The causes of chronic disease are varied and complex but a growing body of research shows that environmental factors are increasingly implicated1,2;
There is a gap in critical knowledge about etiology that exists because of the lack of systematic data on the prevalence, incidence, pattern and trends of chronic disease and environmental factors that may relate to such chronic diseases.3 In addition, there is a lack of basic information available that can document possible links between environmental hazards and chronic illness. This lack of information is hindering our practitioners, communities and public health providers from understanding how the environment actually links to a broad array of chronic diseases;
To date there is still no comprehensive system that enables public health officials to explore the connections between chronic diseases and conditions and environmental exposures and hazards. The tracking programs that do exist at the state and local levels are inconsistent because there are no agreed-upon minimum standards or requirements for environmental health tracking. In addition, much of the data collected are never analyzed or interpreted in a way that could identify targets for further action4;
In 2000, following two years of research on the current public health capabilities to understand and respond to environmental threats, the Pew Environmental Health Commission proposed the development of a Nationwide Health Tracking Network that would work to effectively close these critical information gaps;
Effective environmental health tracking requires a coordinated approach that identifies hazards, evaluates exposures and tracks the health of the population. Environmental hazard tracking identifies potential hazards and examines their distribution and trends in the environment. Understanding exposure levels is essential in understanding and preventing environmentally related disease;
A comprehensive tracking network would: Identify populations at risk and respond to outbreaks, clusters and emerging threats; establish the relationship between environmental hazard and disease; guide intervention and prevention strategies, including lifestyle improvements; identify, reduce and prevent environmental risks; improve the public health basis for policy making; enable the public’s right to know about health and the environment; and track progress towards achieving a healthier nation and environment5;
The system will assist in enhancing the ecologic correlation between health and environment, and initiate the necessary data to encourage carefully designed epidemiologic studies;
Information from a nationwide environmental health tracking network would provide everyone from public health officials and health care providers to biomedical researchers and policy makers with information regarding changes in disease patterns and environmental conditions, to illuminate causal pathways in environmentally-related illness. The network would facilitate the work of public health departments in identifying chronic disease clusters and enable physicians and other health care providers to have a greater impact on the health of their patients;
In addition, we recognize that state and local health departments need persons trained in epidemiology, environmental health, chronic disease investigation, information technology, and other relevant expertise, as well as reference laboratories to track chronic disease and evaluate community exposures. Replication of NHANES (National Health and Nutrition Examination Survey) is needed at the community level (CHANES) so that regions, states and localities can call for special studies utilizing the national resources available as a basis for comparison. This would allow public health officials to accurately identify exposures that have occurred and gain an understanding of whether the exposures have an impact on health;
Recognizing that integration of data systems and collaborative programs and partnerships among environmental health professionals and other parts of the public health and medical system also are lacking;
Recognizing that the support and enhancement of a structure able to monitor chronic disease will also assist in more effective preparation for immediate public health emergencies;
Recognizing that several systems are already in place including the biomonitoring project ongoing at the Centers for Disease Control and Prevention. In 1999, 27 chemicals were added to the NHANES examination, providing information on the magnitude and extent of the population's exposure to the built and natural environmental contaminants in the air, water, soil, and food. In 2000, 89 additional chemicals were added, and though the information is still relatively limited, it has been the basis for the fist and second National Report on Human Exposure to Environmental Chemicals;
Recognizing that the U.S. Environmental Protection Agency collects environmental exposure data relevant to human health and continued partnership with this agency is critical;
Understanding that several states in the country including Montana, California, and Texas have passed legislation supporting tracking and surveillance systems;
Recognizing that a comprehensive, nationwide disease-tracking system for chronic disease could help illuminate more clearly the relationship between environmental risks and disease, especially among children, the elderly and other vulnerable populations, identify who is most at risk for environmentally related and exacerbated illnesses and guide our intervention and prevention efforts;
Noting that in FY 2002 Congress appropriated $17.5 million as the first step in the development of a nationwide health tracking network -- the money has been used for the development of pilot projects in 17 states that will be the building blocks of nationwide health tracking;
Noting also that in FY 2003 congress appropriated $28 million for continued support of this initiative;
And because more than 100 state and national health and environment organizations have signed on in support of this initiative including: the American Lung Association, Association of State and Territorial Health Officials, Science and Environmental Health Network, National Association of School Nurses, Physicians for Social Responsibility, March of Dimes Birth Defects Foundation, Trust for America’s Health, Natural Resources Defense Council, U.S. Public Interest Research Group, and the Catholic Health Association of the United States among many others.
The American Public Health Association calls upon government officials to continue to support enhanced funding for CDC and the Agency for Toxic Substances and Disease Registry for a nationwide health tracking network in partnership with EPA and advocate at the federal and state levels for public health resources to more effectively monitor, investigate, and respond to chronic diseases of potential environmental origin and develop appropriate prevention strategies.
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