Environmental Health Surveillance System Research Articles

The Influence of Environmental Issues on Health Promotion: A Historical Journey and Contemporary Challenges

In this editorial, we address the relationship between environmental issues and health promotion, highlighting how these topics are of great global relevance. Over the past decades, understanding of the complex links between health and the environment has progressed, with solid evidence on the adverse effects of air pollution, water contamination, inadequate waste management, biodiversity loss and climate change on human health. These environmental problems can cause a variety of diseases, including respiratory, cardiovascular, cancer and neurological disorders. Despite scientific advances in the field, challenges are persistent. Air pollution and ecosystem degradation continue to affect people's quality of life, compromising the availability of essential resources such as drinking water and food. Climate change also becomes a growing threat, leading to extreme weather events and the spread of vector-borne diseases. As such, integrated and sustainable approaches that protect both human health and the environment are needed. This requires coordinated action at local, national, and global levels, involving governments, the private sector, civil society, and individuals. It reinforces the need to strengthen environmental health surveillance systems, universalize access to basic sanitation and promote environmental education to raise awareness about the importance of health and the environment. We trace the historical evolution of the relationship between health and the environment, highlighting the influence of ancient thinkers such as Hippocrates, passing through moments of greater and lesser attention to environmental issues in public health. Events such as the Stockholm Conference in 1972, Eco-92 in 1992 and the adoption of the Sustainable Development Goals in 2015 are significant milestones in the promotion of environmental and health policies. Human health and the health of the planet are intrinsically linked, hence the need to rethink the development model and adopt effective measures to achieve global environmental goals, aiming to build a healthier, sustainable, and resilient world for present and future generations.

Epidemiological research contributions to local policies of air quality management in the region of Aburra Valley in Colombia.

Area Metropolitana del Valle de Aburra- AMVA, environmental authority of ten municipalities in Colombia, has developed the Integrated Management Plan for Air Quality 2017-2030, whose thematic axis 1 proposes strategies such as the design and implementation of an Environmental Health Surveillance System, based on the strengthening of scientific bases and the development of a scientific research agenda. Since 2016, a collaborative process has been set up between AMVA and the public health academic sector in the región. In the first phase (2016-2017), a research of acute events associated to short-term exposure to air pollutants (daily increases of 10 µg/m3 of PM10, PM2.5 and O3) in vulnerable population (under 5 years of age and older adults 65 years old) for each municipality between 2008 and 2015 was developed. This research achieved important methodological developments, such as: 1) the processes of imputation of data of air pollutants not available and the assembly of unique series by municipality; 2) The identification of cases of sentinel events from health care records using data mining techniques and learn machine for traceability of records, 3) the construction of relational databases for big data analysis, 4 ) the automation of decision-making trees for the construction of explanatory GAM-type models, and 5) the analysis of critical contamination episodes. In its second phase (2017-2018) A prototype of a computational tool was designed in which methodological developments were integrated into data management and analysis. In the third phase (2018-2019), knowledge management processes were developed and epidemiological analyzes for Environmental Health Surveillance were perfected, as well as a web platform - SIVISA was created in order that community actors and decision makers can learn about the phenomenon, manage knowledge, design actions and follow local plans and policies.

Environmental Health Surveillance System for a Population Using Advanced Exposure Assessment.

Human exposure to air pollution is a major public health concern. Environmental policymakers have been implementing various strategies to reduce exposure, including the 10th-day-no-driving system. To assess exposure of an entire population of a community in a highly polluted area, pollutant concentrations in microenvironments and population time–activity patterns are required. To date, population exposure to air pollutants has been assessed using air monitoring data from fixed atmospheric monitoring stations, atmospheric dispersion modeling, or spatial interpolation techniques for pollutant concentrations. This is coupled with census data, administrative registers, and data on the patterns of the time-based activities at the individual scale. Recent technologies such as sensors, the Internet of Things (IoT), communications technology, and artificial intelligence enable the accurate evaluation of air pollution exposure for a population in an environmental health context. In this study, the latest trends in published papers on the assessment of population exposure to air pollution were reviewed. Subsequently, this study proposes a methodology that will enable policymakers to develop an environmental health surveillance system that evaluates the distribution of air pollution exposure for a population within a target area and establish countermeasures based on advanced exposure assessment.

