Transcript Slide 1

Blueprint for Rural
Environmental Health
Reslience
Environmental Health and Emergency
Preparedness: Disparate or Desperate?
Presentation Goals
1. Background on the NACCHO APC Program
2. Provide examples of initiatives and resources in
the area of EH/EP
3. Explain Environmental Health Resilience in the
context of national guidance
4. Gather feedback and needs regarding the
possibilities and realities of addressing EH/EP
Disparate- the accepted definition
 Preparedness: emergency, disaster, recovery,
possible/infrequent, planning, response, risk, all
hazard, interdisciplinary, tactical, TERRORISM,
mitigation…
 Environmental Health: Regulatory, compliance,
standards, assessment, recovery, management,
inspection, promotion, enforcement, consultation,
sanitation, control…
Desparate- the unacceptable
definition
 “Alamosa”
 STEC in childcare center
 Boulder Fires
 Annual Flooding, Pennsylvania, Memphis
 Rocky Ford melons
 Mundane- fires, water contamination (Hotchkiss,
CO)
 Mine water releases/contaminants
 Oil and gas exploration
The Devils Advocate approach:
 What is needed?
 Who says?
 How do they say it?
 What do they expect us to do?
 Why is it valuable for us to do it?
 How can we get it done in light of everything else we
have to do?
 What can happen if we don’t?
 What will that mean?
Do YOU feel the movement?
 The Mesa County APC recognizes that there is a
national movement taking place to address the
integration of Environmental Health and Emergency
Preparedness. At its core, this movement seeks to
address a community plan for resilience in the face
of environmental hazards and emergencies. The
Mesa APC has been working to assure that quality
improvement tools and resources are available to
local public health agencies.
Movement? What Movement?
 National Environmental Health Promotion Network
(NEHPN): Society for Public Health Education
(SOPHE),

http://www.sophe.org/environmentalHealth/NEHPN.cfm
 National Conversation on Public Health and
Chemical Exposures,

http://www.atsdr.cdc.gov/nationalconversation/
 EPA's Community-Based Water Resiliency (CBWR)
initiative,

http://water.epa.gov/infrastructure/watersecurity/communities/index.cfm
The National Environmental Health
Promotion Network (NEHPN)
 is a group created through a cooperative
agreement between SOPHE and CDC/ATSDR.
It is comprised of professionals from the fields of
environmental health, public health preparedness, and
health education.
 One of its major goals is to develop training and
resources regarding environmental threats and
emergency preparedness for consumption by health
educators.

