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PACE-EH SUMMITLouisville KY March 28 & 29, 2006
Alan Kalos
Northern Kentucky Health Department
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