Visualizing Carbon Monoxide Poisoning Surveillance Data on the US CDC National Environmental Public Health Tracking Network

TPS 683: Short-term health effects of air pollutants 2, Exhibition Hall, Ground floor, August 28, 2019, 3:00 PM - 4:30 PM Background: CDC’s National Environmental Public Health Tracking Program (Tracking Program) aims to provide information from a nationwide network of integrated unintentional carbon monoxide (CO) poisoning data that could inform relevant public health action and prevention. Methods: The Tracking Program has developed dynamic environmental health surveillance system that includes standard visualization tools such as charts, interactive maps, and tables, and displays a variety of measures of morbidity and mortality (e.g., crude, and age-adjusted rates per 100,000) for unintentional CO poisoning. Users also can explore these measures by cause (i.e., fire, non-fire, unknown intent or mechanism). The hospitalization and emergency department (ED) data are obtained by the Tracking Program from funded state recipients (26 states); mortality data are from the National Vital Statistics System. We pooled the CO poisoning data from 2010-2014, and examined the proportion of unintentional non-fire CO poisonings, and compared state-specific age-adjusted rates during the same period. Results: During 2010-2014, there were more than 4,500 unintentional CO poisoning deaths with an average of 916 deaths annually. Deaths and hospitalizations categorized as non-fire comprised of 41.4%, and 55.4% of cases respectively. During the same period, states that had the two highest annual age-adjusted rate of ED visits for unintentional CO poisoning were Connecticut (AR: 21.4 in 2011) and Vermont (AR=15.7 in 2013), and the highest hospitalization rate were observed in New Mexico (AR: 2.1 in 2011) and Maryland (AR=1.8 in 2009). Conclusions: The Tracking Program demonstrates the opportunity to visualize environmental and health data on one data platform. This allows users to examine temporal and spatial trends and to identify communities at greater risk for CO poisoning. The Tracking Program’s CO poisoning data can be used to drive public health policy and actions that ultimately will reduce the burden of mortality and morbidity for CO poisoning.

Advancing environmental health surveillance in the US through a national human biomonitoring network.

The United States lacks a comprehensive, nationally-coordinated, state-based environmental health surveillance system. This lack of infrastructure leads to: • varying levels of understanding of chemical exposures at the state & local levels • often inefficient public health responses to chemical exposure emergencies (such as those that occurred in the Flint drinking water crisis, the Gold King mine spill, the Elk river spill and the Gulf Coast oil spill) • reduced ability to measure the impact of public health interventions or environmental policies • less efficient use of resources for cleaning up environmental contamination Establishing the National Biomonitoring Network serves as a step toward building a national, state-based environmental health surveillance system. The Network builds upon CDC investments in emergency preparedness and environmental public health tracking, which have created advanced chemical analysis and information sharing capabilities in the state public health systems. The short-term goal of the network is to harmonize approaches to human biomonitoring in the US, thus increasing the comparability of human biomonitoring data across states and communities. The long-term goal is to compile baseline data on exposures at the state level, similar to data found in CDC's National Report on Human Exposure to Environmental Chemicals. Barriers to success for this network include: available resources, effective risk communication strategies, data comparability & sharing, and political will. Anticipated benefits include high quality data on which to base public health and environmental decisions, data with which to assess the success of public health interventions, improved risk assessments for chemicals, and new ways to prioritize environmental health research.

