Authors Discuss Highlights of the First 15 Years of Environmental Public Health Tracking Program

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We sat down with Holly R. Wilson, MHSE, CHES, and Alex E. Charleston, MPH, to discuss the article, “Environmental Public Health Tracking Program Advances and Successes: Highlights From the First 15 Years”  published in a special supplement of Journal of Public Health Management and Practice.

Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

JPHMP Direct: Your article highlights advances and successes in the National Environmental Public Heath Tracking Program (Tracking Program) throughout the last 15 years. Can you start by explaining the importance of improving capacity of the environmental public health system?

Wilson/Charleston: Over the years we’ve continued to add new data and tools. Now public health professionals have access to an even richer pool of assets to inform public health actions.

CDC established the Tracking Program in 2002. At that time, the nation’s environmental public health system was fragmented and ineffective. Public health agencies lacked the appropriate capacity to assess the impact the environment had on the health of their communities. Data existed in silos and was often not shared across agencies. When data were available, they were in non-standardized formats that made them difficult to use. The Tracking Program worked to break down those silos and create standards for the data. Doing so provided public health professionals with easier access to high-quality data they could use to plan, implement, and evaluate programs and policies to improve community health.

JPHMP Direct: What were some motivators behind the Pew Environmental Health Commission addressing environmental effects on health in 2000?

Wilson/Charleston: In 2000, researchers had announced that they mapped the human genome, allowing for expanded exploration of the connections between genetics and human health. But while those advancements were being made, there remained a lack of basic information about environmental hazards and their links to chronic diseases. At that time, most environmental data collection was done for regulatory and ecological purposes, not for public health use. Public health had a system for collecting national-level infectious disease data in place for years. The Pew Commission called for a comparable environmental health tracking system which would help enhance public health preparedness and prevention efforts.

JPHMP Direct: The article quotes former Surgeon General David Satcher stating, “In public health, we can’t do anything without surveillance. That’s where public health begins.” How has this mindset pushed public health surveillance forward?

Wilson/Charleston: Surveillance is the collection, integration, analysis, and dissemination of information that allows professionals to make informed decisions. Good surveillance data allows agencies to assess the linkage of environmental hazards and potential adverse health effects and improve our understanding of the impact of environmental factors on our health. In public health agencies, particularly those with limited resources, robust surveillance is essential to making the best possible decisions that can positively affect community health.

JPHMP Direct: How does the Tracking Program allow for collaboration with programs on the national, state, and local levels? What is the greatest benefit of bringing together these different groups?

Wilson/Charleston: Collaboration is the heart of the Tracking Program. Not only does CDC require Tracking Program grantees to work together with their environmental health counterparts, we encourage grantees to foster relationships with local health departments, professional organizations, community-based organizations, universities, and other groups. At the same time, CDC Tracking staff work with other CDC programs and with national organizations like the National Association of County and City Health Officials (NACCHO), the National Environmental Health Association (NEHA), and the National Association of Chronic Disease Directors. Working collaboratively helps increase awareness of the Tracking Program among different audience groups, ensure that the data, content, and tools produced by the Tracking Program are relevant, usable, and helpful for various groups, and strengthen the capacity for environmental public health tracking practice at all levels.

JPHMP Direct: What would you say were the biggest challenges in building the foundation for the national environmental public health surveillance program?

Wilson/Charleston: Initially, the biggest challenge was breaking down the silos. Federal, state, and local programs did not always work together, and establishing those relationships sometimes was challenging. The data stewards often got nervous when told that our program wanted to include their data within the Tracking Network. The data stewards had valid concerns regarding confidentially and proper use of their data–compounded by the fact that the Tracking Program did not have an established track record. It was not an overnight process. At times, it felt like taking baby steps while running a marathon. But, over time, we were able to demonstrate competence in publishing data while taking measures to alleviate data stewards’ concerns. Once the program established that reputation, we were able to focus on new challenges.

