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Volume XXlll, No.1
April 2009
The Independent Medical Business Newspaper
O
ver the last half-century we have witnessed a dramatic
change in our nation’s health
burden, from concern with
infectious diseases such as
pneumonia and tuberculosis,
to treating and managing
chronic conditions like asthma, heart disease, diabetes,
and cancer. The last halfcentury has also spawned
rapid advances in the development and production of
tens of thousands of chemical compounds, many of
which have made their way
into our food, water, soil, air,
and homes.
And while the majority
of Americans believe that
exposure to environmental
factors, such as pollution,
causes increased rates of
disease, evidence linking
chemical exposures to disease is often lacking.
Environmental health tracking and biomonitoring are
two tools that can help us
bridge this gap in the
evidence, and help shed
light on the relationships between exposure to environmental hazards and health
outcomes.
Minnesota’s Environmental
Public Health Tracking
Here, as in other states,
existing data on environmental hazards, exposures
to chemicals, and health
Environmental
health tracking
Bridging the gap between
environmental factors and disease
By Michonne Bertrand, MPH
outcomes have never been
accessible in one place
and systematically monitored. Instead, data are collected across many programs, for various purposes,
and are housed separately.
The newly developed
Minnesota Environmental
Public Health Tracking (MN
EPHT) system at the
Minnesota Department of
Health (MDH) represents a
systematic approach to
gathering and integrating
environmental and health
data. MN EPHT collects relevant information from disparate sources—focusing on
the factors that have the
greatest probability of
affecting public health—
analyzes it, and makes it
available to those who can
act to prevent or control disease. MN EPHT data will be
analyzed to recognize trends
over time and geographic
patterns, to identify disparities in exposures and health
status, and to determine
opportunities for research
and public health action.
MN EPHT includes
three types of data:
• Environmental hazard data
indicate the potential for
people to be exposed to an
environmental contaminant or hazardous condition. These data include
information on water and
air quality.
• Exposure data indicate the
presence of environmental
contaminants in the body.
An example of exposure
data is the level of lead
measured in children’s
blood by clinicians around
the state.
• Health outcomes data indicate the occurrence of diseases or health conditions
that are known or suspected to be linked to
exposure to environmental hazards. MN EPHT
health outcomes data
include information on
hospital visits for respiratory disease and heart
attacks; specific cancers
that are thought to be
linked to environmental
factors; carbon monoxide
poisonings; birth defects;
and birth outcomes such
as low birth weight, preterm births, and mortality.
As other priorities are
identified, additional data
will be analyzed. Some of
the priorities currently being
explored are mortality due
to cardiovascular and respiratory disease; indicators of
climate change; and pesticide poisonings.
As with any data surveillance system, the ultimate goal of MN EPHT is to
drive public health action
and policy. In order to reach
this goal, MN EPHT data
must be accessible and
understandable to a wide
audience of stakeholders.
The data will be released in
a variety of ways in the
coming months.
MDH will release the
first environmental public
health tracking data report
this spring. The report will
include a summary of the
environmental public health
tracking data measures that
are currently available, as
well as a description of the
limitations of the data and
recommendations for
improving the data.
MDH is also in the
process of developing a
Web-based data access portal for MN EPHT. This por-
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tal will provide current,
accurate information to
help inform individual
decisions as well as public
policy to prevent disease
and promote health. The
first stage of portal development will be a public portal
for Web-based queries of
MN EPHT data; this public
portal will be launched this
year. Eventually MN EPHT
hopes to develop a secure
data portal in addition to
the public portal; the secure
portal would grant data
access to specific approved
users, such as local public
health agencies and health
researchers. Specific processes for authenticating
and authorizing access to a
secure portal will be developed to ensure that data are
secure.
Biomonitoring
pilot program
Another tool that has the
potential to shed light on the
links between environmental
chemicals and disease is biomonitoring. Biomonitoring
is the direct measurement of
chemicals in people’s bodies—in their blood, urine, or
some other body fluid or tissue. Depending on how it is
conducted, biomonitoring
can be used to identify populations that are most at risk
for exposure, to track
changes in exposure over
time, and to help target programs and interventions to
reduce exposures.
