CDC’s Public Health Emergency Preparedness (PHEP) cooperative agreement has been a critical source of funding for the nation’s state and local public health departments since 2002. This annual grant funding has built a strong public health preparedness foundation that is now showing some cracks as PHEP dollars continue a steady decline. For California this will mean almost 8%, or $3.2 million, less in 2013-14 than this year. When California’s 62 environmental health programs receive PHEP support they typically do so through their local public health department. This support will likely become rarer in the future as local health departments are forced to make significant cuts. The end result will be an impact to the state’s ability to effectively respond to public health and environmental health emergencies. How is your state dealing with this challenge?
Ionizing radiation fields and contamination are not a part of the day-to-day business for Environmental
Health Specialists. This series will provide some limited background and activities related to emergency
preparedness and the EHS.
As an Emergency Planner, I have leaned heavily into our environmental health staff, for a few simple
reasons; they are knowledgeable in many areas of public health, skilled at enforcement, skilled at
interviewing and have a demonstrated willingness to achieve the goals of public health.
There has been an increasing emphasis in the planning arena to respond to Radiological Dispersal
Devices (RDD) or “dirty bombs”, Radiological Exposure Devices (RED), and improvised nuclear weapons.
I will address these devices and importantly, the environmental and epidemiological implications in
Ionizing radiation is that part of the electromagnetic spectrum that has particles and waves of sufficient
energy to separate electrons from atoms, creating ions. In sufficient quantities over a short time, this
radiation can cause prompt symptoms in various body systems. Dose rates over an extended time can
result in no discernible damage or the development of some cancers.
Important for each of us to understand, and be able to communicate with the public, is that we
are exposed to ionizing radiation everyday or our lives. That granite countertop, the glazed tiles in
bathrooms and schools, ceramic coffee cups and the people we allow in our personal space are all
emitting ionizing radiation.
Next: Man-made sources in our communities.
Although Climate Change is a global phenomenon, its impacts are most certainly local. A year of extreme drought, forest fire and high temperature has forced local health departments to grapple with the immediate public health implications of a changing climate. These impacts paired with decreasing resources for community health and prevention efforts have left front line public health with a tremendous challenge. It is essential that public health jurisdictions take steps now to proactively prepare and adapt to change; by doing so, we will be better positioned to build resilience to the impacts of climate change.
One concrete way to take action now is to develop a plan. The Centers for Disease Control and Prevention is currently pilot testing a new climate planning framework with several state and county health departments. The goal is to help local health departments better identify how climate change will impact their area, who is vulnerable to those impacts and to prepare. Their framework, entitled BRACE (Building Resilience Against Climate Effects) is a five step process:
Step 1 Forecast Impacts and Vulnerability Assessment:
The purpose of this step is to set the stage of your assessment. Gather, present and understand the local climate data and brainstorm potential health impacts. (Example: the climate data shows summers will be hotter, a potential health impact is increased heat-related morbidity and mortality)
Step 2 Health Risk Assessment:
The primary purpose of this step is to identify sources of climate-related health data, measures and indicators. Use these data to both qualitatively and quantitatively assess the current status of climate-related health and identify how those health outcomes will be affected by climate change.
Step 3 Intervention Assessment:
The purpose of this step is to identify the most suitable health interventions for the health outcomes affected by climate change. Assess the effectiveness of those interventions and your capacity to implement them.
Step 4 Health Adaptation Planning and Implementation:
The purpose of this step is to develop and implement a plan that introduces program, policy and operational solutions that address the health impacts of climate change. Focus on implementing health interventions into existing plans or processes.
Step 5 Evaluation:
The purpose of this step is twofold:
Process evaluation: Regularly monitor the climate science to ensure the identified health outcomes and solutions stay relevant.
Outcomes evaluation: Ensure that climate change is considered in broader public health planning and implementation activities.
The framework also has two critical points to consider:
- Stakeholder engagement is an important value that should be practiced at every stage of the framework. Engage and foster relationships with public health partners and the vulnerable populations identified in the early stages of assessment.
- Prioritizing your health impacts focuses your work and will set the stage for meaningful and impactful climate preparation strategies. Prioritizing can happen at any of the first three stages and should be based on the quality and availability of data, community concern and existing climate action.
The hope is that after implementing the BRACE framework local health jurisdictions will be better situated to prepare for a changing climate and better protect the communities they serve.
To see which departments are funded to pilot the BRACE framework and track their progress visit the CDC’s Climate-Ready States and Cities Initiative website.