Environmental health surveillance in the areas near large electoronic industrial complex in Korea

(Introduction)There have been constant civil complaints about the health influences caused by air pollution from Industrial Complexes in Korea. The environmental health surveillance system was implemented to identify pollution and consequent health damage in these areas and conduct risk communication with local communities. (Method)Regional air pollution was evaluated through data assessment of pollutant release/transfer register and air pollution monitoring, 130 hazardous air pollutants were also measured in the residential areas. The study areas (exposed(E)/non-exposed(NE)) were selected by the CALPUFF modeling with stack emmission(PM10, NO2) data. The questionnaires on health situation and characteristics of exposure were done from 2,500 subjects(purposive and propotionate quota sampling). The concentration of 18 pollutants were analyzed in blood and urine of 850 people. Regional health issues were examined with the standardized ratio of morbidity and hospital visit by disease from the 10-year data of National Health Insurance Service. (Results)Methylethylketon and lead were released 380, 2.4 tons per year respectively. The atmospheric concs of methylethylketon and lead were 6.71-2.6ppb, 62-53 ng/m3 in E area, which were relatively higher than those in NE areas and other complexes. The urinary lead and ethylbenzene metabolites were 1.96ug/dl, 232ug/g-creatinine. The residents had relatively more experiences of sinusitis(3%), allergic rhinitis(7%). Their standardized morbidity ratio of cardiovascular disease and cancer in E areas were 1.19, 3.19 compared to NE area. The ratio of hospital visits due to conjunctivitis and respiratory diseases were 1.02, 1.05. The lead in blood were attributed to age, residence regions and smoking habits and had significant relations with blood pressure and cerebrovascular diseases in E areas. (Conclusion) The people have lived in areas near industrial complex would be influenced from polutants emission in their exposure and health.

Environmental Health Surveillance On The Area Near Large Steel Manufacturing Industrial Complex In Korea

Introduction : The national environmental health surveillance system has implemented to monitor and protect health effects of pollution in large industrial complex since 2012. Method : Four areas(I, influenced) situated within 1 km from the complex and one area(CA) to compare were selected through the CALPUFF modeling. 136 hazardous air pollutants were measured for 7 days every season. The risk of some pollutants was assessed into excess cancer risk and hazard quotient (HQ). 1,500 persons (area I 1,168, area CA 338) were asked their history of diseases to evaluate the health effects of pollution in questionnaire. Standardized rate of health insurance bill and death were analyzed also. The metabolites of organic pollutants and heavy metals of about 600 people (blood, urine) were analyzed. Results : The concentration of some aldehydes and heavy metals, phthalates are relatively high. Formaldehyde was 2.58～2.45ppb which were higher than 1.8ppb of comparing area(CA). The excessive cancer risk at 95 percentile were 2.66～2.49ｘ10-5.Atmospheric manganese concentration was 564～72 ng/m3 which was higher than 38nof CA. The HQ of manganese were 7.4～0.95 that was higher 0.46 of CA. Biological concentrations of some pollutants in the influenced area were higher than that of CA. 2-naphthol which is the metabolite of naphthalene was 5.2㎍/g-creatinine. 1-OHP, the metabolite of pyrene was 0.15㎍/g-creatinine. But the manganese didn't show difference between areas. The rate of experience of chest pain and discomfort (24.5%) in area I was higher than that of CA(15.1%). The standardized morbidity of cardiovascular and respiratory disease, dermatitis in area I to CA were 1.13, 1.04, 1.06. Discussion : Although atmospheric concentration increase of some pollutants and health effects by industrial complex were observed in this study, biological exposure was not. The more consideration on the use of biological concentration of pollutant would be necessary in environmental health surveillance.

GeoMedStat: an integrated spatial surveillance system to track air pollution and associated healthcare events.

Air pollutants, such as particulate matter with a diameter ≤2.5 microns (PM2.5) and ozone (O3), are known to exacerbate asthma and other respiratory diseases. An integrated surveillance system that tracks such air pollutants and associated disease incidence can assist in risk assessment, healthcare preparedness and public awareness. However, the implementation of such an integrated environmental health surveillance system is a challenge due to the disparate sources of many types of data and the implementation becomes even more complicated for a spatial and real-time system due to lack of standardised technological components and data incompatibility. In addition, accessing and utilising health data that are considered as Protected Health Information (PHI) require maintaining stringent protocols, which have to be supported by the system. This paper aims to illustrate the development of a spatial surveillance system (GeoMedStat) that is capable of tracking daily environmental pollutants along with both daily and historical patient encounter data. It utilises satellite data and the groundmonitor data from the US National Aeronautics and Space Administration (NASA) and the US Environemental Protection Agenecy (EPA), rspectively as inputs estimating air pollutants and is linked to hospital information systems for accessing chief complaints and disease classification codes. The components, developmental methods, functionality of GeoMedStat and its use as a real-time environmental health surveillance system for asthma and other respiratory syndromes in connection with with PM2.5 and ozone are described. It is expected that the framework presented will serve as an example to others developing real-time spatial surveillance systems for pollutants and hospital visits.

