1	The Voices of Stakeholders in California Eddie Oh, MPH eoh@dhs.ca.gov California Department of Health Services Environmental Health Investigations Branch
2	CEHTP Statewide Needs Assessment Components: Phase 1: self-administered surveys of NGOs and Local Agencies Phase 2: in-depth interviews/focus groups Tribal needs assessment Secondary data review Purpose: To assess capacity, resources, gaps, barriers, and priorities in local health and environmental health agencies, non-governmental organizations, and tribes for implementing, utilizing, and participating in an Environmental Health Tracking Network.
3	Phase 1: Self-administered survey questionnaires Issues/needs sought in the questionnaire: Priority hazards, exposures, and health effects and other environmental health issues/ concerns Training and capacity building Utilizing, accessing, analyzing, and collecting data Communicating environmental health information
4	Who Responded? 29 NGOs 17 Local Health Agencies 13 Local Environmental Health Agencies
5	Focus Areas NGOs are engaged in: Public education/ outreach/advocacy Building partnerships/ coalitions Accessing data Analyzing and interpreting data
6	Capacity Building and Training Priority Focus Areas: Public education/outreach/advocacy Building/fostering partnerships/coalitions Strong Capacity: Public education/outreach/advocacy Building/fostering partnerships/coalitions Regulation/pubic policy development Risk communication Priority for Training: Public education/outreach/advocacy Interpreting/analyzing data GIS mapping/spatial statistics
7	The Center for California Health Workforce Studies at the University of California, San Francisco: a Snapshot of California's Local Pubic Health Departments
8	The Center for California Health Workforce Studies at the University of California, San Francisco: a Snapshot of California's Local Pubic Health Departments
9	Frequently Asked of Respondents Frequently asked of respondents: Basic information on environmental health Frequently asked of NGOs: Data on environmental hazards/exposures Frequently asked of local agencies: Data on health effects Respondents are most able to provide: Basic information on environmental health Assistance in utilizing data for action Respondents are least able to provide: Assistance in collecting community data Assistance in conduction community-based research/studies
10	Frequently Asked by Whom General public/community members Non-governmental organizations Pubic agencies Media
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12	Listed as one of the top three Priority Health Effects Non-governmental organizations Respiratory disease x18 Cancer x14 Reproductive outcomes x10 Developmental disabilities x8 Neurologic disease x7 Local Agencies Respiratory disease x13 Cancer x13 Diabetes x9 Cardiovascular disease x5
13	California Biomonitoring Project Needs Assessment: Report to the Advisory Committee
14	Pew Environmental Health Commission: America’s Environmental Health Gap Priority Health Effects: Birth defects Developmental disabilities Respiratory disease Cancer Neurological diseases Priority Hazards/Exposures Persistent organic pollutants (POPs) Heavy metals Pesticides Air pollution Water contamination
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16	Listed as one of the top three Priority Hazards/Exposures Non-governmental organizations Air pollutants x14 Pesticides x13 Indoor hazards x11 Persistent Organic Pollutants x9 Heavy metals x8 Local Agencies Water pollutants x16 Hazardous & solid waste x14 Indoor hazards x10 Foodborne pollutants x8 Pesticides x7
17	Public Policy Institute of California (PPIC) Statewide Survey: Special Survey on Californians and the Environment June 2002
18	Health-Track – National Survey of Public Perceptions of Environmental Health Risks, California Component
19	Children’s Environmental Health Network: California Project Interim Findings
20	Marin Cancer Project – Search for the Cause Survey Results November 2002
21	Most Often Utilized Sources of Data Health Effects Data Sources: Local/Community generated data (e.g. community health surveys) California Health Interview Survey California Cancer Registry Vital Statistics – California Office of Health Information and Research Patient Discharge Database – California Office of Statewide Health Planning and Development Environmental Hazards/Exposures Data Sources: Scorecard – Environmental Defense Toxic Release Inventory – US EPA National Toxics Inventory database – US EPA Other federal data sources (such as HUD E-Maps) California Integrated Waste Management Board databases GeoTracker (Groundwater Resources Information Database)
22	How to Improve the Usefulness of Data Data Accessibility: Awareness of where data and websites are. Easier navigation on websites and centralized access point. Technical assistance in accessing data. Provide data at no cost. Transportability between different file types. State should network their data together. Data Quality: Improve geographic scale of data: need data by zip code or census tract or some other small area. Timely and up-to-date: not less than two years old. Compilation of statewide information and local "hotspots" or geographic abnormalities. Need to address severe validity and reliability problems. Better data by race/ethnicity, not just for major population groups. Larger samples in surveys.
23	How to Improve the Usefulness of Data Data Accessibility: Awareness of where data and websites are. Easier navigation on websites and centralized access point. Technical assistance in accessing data. Provide data at no cost. Transportability between different file types. State should network their data together. Data Quality: Improve geographic scale of data: need data by zip code or census tract or some other small area. Timely and up-to-date: not less than two years old. Compilation of statewide information and local "hotspots" or geographic abnormalities. Need to address severe validity and reliability problems. Better data by race/ethnicity, not just for major population groups. Larger samples in surveys.
