# Defining Policies and Legislation on Environmental Public Health for State Legislatures {#defining-policies-and-legislation-on-environmental-public-health-for-state-legislatures .unnumbered}

2006 - 2007

# Environmental Public Health Leadership Institute Fellow: {#environmental-public-health-leadership-institute-fellow .unnumbered}

# Doug Farquhar, J.D. {#doug-farquhar-j.d. .unnumbered}

Program Director for Environmental Health\
National Conference of State Legislatures

7700 East First Place\
Denver, CO 80230

303/364-7700

doug.farquhar@ncsl.org

# Mentor: {#mentor .unnumbered}

Sarah B. Kotchian, EdM, MPH, PhD\
Research Assistant Professor\
University of New Mexico School of Medicine

Albuquerque, NM

# Acknowledgements: {#acknowledgements .unnumbered}

## Don Mydlowski Environmental Quality Program Manager El Paso County Department of Health & Environment Colorado Springs, CO {#don-mydlowski-environmental-quality-program-manager-el-paso-county-department-of-health-environment-colorado-springs-co .unnumbered}

Lisa Conti, DVM\
Director, Division of Environmental Health\
Florida Department of Health

Tallahassee, FL

**EXECUTIVE SUMMARY**

Public health, and especially environmental public health (EPH), has no
direct contact with state policy makers, unless (or until) a crisis
occurs, requiring state resources and reaction, or when a program is
created, requiring legislative authorization. EPH programs are designed
to avoid crises, and give the public a level of protection from
environmental harms. By its structure and mission, EPH is designed to
avoid any contact or relationships with state policy makers.

This poses an inherent problem for EPH, creating a disjoint and the
potential for miscommunication between the state agencies responsible
for operating EPH programs and the policy makers elected to authorize
and fund such programs.

This project seeks to identify the factors of this disjoint, through an
assessment of state EPH laws and discussions with state legislators
familiar with environmental health policy and the state agency director
responsible for carrying out those policies. First, the project
collected most of the state laws relating to environmental health from
the 50 states and territories (the District of Columbia and Puerto
Rico), gathering a sense of progressive states vs. ones with fewer laws,
as a determinant of the level of activity among the state legislature.
Following this collection the project interviewed legislators from four
states: Illinois, Missouri, Pennsylvania and Utah, as well as the
directors of five state environmental health programs in California,
Florida, New Jersey, North Carolina and Rhode Island.

The intent of the project was to determine the level state legislators
understand EPH, and the extent directors of EPH programs interact with
their legislatures. This information would guide the project toward any
conclusions as to whether the disjointedness and undefined mandate of
EPH has retarded its growth, or if policy makers had an adequate level
of understanding which allowed them to make enlightened decisions
regarding funding, authorizations, staff, enforcement and other
resources necessary for a state to perform a competent EPH program.

**INTRODUCTION**

Environmental Public Health (EPH), which has no organic statute to
establish programs, rather has evolved from various programs to address
a variety of health concerns, is ill-defined and complicated to explain
to the public and state policy makers. Programmatic elements, such as
sanitation, food safety, wastewater systems, housing (radon, lead,
asbestos) and air quality have been identified as programs within
environmental health, but the capacity and services that comprise EPH
have not been effectively identified, especially for purposes of
communicating the issue to public policy makers. EPH programs are often
split between agencies, whose missions regarding environment and public
health differ.[^1]

State policy makers understand health policy, especially as it relates
to Medicaid. Medicaid directly impact state budgets. Environmental
concerns, especially regulatory programs with enforcement delegated by
EPA, require state policy to authorize the state to accept the
delegation.

But environmental public health has little or no direct contact with
state policy makers, unless (or until) a crises occurs, requiring a
state response, or when a program requires authorization. EPH programs
are designed to avoid crises, and give the public a level of protection
from environmental harms. And they are thought to be complete, with no
major environmental programs pending[^2] By its structure and mission,
EPH is designed to avoid any contact or relationship with state policy
makers.

With much funding for EPH coming from federal grants dedicated for
specific programs, resources to operate core EPH services often have
come from states. Without any demand from the public or insight as to
the need for these core services leaves EPH ripe for funding reductions.
Programs without specific mandates or ones that fail to demonstrate a
clear public service provide legislators with an easy target to reduce
appropriations. And legislators are constantly under pressure to limit
spending.

