Healthy People 2000 Consortium Meeting November 7, 1997

Summary of Breakout Group Discussion Concerning Priority Area 11: Environmental Health

I. Structure of Environmental Health Focus Area

A. Special Populations

The group agreed that "eliminating health disparities" was the most appropriate goal. While setting single targets is a good idea, the gaps that do exist must be kept in sight. It is possible to eliminate health disparities (e.g., Washington, DC, has its lowest infant mortality rates in a decade and the numbers continue to go down). Having agreed that setting equal targets was a good idea for 2010, governments must continue to target resources at populations that need them the most.

B. Vision Fan

There was a general feeling that the Vision Fan was appropriate because it tied people and communities together. It is important that the overarching goals are related to all parts of the fan.

Comments of other focus areas on Fan:

Infectious Diseases needs a stronger environmental component.



The "Host-Agent-Environment" paradigm demonstrates that to be a factor, infectious diseases need all three, including the environment. For example, greenhouse gases may result in increased malaria areas and rates.

Add consumer products to Food and Drug Safety (e.g., cosmetics are risk factors for cancer).

Unintentional Injuries could include an environmental component (e.g.,. safer highway designs, handguns, designing safer stairs).

II. Environmental Health Objectives for 2010

The breakout session held a healthy discussion of the existing HHS and EPA objectives and recommended a number of new proposals.

The group agreed that tracking the Nation's Toxic Release Inventory (TRI) only involves tracking potential exposure to the public but not potential exposure for the individual. Exposure does not tell you what gets into the human system. We need to look at biomarkers to tell us what gets into the human system (finding the data is the problem).

The group then reviewed the list of approximately 35 new environmental health objectives that were developed at a meeting of State, local, Federal, and nongovernmental organization representatives in October 1997 (see table below). The table is divided into seven areas of environmental health including Air Quality, Food Quality, Healthy Homes/Communities, Infrastructure, Biomonitoring, Surveillance and Training, International Environments, Toxics/Waste, and Water Quality. Several suggestions were raised:

2010 needs to track production, use, and disposal of household pesticides.

In addition to tracking housing inspectors, we should track State health inspectors.

While weathertight housing is an interesting objective, there must be a balance (i.e., weathertight houses are more important in States with cold winters or hot summers).

Track the number of States that require private well inspectors. How often is an inspection required if at all.

Track improvements to monitoring and inspections for water systems.

Track technology that would decrease the amount of hazards released back into water and soil.

In addition to tracking training programs in risk communications, consider tracking risk assessment programs.

Track uniformity in setting international environmental standards.

War veteran groups should be added to Consortium.

California and Florida are models for tracking migrant workers.

Important to track birth defect rates that may be related to environmental factors.

Track radiation in the environment from past explosions.

One participant who could not attend the Consortium faxed in a recommendation that because the standards for ozone and particulate matter have been revised, the baseline proportion of the population living in attainment areas will change, and thus the target objectives will have to change as well. When setting new objectives, it is important to note that implementation of the new standards will not be completed until considerably after 2010.

The fax also addressed the asthma objective and recommended that we add indoor and outdoor environmental controls such as controlling indoor air pollutants in homes and schools as well as in other public buildings.

Some suggested tracking more sentinel diseases among animals (e.g., canary in the cave). Examples mentioned include deformed frogs in Minnesota and the pfiesteria outbreaks in the mid-Atlantic States.

Another suggestion was to track water-related cryptosporidium (it's not good enough to track populations being served by municipal water systems, we should track populations being served by effective water systems).

Table of Existing and Proposed Environmental Health Objectives for 2010

Air Quality
Chair, John Schelp, NIEHS/NIH
schelp@niehs.nih.gov

HP Objective or EPA Milestone	Text of HP 2000 Objective or EPA 2005 Milestone	Comments/Proposed Modifications/Proposed HP 2010 Objectives
HP 2000 11.1	Reduce asthma morbidity, as measured by a reduction in asthma hospitalizations to no more that XX per 100,000 people.	Shared with Healthy Homes/Communities (See below). Should there be separate asthma targets for special populations?
EPA 2005 1.1. (Replaces HP 2000 11.5)	By 2010, make the air safer to breathe for an additional XX million Americans living in areas that do not meet national ambient air quality standards.	Modify to focus on population based data
HP 2000 11.17	Reduce to no more than XX% the proportion of children aged 6 and younger who are regularly exposed to tobacco smoke at home.	Modify to focus on broader exposed population, maybe utilizing continued levels. Shared with Healthy Homes.
		Issues or proposed objectives from Oct 27-28 meeting at NIH: Skin Cancer

Note: HP 2000 Objective 11.2 has been dropped from Environmental Health and will be addressed in another focus area.