National Environmental
Health Promotion Network
 http://www.sophe.org/EHEP/index.cfm
 This project will establish a network of subject matter
experts in environmental health and emergency
preparedness. The role of these network members
includes but is not limited to:
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Assisting with development of trainings and resources for use
by public health professionals in environmental health
response and all-hazards emergency preparedness
Receiving training in environmental health, all-hazards
emergency preparedness, risk communication and outreach to
vulnerable Populations
Serving as a liaison to the ATSDR regional offices, offering
training and technical assistance as deemed necessary
The National Environmental Health
Promotion Network (NEHPN)
 Past data collected by SOPHE has shown that
health educators lag behind in terms of level of
training and knowledge regarding issues in
environmental health and emergency
preparedness.
 This is not for lack of desire to be informed, but a
lack of available training opportunities and
resources.
National Conversation on Public
Health and Chemical Exposures
 Recommendations for the local level:
 http://www.nationalconversation.us/sectors/government/local
 Highlights:
 2.4 Expand environmental public health tracking and
occupational health surveillance
 4.6 Provide training to all relevant parties to maximize the
success of community-engaged projects
 5.3 Develop current and comprehensive environmental and
occupational health education for grades K-16
 6.5 Expand professional development opportunities for the
environmental public health workforce
 7.8 Develop capacity of Emergency Support Function (ESF) #8
– Health and Medical Service planners and responders
EPA's Community-Based Water
Resiliency (CBWR) initiative aims to:
 Increase overall community preparedness by raising
awareness of water sector interdependencies and
enhance integration of water sector into community
emergency preparedness and response efforts; and
 Increase preparedness and resiliency of drinking
water and wastewater utilities by delivering tools and
information to increase community collaboration and
bolster security practices.
 Water Contaminant Information Tool:
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http://water.epa.gov/scitech/datait/databases/wcit/index.cfm
National Health Security Strategy
 The National Health Security Strategy (NHSS)
1
states that communities will work to “Ensure
prevention or mitigation of environmental and other
emerging threats to health” by:
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Enhanced risk analysis and research to improve
understanding and anticipation of environmental and emerging
threats;
Improved mechanisms to prevent and mitigate existing and
novel environmental and emerging threats, including those
relating to food safety and resulting from the misuse of life
sciences
information and technology;
National Health Security Strategy
(cont.)
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Enhanced ability to detect and report environmental and
emerging threats early and to characterize them fully;
Improved ability to effectively and efficiently respond and
recover from health incidents caused by environmental and
emerging threats.
Sources:
 National Health Security Strategy, HHS,
http://www.phe.gov/Preparedness/planning/authority/nhss/strategy/Documents/nhssfinal.pdf ;
Biennial Implementation Plan, HHS,
http://www.phe.gov/Preparedness/planning/authority/nhss/strategy/Documents/nhssfinal.pdf.
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Background on PHEP
 In December 2009, the U.S. Department of Health and Human
Services released the National Health Security Strategy (NHSS)
followed by its companion document, the Biennial
Implementation Plan (BIP) to “galvanize efforts” for achieving the
vision of complete national health security. The NHSS
compliments and supports the implementation of strategies
developed by the Department of Homeland Security’s (DHS)
National Response Framework which assist in addressing the 10
Essential Public Health Services. These strategies culminate in
the Centers of Disease Control and Prevention’s (CDC) 15
Public Health Emergency Preparedness (PHEP) target
capabilities. The PHEP capabilities provide a framework to help
rural communities prepare for, protect against, respond to, and
recover from incidents with potentially negative environmental
health consequences.
CDC’s Public Health Emergency
Preparedness (PHEP) Capabilities
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Public Health Laboratory Testing
Public Health Surveillance and Epidemiological
Investigation*
Community Preparedness
Community Recovery
Responder Safety and Health
 *The biosurveillance aspects of animal disease and emergency
support, food and agriculture safety and defense, and environmental
health were incorporated into the public health surveillance and
epidemiological investigation capability.
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PHEP Capabilities: National Standards for State and Local Planning, March 2010, www.cdc.gov/phpr/capabilities.
The RAND Report:
 “Community resilience or the sustained ability of a
community to withstand and recover from adversity
(e.g., economic stress, influenza pandemic, manmade or natural disasters)”, is an intrinsic goal of the
efforts that guide environmental health actions.

