# Environmental Health Practitioners Developing Strategic Partnerships and Engaging Public Health Policymakers

## Abstract

In 2003, the National Center for Environmental Health (NCEH) published
the *National Strategy to Revitalize Environmental Public Health
Services*. The strategy identifies six critical areas for action. One of
those areas is the formation of strategic partnerships. The document
states that there is a "need to build and expand strategic
partnerships," especially "with legislative and policy-making groups"
(National Center for Environmental Health, 2003).

A small group of representatives of the 14 current NCEH
capacity-building grantee projects collaborated to produce a set of
talking points. These points are designed to facilitate the development
of strategic partnerships that recognize the critical role that public
policymakers play in supporting the delivery of environmental health
services.

These talking points are offered to help state and local environmental
health practitioners develop information and education strategies for
their state legislators, local elected officials, and other public
policymakers. These influential leaders are viewed as key components of
the operational infrastructure that supports environmental health
services through legislation, including bills and ordinances that
authorize public funding for these services.

## Introduction

Some 300 million U.S. citizens drink tap water every day, but they do so
without a second thought about its cleanliness. Rarely do they hear
about waterborne diseases affecting their communities. Think about it:
300 million people drink and cook with water four times a day. That
equals 1.2 billion times every day of the year that environmental health
practitioners assume responsibility for assuring that our drinking water
is safe from potentially harmful organisms and chemicals. These
practitioners also provide services daily to assure that we have safe
food to eat, healthy air to breathe, and safe shelter in which to live
and work.

These services are provided by a broad spectrum of environmental health
practitioners who work in areas such as indoor and outdoor air quality;
disaster response and sanitation; drinking water quality; food safety;
containment of the impact of hazardous materials; housing sanitation;
radiation control; solid waste; swimming pool safety; vector control;
and wastewater treatment. The talking points and action suggestions
below are offered for local environmental health practitioners as they
communicate with their legislators and other policymakers to build and
enhance strategic partnerships to maintain and expand support for
environmental health services.

## Addressing the Values and Benefits of Environmental Health Services

### What Are The Benefits of Environmental Health Services?

Operating with a solid, sustainable infrastructure, environmental health
services produce the following benefits for all citizens in communities
across the country:

-   Safe drinking water and appropriately treated residential and
    commercial wastewater.

-   Safe swimming in community swimming pools, lakes, and rivers.

-   Clean indoor and outdoor air to breathe.

-   Safe food purchased from restaurants and grocery stores for
    consumption.

-   The provision of necessary and uncontaminated food and water
    supplies during and after disasters.

-   Homes secured from hazards such as lead, radon, mold, carbon
    dioxide, and asthma triggers.

-   Neighborhoods free of potentially hazardous nuisances such as toxic
    waste, illegal dumping, noise pollution, unsafe structures, mosquito
    breeding areas, and unvaccinated animals.

-   Attendance of schools that are protected from environmental hazards
    and threats, including, but not limited to, indoor air contaminants
    such as mold, unsafe food, impure drinking water, and unsafe
    playgrounds.

### What Kinds of Health Risks Do Environmental Health Services Address?

It is critical that environmental health services be viewed as absolute
necessities for ensuring the health and safety of our citizens. The
following are examples of serious health threats from environmental
causes:

-   In 1993, in Milwaukee, Wisconsin, 403,000 people became sick and 50
    people died from *Cryptosporidium* that contaminated the public
    water supply. The cost of the outbreak was \$96.2 million (Corso et
    al., 2003)

-   The Centers for Disease Control and Prevention (CDC) estimates that
    foodborne diseases cause approximately 76 million illnesses,
    325,000 hospitalizations, and 5,000 deaths in the United States each
    year. Known pathogens account for an estimated 14 million illnesses,
    60,000 hospitalizations, and 1,800 deaths (Mead et al., 1999).

-   In 2002, the West Nile virus epidemic in Cuyahoga County, Ohio, cost
    nearly \$4 million for health care alone. At least 150 county
    residents with life-threatening complications of the mosquito-borne
    disease spent a combined 1,800 days in the hospital. Each case
    typically cost more than \$25,000 to treat (Mezger, 2003).

-   In 2003, a poultry outbreak of Newcastle disease cost the state of
    California \$13 million and the federal government \$22 million. The
    poultry and egg industries found themselves being overwhelmed by the
    high costs of disinfection and biosecurity upgrades, along with
    losses of approximately \$2 million in sales and 5% of business due
    to export bans. About 2.1 million birds were destroyed (FASS Track,
    2003).

-   In 2006, a *Salmonella* outbreak costs Cadbury Chocolate Company
    \$20 million dollars when it was forced to recall 1 million candy
    bars (Which, 2006).

