Success Stories from Environmental Public Health Tracking (Part 2 of 2)

September 01, 2016|11:27 a.m.| Samantha Williams

This is the second of a two-part interview with Fuyuen Yip, PhD, MPH, acting branch chief for the Environmental Public Health Tracking Program at the National Center for Environmental Health at CDC. [Click here to read part one]

In part two of my interview with Dr. Yip, she describes some of the CDC Tracking Program’s most interesting partnerships, as well as outcomes and lessons learned along the way.

Is there a partnership that arose from tracking that people might find surprising?

I think one that's very interesting and that might not be something people think of immediately, is our partnership with the National Aeronautics and Space Administration (NASA). We've worked with NASA for many years now and they've been instrumental in providing us with remote sensing data collected using their satellites. The information that they share with us helps us to estimate air pollution levels for the nation. As a result, the Tracking Network is able to provide air pollution information at the state and county level. We also incorporate some of the NASA data to help validate our data, and also to fill in some of the gaps, because the air pollution monitoring network that the EPA has set up is not located everywhere. The NASA data complements our air data and makes it more robust.

Earlier you explained that tracking also encompasses the people who develop and maintain the network. Many states have an interdisciplinary tracking team, which often includes a health educator. Do you have an example where a health educator was particularly instrumental in engaging with the public, leading to an increase in their understanding of health or changes in behaviors?

I agree that public health educators play a very important role in being able to communicate what tracking offers, in a way that's very accessible to a broader audience. We found our collaborations with public health communication experts and educators are very important for the program. One good example is Oregon. 

Radon is a concern for Oregon because based on recent data from home radon test results, they observed that some areas in the state had very high radon levels—despite the fact that the existing risk map identified Oregon as having low to moderate levels of radon. The state thought it would be important to obtain more accurate data on radon hazards and tracking provided an opportunity to capture some of the data collected from home radon tests. The results led them to promote testing and get a better appreciation for radon levels across the state. 

Oregon’s tracking program and its partners developed maps showing radon hazards for sub-county areas—a much more granular scale. They used these maps to help support public education and encourage in-home radon testing, and they published the maps on the health department's radon program webpages, and on Oregon tracking's Facebook page to increase visibility and awareness. They also send that group (specifically health education and communications communities) news releases for media outlets and provided information about radon testing. There was also a lot of TV news coverage and front-page articles in The Oregonian newspaper, especially during the month of January, which is Radon Action Month. 

All of this helped to raise public awareness and encourage testing. Following the media coverage they noticed that the monthly average of visits to the radon program's webpages tripled. The American Lung Association (ALA) of Oregon also shared that they sold nearly 300 testing kits the day that The Oregonian ran the front-page article. The ALA also shared that within three days they sold more radon test kits online than they did for the entire year of 2012. This all happened during the 2013 Radon Action Month. So I think efforts to increase the visibility and communication using public health education were very successful.

The power of tracking really rests largely on collecting and analyzing data from several agencies from within or outside of public health. And those who work with data are all too familiar with the challenges this presents regarding consistency and integration. When faced with challenges of this nature and scale, how has CDC attempted to make the development of a tracking program an easier lift for a state or local health department?

There’s certainly no shortage of data, but there’s definitely been an effort to ensure data are accurate and up to date. When the program began it was faced with the challenge of how best to share data in a consistent manner. So the Tracking Network decided to include a core set of nationally consistent data and measures, or NCDMs, for health exposures and environmental hazards. These NCDMs stemmed from the collaboration between partners and the data stewards—the people who own the data at the national, state, and local levels. CDC then adopted these as tracking standards for consistency across all the grantees. 

As we moved forward to determine what data we should include in the Tracking Network, we worked with a group of experts, including data stewards, to evaluate data’s suitability for environmental public health tracking. We also organized teams of grantees and data stewards to develop recommendations for creating new measures and indicators to include on the Tracking Network. Finally, the content workgroup is a group of individuals who explore other possible indicators that we can potentially include on the Tracking Network.

We now have a system in place where we can work with our partners closely to help determine what data we should be including on the Tracking Network. We also have a process in place to vet these data in a formal fashion.

That answer creates a picture of tracking that relies heavily on data infrastructure and expert knowledge. Is there any support or opportunities available to health agencies or departments who are interested in establishing their own tracking networks but might be faced with resource constraints?

ASTHO’s Environmental Public Health Tracking: Peer-to-Peer Fellowship Program is probably the best example of an opportunity for unfunded states to participate in tracking. The Fellowship helps fellows explore and develop tracking capacity at the state and local level through environmental public health projects. Fellows get support from CDC mentors and learn more about CDC standards and resources for tracking.

In addition to the Fellowship, there are opportunities to receive technical assistance from CDC. We have provided technical assistance in the past to states such as West Virginia and other areas that are interested in building capacity—and these states do not have to be part of the Fellowship to receive this assistance.

Environmental health professionals have limited tools that allow them to demonstrate the value of their services, which are concerned with addressing upstream factors related to hazards and exposures. Do you have an example where tracking was used to communicate the value of their work to the rest of the public health community?

That's a very good question. The Tracking Network serves as a resource to help identify people at risk, and then protect public health. Information from the network also helps educate audiences and provide information to help inform interventions or policies. The speed and accuracy also helps save some money, because the data are available in a very timely fashion. An example related to environmental health professionals is that several of our state grantees have been able to use tracking data to complete state-specific reports that describe the economic burden of some childhood health conditions such as asthma and cancer and lead poisoning. They were able to use tracking data to help quantify costs associated with these diseases, and then estimate a return on investment of public health dollars. Some states include California, Minnesota and New Hampshire.

The Tracking Network is approaching its 16th year. What would you say are some most valuable lessons learned along the way?

I think the biggest one for us is the importance of being able to work collaboratively. I think we've learned that the program's growth and success have been built on the involvement of grantees, stakeholders, data stewards and partners throughout this entire development. They have been instrumental in the implementation and the development of the tracking program and its continued success. I think this approach has definitely helped ensure that everyone's priority needs were addressed and we definitely benefited from the collective people power, and have reinforced this.

In addition, through these levels of engagement we were confident that the most innovative and scientifically sound methods were used. So that has been a very important lesson learned for us, and a huge benefit. And I would have to add that I’m sure everyone who has participated in tracking in some capacity would have to agree.

Tracking is a legislative priority for ASTHO, which has issued a position statement supporting efforts to maintain and enhance the CDC Tracking Network. ASTHO has recently released a request for applications for its 2016-2017 Fellowship.

Read part one of this interview »

Samantha Williams

Samantha Williams is an analyst for environmental health at ASTHO. She coordinates ASTHO's Environmental Public Health Tracking: Peer-to-Peer Fellowship Program and supports projects related to environmental surveillance data. Samantha received a Master of Science degree in environmental health from Macquarie University in Sydney, Australia.