# Presentation: 656253

## Linking Health and Environmental Datain a Public Health Surveillance System 

- Doug Rickman
- Amanda Sue Niskar
- Dale Quattrochi
- Maury Estes

**Climate Science in Support of Decisionmaking**
- November 14-16, 2005

- NASA/MSFC

- Ashutosh Limaye
- William Crosson
- Mohammad Al-Hamdan

- USRA

- formerly CDC

## What type of information do decision makers need and what are the pressing science questions?    
Are we communicating information to decision makers effectively or are we falling short on delivering the information they need?
What are the barriers to using climate information in decision making and how can they be overcome?
How can CCSP best maintain a dialogue with decision makers to evolve the program?

**Are we communicating information to decision makers effectively or are we falling short on delivering the information they need?**
**What are the barriers to using climate information in decision making and how can they be overcome?**
**How can CCSP best maintain a dialogue with decision makers to evolve the program?**

## Public health surveillance is the ongoing, systematic collection, analysis, interpretation, and dissemination of data regarding a health-related event for use in public health action to reduce morbidity and mortality and to improve health. Data disseminated by a public health surveillance system can be used for immediate public health action, program planning and evaluation, and formulating research hypotheses. 

**Public health surveillance is the ongoing, systematic collection, analysis, interpretation, and dissemination of data regarding a health-related event for use in public health action to reduce morbidity and mortality and to improve health. Data disseminated by a public health surveillance system can be used for immediate public health action, program planning and evaluation, and formulating research hypotheses. **
**Public health surveillance activities are generally authorized by legislators and carried out by public health officials.**

**Notes:**
Environmental public health tracking is the ongoing, systematic collection, integration, analysis, and interpretation of data about: 1- environmental hazards, 2 -human exposure to environmental hazards, and 3 - health effects potentially related to exposure to environmental hazards.  The Centers for Disease Control and Prevention (CDC) is working with the National Aeronautics and Space Agency (NASA), Environmental Protection Agency (EPA), and other federal, state, and local agencies to build a National Environmental Public Health Tracking Network (EPHTN).   Information from the National EPHT Network will  be used to plan, implement, and evaluate environmental public health actions and to inform policy. The national network, a network of data, will track trends in priority, non-infectious health effects.

Around 2008, when fully functional, the national EPHTN will be an early warning system for the rapid identification of adverse health events related to environmental sources.  Examples of data within the network include NASA’s Earth-Sun System science results and EPA data.  These data are not acquired for the purpose of the EPHTN.  Coupled with health outcome data it will also be possible to examine relationships between environmental factors and chronic disease.  Further, within such a framework it becomes possible to create coupled Earth system-chronic disease models.

## Public health surveillance systems can be used to 

**guide immediate action for cases of public health; **
**measure the burden of a disease, related factors, and risk populations; **
**monitor trends, including the detection of epidemics (outbreaks) and pandemics; **
**guide planning, implementation, and evaluation of programs to prevent and control disease, injury, or exposure; **
**detect changes in health practices and the effects of these changes; **
**prioritize the allocation of health resources; **
**describe the clinical course of disease;**
**provide a basis for epidemiologic research. **

- Modified from “Updated Guidelines for Evaluating Public Health Surveillance Systems, Recommendations from the Guidelines Working Group”; Robert R. German, Chairman;  Morbidity and Mortality Weekly Report; July 27, 2001 / 50(RR13);1-35

**Notes:**
As part of EPHTN the Environmental Health Tracking Branch, Division of Environmental Hazards and Health Effects, National Center for Environmental Health (NCEH), CDC is developing Health and Environment Linked for Information Exchange in Atlanta (HELIX-Atlanta). This effort is testing a process for developing a local environmental public health tracking (surveillance) network.   The project is demonstrating feasibility and examine methods.  This work is a classic illustration of, “The process is the product.”  

HELIX-Atlanta follows typical practice in design and implementation of a public health surveillance program.  This modality is the analog of NASA system engineering approach, but designed to meet the realities of epidemiology.  The project has five teams working with existing information systems to address topic areas selected based on local priority health and environmental issues  Each team is integrating one or more existing health databases with selected environmental data.  Several of the teams are examining air quality measures obtained from both EPA monitoring sites and from satellite estimates.   Another environmental data source of interest is the land’s radiative surface temperature as measured from satellite.

None of the environmental data sources are well suited for public health surveillance, but they are adequate to prove concept and methodology.  Common deficiencies are spatial or temporal resolution, timeliness, sample density, and the geophysical parameter measured.  But existing assets are sufficient for some applications and are satisfactory for demonstration of concept.

