Presentations

SUMMIT WORK GROUP DISCUSSIONS (FIRST DRAFT)

Following two days of discussion at the September 28-29, 2010 Summit, the link below contains the INITIAL recommendations from each of the three work groups (policy, research/analytical tools and outreach/education/mobilization). THIS IS NOT A FINAL PRODUCT but rather an initial summary of the discussions. Please note that all of these ideas will be incorporated into the Summit’s final work product (a policy document) with additional input from the planning committee and Summit attendees. That process will take place the remainder of 2010 and into 2011. Any questions should be directed toward Martin Armes … martinarmes AT nc.rr.com.

Initial Summit Recommendations

SUMMIT INTRODUCTION

“Exploring America’s Healthcare Policy through the Lens of Environmental Health: Time to Have a Seat at the Table”

Hal Zenick, U.S. Environmental Protection Agency, National Health and Environmental Effects Research Laboratory, Office of Research and Development, Director

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PLENARY PRESENTATIONS

“The Connection of Environmental Health to Disease Prevention and National Health Reform: The importance of collaborating with agencies traditionally viewed as non-public health agencies”

Thomas A. Burke, The Johns Hopkins Bloomberg School of Public Health, Associate Chair

There is increasing recognition of the importance of the environment in shaping the health of our population. The advent of National Health Reform brings new opportunities to understand the linkages between environment and community health, and to improve public health. Improved access to care and innovations such as electronic patient records will provide an unprecedented view of the health of our population. Unfortunately, there has been little historical collaboration between the many agencies and providers impacted by health reform, particularly regarding environmental health. This presentation will examine the possibilities and challenges of breaking down historical barriers and forging new partnerships in environmental protection, community health, and health care.

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“Environmental Contribution to Health Disparities: Where the Health Burden Is”

J. Nadine Gracia, Office of the Assistant Secretary for Health, U.S. Department of Health and Human Services, Chief Medical Officer

Health status is not only influenced by individual behavior or genetics, but also family networks, living and working conditions, and broad social, economic, cultural, and environmental conditions in which we live, work, and play. The intersection of the environment and social conditions has important impacts on our health. Specific communities and populations, including children, racial/ethnic minorities, and tribal populations, experience a disproportionate burden of environmental hazards and associated health effects. These differential exposures can play a significant role in health disparities from the onset and severity of asthma to blood lead poisoning to birth defects. This presentation will review the connection between the environment, social determinants of health, and health disparities and highlight activities of the U.S. Department of Health and Human Services to address environmental hazards and health disparities.

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“Environmental Impacts on Public Health in North Carolina: What Is Known? Key Gaps in Our Understanding of State Trends”

Jeffrey Engel, N.C. Division of Public Health, State Health Director

The effects of many contaminants in air, water, and food on the public’s health are not fully understood. This presentation will provide a broad overview of the limited environmental data of ubiquitous naturally occurring and man-made toxins in North Carolina and their links to human health. Examples of policy changes and the effect on environmental improvement will be discussed using the precautionary principal when environmental epidemiologic studies are lacking.

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“Environmental Public Health Tracking: How It Informs Health and Healthcare Decisions”

Greg Kearney, CDC Environmental Health Tracking Branch

The environment we live in plays an important role in our health. However, limited information exists to address basic concerns about our exposure to chemicals and other agents in the environment and the occurrence of adverse health outcomes such as asthma, selected cancers, birth defects and other chronic conditions. In 2000, the Pew Environmental Health Commission urged Congress that a “Nationwide Environmental Health Tracking Network” be established with the goal of reducing and preventing chronic diseases and increasing our understanding of the relationship between the environment and health. In response, CDC created the National Environmental Public Health Tracking (EPHT) Program and a web-based Environmental Public Health Tracking Network (Tracking Network http://ephtracking.cdc.gov/) to provide data and information on how the environment impacts people’s health. Launched in July 2009, the Tracking Network is a surveillance system of integrated health, exposure and hazard information and data from a variety of national, state, and city sources. The Tracking Network features maps, tables, and charts with data about chemicals and other substances found in the environment and selected non-infectious diseases and conditions. The Tracking Network is designed to inform communities of environmental hazards; identify populations at risk and inform public health practice and policy while providing public health practitioners and researchers access to data to further explore the relationships between environment and health.