Food Quality
Chair, Chris Kochtitzky, NCEH/CDC
csk3@cdc.gov

HP Objective or EPA Milestone	Text of HP 2000 Objective or EPA 2005 Milestone	Comments/Proposed Modifications/Proposed HP 2010 Objectives
		Issues or proposed objectives from Oct 27-28 meeting at NIH: Raw vegetables contaminated from untreated animal waste in fertilizer and irrigation water Mercury and other bioaccumulating chemicals Pesticide use and pesticide residues Foodborne pathogens Irradiation Inspections Food code Track seafood inspectors Track E. coli and salmonella outbreaks

Healthy Homes/Communities
Chair, Chris Kochtitzky, NCEH/CDC
csk3@cdc.gov

HP Objective or EPA Milestone	Text of HP 2000 Objective or EPA 2005 Milestone	Comments, Proposed Modifications, or Proposed HP 2010 Objectives
HP 2000 11.1	Reduce asthma morbidity, as measured by a reduction in asthma hospitalizations to no more that XX per 100,000 people.	Shared with Air.
HP 2000 11.4	Reduce the prevalence of blood lead levels exceeding 15 µg/dL and 25 µg/dL among children aged 6 months through 5 years to no more than XX and XX, respectively.	Shared with Toxics.
EPA 2005, 6.2 (Replaces HP 2000 11.6)	XX million home will have been voluntarily tested for radon, corrective action will have been taken in XX million homes, and XX million new homes will have been built with radon-resistant features, resulting in a XX percent reduction from 1985 levels in the number of Americans exposed to elevated radon in their homes.
HP 2000, 11.11	Perform testing for lead-based paint in at least XX percent of homes built before 1950.	Identify additional sources of data for tracking this objective.
HP 2000, 11.12	Expand to at least XX the number of States in which at least XX percent of local jurisdictions have adopted construction standards and techniques that minimize elevated indoor radon levels in those new building areas locally determined to have elevated radon levels.
HP 2000, 11.13	Increase to at least XX the number of States requiring that prospective buyers be informed of the presence of radon concentrations in all buildings offered for sale.
		Issues or proposed objectives from Oct 27-28 meeting at NIH: Indoor Air Weathertight housing Allergens Household hazardous waste Poisonings "Hazardous" lead as opposed to simply the presence of lead Pesticide exposure from household use Environmental Justice Noise Pollution Tracking number of housing inspectors Tracking vermin Tracking dust samples through HUD or NHANES Addressing other environments: schools, day care centers, playgrounds New home building standards Develop a tie-in with the energy-audit programs

Infrastructure, Biomonitoring, Surveillance, and Training
Chair, Gib Parrish, NCEH/CDC
rgp1@cdc.gov

HP Objective or EPA Milestone	Text of HP 2000 Objective or EPA 2005 Milestone	Comments/Proposed Modifications/Proposed HP 2010 Objectives
HP 2000 11.16	Establish and monitor in at least 35 States plans to define and track sentinel environmental diseases.	The consensus was that the objective should be kept, but clarified and made more ambitious.
		Issues or proposed objectives from Oct 27-28 meeting at NIH: Surveillance Pesticides: farm families, agricultural workers Metals Surveys or sentinel sites Other respiratory diseases besides asthma What are the public health advisory and surveillance systems out there? Threshold reporting Biomonitoring Lab methods/Environmental health testing Development of Federal standards for laboratory analysis Development of core group of toxicants Endocrine disrupters Pesticide metabolite measures for priority pesticides (e.g., NHANES) Infrastructure Count State health plans with environmentally related objectives Lab capacity (Federal, State, and local) Joint projects Require in Federal grants/cooperative agreements closer coordination NACCHO survey that covers effectiveness of health and environmental coverage Training Joint personnel visitations, internships Training programs for expertise in both environment and public health practice (including risk communication) Track minimum standards for environmental health professionals through HRSA data

