Testimony
Before the Senate
Subcommittee on Public Health, Committee on Health, Education,
Labor, and Pensions
CDC
Efforts to Develop and Implement an Environmental Health
Tracking System
Statement of
Richard J. Jackson, M.D., M.P.H.
Director,
National
Center for Environmental Health,
Centers
for Disease Control and Prevention
For
Release on Delivery
Expected at 10:00am
on Wednesday,
March 6, 2002
Good morning. I am Dr. Richard
Jackson, Director of the National Center for Environmental
Health (NCEH), of the Centers for Disease Control and
Prevention (CDC), U.S. Department of Health and Human
Services. I would like to thank the Senate Health, Education,
Labor and Pensions Committee for inviting me here today.
I would like to discuss CDC's work to develop and implement
an Environmental Health Tracking Program.
There is no doubt that the
environment plays an important role in human development
and health. Some links between environmental exposures
and disease such as asbestos and lung cancer, and lead
and impaired cognitive development in children, are well
documented. Others, such as a possible link between environmental
exposures and such conditions as childhood cancers, birth
defects, multiple sclerosis, and Alzheimer's disease are
suspected, but still not proven.
In January 2001, the Pew
Environmental Health Commission, chaired by former Senator
Lowell Weicker, Jr., issued a report entitled America's
Environmental Health Gap: Why the Country Needs a Nationwide
Health Tracking Network. The gap that this report
describes is the lack of basic information needed to document
or disprove possible links between environmental hazards
and chronic diseases. Chronic diseases cause four of every
five deaths each year in the United States and have annual
health care and lost productivity costs of $325 billion
according to the Commission's report. The report also
presents a logical and compelling prescription to fill
this gap with an integrated environmental health tracking
network that can rapidly detect and respond to hazardous
conditions and acute disease outbreaks, including those
that terrorists perpetrate. The Pew report also prophetically
indicates that the nation's preparedness against biological
and chemical terrorism underscores the need for a strong
tracking infrastructure that can rapidly detect and respond
to environmental threats and disease outbreaks associated
with terrorist acts.
CDC and ATSDR work jointly
on important environmental public health problems. In
response to the Pew report, by August 2001, CDC and ATSDR
developed a plan of action for a nationwide health tracking
network. This plan, CDC and ATSDR's Proposed Plan
for an Environmental Public Health Tracking Network,
describes a strategy to develop and implement an integrated
tracking system; to develop a trained environmental health
workforce, particularly at the state and local levels;
and to improve collaboration among agencies and organizations
with public health and environmental responsibilities.
Congress appropriated $17.5
million in the fiscal year 2002 budget for CDC to begin
the implementation of a national environmental health
tracking network. These resources will be used to support
the development of pilot tracking programs in selected
states. To achieve a national tracking system, environmental
health capacity and comprehensive tracking programs would
need to be developed in all 50 states. The key building
blocks necessary for effective tracking programs at the
national, state, and local levels include: 1) establishing
collaboration and partnerships between public health and
environmental agencies and organizations; 2) strengthening
state and local capacity in terms of personnel expertise
and the latest technology; 3) developing appropriate,
timely and complete data; and 4) ensuring the timely dissemination
of data and other tracking information to those responsible
for prevention and control programs, to researchers, and
to the public.
The goals of environmental
health tracking are to: (1) develop a system to collect
and link data on environmental hazards and exposures with
data on the occurrence of disease; and, (2) analyze and
interpret the data in this system for use in hazard mitigation
and disease prevention. The critical components of such
a system include: hazard tracking--measuring
the amount, concentration, and geographic and temporal
distribution of toxic chemicals, physical agents, biomechanical
stressors, and other factors in the environment; exposure
tracking--assessing and measuring human exposure
to environmental contaminants, including levels of exposure
among population subgroups; and health outcome
tracking-- monitoring disease events and trends
in health risk behaviors within populations over time
through tracking systems such as vital statistics, health
surveys, and disease registries.
This integrated tracking
system will allow on-going monitoring and dissemination
of information on levels of environmental contaminants
and trends in disease occurrence, facilitate research
on the relationship between environmental factors and
disease, and measure the impact of regulatory and prevention
strategies. Disseminating information, with appropriate
privacy safeguards, to stakeholders, including public
health and environmental officials, policy makers, health
care providers, and the public is essential. With this
information, federal, state, and local public health and
environmental agencies and their numerous partners in
academic institutions, the private health care sector,
and interest groups, will be better prepared to develop
and evaluate effective public health actions to prevent
or control chronic and acute diseases that are linked
to hazards in the environment and, if possible, remove
these hazards from the environment. With this information,
health care providers can provide better care and targeted
preventive services. Further, the public will have a better
understanding of health trends and environmental exposures
in their communities and what actions they as individuals,
or collectively as a community, should take to improve
their health.
The leukemia cluster among
young children currently under investigation in Fallon,
Nevada, as well as historical worker and community exposures
to tremolite asbestos in Libby, Montana, highlight the
need to strengthen the nation's ability to rapidly detect
and respond to disease clusters, disease outbreaks, and
related environmental hazards and exposures. One objective
for linking data on hazards, exposures, and health outcomes
is to assist public health and environmental agencies
in identifying potential problems in a timely manner so
that prompt action can be taken to mitigate hazards, reduce
the potential for exposure, and prevent disease. Over
the past decade, CDC birth defects surveillance data showed
an increase in reported cases of hypospadius which was
suspected of being linked to endocrine disrupters, but
evidence of exposure was not available.