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WORK GROUP 1: POLICIES THAT COULD PREVENT/REDUCE ENVIRONMENTAL IMPACTS ON HEALTH & HEALTHCARE SYSTEM

“Estimating the Health and Economic Benefits of Federal Air Quality Regulations”

Susan Lyon Stone, EPA Health and Environmental Impacts Division

EPA’s process for setting air quality standards are guided by the Clean Air Act, which identifies several elements, including review of the scientific information regarding pollutants, and conduct of a risk assessment, all under the umbrella of a formal scientific peer review process. In addition, our regulatory development process requires us to estimate the health benefits of setting air quality standards. This talk will present the approach that EPA uses in considering both the quantifiable and non-quantifiable health benefits in setting air quality standards. It will also describe the way that EPA communicates the impacts of air pollution to health care providers and the public using the Air Quality Index (AQI), and some assessments of the effectiveness of the AQI.

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“North Carolina’s Clean Smokestacks Act Delivers Cleaner Air and Better Health”

Bill Ross, Duke Nicholas School of the Environment/Comprehensive Cancer Center

Passed in 2002, North Carolina’s Clean Smokestacks Act has delivered significant reductions of NOx and SO2 emissions in North Carolina and provided significant co-benefits, such as reductions in mercury emissions. As a result of the Clean Smokestacks Act and several other state and federal clean air programs, ozone and fine particle levels in the air in North Carolina have decreased significantly. The bottom line is better health for people and the environment.

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“Building a Diverse Transportation Network and Healthier North Carolina”

Gene Conti, Secretary of North Carolina Department of Transportation

The way people travel has a direct impact on their health as well as the health of those around them. Transportation policy in the past has placed importance on vehicle throughput at the expense of bus lanes, bike lanes and sidewalks. Emphasis on the use of alternative transportation can have significant positive impact on physical activity, a key tenet of human health. This idea can only be implemented through policies and programs that reduce vehicle miles traveled and give people safe, efficient options for getting where they need to go. NCDOT’s Complete Streets policy, which ensures that all modes of transportation are considered in the design process, is one of several examples of how the department is putting this idea into practice.

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“Public Health Impacts of Corporate-Government Relationships: Case of Industrial Agriculture”

Steve Wing, UNC-Chapel Hill, Department of Epidemiology

Clean air, clean water, safe jobs, and safe food are important for preventing disease and promoting health. These goals may be threatened when businesses increase profits by cutting costs of pollution prevention, job safety, and product safety. Government agencies have responded by establishing permitting systems for polluting facilities and regulations regarding job and product safety. However, when corporations collaborate closely with the government agencies that regulate them, lax regulation and enforcement can compromise public health. Operating under government permits, confined animal feeding operations (CAFOs) create unsafe working conditions, pollute air and water, and contribute to development of antibiotic resistance. For example, the State of North Carolina has issued permits for hog CAFOs to exhaust dusts and gases from confinements without pollution controls, locate waste lagoons in flood plains, and spray fecal waste where it drifts onto neighboring homes. Meanwhile state law prevents local health departments from enacting stricter rules to protect public health. Greater independence of government agencies could lead to collection of better data about pollution and health and to more effective regulation and enforcement.

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WORK GROUP 2: RESEARCH/ANALYTICAL TOOLS TO SUPPORT EXISTING POLICY OR POLICY CHANGES TO REDUCE ENVIRONMENTAL IMPACTS ON HEALTH & HEALTHCARE SYSTEM

“Burden of Disease Approach to Prioritizing Environmental Policy Initiatives: A Case Study in the United Arab Emirates”

Jackie MacDonald Gibson, UNC-Chapel Hill, Department of Environmental Sciences and Engineering

Over the past decade, the World Health Organization (WHO) and others have developed new approaches to characterizing the burden of disease due to environmental degradation. The methods are designed to support the development of new environmental policy initiatives to protect public health, but to date their practical application in policymaking has been limited. This talk will present the results of a case study application of burden of disease assessment methods that UNC-Chapel Hill, in collaboration with local partners undertook to support an environmental health strategic planning process in the United Arab Emirates (UAE). In this case study, UNC researchers estimated the number of annual deaths and medical visits attributable to indoor and outdoor air pollution, coastal and drinking water pollution, occupational exposures, and climate change in the UAE. Results of this work formed the basis for developing the UAE National Strategy and Action Plan for Environmental Health. The quantitative and stakeholder participation methods used in this study could serve as models for new initiatives to maximize the benefits of public investments in environmental protection for public health in North Carolina and elsewhere.

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“Valuing Health Benefits of Air Pollution Reduction Policies”

Bryan Hubbell, EPA Health and Environmental Impacts Division

An important element of EPA’s policy process is the estimation of costs and benefits of regulations. Valuing public health benefits of air pollution regulations involves estimation of health impacts, combined with valuation of those impacts using a number of valuation methods, including cost-of-illness and willingness-to-pay. The economic value of future improvements in air quality include substantial reductions in medical costs, as well as large economic benefits from reductions in risk of premature death and pain and suffering associated with chronic illnesses.