Health Impact Assessments (HIA) are an emerging trend in public health in the United States. There are a growing number of recommendations, guidance, and workshops regarding how to implement these assessments within communities. The World Health Organization has defined Health Impact Assessments as “means of assessing the health impacts of policies, plans and projects in diverse economic sectors using quantitative, qualitative and participatory techniques.” Here in the U.S. the CDC has taken steps to promote these assessments and provide information to practitioners. They have created a factsheet to inform those in public health on the major steps that need to be taken as well as provide resources and links to guidance from other organizations.
The field of environmental health could benefit from implementing a Health Impact Assessment regarding the threats faced from the environment. Practitioners are already familiar with environmental impact assessments, but this gives further guidance on how to protect the health of communities. Many of the steps included in the CDC guidance align with common practices in environmental health, including screening, assessing risks, reporting and evaluation. However, the added bonus in the Health Impact Assessment framework is that is gives a groundwork for formulating policies and procedures that can implemented to educate and protect the public from the threats faced from the environment.
We encourage those attending the SOPHE Annual Meeting to attend the workshop on Health Impact Assessments (Thursday, October 27th, 6:00 to 9:00 PM).
By: Pete Baril, Western Upper Peninsula Health Department, Hancock, MI
In this post I will try to speak directly to those working in the emergency management field. I feel vaguely qualified to do this as I work in the field of public health preparedness and I understand the daunting task of planning for emergencies. In spite of my current position, my professional “roots” are deeply set in environmental health, and I feel compelled at every opportunity to extol the virtues of the sanitarian. Yes, you have a local sanitarian; you can typically find them working for your city or county health department. Look them up, make an appointment (they are very busy), introduce yourself, and see what they can do for you. I would be willing to bet it’s more than you thought. Perhaps your concerned about shelter or food service sanitation, debris management, vector control, etc. How about solid waste, wastewater, drinking water? I could go on and on, but I recommend making the connection and getting the gritty details on your own. Sanitarians or Environmental Health Specialists as they are often called, have a diverse, and oftentimes unique skill set in your community. They are well versed in dealing with the general public, business owners, and high stress situations. In addition to their education, experience, and ability to work with people, they also bring another less obvious asset to your planning and response system… they know your community inside and out.
A trip to your typical environmental health office can arm you with an abundance of information. Drainage issues, soil composition, surface water quality, areas of groundwater contamination, details pertaining to food service operations, daycare centers, schools, churches, fairgrounds, port-o-potty companies, waste haulers and much more. These folks keep a watchful eye over a variety of items in your community, and because of this, they develop a local knowledge base that no “office dweller” could ever hope to amass. This source of local knowledge should not go untapped. The task of planning and response coordination is difficult enough, do yourself a favor, and pull environmental health into your process BEFORE you find yourself knee deep in something only a sanitarian can identify.
In April of 2011, the American Public Health Association released the guidebook “Climate Change: Mastering the Public Health Role.” This guide presents the basic science behind climate change, provides an outlook on the impacts on health, and gives perspectives in state and local public health preparedness planning in light of a changing environment. It is a practical and data-driven resource that is certainly recommended for practitioners in environmental health and public health preparedness. Today, the National Institute of Environmental Health Sciences released a statement in which it outlined it’s support for several research projects regarding the effects on human health due to climate change. Many of these studies are population driven, looking at which specific populations may be the most vulnerable to the changes our planet has gone through and will continue to go through in coming years.
It is important to recognize that studies such as these (looking at effects of air quality, extreme heat scenarios, and effects on vulnerable populations) will provide the data needed for public health professionals to make informed decisions regarding education of the public, planning for emergencies, and how to mitigate negative health effects from the environment. Whether we recognize it or not, the effects of climate change represent a paradigm shift in the way we approach public health preparedness and environmental health. The scenarios that data from these studies yield could lead to new ways to create preparedness plans, new techniques in informing the public of threats, and the forging of new community partnerships never envisioned before by public health professionals. The vulnerable populations could become even more vulnerable. The threat to our urban and coastal areas may become even more heightened than it is today.
While we await the results of such studies to enlighten our thinking and inform our efforts, we need to be thinking about how we can act now. “Community Resilience” is the term day, week, month, or the year. How can we inform our communities that threats from climate change are tangible, but at the same time let them know we are planning for them? How will our planning efforts change and who else needs to be involved? For now, there may be more questions than answers. However, we should be at the ready, knowing that a change in our climate means a change in our thinking, planning, and actions around protecting the health of our communities.
One can make the argument that all of us involved in the world of public health are educators. We may not where the label of “health educator”, we may not come from a school of health education or even focus on it our everyday work. But at some point or another we have all had to educate members of the community or even our colleagues regarding protection of our health and wellness. Environmental health practitioners have a role in reaching out and educating their population on the hazards to their health from the environment. They are playing the role of health educator.