24	Public Health Foundation: Environmental Health Data Needs – Workshop Results
25	Preferred Data Formats
26	Examples of Activities Utilizing Environmental Health Data Programs/Initiatives: Childhood lead prevention Environmental Justice Assessment/Research Drinking water and groundwater contamination assessment Reports: Fields of Poison: California Farm workers and Pesticides and Secondhand Pesticides
27	Factors for Utilizing Environmental Health Data for Action Quality of data Relevant, specific, valid, timely data. Data availability and access Information about where to find data, the types of data contained, and how to access the data. Coordination, centralization, and integration of various data, including environmental and health data.
28	Utility of Environmental Health Tracking
29	Utility of Environmental Health Tracking Monitor health status to identify community health problems Better track changes or improvements in air quality, especially toxics, and changes in the health status of residents. Inform, educate, and empower people about health issues Educate families and clinical professionals as to exposure risks for prevention and knowledgeable decision-making. Develop policies and plans Improve the competitiveness of grant applications by improving the access to data.
30	Utility of Environmental Health Tracking SAVE THE PLANET! Educate those living at the agricultural interface. Make correlations between pesticide use and public health and water quality. Educate communities about their rights and resources.
31	Factors for Accessing Data Awareness/knowledge of data and data sources Quality and format of data Need to put more raw data online. Updated information in report format. Processes/procedures related to accessing data Coordination, consolidation and integration of health and environmental data. More robust query functions: for example, hospital discharge data by zip code, age, and by ICD instead of just by hospital. Resources/capacity/infrastructure
32	Factors for Analyzing/Interpreting Data Quality and format of data Lack of clear statements about limitations and assumptions. Out-of-date information. Data validity and reliability problems. Data Access (acquiring data) Lack of state and federal networked information. Lack of summarized information. Expertise/Competency/Technical Assistance Need for experts in GIS, SPSS, etc. Training/TA for those interested in the particular data you plan to collect. There are always idiosyncrasies of data sets that are important to understand before you can draw conclusions from them. Resource/Capacity/Infrastructure
33	Factors for Collecting Data Resource/capacity/infrastructure issues Data collection processes/procedures Lack of coordination of databases. Various State agencies request data in different formats. Scope/priority of the agency. The priority involves collecting data to meet reporting requirements.
34	Public Health Foundation: Measuring Health Objectives and Indicators – 1997 State and Local Capacity Survey Top barriers to collecting or accessing data for objectives that are difficult to measure (Santa Clara County) Multiple and/or incompatible data systems – 14 Not enough resources to purchase data – 15 Not enough staff to do the work – 12 No data systems exists – 0 Inadequate software – 9
35	Public Health Foundation: Examining Data Sharing Among State Governmental Agencies
36	Conclusion Utility of Environmental Health Tracking depends on accessibility, quality, specificity, and consolidation/ coordination/integration of data. Stakeholders are engaged in a range of activities that are critical for Environmental Health Tracking. Stakeholders are faced with limitations in resources, capacity, and infrastructure, especially when it comes to collecting, analyzing, and/or reporting data. If you build it, they will come. There is tremendous potential for and interest in utilizing Environmental Health Tracking information.
37	Key Differences NGOs utilize data much more for advocacy. Local agencies are generally more involved in data collection and reporting. The perceived role in Environmental Health Tracking was least articulated by local environmental health agencies – their activities/initiatives are driven much more by regulations and mandates. Local agencies were generally more cautious and had more concerns about Environmental Health Tracking, including issues related to resources misuse/misinterpretation of data.
38	Lessons Learned Phase 1 helped us to evaluate program communication activities and develop key messages Needs assessments are also opportunities for outreach/education Involving stakeholders at an early stage helped us to Identify and engage future partners/ collaborators There is a need to further engage stakeholders and build capacity through outreach/education and training
39	Next Steps Conduct in-depth interviews/focus groups with a sample number of respondents. Conduct a Tribal needs assessment. Compare survey findings with secondary data. Convene a CEHTP Outreach and Training Team. Utilize needs assessment findings to inform program activities. Collaborate with CDC, Centers of Excellence, ASTHO, and NACCHO in outreach and training activities.
40	Thanks to the CEHTP Needs Assessment Team Members Martha Arguello: Physicians for Social Responsibility - Los Angeles Holly Brown-Williams: California Policy Research Center – University of California Fred Cagle: Sierra Club David Harrington: Occupational Health Branch – CDHS Mimi Johnson: California Environmental Health Tracking Program Yana Kucher: Environment California – CALPIRG Diana Lee: Environmental Health Investigations Branch – CDHS Dee Lewis: Concerned Residents Initiative Meena Palaniappan: Pacific Institute Thu Quach: Environmental Health Investigations Branch – CDHS Mee Ling Tung: Alameda County Department of Environmental Health & the California Conference of Directors of Environmental Health Winona Victery: US EPA, Region 9 Lisa Wanzor: Breast Cancer Action Michelle Wong: California Environmental Health Tracking Program
41	Thank You Principal Investigator Paul English, PhD MPH Pilot Project Manager and Principal Investigator Eric Robert, MD, PhD Research Director Geoff Lomax, DrPH