La salud ambiental en México: situación actual y perspectivas futuras

Environmental health has been established in Mexico as a discipline since the early nineties resuming the sanitarian tradition developed over the past century and incorporating new knowledge generated by environmental toxicology and epidemiology. During the last decade there has been some progress in reviewing and updating the regulations, designing programs and policies to reduce exposure to pollutants and consolidating research groups and teaching in the area. However, the most prevalent problems previously diagnosed still remain and new risks have emerged due to environmental degradation (air pollution, toxics exposure and climate change among others) have been incorporated. If this trend persists, the environmental risks will continue to increase and multiply. The environmental health governance in Mexico has to be redesigned involving a transectoral approach. Future proposals might include: establishment of a National Environmental Health Program, update the situational diagnosis at national and regional level, strengthening teaching and graduate programs in environmental health as well as increase support for research in the area and development of an integrated environmental health surveillance system.

Urinary levels of some metals among children in the red sludge area

Background: Hungary’s largest ecological disaster took place on October 4, 2010 when the western dam of a red sludge reservoir had ruptured, and a mixture of 700 thousand m3 of red sludge and water inundated the lower sections of the nearby settlements, causing 9 deaths and 150 injuries. At the affected sites, measures were promptly taken to neutralize the corrosive mud and clean the area. As the sludge has receded and its pH decreased, an environmental health surveillance system was initiated to monitor possible health consequences and to prevent further potential health risks to the population. Objective: to assess the possible health risk of the local population due to the dust exposure originating from the dried red sludge, by measuring the urinary levels of the selected metals in the „Red sludge” and the Control area, comparing the measured values to „reference values” and assessing the tendencies of urinary levels of metals in the two areas. Methods: Monthly 10-10 randomly chosen children were examined from both the exposed (Kolontár and Devecser) and the control (Ajka) settlements. Cadmium, nickel, arsenic, cobalt, chromium, aluminium and vanadium concentrations of freshly collected urine samples of alto­gether 351 children (176 from the affected and 175 from the control area) were analysed by inductively coupled plasma mass spectroscopy (ICP-MS). Both absolute and creatinine adjusted concentrations were evaluated. Results: There were no significant differences in the concentrations of various metals between the children’s urine samples from the exposed and the control areas. In the studied period of 18 months, there was no increasing time trend observed, either. The measured concentrations were similar to those published in the international litera­ture referring to non-exposed areas. Conclusion: No increase of health risk due to the dried red sludge was observed by measuring the urinary levels of 7 metals among children in the area affected by the red sludge

A GIS-BASED ENVIRONMENTAL HEALTH INFORMATION SOURCE FOR MALAYSIAN CONTEXT

In environmental health studies, it is important to have good interaction between human and environment to produce a quality ecosystem. However, this is rather difficult to control due to mass economic development and natural disasters in the past few decades. These situations will eventually cause bad living environment to living species due to environmental hazards, exposures and health. In Malaysia, a real-time environmental health surveillance system has not been readily adopted. There are systems in European countries and the United States which may not be compatible for use in Malaysia. This research aims develop a real-time environmental health surveillance system to mitigate environmental health issues and assist public users to receive earlydetection emergency outbreaks near the location. A comprehensive environmental health ontological model was developed by integrating existing models of environmental health surveillance systems with customized map interfaces to assist public users to receive earlydetection of any emergency outbreaks near the location. The public users can also share and comment on the relevant environmental health outbreaks in social media networks. The proposed real-time environmental health management system (MyEHMS) has gone through the analysis, design, implementation and evaluation cycle. The testing and evaluation was conducted on the first prototype. The initial findings were used to model the final prototype and later the final prototype testing was tested on matching input against a dictionary of known patterns in database and public user query over the output accuracy and effectiveness. In MyEHMS accuracy testing, results showed that the proposed environmental health ontological model and the methods (N-gram approach and multi-tier approach) applied in environmental health management system was able to match most of the inputs from online media news and social media networks in both simulation platforms and real time platforms. However, constant revise of the environmental health ontological model is needed in order to continuously serve the increase number of environmental health issues. Besides, results in MyEHMS user testing also indicated that the environmental health management system has positive potential to be enhanced in order to assist public health in long run. Lastly, the overall results showed that the proposed environmental health ontological model adopted in MyEHMS is able to assist the public users to receive early-detection on emergency outbreaks near the location.

