical need to include the work environment in these new efforts. Integration of the work environment can advance the public’s environmental health because: the workplace can contribute critical information about exposure-effect relationships; mandated and voluntary worker monitoring programs already exist and can provide wealth of data; the infrastructure for occupational surveillance is in place or developing in some states; and occupational health professionals can

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Environmental Health Indicators: Bridging the Chasm of Public Health and the Environment, Workshop Summary provide substantial experience and expertise to the tracking of environmental health indicators. Given the integral relationship between occupational and environmental health, it is ill-advised to discuss bridging the gap between environmental hazards, exposures, and health effects without considering and tracking exposures and health effects in the work environment. The time is right to enhance both federal and state capacity in environmental and occupational health tracking and to exploit potential synergies for advancing public health. YES, BUT WILL THE PUBLIC CARE? (AND DO THE MEDIA CARE?) Bud Ward People get their information and misinformation about environmental and health issues—and draw their opinions—based in large part on what they see, hear, and read via the mass news media. Yet what is the state of the “environment beat” in today’s print and broadcast newsrooms? Is the beat attracting the best and brightest in the newsroom? Is it a cherished assignment and a ticket to increased air time and column inches? Or is it rather like being consigned to the “lower 40”? The environmental beat, like others in journalism, is cyclical, but just what is it that drives those cycles? Also, how will the public come to know and understand issues related to environmental health indicators if the media themselves don’t give issues the air time and column inches that they might warrant—or demand? Recent indications are that the print and broadcast media are increasingly influenced by the need to have attractive demographics that can in turn attract high-paying advertising. Is this trend compatible with expectations that the media meet their news and information responsibilities in a democracy? If the environmental beat itself is not “in” in many of today’s newsrooms, are there other avenues for reaching the public with the information it needs to make informed decisions? This presentation provides insights into some of these questions and helps program participants better understand the realities facing the news media on which they may be depending to carry forward their message on environmental health and environmental health indicators.

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