MDH is currently
implementing three biomonitoring projects as part of
a pilot biomonitoring
program:
• The Minneapolis Children’s
Arsenic Study is measuring
exposure to arsenic in children living in specified
neighborhoods in south
Minneapolis where elevated levels of arsenic were
detected in the soil. Total
arsenic levels are being
measured in the children’s
Resources
For more information about environmental health tracking and
biomonitoring, please visit:
• The Environmental Health Tracking and Biomonitoring programs
at the Minnesota Department of Health (established by the
Legislature in 2007): www.health.state.mn.us/tracking.
• National Environmental Public Health Tracking Network:
www.cdc.gov/nceh/tracking.
• National Biomonitoring Program: www.cdc.gov/biomonitoring.
urine; if the total arsenic
level is above 15 ug/L, the
urine sample is further
analyzed to determine how
much of the arsenic is
organic (generally a safe
form of arsenic) and how
much is inorganic (a
potentially harmful form
of arsenic). The study will
help determine whether
children living in the community as a whole have
elevated levels of arsenic
when compared to the
level considered “normal”
from a health viewpoint
and when compared to
average levels found in the
U.S. population. Results
will be released this year.
• The East Metro PFC
Biomonitoring Study is
measuring exposure to
PFCs (perfluorocarbons)
in adults living in two
communities in Washington County, where the
drinking water was found
to be contaminated with
PFCs. The two communities are defined not by
geographic boundaries,
but by their drinking
water source. The first
community is defined as
households that are
served by the Oakdale
municipal water supply.
The second community is
households with private
wells contaminated with
PFCs in Lake Elmo and
Cottage Grove. The levels
of seven PFCs—the same
PFCs that were measured
in the drinking water in
the east metro area—are
being measured in blood
serum. The study will help
determine whether the
community as a whole
has elevated levels of
PFCs in comparison to
the national average,
when available. Study
results will be released
this year.
• The Lake Superior Mercury Biomonitoring Study
is being conducted at
MDH in collaboration
with state newborn
screening programs in
Wisconsin and Michigan
and is funded primarily by
the U.S. Environmental
Protection Agency. Mercury is being measured in
newborn dried blood
spots. The mercury in the
newborns’ blood indicates
the mothers’ exposure to
mercury while the baby
was in utero. It is anticipated that study results
will be released in 2010.
MDH staff are working
with physicians in each of
the project communities to
ensure that medical providers have the necessary
resources for providing
study participants and other
community members with
appropriate follow-up care
and counseling.
One of the challenges of
the science of biomonitoring
is that the ability to measure
chemicals in people’s bodies
has far outpaced the ability
to explain what the presence
of those chemicals means
for people’s health. For
many chemicals, little is
known about potential
health effects in humans
and the levels in the body
that are considered safe or
unsafe.
As pilot projects, these
biomonitoring studies are
limited in scope. The biomonitoring projects will
determine the ranges in the
levels of selected chemicals
in the study communities
and are not designed to
determine the ways people
are exposed to the chemicals
or the health effects associated with exposure to the
chemicals. However, in making recommendations for
designing an ongoing biomonitoring program, MDH
will consider how biomonitoring data could be used in
the future to support
research to help us better
understand health outcomes
and exposure pathways.
Environmental
health data in action
Community members have
many concerns about the
ways that the environment
around them might be
affecting their health. Given
the current gaps in the data
about the environment and
health, physicians may find
themselves without answers
to patients’ questions.
As time goes on, data
from the environmental
public health tracking and
biomonitoring programs in
Minnesota—and from similar programs in other states
and at the national level—
will provide insights into
noninfectious diseases. As
we learn more about the
role of the environment in
contributing to the occurrence of disease, physicians
will be better able to help
their patients understand
and make informed choices
to reduce exposures to
chemicals and potentially
prevent disease.
Michonne Bertrand, MPH, is
coordinator of the Environmental
Public Health Tracking and
Biomonitoring program at the
Minnesota Department of Health.