Unrecognized Bomb Hidden in the Babies' Room: Fatal Pulmonary Damage Related with Use of Biocide in Humidifiers

Unrecognized Bomb Hidden in the Babies' Room: Fatal Pulmonary Damage Related with Use of Biocide in Humidifiers

A Spatial Analysis System for Integrating Data, Methods and Models on Environmental Risks and Health Outcomes

AbstractIntegrating data on health outcomes with methods of disease mapping and spatially explicit models of environmental contaminants are important aspects of environmental health surveillance. In this article, we describe a modular, web‐based spatial analysis system that uses GIS, spatial analysis methods and software services delivered over computer networks to achieve this end. The Environmental Health Surveillance System (EHSS) is a prototype system that is designed to serve three purposes: a secure environment for producing maps of disease outcomes from individual‐level data while preserving privacy; an automated process of linking environmental data, environmental models, and GIS tasks like geocoding for the purposes of estimating individual exposures to environmental contaminants; and mechanisms to visualize the spatial patterns of disease outcomes via Web‐based mapping interfaces and interactive tools like Google Earth.

GIS Based Environmental Surveillance System of Low Birth Weight by PM10 in Seven Cities, Korea

ISEE-769 Objective: The environmental pollution has been associated with adverse birth outcome in many studies. Environmental health surveillance system will support for estimating the environmental health risk magnitude and environmental health policy making system. We tried to develop the geographical information system (GIS)-based environmental surveillance system of LBW. Materials and Methods: We obtained air pollution data of 7 Korean metro cities from the Ministry of Environment, meteorological data from the Korean Meteorological Administration, exposure assessment from the National Institute of Environmental Research, and birth data from the Korean National Statistical Office, 2003–2004. We used the generalized additive logistic regression model using individual birth data linkage to air pollution monitoring station data. Results: In 7 metro cities by districts using linear regression analysis, LBW risks were especially increased to 2.5% (95% CI = 0.2–4.9%) in Daegu, and 2.6% (95% CI = 0.3–4.9%) in Ulsan for PM10. In individual residents using logistic regression analysis, LBW risks were increased to 25% (95% CI = 2–53%) in Pusan, 20% (95% CI = 4–38%) in Daegu, and 19% (95% CI = 3–38%) in Ulsan for PM10. In individual residents with adjustment for demographic factor further using multiple logistic regression, LBW risks were increased to 24% (95% CI = 2–52%) in Pusan, 19% (95% CI = 4–37%) in Daegu, and 19% (95% CI = 3–38%) in Ulsan for PM10. Conclusions: Environmental health surveillance is systemic, ongoing collection, and analysis of data correlated to environmentally related disease and exposures and the timely dissemination of information to those who need to know about them in order to take action. GIS modeling is very important for this purpose, so we tried to develop the GIS-based environmental surveillance of low birth weight.