JPHMP Direct: In 2006, once the foundation was established, the Tracking Program entered its implementation phase. What was the first, or major, significant achievement during this time period?

Wilson/Charleston: The implementation phase was an exciting time! After years of brainstorming, discussing options, and pilot testing, the Tracking Program was ready to begin constructing the system that the Pew Commission recommended. In July 2009, CDC launched the Tracking Network. Many grantee tracking programs debuted their local tracking networks around that same time. It was rewarding—and fun—to see and interact with the system that so many people had spent years imagining and planning.

JPHMP Direct: In recent years, the focus of the Tracking Program has shifted from a developmental mindset to a more applied approach. How do you think this transition in focus has been demonstrated at the local or state level?

Wilson/Charleston: Initially, the program focused primarily on developing the infrastructure for such a surveillance system. Once the Tracking Network was operational, our state and local partners started utilizing the data and tools available on the Tracking Network. The program has seen the number of public health actions at the state and local level increase every year. Since 2005, state and local public health officials have used the Tracking Network to implement over 400 data-driven public health actions to save lives and prevent adverse health effects related to environmental exposures.

JPHMP Direct: The article discusses the ASTHO Peer-to-Peer Tracking Fellowship. What types of programs does this fellowship support, and what successes come as a result since it began in 2009?

Wilson/Charleston: After completing the Fellowship, five health departments—Arizona, Kentucky, Louisiana, Michigan, and Rhode Island—successfully competed to receive CDC funding to join the Tracking Program.

The Tracking Fellowship has been open to applicants from health departments at all levels. Fellowship recipients have included state, county, city, end even territorial health departments—all of which were able to amplify their capacity to conduct environmental public health activities. Fellowship projects have covered a range of environmental health issues including air quality, asthma, birth outcomes, building local tracking systems, data collection and submission, and water quality just to name a few.

JPHMP Direct: Is there one environmental hazard that the public views as most important? How does the Tracking Program help to address this?

Wilson/Charleston: The public seems to be interested in how multiple factors in the environment affect their health within their community. One way the public uses the Tracking Network is through the Info by Location feature. Info by Location allows an individual to see a snapshot of their community, including demographic information, as well as data on several environmental factors and health topics.

Environmental factors play an important role in human health. All human beings are affected in some way by these environmental factors in their daily lives. Environmental factors have been associated with many of the leading causes of death including the five leading causes for 2013 and 2014: diseases of the heart, malignant neoplasms, chronic lower respiratory diseases, unintentional injuries, and cerebrovascular diseases. Info by Location helps to address a main goal of the Tracking Program, namely, to provide information to the public to improve their understanding between the environment and health.

JPHMP Direct: Do you have any final thoughts you would like to share on the topic of environmental public health and surveillance?

Wilson/Charleston: Before the Tracking Network, there was no single source where public health professionals and communities could access data and information to help them better understand relationships between the environment and health. Through the years the Tracking Program has continued to improve and expand that first iteration of the Tracking Network. Thinking about the ever-changing needs of our varied users and designing information and tools that continue to be relevant and usable for them is key to the sustainability, and hopefully expansion, of environmental public health tracking.

Read our other author Q&As:

About the Authors

Holly Wilson

Holly R. Wilson, MHSE, CHES, is the Communications Team Lead for CDC’s Environmental Public Health Tracking Program and has been part of the program since 2009. Prior to working in environmental health, she spent 10 years with other CDC programs communicating with and educating a wide variety of audiences about infectious disease prevention and control.




Alex Charleston

Alex E. Charleston, MPH, is the Acting Deputy Branch Chief for the Environmental Public Health Tracking Program at CDC. He has worked with the Tracking Program for 10 years and has been at CDC for over 24 years. In his tenure at CDC, he has worked with CDC WONDER, Epi Info, Global Tobacco Surveillance, and Genomics in addition to the Tracking Program.