Category Archives: Environmental health
In a new interview with Ramona Trovato, Deputy Assistant Administrator of the Environmental Protection Agency (EPA), NewPublicHealth continues its conversation series about the National Prevention Strategy. The strategy was released last year by Surgeon General Regina Benjamin, MD, MBA, to help create a healthier and more fit nation.
Earlier this year the Surgeon General’s office released the Strategy’s National Action Plan, designed to show how the 17 Federal Agencies charged with advancing the National Prevention Strategy are implementing its vital components. The EPA has several partner initiatives critical to the health of the nation, which include:
- Partnership for Sustainable Communities: The EPA is a partner, together with the Department of Transportation and the Department of Housing and Urban Development, in this partnership to help communities improve access to affordable housing and transportation while protecting the environment, all critical aspects of healthy living.
- Green Ribbon Schools: EPA is a partner with the Department of Education and other agencies for this recognition award that encourages state education agencies and schools to recognize the links between education, health, and the environment, and to make all three of these areas a priority.
- Safe routes to school: Agencies including HHS, EPA and the Department of Transportation support efforts to improve the ability of students to walk and bicycle to school safely.
- Task Force on Environmental Health Risks and Safety Risks to Children: This multi-agency task force, which includes the EPA, recommends strategies for protecting children's health and safety, including specific priorities around asthma, unintentional injuries, lead poisoning, cancer, and environmental health in schools.
- Aging Initiative: This EPA initiative aims to prioritize environmental health hazards that affect older persons, focus on “smart growth” principals to support active aging, and examine the environmental impact of an aging population, and encourage civic involvement among older persons in their communities to reduce hazards.
Ramona Trovato shared with us EPA’s long history of health promotion and its current efforts to help improve population health as a member agency of the National Prevention Council.
NewPublicHealh: How does the Environmental Protection Agency (EPA) align itself with the National Prevention Strategy?
Ramona Trovato: The EPA is really pleased to be part of the National Prevention Council and the National Prevention Strategy. We firmly believe in preventing ill health and in promoting wellness, and it’s something that matters to us in all the work that we do. We have very successfully partnered with Department of Health and Human Services in the past and with a number of other federal agencies including the Consumer Product Safety Commission, the Department of Transportation and the Department of Housing and Urban Development to benefit the public’s health.
NPH: What are the key roles of the Environmental Protection Agency in protecting the nation’s health?
Older adults may be at increased risk of being hospitalized for lung and heart disease, stroke, and diabetes after long-term exposure to fine-particle air pollution, according to a new study by researchers at Harvard School of Public Health. The study, published in PLoS One, is the first to look at the link between long-term effects of exposure to fine particles in the air and rates of hospital admissions.
Between 2000 and 2009 in the United States, the annual rate of maternal opiate use increased nearly fivefold and diagnosis of drug withdrawal syndrome among newborns increased three-fold according to a new study in the Journal of the American Medical Association. Use of opioids and other illegal drugs is associated with a significantly increased risk of adverse neonatal outcomes including low birth weight and death, according to the study authors. The research was supported by a grant from the Robert Wood Johnson Foundation Clinical Scholars Program.
The Department of Justice has announced that it has settled its lawsuit against the Mortgage Guaranty Insurance Corporation for discriminating against women on maternity leave in violation of the Fair Housing Act. The settlement is the department’s first involving discrimination against women and families in mortgage insurance.
The lawsuit was filed in July 2011 and alleged that MGIC required women on maternity leave to return to work before the company would insure their mortgages, even for women who had a guaranteed right to return to work after the leave.
The Department of Agriculture's Animal and Plant Health Inspection Service has confirmed the detection of bovine spongiform encephalopathy (BSE) in a dairy cow from central California. The USDA says the animal will be destroyed and had not been for slaughtered for human consumption, so at no time presented a risk to the food supply or human health. Additionally, according to USDA, milk does not transmit BSE.