-   In September 2006, a multistate (first in Wisconsin, Oregon, and New
    Mexico) outbreak of *Escherichia Coli* serotype O157:H7 infections
    occurred that were associated with consumption of fresh spinach.
    There were 199 persons infected from 26 states. Three deaths were
    confirmed. Wisconsin public health officials were the first to
    report to CDC. All state public health officials played a vital role
    in the joint investigation and outbreak control measures undertaken
    by CDC and the Food and Drug Administration (Centers for Disease
    Control and Prevention, 2006).

### What Can Legislators, County Commissioners/Supervisors, and City Leaders Do?

Environmental health service capacity begins with policymakers who set
the stage for legislative and local ordinances for environmental health
protection and safety. Policymakers then make decisions about the
funding for environmental health services. Thus, policymakers play a key
role in developing and maintaining the infrastructure needed to provide
citizens with environmental health services. The infrastructure allows
environmental health practitioners to do their day-to-day jobs, as well
as to respond to emerging or emergency environmental health threats.
Encourage policymakers to increase the funding for environmental health
services at all levels of government. The needed infrastructure includes
the specific availability of:

-   Professionally trained, competitively salaried workforce members.

-   Appropriate physical facilities and up-to-date equipment and
    materials.

-   Current information technology hardware and software.

-   Opportunities for workforce members to participate in continuing
    professional training and education.

These elements of the environmental health infrastructure enable
practitioners to deliver the following ten essential environmental
public health services:

1.  **Monitor** health status to identify and solve community
    environmental health problems.

2.  **Diagnose and investigate** environmental health problems and
    hazards in the community.

3.  **Inform, educate, and empower** people about environmental health
    issues.

4.  **Mobilize** community partnerships and action to identify and solve
    environmental health problems.

5.  **Develop** policies and plans that support individual and community
    environmental health efforts.

6.  **Enforce** laws and regulations that protect health and ensure
    safety.

7.  **Link** people to needed personal health services and assure the
    provision of health care when it is otherwise unavailable.

8.  **Assure** a competent environmental health workforce.

9.  **Evaluate** effectiveness, accessibility, and quality of
    environmental health services.

10. **Research** for new insights and innovative solutions to
    environmental health problems.

## Action Suggestions for Environmental Health Workers

### What Can Local Environmental Health Practitioners Do to Begin a Strategic Partnership?

-   **Familiarize yourselves with and be able to discuss the Ten
    Essential Environmental Health Services and why they are critical to
    a strong environmental health infrastructure.**

> To learn more about the essential services, go to this Web site:
>
> [http://www.cdc.gov/nceh/ehs/Topics/workforce.htm](http://www.cdc.gov/nceh/ehs/Topics/workforce.htma)
> and click on: [Essential Services of Environmental Health
> CD-ROM](http://www.cdc.gov/nceh/ehs/Docs/Essential_Services_Environmental_Health_Transmittal_Package_12-2004.pdf)

-   **Advocate for environmental health to be a priority not only in
    their local communities, but also at the state and national
    levels.**

> Educate policymakers about the benefits of environmental health
> services, so they can continue to prioritize environmental health
> funding. Copies of the previous talking points can be provided to
> city, state, and federal policymakers.
>
> For resources to learn more about influencing policymakers and
> community leaders, go to the following two Web sites:
>
> <http://www.naccho.org/localpublichealthbrand> and click on
> [Toolkit]{.underline} on the right sidebar or [Public Health
> Communications Toolkit]{.underline} about halfway down in the center
> section narrative. The American Public Health Association also has
> information on how to work with public policymakers at its Web site:
> [http://www.ephs.apha.org](http://www.ephs.apha.org/).

-   **Share success stories with policymakers and ask them to support
    funding for capacity building initiatives.**

> Local environmental health practitioners can garner support from
> public policymakers by identifying some of the particular successes
> their services have achieved to protect the public's health. Sharing
> these success stories with key community leaders and opinion shapers
> will enable them to be more actively supportive of environmental
> health services.
>
> For example, the NCEH's Capacity Building Initiative partners have
> made significant contributions to enhancing the local and national
> infrastructure needed to prevent and respond to environmental health
> risks.
>
> One such contribution comes from the Multnomah County Environmental
> Health (MCEH) in Oregon. MCEH increased its capacity to conduct
> education and outreach to its communities about West Nile virus, Avian
> flu, lead poisoning prevention, food safety, vector-borne disease and
> control, and indoor air quality. Since September 2004, it has
> developed 101 educational materials and conducted 70
> educational/outreach events that reached 8,553 people from 17 ethnic
> populations. The educational tools are being made available to other
> jurisdictions throughout the nation.