For EPH to sustain current activities and be prepared to handle emerging
concerns it must gain acceptance and support from the policy makers that
authorize and fund its programs. Without an effective communication and
relationship with legislators, EPH will continue to lose support and
subject itself to a further lessening of resources.

**PROBLEM STATEMENT**

This EPHLI project will identify current environmental public health
programs, as determined by state law, not policy or regulation, through
a database of laws available on-line. Based on this statute review, two
surveys were developed, one for legislators and the second for EPH
agency officials, and given to a select group. These activities will
provide an assessment as to the level of interest and sophistication
among various state legislatures as to EPH, and the extent of need for
outreach to state legislators on EPH.

####### ***Behavior Over Time Graph:***

Time \-\-\-\-\-\-\-\-\-\-\-\-\-\-\--

Public (i.e., policy makers) perceptions v. EPH ability to respond

*Two groups have differing expectations as what EPH can and does
provide, leaving a gap in perceptions. This misperception as to what EPH
provides inevitably leads to a perceived failure by the agency.*

**Causal Loop Diagrams and applicable archetypes:**

![](media/image1.wmf){width="6.932638888888889in"
height="3.7395833333333335in"}

Public misconceptions leads to policy misconceptions; policy must define
purpose to properly respond to EPH needs

-   *EPH never has enough resources to address crises in the manner the
    public expects*

-   *Ineffectual response leads to less political/economic resources for
    EPH*

-   *Misguided perceptions of the EPH system leads to disappointment by
    public*

Public drives all policy demands; at Federal, State and Local levels

-   *Federal agencies pressure states; state agencies pressure local
    governments*

-   *Federal and state policy makers pressure federal, state and local
    agencies*

**10 Essential Environmental Health Services:**

![](media/image2.png){width="3.75in" height="3.8125in"}

Figure 1: Osaki, Ten Essential Environmental Public Health Services

####### Inform, educate and empower people about environmental health issues

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

4.  Enforce laws and regulations that protect health and ensure
    safety[^3]

By assessing the level of knowledge that legislators have about EPH,
this project aids in identifying approaches to informing policy makers,
giving EPH agencies a better sense of legislators\' interests, and (in
the long term) provide legislators with the information justifying the
support of EPH programs, laws and regulations.

***National Goals Supported - National Strategy to Revitalize
Environmental Public Health Services***[^4]

*Goal I - Build Capacity*. Enlightening state policy makers as to EPH,
identifying the tools to develop better EPH policy. Providing state
agency officials an opportunity to communicate in policy making,
incorporating their concerns within state policy.

*Goal III - Foster Leadership to Enhance Environmental Public Health
Service*. Enhance EPH by developing strong working relationships among
stakeholders, specifically state policy makers.

*Goal IV - Communicate and Market*. Improve communication and
information sharing among public health agencies and policy makers.

*Goal VI - Create Strategic Partnerships*. Foster partnerships among
agencies and entities that influence EPH services; also foster
communication and interaction among policy makers.

This effort will assist in the design of EPH policy goals, identifying
the factors that allow policy makers to develop better policies for
agencies. In addition, it offers an opportunity for agencies to work
directly with policy makers, to design better expectations and policies
for the public. Policies that stagnate, fail to receive legislative
review, or that do not appear to provide any public service are
vulnerable to legislative deauthorization and defunding.

**Environmental Health Competency Project: Recommendation for Core
Competencies for Local Environmental Health Practitioners**[^5]

**B2. *Economic and Political Issues:* The capacity to understand and
appropriately use information about the economic and political
implications of decisions.**

-   Understand local history and community demographics, as well as
    cultural and political issues and sensitivities.

-   Enforce regulations equitably and consistently---but with an
    awareness of the political realities of the work.

-   Develop and present options and recommendations that demonstrate an
    understanding of economic and political conditions in an effort to
    find appropriate solutions and prioritize actions.

-   Understand the economic and political underpinnings and implications
    of broader agency priorities/decisions.