To satisfy the definition of a surveillance system the data must be disseminated to plan, implement, and evaluate environmental public health action.  A sixth team, “Outreach”, is charged with identifying target audiences and designing products and protocols specific to each audience.

## Particulate Matter (PM2.5) in 2003

**Particulate Matter (PM****2.5****) in 2003**

- NASA/MSFC and the CDC are partners in linking environmental and health data to enhance public health surveillance.
- The use of NASA technology creates value – added geospatial products from existing environmental data sources to facilitate public health linkages. In the future, MODIS data will be combined with the EPA data.
- Additional environmental and technology data products, such as ozone and surface temperature, are being developed to provide information to the national Environmental Public Health Tracking Network (EPHTN).

- Technical Contacts: Doug Rickman (doug.rickman@nasa.gov)
-                                  Dale Quattrochi (dale.quattrochi@nasa.gov)

- CDC Contact:
- Jeffrey ShireNational Environmental Public Health Tracking Program
- Centers for Disease Control & Prevention
- 1600 Clifton Rd, NE, MS E19
- Atlanta GA 30333
- NASA Program Contact:
- John A Haynes, Program Manager
- Public Health Application, Applied Sciences Program
- NASA Headquarters MS 5L79
- Washington DC 20546-0001

- EPA sites

- High : 50 g/m3

- Low : 0 g/m3

- Data from scattered EPA monitoring sites were used to make daily surfaces of PM2.5 concentrations.   High PM2.5 concentrations are associated with respiratory and cardiovascular problems.

**Notes:**
Example of work to date.

## What type of information do decision makers need and what are the pressing science questions?    
Are we communicating information to decision makers effectively or are we falling short on delivering the information they need?
What are the barriers to using climate information in decision making and how can they be overcome?
How can CCSP best maintain a dialogue with decision makers to evolve the program?

**Are we communicating information to decision makers effectively or are we falling short on delivering the information they need?**
**What are the barriers to using climate information in decision making and how can they be overcome?**
**How can CCSP best maintain a dialogue with decision makers to evolve the program?**

## October 9, 2003

**October 9, 2003**
**EPA AQS PM2.5 Sites**

**Notes:**
Slide showing EPA AQS sites.

## Particulate Matter (PM2.5) in 2003

**Notes:**
There are 2 time delays buitl into this slide.

Using the environmental data is not simply a matter of take the information and plug it into the decision support system.  

How do you relate the available environmental data to the variables of interest?

Problems with the individual data values.

## June 25, 2003 

**June 25, 2003**
**EPA AQS PM2.5 Monitors**
**&**
**MODIS Postings**

**Notes:**
The MODIS data has much higher density (clouds permitting).

## Monthly correlation coefficients between 

**Monthly correlation coefficients between **
**MODIS AOD and AQS-measured PM2.5 **

**Notes:**
Does the MODIS data even mean the same thing as the AQS data?  And is the meaning consistent with time? Or with place?

## What type of information do decision makers need and what are the pressing science questions?    
Are we communicating information to decision makers effectively or are we falling short on delivering the information they need?
What are the barriers to using climate information in decision making and how can they be overcome?
How can CCSP best maintain a dialogue with decision makers to evolve the program?

**Are we communicating information to decision makers effectively or are we falling short on delivering the information they need?**
**What are the barriers to using climate information in decision making and how can they be overcome?**
**How can CCSP best maintain a dialogue with decision makers to evolve the program?**

## By being in the mine with them!

**Mining Lead**

**Dressed at the mine mouth in Coahuila**
** ****Strontium Mine**

**Notes:**
Slide has 1 time delay object.

If you are going to sell a new and improved method you had better be willing to go down into the mine.  If your product has value the customer will develop the necessary institutions.  

## Schematic data transfer process for HELIX-Atlanta.

- 3

**Health**
**Data**

**MODIS**

**AQS**

**Linkage**

**Linked**
**Data**

**Acute Asthma **
**Visits **

**Aggregation**

**email**

**email**

**EHTB**

**NCEH**

**HELIX - Atlanta Team**

**Envirn**
**Data**

**Schematic data transfer process for HELIX-Atlanta.**

**EPA**

**NASA**

**Notes:**
The “decision makers” are not paid to become experts in data outside their management puview. And it is not reasonable to expect they should be, even if they are deeply interested. “Their plates are full, budgets stretched, competing demands, lack of expertize, .....”  Notice in this diagram there is no handoff.  No break point where NASA or EPA quit and CDC begins.  Right now the boundary is in the extreme lower-right corner.  It will move to the upper left with time.