Building Community Resilience to Disasters: A Way Forward to
Enhance National Health Security, RAND Corporation, 2011.
ISBN 978-0-8330-5195-0
The Basic Resilience Model
Adapt
Withstand
Rapidly
Recover
Resilience-Workforce Tasks:
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Perform exercises and drills
Provide training in environmental health response
Conduct inspections and plan reviews
Create/Implement plans for mitigation and
recovery
Resilience-Partnership Tasks:
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Solicit community input and awareness
Support collaboration and execute agreements
Enforce laws and compliance measures
Inform community of disaster management
services
Mesa APC’s role
 In the fall of 2009 the Mesa County Health
Department was selected as an APC by the National
Association of County and City Health Officials
(NACCHO.) Over the past 7 years APC sites around
the nation have created 130 toolkits. Of those, 19
address issues related to environmental health
emergencies.
Mesa APC’s role
 The first step in the construction of community
resilience is identifying the places within local
environmental health programs where knowledge,
support, and resources are lacking. Filling these
environmental health planning and preparedness
gaps is foundational to the overall sustainability of
rural community resilience, and central to the
mission of the NACCHO Advanced Practice Center
(APC) program.
Mesa APC’s role
 The Mesa County APC, in partnership with the
Toledo-Lucas County (Ohio) APC, began an
environmental health toolkit evaluation process that
includes “usability” reviews, subject matter expert
(SME) analysis, toolkit user input, and a quality
improvement review.
Mesa APC’s role
 In order to identify these gaps, the Mesa County
APC launched an Environmental Health Gaps
survey to gather feedback from environmental health
professionals regarding the programmatic gaps in
their jurisdiction. This data was compared to the 19
environmental health toolkits produced by the
NACCHO APC program.
Environmental Health Gaps
In a survey administered by the Mesa County Advanced Practice
Center (APC) through the National Environmental Health
Association and the Colorado Environmental Health Association,
the following categories were identified as gaps by local
environmental health professionals.
Ambient Air Quality
Noise
80.0%
Greenhouse Gases
80.0%
Vehicle Emissions
66.7%
Disease Control
Environmental (cancer,
asthma, lead, etc.)
64.3%
Water Quality
Solid Waste Management
Urban Runoff (pesticides,
fertilizers, chemicals, animal
waste)
86.7%
Pharmaceutical/Bio-Medical
57.1%
78.6%
Household Hazardous (paint,
oils, batteries, etc.)
52.9%
Agricultural Runoff
http://www.surveymonkey.com/s/ehgaps
Environmental Health Gaps
Indoor Air Quality
Green Initiatives
Ventilation (Public/Work
Places)
64.7%
Design Walkable Communities
85.7%
Mold/Mildew
56.3%
Alternate Energy
66.7%
Energy Efficiency
66.7%
Alternative Transportation
66.7%
Food safety
Allergens
80.0%
Internet Sales
66.7%
Home Preparation
60.0%
Delivery Services
60.0%
What is an Advanced Practice
Center (APC)?
 The National Association of County and City Health
Officials (NACCHO) Advanced Practice Centers (APC)
Program is a network of local health departments that exist
to serve the public health community, developing resources
and training on topics such as:
 Bio-surveillance
 Vulnerable populations
 Risk communication
 Countermeasure distribution
 Workforce development
 Visit http://apc.naccho.org for more information on the APC
mission, other APC sites, and other resources.
Barriers: Budget offers and
Contracts
 Compliance/Regulation vs Education/Outreach- perceived
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80/20 rule.
If its not part of the budget (as determined by what is
offered by CDPHE or other) then we CAN’T do it (unless
we truly care about it.)
Status quo- we’ve always done it this way- or eveyone else
does it this way…or it is someone else’ responsibility.
Clearly defined objectives- linked to contract outcomes,
and measureables.
Data/Indicators…have they been identified locally? Can
they be ascertained?
What would make our (rural)
environmental health jobs easier
 Workload analysis- risk based vs. routine- a different
strategy or a more outcome-based strategy

Foodborne illness risk factors (FDA): “number of hits”
 Quality Improvement: Contract Outcome Data
Assessment (CODA)
 Creating a local system of “consumable”
data/information base for EH that is not reliant on
personality or experience.
 Reducing the drags on effectiveness: effect of funding
and programmatic direction from the area of EH.
Getting involved in future
developments
 The Mesa County APC launched an Environmental Health
Gaps survey to gather feedback from environmental health
professionals regarding the programmatic gaps in their
jurisdiction. You are encouraged to take the survey by visiting:
http://www.surveymonkey.com/s/ehgaps to help us produce a
strong dataset.
 Environmental Health Response Toolkits are always available at
the NACCHO APC website (www.apc.naccho.org) and by linking
to them from the Mesa APC page, which contains a list of the
Environmental Health toolkits. NACCHO and the Mesa County
APC is in need of subject matter expert (SME) feedback from
environmental health professionals that have used the APC
toolkits. Please contact the Mesa County APC to get involved.
Contact:
 Mesa County Advanced Practice Center:
 http://health.mesacounty.us/APC2
 [email protected]
 Greg Rajnowski, Health Informatics
 [email protected]
 970-248-6929