The goal of this project will be to sensitize EPH agencies (including
CDC and EPA) as to the concerns and interests of state policy makers,
aiding in the development of policy approaches.

**C1. *Educate:* The capacity to use the environmental health
practitioner's front-line role to effectively educate the public on
environmental health issues and the public health rationale for
recommendations.**

-   Identify "teaching moments" as part of regulatory function, and
    opportunities to share "lessons learned."

-   Seek continual learning, educational, and mentoring opportunities.

This project will assist in defining the opportunities to work with
state policy makers.

**C.2. Communicate: the capacity to effectively communicate risk and
exchange information with policy makers**.

-   Explain complicated issues and procedures simply and accurately.

-   Handle interaction with the public and media (*i.e., policy makers)*
    using tactful, objective, non-confrontational, culturally sensitive
    language.[^6]

Provide EPH agencies insight into effective communication strategies to
promote and highlight EPH programs.

***Project Logic
Model:***![](media/image3.png){width="6.502083333333333in"
height="8.3in"}

PROJECT OBJECTIVES/DESCRIPTION/DELIVERABLES:

####### *Program Goal -- to determine the base policy needs required for a competent state environmental public health program, identifying factors to build communications and understandings between state policy makers and agency officials*

####### *Health Problem -- the lack of core environmental public health program impedes the agency from effectively meeting its mission, to protect the public's health from environmental harms*

####### *Outcome Objective -- if factors are identified to better communicate environmental public health to state policy makers*

####### *Determinant -- changes (long term) to EPH programs that ensure essential authorities and resources are provided; ensure programs are sustained*

####### *Contributing Factors -- Public, Federal, State*

####### *Reaction by the public, response to crises (both real and perceived) and health threats, willingness to incur additional regulations and costs for protection from environmental harms.*

####### *actions from the federal government, Congressional actions, increased/decreased funding for EPH at both EPA, CDC and other federal agencies, also the authorization/reauthorization of federal EPH laws, driving agencies to respond. state resources, crises, demand from the public*

####### *actions by state government, acting beyond federal acts or responding to federal inaction, devising policies/programs that address specific concerns, independent of any federal law or funding.*

# METHODOLOGY: {#methodology .unnumbered}

**Determine level of activities regarding outreach on EPH to state
policy makers**

-   Contact the EPA and CDC regarding any similar efforts being pursued.
    EPA has no activities or efforts designed to enlighten state
    legislatures as to EPH (with the exception of the Indoor Air Program
    Radon program.) At CDC, however, the Public Health Law Project has
    initiated an environmental health component.[^7]

-   Contact ASTHO, APHA, ECOS and NEHA regarding their efforts. APHA
    does have a government relations section, but focuses on public
    health before Congress. APHA has developed state environmental
    health summaries. NEHA's government relations are in its infancy,
    and ASTHO's and ECOS government relations deals solely with
    Congress.

-   Identify federal laws that address environmental health. Toxic
    Substances Control Act, the Resource Conservation and Recovery Act,
    parts of the Clean Air Act and Clean Water Act.

**Identify and Collect State Legislation**[^8]

For any EPH program to operate, the state legislature must grant some
sort of authorization for the state agency to act. This can be specific
(directing to state agency to perform a single task) or broad (such as
the state public health director's authority to provide for and protect
the public's health).

Identify and collect state statutes that address environmental public
health.

Database of State Legislation covers:

+-----------------------------------+-----------------------------------+
| Air Quality                       | Lead Hazard Reduction             |
|                                   |                                   |
| -   Indoor                        | Mercury                           |
|                                   |                                   |
| -   Outdoor                       | Mold                              |
|                                   |                                   |
| Asbestos                          | Mosquito Control                  |
|                                   |                                   |
| Asthma                            | Pesticides                        |
|                                   |                                   |
| Biomonitoring                     | Solid Waste                       |
|                                   |                                   |
| Chemical Agents                   | Toxics                            |
|                                   |                                   |
| Children's Environmental Health   | Tracking and Surveillance         |
|                                   |                                   |
| Hazardous Waste                   | Water Quality                     |
+-----------------------------------+-----------------------------------+

**Survey State Legislators**[^9]

-   Series of questions designed after consultation with ASTHO, NEHA and
    state environmental health directors