-   **Collaborate with federal public health agencies to promote and
    disseminate local innovative solutions that have national
    environmental health impact.**

> Valuable time, energy, and financial resources are wasted when
> jurisdictions unknowingly recreate environmental health systems and
> solutions that have already been tried, tested, and determined to work
> in other parts of the country. Environmental health service agencies
> can document their programs' outcomes and benefits that have
> contributed to reduced health risks and improved health outcomes.
> Sharing these outcomes with entities in the federal public health
> system and national public health and environmental health
> professional organizations will facilitate the transfer of the lessons
> learned to potential users across the nation.

## Conclusion

Forming and sustaining strategic partnerships with policymakers are
critical functions for insuring the continued provision of environmental
health services. In order to maintain and enhance or expand the reach of
environmental health services, local environmental health practitioners
and policymakers must work together to protect the public's health from
environmental hazards and threats. Local practitioners should establish
active, ongoing relationships with their public policy allies.

Use of the talking points and suggested actions described in this
article will help practitioners keep their public policy allies up to
date on the significance of supporting and adequately funding
environmental health services. After all, environmental health services
are for "everyone, everywhere, every day" (American Public Health
Association, 2006).

***If you have comments pertaining to this document please send them
to:*
[ehsb@cdc.gov](mailto:ehsb@cdc.gov?subject=Comments on Value and Benefits of Environmental Health Services Document).**

## References

American Public Health Association. 2006. Web site:
[http://www.ephs-apha.gov](http://www.ephs-apha.gov/).

Centers for Disease Control and Prevention. 2006. *E. coli* O157:H7
outbreak from fresh spinach. Atlanta: US Department of Health and Human
Services; October 6. Retrieved October 31, 2006, from
<http://www.cdc.gov/foodborne/ecolispinach/100606.htm>.

Corso PS, Kramer MH, Blair KA, Addiss DG, Davis JP, Haddix AC. 2003.
Cost of illness in the 1993 waterborne *Cryptosporidium* outbreak,
Milwaukee, Wisconsin. Emerg Infect Dis*,* \[serial online\] 2003 April.
Retrieved October 23, 2006, from:
<http://www.cdc.gov/ncidod/EID/vol9no4/02-0417.htm>

FASSTrack. 2003. Poultry disease outbreak costs government \$35 million;
March 5. Retrieved October 23, 2006, from
<http://www.fass.org/FASStrack/news_item.asp?news_id=1059>

Mead PS, Slutsker L, Dietz V, McCaig LF, Bresee JS, Shapiro C, et al.
1999. Food-related illness and death in the United States. Emerg Infect
Dis, \[serial online\] 1999, September--October. Retrieved October 23,
2006, from
<http://www.cdc.gov/ncidod/eid/vol5no5/mead.htm>[.]{.underline}

Mezger R. 2003. West Nile outbreak cost \$4 million for care. The Plain
Dealer Reporter; June 12. Retrieved October 23, 2006, from
<http://www.cleveland.com/westnile/index.ssf?/westnile/more/1055415322144370.html>.

National Center for Environmental Health, Centers for Disease Control
and Prevention. 2003. A national strategy to revitalize environmental
public health services. Atlanta, GA: US Department of Health and Human
Services.

WHICH? 2006. *Salmonella* scare to cost Cadbury 20 million pounds, but
chocolate firm's profits are still up. London: WHICH?; August 2.
Retrieved October 23, 2006, from
<http://www.which.co.uk/reports_and_campaigns/food_and_drink/reports/diet_nutrition_and_safety/Cadbury_salmonella_cost_news_article_557_90835.jsp>.

## Acknowledgements

The workgroup members consisted of representatives from the 14 current
NCEH capacity-building grantee projects that collaborated to develop
these talking points:

-   Tom Struzick, MSW/M.Ed., University of Alabama at Birmingham;

-   Ken Sharp, REHS, Iowa Department of Public Health;

-   Carl Osaki, RS, MSPH, University of Washington;

-   Lynn Schulman George, Multnomah County Environmental Health;

-   Joy Harris, MPH, Iowa Department of Public Health.

Two additional work group members were Sarah Kotchian, University of New
Mexico; and Daneen Farrow Collier, Centers for Disease Control and
Prevention.

The workgroup would like to acknowledge the important contributions made
by the following individuals for content selection and editing of this
paper: Gerald Barron, David Dyjack, Brian Hubbard, Vincent Radke,
Sharunda Buchanan, and Paul Shoemaker.

This paper was supported by grant #U50/CCU4241-03 from the U.S. Centers
for Disease Control and Prevention. Its contents are solely the
responsibility of the authors and do not necessarily represent the
official views of the Centers for Disease Control and Prevention.