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“Using Spatial Analysis to Support Environmental Health Research and Practice”

Marie Lynn Miranda, Duke University, Nicholas School of the Environment and Department of Pediatrics

Recent advances in spatial statistics and geographic information systems (GIS) provide innovative platforms for both diagnosing environmental health problems and for developing interventions. These approaches are especially suitable for addressing issues of environmental justice. This presentation uses spatial analytics to assess whether the Clean Air Act and its Amendments have been equally successful in ensuring the right to healthful air quality in both advantaged and disadvantaged communities in the United States. The talk will include a discussion of when and where spatial techniques can most effectively be deployed to address environmental health issues.

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“Health Impact Assessments: A Practical Framework for Identifying Environmental Human Health Effects & Relevant Policy Solutions”

Kara Vonasek, Health Impact Project, The Pew Charitable Trusts

Many analytical tools focus on quantifying human health risk of environmental exposures, and our ability to gauge and forecast the risk of environmental exposures for humans continues to grow. However, a well defined process for translating scientific data into actionable policy solutions that recognize risk in the broader context of social, political, economic and environmental concerns and tradeoffs is equally important. Health impact assessment (HIA) is a valuable tool for doing just that. HIA provides a framework for bridging scientific analysis and the policy-making process. It uses a practical, well-defined approach that brings together scientific data and health expertise to identify the potential health effects of a new project, proposal or policy and builds in solutions that maximize benefits and minimize unintended consequences. This talk will cover the ways that HIA can be applied to environmental health field and expand its applicability to effective policy solutions and cross-sector collaboration.

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WORK GROUP 3: OUTREACH, EDUCATION & MOBILIZATION ABOUT IMPACT OF ENVIRONMENTAL QUALITY ON HUMAN HEALTH AND HEALTHCARE SYSTEM

“Integrating Environmental Stewardship and Local Economic Development to Enhance Community Health”

Jay Levine, North Carolina State University, College of Veterinary Medicine

Local economies drive household income, and household income is a social determinant of a family’s lifestyle. It determines their access to goods and services, including healthcare services and the built environment in which they live. The social conditions associated with poverty have been linked to obesity, diabetes, the use of illegal drugs, early teenage pregnancy, domestic violence, and high school-drop out rates. Each has a profound family as well as societal cost. Unfortunately, local efforts to enhance local economic development often challenge the health of natural resources; local resources that provide low-cost recreational opportunities for communities. The clashing objectives of community groups driving economic development and community advocates fighting for environmental preservation often divide communities. Planned projects are delayed, the cost of construction rises, and the loss of recreational greenspace often represents a form of social injustice. However, environmental restoration can support and enhance local economic development, and contribute to the health and well-being of the community. A local North Carolina case study is provided as an example of how environmental stewardship is compatible with local economic development.

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“Key Lessons from a Decade of Environmental Health Advocacy: One Physician’s Experience”

Katherine Shea, UNC-Chapel Hill, Gillings School of Global Public Health

The environmental determinants of health and disease were somewhat neglected by the modern health care system in the latter half of the 20th century. A resurgence of interest in and research on environmental health began in the ’90s and continues to grow, but most health care professionals continue to have limited knowledge and skills in this area. While there is little doubt that an unhealthy environment harms human health, improving the environment and/or avoiding dangerous environmental exposures is often outside of the control of the individuals. Often a range of strategies from individual behavior change to large scale systemic change is necessary to modify environmental health hazards. As such multi-level approaches to outreach, education and advocacy are needed to achieve substantive improvements in environmental health. This talk will use a case study approach to describe several outreach and educational strategies, identify lessons learned, barriers to change, and elements of success as a jumping off place for discussion and strategic planning.

“The Lack of Basic Amenities as Indicators of Health Disparities in Low-Income Minority Communities and Tribal Areas”

Omega Wilson, West End Revitalization Association

North Carolina has numerous low-income minority communities and Native American territories that suffer from the lack of “basic public health amenities.” These disparities in clean air, safe drinking water, and toxic free soil creates human exposures that produce poor health, depressed property value, and generally a more contaminated environmental than higher income communities. For the last 16 years the West End Revitalization Association (WERA) of Mebane, NC, has worked with legal, public health, university research, foundation, and government partners in order install first-time sewer and safe drinking water services, pave dirt streets, and remove underground storage tanks leaking cancer causing benzenes and xylenes. As a member of the U.S. Environmental Protection Agency’s National Environmental Justice Advisory Council, Omega Wilson has provided recommendations supporting inter-agency actions focused on environmental hazards reduction that threaten environmental and public health.

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