-   Due to the difficulty in contacting state legislators, all
    interviews were done by phone

-   Three other state legislators[^10] were contacted for an interview,
    but schedules made them unavailable

**Survey State Environmental Health Directors**[^11]

-   Worked with Don Mydlowski at El Paso County in Colorado regarding
    his survey to the Colorado county EPH directors; gave me insight
    into policies and concerns facing directors

-   Spoke with Glen Takeoka, CA director, Pat Curran, NC director and
    Lisa Conti, director in Florida; these conversations helped me frame
    the survey

-   Performed phone surveys with CA and NC, and a written survey with
    FL, NJ and RI.

# RESULTS: {#results .unnumbered}

*State Legislation*: Many EPH laws are in response to federal laws.
Requirements under the Clean Air Act, Clean Water Act, Toxic Substances
Control Act, Resource Conservation and Recovery Act, Comprehensive
Environmental Response, Compensation and Liability Act and the like that
delegate authority to states need legislative authorization. Because EPH
has no organic federal act but instead several acts respond to
environmental health needs, states adopt a variety of loosely related
laws that provide for EPH. Not all states adopt every provision demanded
by federal authorities, and no state authorizes EPH in the same manner.

Often, state legislators only experience with EPH comes when state
agencies request additional authorizations to respond to federal demands
or need additional funding.[^12] States rarely delve into EPH unless a
crisis has occurred and the public demands a response. The federal
government has been a strong instigator to encourage states to adopt or
expand EPH programs, but resources and new programs from federal
agencies have been lacking in recent years.

Certain states have many laws specifically addressing EPH, such as
California, and many of the mid-West and Northeastern states, reflecting
certain knowledge of environmental health issues. States in the South
and West (except California) tend to have less specific EPH laws,
relying on their state agencies to address EPH via regulation. States
providing specific authority to address EPH tend to have more resources
to support that law.

*State Legislators*, based on the surveys and interviews:

-   None of the legislators surveyed had heard of the 10 Essential
    Environmental Public Health Services

-   Sen. Dougherty knew of the NCEH at CDC. Rep. Rubley and Sen.
    Peterson knew of ATSDR. All could identify the EPA.

-   None could name their state's director of environmental health,
    though they all knew of their public health officer.

-   The EPH director generally only appears before the committee upon
    request to testify on a bill or budget question.

-   Legislators rarely try to work directly with the EPH program, though
    Sen. Dougherty often discussed EPH matters and served on various
    state task forces related to EPH as a legislative member. Rep.
    Rubley said that EPH was undefined with an unclear mandate, making
    it difficult to develop and support EPH policies. Environment in
    Pennsylvania is in one department and health in another, controlled
    by a strong Governor.

-   None of the legislators felt they effectively address EPH. They can
    fund and authorize specific programs, but general do not believe
    they have complete oversight. Would prefer to have much more
    knowledge of EPH efforts.

-   With the de-emphasis of environmental health at the federal level,
    several legislators worried that states will follow suit.[^13] Rep.
    May and Sen. Peterson, however, felt this gave states an opportunity
    to better regulate environmental concerns.

-   All felt that EPH was a growing concern, though for different
    reasons. Rep. May noted of the 100 races in which the League of
    Conservation Voters endorsed a candidate in Illinois, the LCV
    candidate won in 88 of them.

-   Sen. Peterson, in his work with the federal government (i.e., the
    EPA) never felt they respected Western states\' approach to
    environmental health, which prohibited states from effectively
    utilizing their resources. The goal of EPH should be results, not
    debate.

*State Directors*:

-   Most had little interaction with their state legislature. Since none
    are independent agencies, they must rely on their Secretary\'s
    Office to provide legislative support.

-   Not all can respond if questioned by a legislator. California was
    forbidden under the last administration. Florida and New Jersey can
    respond.

-   Most essential EPH services are handled by the states, the federal
    government lacks the on-site resources to enforce federal laws.

    -   Some states rely on federal government to regulate EPH; very
        rarely are such regulations enforced.

    -   Most directors had other agencies (either health or environment)
        that handled certain aspects of EPH

-   Most enforcement is done by the Attorney General, and not the state
    agency. Some agencies can levy civil fines, but not criminal,
    without AG approval.

