Workshop discussions were focused on the gaps and barriers in fulfilling state and local environmental health information needs. These discussions led to the development of potential solutions, with an emphasis on actions that the Federal Government, through its Environmental Health Policy Committee, could take to improve state and local environmental health information and surveillance capabilities. These broad-based solutions were organized around seven roles or functions of the Federal Government with respect to its relationship with states and localities. Examples of solutions ranked as high priority by participants are outlined below, according to the seven functions.
Facilitator of Consensus
The Federal Government plays a unique role in being able to
convene national experts to reach consensus on important issues.
In this capacity, it should guide and encourage the development
of a common data architecture that cross-cuts programs (not
necessarily unique to environmental health). This includes the
development of minimum standards and core variables for
environmental health data collection. In addition, the Federal
Government should develop consensus on basic needs and essential
competencies of environmental health
programs, including types of personnel needed at all levels of
governmental public health. The Federal Government can help
ensure the adequacy of training in schools of public health, and
other schools involved in training environmental health
professionals, as the role of environmental health practitioner
has changed from that of sanitarian to facilitator of coordinated
community approaches.
Program Manager
In carrying out its executive branch duties, including managing
the programs for which it is statutorily charged, the Federal
Government should provide the capacity for localities to use the
data they are transmitting to state and federal levels; develop a
national environmental health research agenda based on the needs
of states and localities; ensure that newly-developed federal software and databases are compatible with commercial operating
systems and allows for the exporting and importing of data with
commercial applications; and evaluate the status and quality of state public and environmental health data.
Source of Resources
With its ability to provide resources to address public health
problems at the state and local levels, the Federal Government
should implement the block grant approach for state and local
environmental health programs (e.g., EPA performance
partnerships); direct funds to states and localities, (e.g., for
continuing education scholarships, localized research, community
interventions, and for laboratory capacity building in
environmental health programs, etc.), considering both community
need and the quality of proposals; and provide or allow use of federal funds for data entry staff or for electronic capacities
(i.e., hardware).
Technical Expert
As a provider of technical expertise and training for state and
local practitioners, the Federal Government should develop
environmental health training programs for public health
personnel and other professionals in the field of environmental
protection (e.g., partnering with schools of public health;
undergraduate, environmental health program staff; and
practitioners); continue the expansion and updating of
information made available through the Internet to improve
availability and access to environmental health information;
expand its commitment to internships for students, public health
personnel, and environmental protection personnel; and assist
local agencies in the interpretation of data, by the efforts
listed above and by facilitating staff exchanges.
Leader
In its role as a leader of sound public health policy and
practice, the Federal Government should encourage stronger ties
among environmental regulatory, environmental health and other
public health activities; enhance compatibility of data bases;
and assist HHS in incorporating the best science has to offer
into standard practice settings.
Integral Part of Public Health System
As an integral part of the public health system, the Federal
Government should create staff exchange opportunities to get federal experts and faculty from schools of public health,
undergraduate environmental health programs, and other schools
involved with environmental protection, into state and local
practice settings, and vice-versa (allow local experts to
temporarily serve at the federal level). The Federal Government
can also encourage staff exchanges between state and local
environmental protection and environmental health agencies.
Congressional Liaison
The Federal Government can assist stakeholders from states and
localities in contributing to Congressional discussions on
environmental policy. To help meet its Congressional mandates
(e.g., GPRA), the Federal Government should
reaffirm on behalf of localities the need for comprehensive
demographic information, developed by the U.S. Census, for
environmental health planning and program development.
The final charge to workshop participants was to identify some potential short-term strategies for consideration by the EHPC, as the agent for change among its member agencies, that could set the stage for implementing some of these solutions. Suggested strategies included:
- Healthy People 2010: The national objectives-setting process for 2010 could facilitate development of new baselines and tracking data for monitoring progress. Environmental health should play a more prominent role in the development of these objectives, building upon the progress made during Healthy People 2000 efforts, including a special section within the Healthy People 2010 publication on environmental health which identifies current partnerships and describes new methods of integration with other public health areas. Healthy People 2000 Objective 11.16 "Establish and monitor in at least 35 states plans to define and track sentinel environmental diseases" could be set as a top priority.
- Government Performance Results Accountability (GPRA): The suggestions contained in the results of this workshop could help the Federal Government in meeting provisions of this Act by streamlining data systems and promoting expanded usage of existing systems. Enhanced environmental health information will not only improve public health, it will make it easier to promptly prove the efficacy of interventions, and validate the appropriateness of continued funding or additional resources.
- Centers for Disease Control and Prevention, Health Information Surveillance Systems Board (HISSB): The EHPC could send a message to the (HISSB) Board that environmental health data and surveillance systems should take on a higher priority for this group. The group could be instrumental in developing or proposing minimum structural and data standardization requirements for environmental health databases that would improve the linking potential of databases and interoperability with different types of hardware/operating systems.
- Other federal agencies: Opportunities for improving environmental health information access and usability might exist in agencies other than the Environmental Protection Agency or Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry, where environmental mandates are being carried out (e.g., Department of Defense, Department of Energy, Food and Drug Administration, Federal Emergency Management Agency, and National Institutes of Health).
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