International Environments
Chair, Sheila Newton, NIEHS/NIH
newton1@niehs.nih.gov

HP Objective or EPA Milestone	Text of HP 2000 Objective or EPA 2005 Milestone	Comments/Proposed Modifications/Proposed HP 2010 Objectives
		Issues or proposed objectives from Oct 27-28 meeting at NIH: Objectives to improve U.S. standing in internationally reported measures (e.g., sentinel diseases: cancers, lead poisoning) Global climate change Stratospheric ozone CO2 emission reductions EPA toxic air emission milestone Border environmental health issues (Great Lakes water quality/colonias/migrant farm worker health) Ban export of substances that are banned in the U.S. to other countries

Toxics and Waste
Chair, David Evans, ATSDR
dae3@cdc.gov

HP Objective or EPA Milestone	Text of HP 2000 Objective or EPA 2005 Milestone	Comments/Proposed Modifications/Proposed HP 2010 Objectives
HP 2000 11.4	Reduce the prevalence of blood lead levels exceeding 15 µg/dL and 25 µg/dL among children aged 6 months through 5 years to no more than XXX and XXX, respectively.	Shared with Healthy Communities.
EPA 2005 7.1 (Replaces HP 2000 11.7)	Industrial facilities will reduce by XX percent (from 1992 levels) the quantities of the toxic chemicals in waste streams that are released, disposed of, treated, or combusted for energy recovery. Half of this reduction will be achieved through pollution prevention practices.
EPA 2005 7.4 (Replaces HP 2000 11.8)	Municipal solid waste generation will be reduced to the 1990 level of 4.3 pounds per person per day, with the amount of waste combusted or landfilled decreasing to 2.8 pounds per person per day.	The consensus was that we should use the EPA objective in place of HP 11.8. In addition, there were questions about whether we should also add EPA objectives 9.1 and 9.2 about dioxin and mercury pollution related to solid waste management. The question was also raised as to whether there should be a solid waste objective(s) at all, due to the perception that it is too disconnected from a health risk or effect. The subsequent suggestions included adding a safe waste disposal objective and/or a smaller waste stream objective because of the synergistic effects that some of the workgroup members believe producing waste can have on public health.
EPA 2005 10.1 (Replaces HP 2000 11.14)	Long-term health threats will be eliminated and cleanup will be completed at 95 percent of the 1,212 non-Federal facility contaminated sites on the 1995 Superfund National Priorities List.	Modify EPA 2005 10.1 to be more specific and measurable.
HP 2000 11.15	Establish programs for household hazardous waste in at least 75 percent of counties.	Remove curbside recycling. Consider the other part of 11.15 (increase household hazardous waste collection programs) as a Developmental Objective
		Issues or proposed objectives from Oct 27-28 meeting at NIH: Brown-fields Radioactive materials in the Arctic Non-food-related pesticide exposure Endocrine disrupters Birth defects

Water Quality
Chair, Mark McClanahan, NCEH
mam4@cdc.gov

HP Objective or EPA Milestone	Text of HP 2000 Objective or EPA 2005 Milestone	Comments/Proposed Modifications/Proposed HP 2010 Objectives
HP 2000 11.3	Reduce outbreaks of waterborne disease from infectious agents and chemical poisoning to no more than XX per year.	Maintain the current objective, but also look at how to capture outbreaks of microbial and chemical poisoning that are not being reported. Boil water alerts Fish and shellfish advisories
HP 2000 11.9	Increase to at least XX percent the proportion of people who receive a supply of drinking water that meets safe drinking water standards established by the Environmental Protection Agency.	Maintain current objective while considering the issues raised by the following bullets (see also EPA 2005 Milestones 4.1,4.2, 4.3, and 4.4.): How to address and monitor users of individual water sources/wells. Develop a low-cost method of testing well water (Developmental Objective) How to treat community water systems that don't report because they are either too small or not testing. Consider using State surveys of potential sources of water pollution from the Safe Drinking Water Act (available in 2-3 years) to monitor progress.
HP 2000 11.10	Reduce potential risks to human health from surface water, as measured by a decrease to no more than XX percent in the proportion of assessed rivers, lakes, and estuaries that do not support beneficial uses, such as fishing and swimming.	Maintain in current form, using the EPA data in whatever form they change it to.
		Issues or proposed objectives from Oct 27-28 meeting at NIH: Reduce nutrient loading from agricultural operations, particularly livestock waste from feedlot operations (see EPA 2.5) Track industrial and agricultural waste through USDA Require buffer zones in riparian areas Safeguard general ecosystem health

Participants

Ellen Ceppetelli, University of Vermont
John Schelp, National Institute of Environmental Health Sciences
Bailus Walker, Howard University
Robert Windom, Florida State Department of Health



Breakout Session List