-   Federal overfilling of a state EPH program is rare, but threatened
    often over controversial issues (where the state and federal
    government disagree).

-   Fees rarely cover the cost of the program. Fees must be kept
    conservative to maintain public support. Federal grants are
    extremely important to state programs.

-   Certain directors rely on private organizations to provide
    information, resources to legislators, though not publicly. Others
    rarely sought outside assistance.

-   Most legislatures have the authority to negate an agency rule,
    either through regulatory review (as in IL and NJ) or via \"sunset
    provisions\" (which require a legislative reauthorization after a
    certain period).

# CONCLUSIONS: {#conclusions .unnumbered}

Environmental Public Health, fitting neatly into neither the health
mission nor the mission for environmental agencies, often became
divided, with an unclear mission (few solid regulatory missions or
funding streams), became even less of a policy concern for state
legislators. As long as the system worked and no crises occurred, policy
makers heard no demand from the public for EPH, making it an easy target
for budget reductions.

This is especially problematic for EPH advocates, both in the
legislature and for agency officials. The lack of clear mandates,
funding streams, or a clear mission places EPH in a vulnerable position.
The division of EPH between environmental and public agencies creates
confusion, and defining EPH is difficult.

Factors to aid enlightening and communicating with state policy makers

-   Unified mission statements for all EPH agencies, with clear
    direction and joint goals

-   Providing basic learning session (EPH 101) to legislative committees
    with jurisdiction over EPH programs early in the legislative
    sessions

-   Requiring legislative review (sunset provisions) of EPH statutes, to
    ensure relevancy and update provisions

-   Providing training opportunities for legislative chairs and staff on
    EPH; give them an overview of EPH programs, funding streams, and
    effect on public and business community.[^14]

-   Provide indicators (annually, or at least once a session) of the
    state's environmental health, the number of people affected by EPH's
    efforts, money saved, business benefits (restaurant inspections,
    food safety), level of federal support

-   Give EPH directors authority to communicate directly to state
    legislators, as they do the public

More than communications, relationships between EPH programs and policy
makers must be established, to assist legislators in their role as
representatives of the public and for EPH to sustain itself. Legislators
have noted a rise in the demand for states to protect the public from
environmental harms. It is for EPH to define itself in a fashion to meet
these demands.

# LEADERSHIP DEVELOPMENT OPPORTUNITIES: {#leadership-development-opportunities .unnumbered}

#  {#section .unnumbered}

# Doug Farquhar {#doug-farquhar .unnumbered}

As the program director for Environmental Health at the National
Conference of State Legislatures, and in advancing EPH policy for the
past 16 years, I have had the opportunity to work with many state
legislators and the EPH agency counterparts, along with federal
officials and advocates seeking to promote various policies within
legislatures. This EPHLI program came at a time when few resources were
available to support environmental health at this organization, and the
EPHLI resurrected these efforts for me.

EPHLI has given me the opportunity:

-   To learn about and expand my knowledge of environmental public
    health, at the local, state and federal level

-   To experience emergency response programs, the pressures responders
    face, and the need for base level support

-   To meet peers, local officials, mentors and trainers that gave me
    insight into their needs, interests and pressures

-   To reaffirm EPH efforts in a transitional time in my career

Though some of the activities did not relate to my current career
position, each one offered some knowledge that I value. It has been an
excellent program, and will provide the seeds for future EPH managers.

# ABOUT THE EPHLI FELLOW {#about-the-ephli-fellow .unnumbered}

Doug Farquhar directs the program that performs legislative analysis and
outreach on state and federal environmental, health and trade laws;
focusing on the delegation and authorization of federal and state laws;
and provides legal and technical assistance to state legislators and
agency staff on state, federal and international environmental,
environmental health, and trade policies. He also provides testimony
before state legislative committees and task forces; reviews and
comments on legislation and regulations, drafts memos, articles and
books on state environmental health policies; and represents state
interests before federal and international bodies.

As director of Environmental Health he works closely with federal
counterparts at the Centers for Disease Control and Prevention (CDC),
U.S. Environmental Protection Agency (EPA), Department of Housing and
Urban Development (HUD), and the Commission for Environmental
Cooperation (CEC).

