Evaluating Public Health Outcome: An Overview

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Evaluating Public Health Outcome An Overview
Rebecca Calderon, Danelle Lobdell, Harold
Zenick U.S. Environmental Protection Agency,
Office of Research and Development, NHEERL
A centerpiece of this effort has been the
publication of an initial Draft Report on the
Environment in 2003 (EPA, 2003) that will be
supplemented by periodic updates the next due
out in 2006. In the Health chapter of the ROE,
a number of data gaps are identified that relate
to the need for improved indicators of the actual
public health impact associated with Agency
decisions and actions.
Science Question
Collaborations
Future Directions (continued)
What environmental public health indicators
(EPHIs) should be examined/tracked to further
assist the Agency in evaluating its decisions and
actions? What approaches and tools are needed to
be able to evaluate and attribute changes in such
public health outcomes to Agency
decisions/actions? Is the Environmental Public
Health Paradigm an appropriate vehicle by which
to identify and then address data gaps through
research to develop and validate potential EPHIs
and their predictive linkages (i.e., linkages
between the sequence of events from exposure to
outcome)?

• Center for Disease Control and Prevention (CDC)
  National Center for Environmental Health
• Memorandum of understanding (MOU) established
  between EPA (ORD and Office of Environmental
  Information (OEI) leads) and CDC (Environmental
  Public Health Tracking Program)
• Exchange network project
• Public Health Air Surveillance Evaluation (PHASE)
  Project (ORDs National Exposure Research
  Laboratory (NERL) and Office of Air Quality,
  Standards, Planning)
• Discussions have begun with the Environmental
  Public Health Indicators Project staff.
• U.S.-Mexico Border Program
• ORDs National Center for Environmental Research
  (NCER) will be issuing RFA focusing on linking
  environmental and health databases

The Draft Report on the Environment, Technical
Document is currently being updated for release
in 2006. Much of the same indicators used in the
2003 report will be utilized. In addition to
updating the health and biomonitoring indicators
on a National scale, the 2006 updated report will
also provide for select indicators regional
breakdowns of the data. Such an example is shown
below for cancer.
Research Goals
The overall goal of Office of Research and
Developments (ORD) Public Health Outcomes
Research Program is to develop tools and
methodologies for the Agency to apply, where
appropriate, in evaluating its regulatory and
environmental management program. Under an
initiative begun by previous Administrator
Whitman, the Agency has started a process to
better assess the state of the environment that
may result from its policies and actions to
improve environmental quality.
Impact and Outcomes
Approach
Draft Report on the Environment, 2003, Technical
Document Selected examples of indicators used
in the Health Chapter.
Research on public health outcomes is a
relatively new effort in ORD. This research is a
key component in the Agencys ability to protect
the human health and the environment. With the
advent of the Government Program Review Act, it
is critical for the Agency to be able to
demonstrate measures of success. Research on
public health outcomes will provide the methods
and models necessary to enable evaluation of
actual public health outcomes for risk management
actions. The ROE had identified data gaps and
research needs to describe environmental
conditions and human health concerns.
ORD has implemented a research program that will
lead to the development and validation of
environmental public health indicators (EPHIs).
These indicators, while complementing traditional
performance and process indicators (e.g.,
decreases in emissions, discharges and pollutant
levels in environmental media) are intended to
reflect more closely the actual impact on public
health that result from environmental
decision-making and to help clarify the benefits
and costs associated with further incremental
environmental improvements. The current lexicon
that is ascribed to this overall effort is
accountability, i.e., the Agencys desire to be
more accountable to the public in demonstrating
true environmental progress. This research
program is called the Accountability Research
Program. The key to using outcome-based
indicators is a clear understanding of the
sequence of events that link changes in the
environmental conditions to health as shown in
Figure 1. Critical to the eventual employment of
outcome-based indicators is a clearer
understanding of the sequence of events that link
predictive changes in environmental conditions to
health outcomes.
Future Directions
In considering the design and subsequent
implementation of this research program, the
methodologies that form the current
state-of-the-science are recognized to be in
varying stages of maturity. In many cases, a
clear need for the development of the proper
tools or assays may be required, hence the link
to the three other areas of the Human Health Risk
Research Program. The program has been initiated
in FY05 with an innovative demonstration
project approach through the solicitation of
nominations from Program and Regional office of
actions and policies to be considered for
research in this program. The Office of Research
and Development will the form design teams to
prepare proposals for scientific peer review.
Based on available resources and a successful
peer review projects will be initiated.
References
U.S. Environmental Protection Agency (EPA).
(2003) Draft Report on the Environment 2003,
Technical Document. EPA publication number
600-R-03-050