Baden-Wuerttemberg Environmental Health Survey (BW-EHS) from 1996 to 2003: Toxic metals in blood and urine of children

The environmental health surveillance system in the Federal State of Baden-Wuerttemberg (South Germany), among others, was implemented to monitor pollutant exposures and their temporal and regional trends in children at the age of about 10 years. The investigations were performed in two larger cities, one small city and one rural area. Between 1996 and 2003, in total 5470 children were investigated in consideration of environmental health parameters in four cross-sectional studies. The data presented here cover the results of the determination of the internal load with toxic metals. The median values observed in the investigation in 2002/03 were: 4.6 μg/l urine for arsenic, less than 0.2 μg/l urine for mercury, 20.7 μg/l blood for lead, and 0.25 μg/l blood for cadmium. From 1996 to 2003, mercury concentrations showed a substantial decrease (−0.027 μg/l/year) and lead levels also decreased (−0.25 μg/l/year), whereas arsenic and cadmium levels did not change significantly over time. There was no consistent difference in the mean internal load of the metals between the four investigation areas. Important factors influencing the measured concentrations were consumption of fish in the last 48 h, which had an impact on arsenic (factor 2), and amalgam fillings, which accounted for an increase in mercury (factor 4.6). In the 2002/03 study period, levels above the limit of health concern for children (German HBM values) were found in about 0.5% of the lead measurements (maximum value 180 μg/l blood) and in about 0.2% of the mercury measurements (maximum value 8.2 μg/l urine). In conclusion, this environmental health survey generates objective data on secular trends and regional differences and provides insight into probable sources of toxic metal exposure in children.

Sentinel health department project in Baden-Wuerttemberg (Germany) – a useful tool for monitoring children's health and environment

In the Federal State of Baden-Wuerttemberg, Germany, an environmental health surveillance system has been established focusing on children aged 10 years. Four study regions (two larger cities, one small city, and one rural area) were designated in order to get information about the body burden of persistent chemicals (toxic metals and chlorinated compounds) in children and about lung function, frequency of respiratory diseases, and allergies. From 1992/1993 to 2002/2003, seven cross-sectional investigations were carried out, and more than 10,000 children took part in the study. DDE, HCB, PCB-138, PCB-153 and PCB-180 were measured in individual blood samples of about 400 children per year, whereas PCDD/PCDF and coplanar PCBs were determined in pooled blood samples. From 1993 to 2003, blood concentrations of these compounds decreased 2 to 4-fold. Concerning regional differences, slightly lower concentrations of DDE, PCBs and PCDD/PCDF could be seen in children from the municipal population of Mannheim compared to other regions. Breast feeding was associated with considerably higher concentrations of PCBs and most other chlorinated compounds. Static and dynamic lung function parameters showed no differences between the investigated areas. For prevalences of respiratory diseases and allergies, no time trend was observed except for pertussis, which showed a decrease in 2002/2003 probably due to an increase of vaccination rates. In addition, the prevalence of atopic sensitization against aero allergenes remained unchanged at about 35% during the observation period. In conclusion, this environmental health survey delivers objective data about spatial and temporal trends and provides information about possible sources of children's exposure to toxic compounds in the environment. Adaptations of the survey to new problems are discussed.

Environmental Health Surveillance of Low Birth Weight in Seoul using Air Monitoring and Birth Data

The principal objective of this study was to determine the relationship between maternal exposure to air pollution and low birth weight and to propose a possible environmental health surveillance system for low birth weight. We acquired air monitoring data for Seoul from the Ministry of Environment, the meteorological data from the Korean Meteorological Administration, the exposure assessments from the National Institute of Environmental Research, and the birth data from the Korean National Statistical Office between January 1, 2002 and December 31, 2003. The final birth data were limited to singletons within 37-44 weeks of gestational age. We defined the Low Birth Weight (LBW) group as infants with birth weights of less than 2500g and calculated the annual LBW rate by district. The air monitoring data were measured for CO, SO(2), NO(2), and PM(10) concentrations at 27 monitoring stations in Seoul. We utilized two models to evaluate the effects of air pollution on low birth weight: the first was the relationship between the annual concentration of air pollution and low birth weight (LBW) by individual and district, and the second involved a GIS exposure model constructed by Arc View 3.1. LBW risk (by Gu, or district) was significantly increased to 1.113(95% CI=1.111-1.116) for CO, 1.004 (95% CI=1.003-1.005) for NO(2), 1.202(95% CI=1.199-1.206) for SO(2), and 1.077(95% CI=1.075-1.078) for PM(10) with each interquartile range change. Personal LBW risk was significantly increased to 1.081(95% CI=1.002-1.166) for CO, 1.145(95% CI=1.036-1.267) for SO(2), and 1.053(95% CI=1.002-1.108) for PM(10) with each interquartile range change. Personal LBW risk was increased to 1.003(95% CI=0.954-1.055) for NO(2), but this was not statistically significant. The air pollution concentrations predicted by GIS positively correlated with the numbers of low birth weights, particularly in highly polluted regions. Environmental health surveillance is a systemic, ongoing collection effort including the analysis of data correlated with environmentally-associated diseases and exposures. In addition, environmental health surveillance allows for a timely dissemination of information to those who require that information in order to take effective action. GIS modeling is crucially important for this purpose, and thus we attempted to develop a GIS-based environmental surveillance system for low birth weight.