The American Lung Association’s State of the Air 2012 report, released today, finds that in America’s most polluted cities, air quality was at its cleanest since the organization began releasing the report thirteen years ago as efforts continue to make environmental hazards.
However, the report shows that more than 40 percent of people in the U.S. live in areas where air pollution continues to threaten their health--127 million people are living in counties with dangerous levels of either ozone or particle pollution that can cause serious health problems such as wheezing and coughing, asthma attacks, heart attacks, and premature death.
Implantable pacemakers or defibrillators may pose a risk for developing deadly infections, according to a new study in the Journal of the American Medical Association.
The study shows that more than 4.2 million people in the US had a permanent pacemaker or defibrillator implanted between 1993 and 2008, and that infections related to heart devices infections increased 210 percent during that time, according to the study.
The study authors say a contributing factor may be that some patients may have other medical conditions and be particularly vulnerable to developing infections.
The Environmental Protection Agency is inviting people to write six-word “micro essays” about Earth in observance of Earth Day this Sunday. Many of the micro-essays will be featured on the EPA home page and on the EPA’s social media channel.
EPA Administrator Lisa Jackson wrote: Healthier families, cleaner communities, stronger America.
NewPublic Health’s entry: Live, Learn, Work, Play and Breathe.
The EPA has a webpage devoted to Earth Day(and the days beyond—when we should still be decreasing our energy usage, reusing and recycling as much as we can, and using human-powered transportation whenever possible). Other EPA resources include:
- A map of Earth Day activities throughout the nation—for example, Birmingham, Ala., will hold the country’s largest Earth Day parade, while Georgia Tech’s Earth Day celebration includes eco-friendly giveaways, recycling opportunities, a clothing swap, an office supply exchange and organic popcorn.
- Join an EPA discussion group on the environment or start your own.
- Choose Five things to commit to doing to help protect the environment
- Sign on for EPA’s Green Tips such as, "Leaving your car at home twice a week can cut greenhouse gas emissions by 1,600 pounds per year."
>>Bonus Earth Day activity: The American Public Health Association (APHA) recently held an Emergency Stockpile Recipe Contest. The contest was part of the APHA’s Get Ready Campaign, which helps Americans become prepared for disasters and emergencies. What makes the recipes so Earth Day-appropriate is that none require an energy source for preparation and are made from foods you’d stockpile for an emergency (be sure to replace any cans or packages you take out of your stash, though). The winners:
>>Weigh In: What are you doing for Earth Day?
The Department of the Interior has released the "Environmental Justice Strategic Plan 2012-2017."
The plan sets forth goals, strategies and measures to help the Interior Department work more effectively with disadvantaged communities to reduce environmental and health hazards, and outlines steps that the department will take to help protect communities facing disproportionate health and environmental risks.
“Every community deserves a healthy environment in which to live, learn, work, and play,” says Secretary of the Interior Ken Salazar. Salazar says the Strategic Plan will help the Department to better serve minority and low-income communities, including American Indian tribes, by assisting local efforts to recover from environmental, economic and public health impacts associated with abandoned coal mines and industrial pollution, increase the efforts of government agencies to identify and use federal resources to the benefit of environmentally and economically distressed communities; to participate in community revitalization and economic development initiatives; and to conduct community outreach and education projects.
Throughout 2011, representatives from Interior participated in several listening sessions across the country including the 2011 and 2012 listening sessions held during the Alaska Forum on the Environment.
>>Read the Strategic Plan.
Do couches need a pound of flame retardant that may pose its own health risk? A recent presentation at the Harvard School of Public Health looked at flame retardants, found in some household goods, that have been linked in some studies to cancer, fertility and brain development issues. The keynote speaker, Arlene Blum, a visiting scholar in chemistry at the University of California, Berkeley and executive director of the Green Science Policy Institute, has been researching flame retardants since the 1970s. Among Blum’s concerns: many items such as office and home furniture contain substances that may pose a danger, but are not regulated by any federal agency.