Prior to coming to NCSL, Doug worked in the Texas House of
Representatives and on Capitol Hill in Washington. He received his law
degree from the University of Denver, and is an adjunct professor in
their graduate school of Environmental Policy and Management.

[^1]: The U.S. Department of Health and Human Services mission, being
    the government\'s principal agency for protecting the health of all
    Americans and providing essential human services, especially for
    those who are least able to help themselves. The mission of the
    Environmental Protection Agency is to protect human health and the
    environment. Since 1970, EPA has been working for a cleaner,
    healthier environment for the American people.

[^2]: The last major piece of legislation was the Comprehensive
    Environmental Response, Compensation and Liability Act (CERCLA)
    passed in 1980, though the Emergency Planning and Community
    Right-to-Know (EPCRA) (1986) and the Oil Pollution Act (1990) were
    enacted later.

[^3]: Osaki, Carl. The Ten Essential Environmental Public Health
    Services

[^4]: National Center for Environmental Health, CDC, A National Strategy
    for Revitalizing Environmental Public Health Services, 2003
    available at
    <http://www.cdc.gov/nceh/ehs/Docs/nationalstrategy2003.pdf>

[^5]: NCEH/CDC, APHA, Environmental Health Competency Project:
    Recommendation for Core Competencies for Local Environmental Health
    Practitioners, American Public Health Association, 2001. Available
    at <http://www.apha.org/ppp/Env_Comp_Booklet.pdf>.

[^6]:

[^7]: Based on conversations with Montrece Ransom, J.D., project lead
    for environmental health at the CDC's Public Health Law Project.

[^8]: The database can be found at:
    <http://www.ncsl.org/programs/environ/envhealth/ehdatabases.htm>.
    The database uses StateNet, which has access to all state statutes,
    and are reviewed and analyzed by law interns from the University of
    Denver College of Law.

[^9]: The four legislators interviewed: *Representative Karen May*
    (D-IL) chairs the Environmental Health Committee in the Illinois
    House. She petitioned the speaker to create the committee after
    becoming aware of environmental health concerns at a national
    meeting, and wanting to promote better EPH policy in the state.

    *Senator Pat Dougherty* (D -- MO) has served in the legislature for
    24 years. Senator Dougherty sponsored comprehensive lead hazard
    reduction legislation and bills on children's environmental health,
    mercury and food safety. *Representative Carole Rubley* (R -- PA)
    has chaired the state's environmental health committee. She has a
    masters in Environmental Health and has fought against her party's
    leadership regarding the "Clear Skies" initiative, testifying before
    Congress as to it ineffectiveness. *Senator Craig Peterson* (R --
    UT) chaired the state's environment committee and is a full-time
    environmental consultant. He supports his party's positions on
    environment, and rejects many of the EPA's mandates regarding
    environmental health, saying they are not effectiveness in his
    state.

[^10]: The three legislators not interviewed were: *Representative Karla
    Drenner*, (D-GA) who formerly worked at ATSDR; *Delegate Jim
    Hubbard* (D - MD) who served on the federal Children\'s
    Environmental Health FACA committee; and *Senator Donnie Trotter*
    (D - IL) who retired from the Cook County Department of Health.

[^11]: Four state environmental health directors interviewed: *Glen
    Takeoka*, directs California's Environmental Health Program for the
    Department of Health Services. *Lisa Conti*, DVM directs Florida's
    Department of Environmental Health. She leads an effort to organize
    the directors of every state's environmental health program. *Jim
    Brownlee*, MPH directs the environmental health program for New
    Jersey's Department of Consumer Affairs. *Pat Curran* formerly
    directed the North Carolina program. *Walter Combs* directs Rhode
    Island's program, and has recently surveyed state environmental
    health directors.

[^12]: Based on conversation with Senator Joe Hackney, NC.

[^13]: This concern has come up in conversations with legislators beyond
    this survey.

[^14]: The University of North Carolina School of Public Health Chappell
    Hill held two week summer program for state legislators and staff
    interested in health issues, funding by the Robert Wood Johnson
    Foundation and Kellogg Foundation. EPH was never covered in the
    program.