pace-eh summit louisville ky march 28 & 29, 2006 alan kalos northern kentucky health department...

PACE-EH SUMMITLouisville KY March 28 & 29, 2006

Alan Kalos

Northern Kentucky Health Department

alan.kalos@ky.govwww.nkyhealth.org

Genetics

BehaviorEnvironment

Determinants of Health

What is “Environmental Health”?

Environmental HealthA definition:

“Environmental health is the complex relationship among

people, the physical environment and the health of our population.”Kentucky Environmental Indicators Committee, July 8, 1999.

What is an “Indicator”?

IndicatorDefinition:

Indicators are direct or indirect measures of some valued component or quality of a defined system, used to assess and communicate the status and trends of that system’s “health.”Green Mountain Institute for Environmental Democracy, September 1997

IndicatorDefinition (2):

Indicator: A measurement that reflects the status of a system. Indicators reveal the direction of a system (a community, the economy, the environment), whether it is going forward or backward, increasing or decreasing, improving or deteriorating, or staying the same.National Public Health Performance Standards, CDC July 2005

IndicatorDefinition (3):

Indicators are tools for quantifying, through direct or indirect measures, a significant aspect of an environmental issue. They can be used to assess and communicate the status of and trends in overall environmental health.Protocol for Assessing Community Excellence in Environmental Health, NACCHO, May 2000.

IndicatorDefinition (4):

Indicator: a pointer, a sign, a symptom or an index; a suggestionWebster’s New Ideal Dictionary, 1984

Sources, Exposures & Outcomes

Sources, Exposures & Outcomes

Sources, Exposures & Outcomes

Sources, Exposures & Outcomes

Sources, Exposures & Outcomes

Sources, Exposures & Outcomes

Sources, Exposures & Outcomes

Sources, Exposures & Outcomes

Levels of IndicatorsTertiary

Infrastructure, sources and activities

Samples –

Percent population on public water systems

Percent population on public sewer systems

Smoke-free workplaces

Levels of IndicatorsSecondary

Environmental stressors, exposures, and pathways

Samples –

Air Quality Index

Hazardous waste generated

Radon exposure

Agricultural chemicals

Levels of IndicatorsPrimary

Outcome Indicators – Human and environmental health Samples – human health:

Birth defects

Blood lead levels in children

Childhood cancers

Samples – environmental health:

Surface water not meeting use standards

Endangered species

Acres of wetlands

Comparative Risk

Which has a higher priority?

One child develops cancer and dies?

or

5,000 adults and children go to the doctor with gastrointestinal distress?

Ranking and Priority Setting

• Magnitude of the Issue• Size of the jurisdiction (community)• Number affected• Percent of the population affected

Ranking and Priority Setting

Ranking and Priority Setting

Ranking and Priority Setting

• Severity of the issue• Who is affected• High mortality or morbidity• Irreversible harm

Ranking and Priority Setting

• Death• Childhood

cancer• Mercury

poisoning• Stomach ache

Severity

Ranking and Priority Setting

• Forces of Change• Is there the political will to make changes• What is the economic impact• Is there public demand for change

Ranking and Priority Setting

• How many jobs lost if plant closes?

• How much will it cost to stop discharges?

• Do the people believe the plan is responsible for illness?

PACE-EH SUMMITLouisville KY March 28 & 29, 2006

Alan Kalos

Northern Kentucky Health Department

Alan.Kalos@ky.govwww.nkyhealth.org