Read more about Professor Blum’s presentation.
Bonus Reading: The Yale School of Public Health published a report on safety concerns linked to flame retardants earlier last year.
Today is World Water Day and in remarks at the State Department this morning, Secretary of State Hillary Clinton pointed out that the U.S. is not immune to the issue. “We are pursuing this not only because we care about it around the world; we care about it here at home. We’ve had increasing problems meeting our own needs in the Desert Southwest or managing floods in the East. No country anywhere, no matter how developed, is immune to the challenges that we face,” said Clinton.
In the U.S. water crises are more likely to be linked to emergencies such as weather disasters that can interrupt or contaminate water supplies:
A key group that presented at the New Partners for Smart Growth conference last week, was the Partnership for Sustainable Communities. Created in 2009, the Partnership is a collaborative initiative of the U.S. Department of Housing and Urban Development (HUD), Department of Transportation (DOT), and the Environmental Protection Agency (EPA) with the combined goal of helping communities across the U.S. improve access to affordable housing, increase transportation options, and lower transportation costs while protecting the environment.
The Partnership works to coordinate federal housing, transportation, water, and other infrastructure investments to make neighborhoods more prosperous, allow people to live closer to jobs, save households time and money and reduce pollution.
"Sustainable communities are those that have access to jobs, quality schools, safe streets, environmental benefits—basically, communities that are built in ways that everyone can be included and have a better quality of life," said Shelley Poticha, who serves as HUD’s advisor to the Partnership and as Director for Office of Sustainable Housing and Communities at the Department.
Taking Action on Environmental Health Could Impact U.S. Health Care Cost Effectiveness: A Q&A with Bobby Milstein
The May 2011 issue of Health Affairs, which focuses entirely on environmental health (see the NewPublicHealth interview with Health Affairs Editor-in-Chief Susan Dentzer) includes an article by Bobby Milstein, PhD, MPH, and colleagues on the critical role taking action on environmental health would play in improving cost effectiveness of the U.S. health care system. Milstein leads the Syndemics Prevention Network at the Centers for Disease Control and Prevention.
NewPublicHealth spoke with Milstein about the Health Affairs article.
NPH: Tell us about the new study.
Bobby Milstein: This is an attempt to examine some of the major proposals for health system change in the United States. We look specifically at scenarios for expanding health insurance coverage, improving the delivery of preventive and chronic care in clinical settings, as well as wider efforts outside the doctor's office to protect people’s health by enabling healthier behaviors and building safer environments. One of the unique things about our approach in this study is its broad scope: it is relatively rare for a single study to look at interventions that deal with financing, clinical interventions, and wider population-level health protection efforts. To consider all of those dimensions in one single study--comparing the relative advantages and disadvantages of each strategy alone as well as what can happen if they were to be combined--gives us a pretty rich space to examine how the U.S. health system functions and how it can be improved over time.
NPH: And what were your key findings?
Bobby Milstein: What we discovered, in focusing on just these three types of interventions, is that each strategy alone could save hundreds of thousands--if not millions--of lives and would be a good economic value. That said, there’s nothing mutually exclusive about these options and if they were to be done together, they could be more effective in combination. Part of the story behind what happens when they’re combined is that the element of health protection--helping people to have healthier behaviors and live in safer environments--is a very critical ingredient in the mix because it is the one element among the things we studied that has a chance of lowering the sheer number of disease and injury events in this country. It can also ease demand on an already over-burdened health care delivery system. So, it not only keeps people healthy, but makes our health care delivery system work better for the people who need it. Those are two key reasons why investing in healthier behaviors and safer environments is likely to contribute to so many more lives saved and ultimately save money in the process.
