The Connecticut Department of Public Health (CT DPH), in collaboration with the CT Department of Environmental Protection (CT DEP), received planning grant funding in federal fiscal year 2002 for the development of CT’s portion of a national Environmental Public Health Tracking Network (EPHTN). The CT EPHT is utilizing a staged approach to achieve its goal to create an EPHT network.
The first stage involved assembling the CT Environmental Public Health Tracking Planning Consortium (EPHTPC or ‘the Consortium’) that represents all facets of the community and consists of technical experts in the fields of public health and the environment as well as other key stakeholders. The Consortium’s primary goal was to provide recommendations for planning and implementing a tracking network in CT. The Consortium’s recommendations can be found in their report, "A New Strategic Direction: A Plan to Implement Environmental Public Health Tracking in Connecticut".
The Consortium has provided critical input to program staff in directing the EPHT network planning process. Key data systems identified through the Consortium process are being evaluated by CT EPHT staff along with the CT DPH and CT DEP programs responsible for these systems. The evaluation is needed to begin the process of integration and development of a standards-based Public Health Information Network (PHIN) / National Electronic Disease Surveillance System (NEDSS) compliant environment in which to conduct surveillance and that includes the capacity to query metadata.
Most of the data sets that have been identified as being necessary to begin a tracking system are already collected by our state environmental and health agencies. Unfortunately, most of the data lives within hundreds of miscellaneous databases rather then one central repository. To determine who has what data and if the data would be beneficial for a tracking effort, interviews were conducted using a specially designed survey by the CT EPHT unit on behalf of the EPHTPC Data Committee. These finished surveys are the initial basis for an ongoing effort toward a larger, collaborative EPHT inventory effort. The inventory surveys serve as a means to determine what health and environmental databases currently exist, what fields are contained within them, and to begin to answer the question: “how might these data be used to inform discussions about the connections between environmental conditions and chronic diseases?”
The information gathered through this process will eventually be housed in a metadata repository. Agency access to the metadata for these systems provides a valuable tool for refining existing or developing new public health activities and policies by making related data more accessible to programs. It is expected that the inventory will continue to be expanded as additional questions are asked and the corresponding information is added in.
The CT EPHT unit has many existing partnerships and is forming new collaborations including the following CT DPH programs: Asthma, Birth Defects, Public Health Laboratory Biomonitoring, CT Behavioral Risk Factor Surveillance System (BRFSS), the Virtual Children’s Health Bureau, Drinking Water Program, Chronic Disease Surveillance, CT Electronic Disease Surveillance System (CEDSS), Occupational Health Assessment, Toxic Hazards Assessment, and Lead Poisoning Prevention Program, among others. Collaborations are also underway with the following CT DEP programs: Air Bureau, Office of Pollution Prevention, Connecticut Climate Change Initiative and Environmental and Geographic Information Center (EGIC). Other organizations with which the CT EPHT unit has partnered with include: UCONN Occupational and Health Center, Northeast States for Coordinated Air Use Management (NESCAUM), CT Poison Control Center, and the New England Asthma Regional Council (ARC).
CT EPHT staff selected the CT DPH Birth Defects and Asthma surveillance systems for their initial system evaluations based on the CT EPHTP Consortium’s recommendations and CDC’s grant requirements. Discussions with DPH staff in both program areas lead to the identification of limitations of their surveillance systems and avenues for improvements and enhancements to address these limitations.
The CT EPHT unit is also a member of the New England Asthma Regional Council whose mission is to “reduce the impact of asthma across New England, through collaborations of health, housing, education, and environmental organizations with particular focus on the contribution of schools, homes, and communities to the disease and with attention to its disproportionate impact on populations at greatest risk.” The CT EPHT unit sponsored a review of the usefulness of Medicaid data for improving the region’s understanding about asthma prevalence and health care utilization in that population and also sponsored a training session for our New England partners on the same topic.
The CT EPHT program is currently collaborating with the CT DPH Public Health Laboratory Biomonitoring Program. The CT DPH Laboratory is the lead state in the Biomonitoring Project of the New England Four Biomonitoring Consortium (NE4BC). The project is a prevalence study of the presence of mercury, lead, and cadmium in umbilical-cord blood of 100 newborn infants per state for each state in the NE4BC. The analytical method utilizes guidance from the CDC for the testing of mercury, lead, and cadmium in blood using Inductively Coupled Plasma- Mass Spectrometry (ICP-MS).
The CT EPHTP Consortium recognized the potential of the BRFSS survey as a valuable tool for collecting information on environmental exposure-related behaviors, assessing the knowledge and perceptions of the adult public about exposures of concern and providing prevalence data for health conditions associated with environmental exposures. While an extensive list of BRFSS health and environmental topics of interest were identified by the Consortium, state specific questions and/or existing
CDC modules do not exist for all the topic areas of interest for EPHT efforts and, for some topics areas, existing questions do not address the particular aspects of the topic of most concern. Evaluation of existing and historic questions to determine those that provide the best measures for EPHT network purposes is ongoing and questions will be developed where none exist. A 5-year strategic plan to implement the identified questions will be developed in conjunction with the CT BRFSS Coordinator and will be based on priorities identified by the Consortium and CDC grant requirements.
The Consortium recognized drinking water as an important mode of exposure to environmental toxins and made specific recommendations to evaluate private well water and public drinking water data for possible linkages with health outcome data. The Consortium’s literature review indicated moderate evidence for some associations between chlorination by-products and adverse pregnancy outcomes, possible associations between arsenic and organochlorine compounds found in drinking water with bladder, gastrointestinal tract and other cancers, and association of nitrate levels in drinking water with an increased risk of stomach cancer and bladder cancer. The CT EPHT staff met with the CT DPH Drinking Water Program staff to begin an evaluation process for the Safe Drinking Water Information System (SDWIS). The CT SDWIS system contains information on 700 monitored analytes in community and non-community drinking water supply sources including over 3,000 public water supply systems that serve approximately 80% of Connecticut’s population. The evaluation of incorporating public water supplies data, analyses, and results into the tracking system includes the completion of an inventory survey.
Through the database inventory process, CT EPHT staff found that an established information system for handling private well water does not currently exist. CT EPHT staff are proposing the development of a Well Tracking Application (WTA) pilot system that will allow state licensed well drillers, laboratories and local health officials to enter well data on-line via the CT EPHT portal website.
The CT EPHT unit is also collaborating with the Northeast States for Coordinated Air Use Management (NESCAUM). NESCAUM has provided CT EPHT with criteria air pollutant concentration data, relevant meteorological data, and monitor locations for the data time frame of 1997-2003 from the US EPA Air Quality System (AQS). They are also assisting CT EPHT with defining appropriate methodologies for analysis and have completed an evaluation of criteria pollutants in ambient air including ozone and PM2.5 for tracking purposes.
CT EPHT staff are also engaged in an assessment of a list of potential indicators for use in the CT EPHT network. Review of these indicators to determine if they are realistic in terms of data availability, ease of integration, usefulness for program/policy planning, accuracy and sustainability is ongoing. For more information on the CDC Environmental Public Health Indicators Project go to: http://www.cdc.gov/nceh/indicators/default.htm
 Ward MH, Cantor KP, Riley D, Merkle S, Lynch CF. Nitrate in public water supplies and risk of bladder cancer. Epidemiology 14:183-90 (2003).