One of SOPHE’s goals is to advocate for a more comprehensive form of public health education in our nation’s school systems. Schools are critical avenues through which we should be working to improve the standard of health education. That being said it is important for us to paint the picture of school educators as health educators. They are in the company of these children five days a week, nine months out of the year, and can have an enormous impact on health related decisions these they make. While the ultimate goal would be to have a comprehensive curriculum, where all areas of public health are addressed in our education system, we at least can start small with some of the resources we currently have in place. In particular, there are a number of resources and advocates for children’s environmental health education (geared both to the children and their teachers). We encourage health educators and environmental health professionals in their role as educators to peruse these resources and join SOPHE in advocating for a more robust infrastructure of health education in our schools.
Find out more:
Survey findings from the National Association of County and City Health Officials (NACCHO) study of local health departments showed a20% elimination or reduction of preparedness workforce and 18% elimination or reduction of environmental health workforce from July 2010 to June 2011. As funding levels may continue to decrease and staff continue to be cut, you are going to have a the remaining health department employees wearing many hats and being thrust into roles they are not accustomed to. When preparedness positions are cut, it undermines the ability of that community to be prepared to respond to emergencies. When environmental health positions are cut, it takes away an avenue to eliminate threats to health from the environment, online pokies game as well as educate the community about these threats.
In step health educators. The general perception of those involved in health education and promotion is of an individual trying to reduce levels of chronic disease, slot machines online influence healthier lifestyle choices, and promote overall good health to the population. These professionals harbor the skills to educate and interact with the community better than anyone else in public health. Why is it then, that the fields of preparedness and environmental health have done little to utilize the skills of these individuals? It”s not for lack of want to be involved from health educators. As a SOPHE employee I”ve spoken with health educators who have notified their local preparedness coordinator or staff member that they are willing and able to assist in educating the public on how to be prepared and to be aware of the threats they may face. Now is the time to take advantage of health educators. With dwindling funding and resources for preparedness, the onus will fall on the general population to make sure they are prepared. But they need help. The kind of help that can come in the form of stylized education that only the great individuals working in health education and promotion can create.
In the past several years, public health preparedness planning on both the local, state, and national level has begun to focus in on specific segments of the population, particularly those deemed at-risk or vulnerable. These populations often have a different set of needs in an emergency and planning efforts need to be conducted accordingly. Communities around the country face different sets of hazards and public health professionals analyze these hazards, build their plans for the their population with considerations and specific response protocols for the at-risk populations within their jurisdiction.
This being said, it should be considered that environmental health education and services be conducted in a similar fashion, with the needs of specific segments of the population in mind. These different groups online casino spiele can face an array of health effects from their environment that may vary greatly from that of the general population. There is much that can be learned working cooperatively with preparedness coordinators about how to slot machines online not only educate at-risk populations of the potential hazards their community faces but also of the threats to their health from the environment. The principles and methods of educating these populations are the same no matter what type of public health message is being conveyed to them.
While there are environmental health education resources for specific at-risk populations that have been developed, there is work yet to be done. Education regarding environmental health and preparedness can and should be streamlined into one, recognizing a true an “all-hazards” approach to public health planning and response. It is a paradigm shift that can have a positive impact on the health and readiness of all segments of the population.
For resources in promoting environmental health in communities, including talking points for certain at-risk populations, visit ATSDR”s Environmental Health and Medicine Education page or the SOPHE Environmental Health & Emergency Preparedness site.
In the world of first responders, we come across and interact with all types of people from the general population in all kinds of living conditions. We enter homes and environments that have obvious hazards outside of the emergency we may be responding to at the time. Anything from lead paint on walls (or toys), mold, bad sources of water, and poisons such as arsenic, cabon monoxide and radon. Some of the residents of these homes and neighborhoods are aware of these threats and the negative health effects, but many are not. As it is the role and duty of first responders to come to slots machine online the aid of those people in need, our nature is to want to do something spielautomaten about the environmental health hazards we witness. The questions of “what can we do to gokautomaat online online casino slot machines mitagte these circumstances?” and “can we pass this information along to people who can make a difference?” come to mind, even in an emergency situation.
It is important that first repsonders stop to think about just how many incidents we respond to and what kind of impact we leave in our wake. In our efforts to save lives and property, are we actually doing any harm to those very entities we are trying to help? Did we do the best we could to preserve the environment and did we leave a footprint on the environmental health of those we serve? These are important things to consider as is the notion that first responders can certainly have an impact on the health of the enviromnent and act as a conduit for information that can help communities improve the health of the environment around them.
Author: Michael Hatch, Stephens Memorial Hospital, Norway, ME
Environmental Health education materials are available from the Agency for Toxic Substances and Disease Registry (ATSDR), please find links on the SOPHE Environmental Health & Emergency Preparedness website: http://www.sophe.org/EHEP/resources.cfm