Our paper also highlights the importance of choosing an appropriate time horizon when studying scenarios for health system change. This study shows that one might draw different conclusions about the impacts of these interventions in the short-term vs. the long-term. If we limit our scope of concern to policy scenarios that extend out over ten years, we’re going to miss some of the fuller effects of what these kinds of national commitments might accomplish. When we carry the analysis out through twenty-five years, we see some very powerful and potentially surprising results regarding the potential impact on health and cost. This is an instance where a long-term view may be needed to transform the functioning of the U.S. health system to be more effective.
NPH: Can you explain the new mathematical tool used to analyze the combinations?
Bobby Milstein: Most of us would like to know the likely impacts over time on health and cost for a range of different policy options. That sort of prospective information could help shape a better overall strategy. What we did, with several years of work at the CDC, is to combine information from many data sources into a single analytic framework. This tool, in turn, has an explicit set of pathways that link together more than a dozen policies that could alter health system dynamics. For example, we can identify how insurance coverage affects not only the receipt of care and the access to it, but also how the demand for that care could change over time based on the success of wider interventions to enable healthier behaviors and build safer environments. That is just one quick example of the work that we did to carefully fit together the moving pieces of our health system into a single tool-and we call that the “HealthBound Policy Simulation Model.” It is this HealthBound model that is the basis for the analysis that was published in Health Affairs.
NPH: Is this the first time the tool has been used?
Bobby Milstein: It is not. The model began as a prototype back in 2008 and one of the early steps that we took was to convene a stakeholder review by twenty-five leading policy analysts and scholars of health system dynamics in the U.S. Those colleagues gave us an early indication that such a tool was plausible, that it had the right policy ingredients, as well as the most essential inputs and outputs they wanted to see.
We then proceeded to develop the tool for a year and a half, primarily through interactions with about five hundred to a thousand colleagues in various venues. We have also been refining it by adding more research as an empirical basis and clarifying how it works. There was a prior publication about a year ago in May of 2010 in The American Journal of Public Health, which laid out the general design and technical features of the HealthBound model. It is also available online at the CDC website through an interface that people can use as an interactive game in their efforts to strengthen leadership and vision for health system change. Hundreds of people have used the HealthBound game in structured ways to think about health policy in this country.
NPH: Are there any immediate steps from the paper’s findings that policy-makers could take?
Bobby Milstein: Absolutely. As I said, there are three broad classes of policies that we considered: insurance, clinical care, and health protection.
There are many practical ways to fulfill the potential in each of these categories, and those specific steps might be different in different contexts. For instance, in the category of clinical interventions, we can think of efforts to improve the adherence to recommended guidelines for blood-pressure control, cholesterol control, smoking cessation and even getting people on aspirin who are at risk for cardiovascular disease. These are all important clinical measures that are well-proven-and just not used as widely as possible.
Turning to the wider community interventions, when we think about healthier behaviors and safer environments, that conversation must begin with efforts to prevent smoking, which is still the single leading cause of preventable death in this country. Comprehensive tobacco control could make tremendous gains both in health and costs. In addition, efforts to deal with obesity, physical inactivity, dietary improvements, and alcohol are just the top of the list of interventions for which guidelines and clear recommendations have already been made. The question is, do we have the will to implement them in this country?
In the environmental realm, we might think about things like reducing air pollution, improving the safety of motor vehicles, and other forms of injury prevention, any of which could be a practical step that people could think of as fitting within the results of the study that we’ve conducted here.
NPH: How else might the tool be used in the future?
Milstein: We’d like to see the HealthBound model used as a way to make sure that when diverse stakeholders get together and think about health system change that they do so with the benefit of a tool that can help them play out the likely consequences of different scenarios. That is just one among many uses. This study, as I mentioned, compares and combines just three broad classes of policies. The model itself, however, offers a much wider range of interventions-such as things having to do with the coordination of care in the clinical realm or social policies to address health equity more broadly. Users can explore a very diverse range of options within this same framework. So the HealthBound model stands as a rich resource for pursuing other policy studies.
Read previous NewPublicHealth.org Q&As with newsmakers and difference makers in public health.