The
recent World Trade Center (WTC) disaster also illustrates
the value of ongoing and integrated hazard, exposure,
and disease tracking data. Site workers and residents
are concerned about health effects from exposures to various
pollutants as a result of the towers' collapse and subsequent
rescue and clean-up efforts. CDC's Environmental Health
Laboratory has evaluated blood and urine samples from
rescue workers at the WTC for exposure to toxic substances.
Since the second week after 9/11/01, CDC has measured
hundreds of samples to test for hazardous exposures to
workers engaged in rescue and recovery, and has worked
to advise the New York City Department of Health, the
Fire Department of New York, and others to establish forms
of worker monitoring that could provide the basis for
a registry for WTC workers. CDC, ATSDR, the Environmental
Protection Agency, the New York City Department of Health,
and others continue to work in tandem to identify and
respond to any increases in asthma and other respiratory
illnesses that may be caused by airborne pollutants associated
with this disaster. Linkage of hazard, exposure, and health
outcome data can provide a comprehensive picture of the
current health status and future health risks for the
community and workers.
CDC and ATSDR have extensive
experience with disease tracking and disease and exposure
registries. For example, CDC funds 45 states, 3 territories,
and the District of Columbia in its National Program of
Cancer Registries, 6 states for possible estuary-associated
syndrome surveillance associated with Pfiesteria and other
algae exposure, 35 states for birth defects surveillance
and data usage activities, and 37 asthma surveillance
projects. Additionally, CDC is implementing a standards-based
approach called the National Electronic Disease Surveillance
System (NEDSS), that enables health data to be obtained
and analyzed from diverse sources and in a secure environment
by state and local public health agencies.
CDC's
childhood lead poisoning prevention program is a classic
example of how the linkages of hazard and exposure data
dramatically improves the public's health. Since the mid-1970s,
CDC has compiled lead hazard and human exposure data.
These data are being used by CDC, state and local public
health agencies, the Department of Housing and Urban Development,
and others to more effectively direct public health efforts
towards identifying substantial numbers of high-risk children
and houses that contain lead paint hazards, conducting
blood lead screening programs, planning and implementing
abatement programs, and educating the public about the
lead hazards that still exist. These hazards include the
exposure of children to industrial sources of lead that
occurs when parents inadvertently bring contaminated clothing
into the home. CDC funds 35 States to track the problem
of adult lead exposure.
How, then, are we developing
the Environmental Health Tracking Program? Using CDC
and ATSDR's Proposed Plan for an Environmental Public
Health Tracking Network as a base, we have convened
four workgroups comprised of over 60 top scientists and
policy professionals from within CDC and ATSDR and from
numerous organizations, including state and local public
health and environmental agencies, EPA and other relevant
federal agencies, academia, interest groups, the private
sector, and others to assist us with the shaping of the
Environmental Health Tracking Program. The four workgroups
are each responsible for providing recommendations on
one of the following categories: (1) organization and
management; (2) data technology and tracking methodology,
(3) tracking system inventory and needs assessment; and,
(4) translation, policy, and public health action. Recommendations
from the workgroups will be forthcoming later this month
and will be used to guide our future actions. These actions
will include providing financial and technical assistance
to a number of state agencies to implement pilot programs
to develop improved tracking methods. CDC will also work
with accredited schools of public health for the establishment,
maintenance, and operation of centers for research and
demonstration with respect to chronic diseases and related
environmental factors and exposures. Continued collaboration
and communications with our partners in this endeavor
also is critical. For example, CDC and ATSDR have worked
with EPA for a number of years and we are expanding this
crucial partnership as we establish the Environmental
Health Tracking Program.
In conclusion, the Environmental
Health Tracking Program is a high priority for CDC and
ATSDR and our partners because it provides a strategic
opportunity to address some of the most challenging public
health problems facing local, state, and national public
health and environmental leaders. Developing a tracking
system is a tremendous challenge, and its successful implementation
will provide information regarding the possible relationships
between environmental exposures and chronic and other
diseases that can lead to interventions to reduce the
burden of these illnesses on the American population.
CDC and ATSDR and our partners have an historic and unique
opportunity to implement a program that will monitor and
safeguard the health of all people living in the United
States.
Thank you for the opportunity
to testify before you today. We would be happy to answer
any questions that you might have.
HHS Home (www.hhs.gov) |
Topics (www.hhs.gov/SiteMap.html) |
What's New (www.hhs.gov/about/index.html#topiclist) |
For Kids (www.hhs.gov/kids/) |
FAQs (answers.hhs.gov) |
Site Info (www.hhs.gov/SiteMap.html) |
Disclaimers (www.hhs.gov/Disclaimer.html) |
Privacy Notice (www.hhs.gov/Privacy.html) |
FOIA (www.hhs.gov/foia/) |
Accessibility (www.hhs.gov/Accessibility.html) |
Contact Us (www.hhs.gov/ContactUs.html)
Last
revised: March 6, 2002