Environmental Health Surveillance System in Japan Air Pollution and Children’s Health

Environmental Health Surveillance System in Japan Air Pollution and Children’s Health

Factors Enabling the Utility of Environmental Health Surveillance Information for Environmental Justice Advocacy

P-583 Introduction: A major public health issue is the limited utility of environmental health data for communities disproportionately burdened with pollution and disease. In an environmental health surveillance demonstration project examining asthma, birth outcomes, and traffic pollution in a single county, we sought to assess the utility of project results, communication materials, and dissemination strategy for advocacy and public health action in environmental justice (EJ) communities. Methods: We assembled an advisory group (AG) of over 20 stakeholders, including representatives from community-based organizations (CBOs), non-governmental organizations (NGOs), and county agencies, to provide input and feedback on project activities and results in a series of meetings over a three-year period. Through partnerships with a local CBO and NGO, we employed Community Participation methodologies to facilitate a group process to provide participants with the information and skills necessary for comprehending the project results and a setting conducive to generating honest and thoughtful feedback. Meeting activities included building group capacity around basic epidemiology and environmental health principles, presenting background information and results in a comprehensible and thorough manner, and facilitating open and productive discussions about participants’ information needs and the project results. Results: Factors enabling the utility of surveillance information for EJ advocacy included density estimation maps illustrating neighborhood-level rates, health disparities placed in the context of healthcare quality and accessibility, and surveillance data in the broader environmental, economic, and social context. The AG indicated that these forms of information would be useful for identifying impacted communities, targeting outreach and education activities, supporting community organizing, developing and evaluating policies, and confirming community anecdotal evidence. Web-based dissemination, presentation of information in formats accessible and comprehensible to a range of audiences, and community capacity-building to understand and access environmental health data are additional factors that contribute to utility of information. Less relevant was information demonstrating the effects of pollution on health outcomes, which was considered conditionally useful depending on whether the relationship was already generally understood. Discussion and Conclusions: Neighborhood-level data, healthcare context, broad environmental and socioeconomic context, accessibility and comprehensibility of information, and capacity-building to understand and access data are elements that contribute to the utility of surveillance information for EJ advocacy. The AG process was critical for understanding the utility of project results, guiding communication and dissemination activities, and planning for future surveillance activities. The results of our AG process highlight the importance of community input in developing an environmental health surveillance system.

International Monitoring for Environmental Health Surveillance

This paper offers an overview of existing international monitoring systems with relevance for environmental health surveillance. Representative monitoring systems are described that: address areas of chronic and acute exposure, and diseases and behavioural effects resulting from human-environment interactions; have an ecosystem focus with perhaps a secondary motivation of ascertaining human health impacts that may result from ecosystem conditions; and that incorporate socio-demographic and economic data that may reflect population health determinants. General conclusions on the state of environmental surveillance systems and suites of indicators reviewed are provided in relation to their utility for the development of a generic environmental health surveillance system. This review indicates, among other things, that no obvious short list of core indicators exists which spans "environmental health" to provide a sufficient set applicable in a global context. Through a summary of challenges and limitations in existing systems and indicator sets, recommendations are provided for the discussion of indicator selection and organization, and of developing general and widely applicable environmental health monitoring and surveillance systems.