State Health Lawmakers' Digest: Children's Environmental Health (Vol. 2, No. 1), Cover Story

IN THE ABSTRACT

America's Children and the Environment: A First View of Available Measures

Study and Results: Data was collected from the Environmental Protection Agency, National Center for Health Statistics, National Cancer Institute, Census Bureau and state environmental agencies.

The report was designed to present quantifiable measures for key factors relevant to the environment and children in the United States, to provide baseline data for analyzing trends in children's environmental health in the future, and to generate discussion between the public and policy makers and data collection related to children and the environment.

What's Important: While some measures of environmental quality and disease morbidity decreased between 1990-1998, there remain issues of concern including:

1.5 million children aged 17 and younger had elevated blood lead levels. Race and poverty continue to affect a child's likelihood of having elevated concentrations of blood lead.
The prevalence of asthma among children in the U.S. increased 75 percent between 1990-1994.
The frequency of cancer in childhood increased from 130 cases per million children in 1975 to 150 cases per million in 1995, though this increase appears to have leveled off since 1990.

Find This Study: America's Children and the Environment: A First View of Available Measures U.S. EPA's first-ever agency assessment of trends in environmental factors that may affect the health of America's children. http://www.epa.gov/children/indicators

Blood Lead Levels in Young children - United States and Selected States, 1996-1999

Study and Results: Researchers reported on elevated blood lead levels (>10 m g/dL) for children younger than 6 years of age. Data for children ages one through five years was taken from the Center for Disease Control and Prevention's Third National Health and Nutrition Examination Survey for 1999 and data for children <6 years from 19 state surveillance systems during 1996-1998.

Overall, average blood lead levels in young children decreased approximately 80percent since the late 1970s. Across the 19 states that reported state and county level data, the county-specific proportion of children whom tested positive for elevated blood lead levels varied from 0.5percent to 27.3percent. This indicates high blood lead levels concentrated in specific geographic areas and populations.

What's Important: Although average blood lead levels have declined, elevated blood lead levels still remain more common among low-income children, urban children, and those living in older housing. As it is a local issue, researchers suggest surveillance efforts to better target screening efforts to communities at risk.

Caveat: NHANES is a nationally representative survey. It cannot be used to provide prevalence estimates at the state or local level.

Find This Study: This study can be found in the CDC's Morbidity and Mortality Weekly Report, December 22, 200/49(50); 1133-7 or at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4950a3.htm

National Report on Human Exposure to Environmental Chemicals

Study and Results: This is the first report to provide information on the U.S. population's exposure to 27 environmental chemicals including metals, organophosphate pesticides, phthalate metabolites, and cotinine (a marker of environmental tobacco smoke exposure). Data is based on blood and urine samples taken from the Center for Disease Control and Prevention's Third National Health and Nutrition Examination Survey (NHANES).

The report establishes a normal ranges for 24 environmental chemicals, found a decline in elevated blood lead levels in U.S. children as a whole; reported a 75percent decrease in cotinine levels (the marker for exposure to environmental tobacco smoke); provided a baseline to assess women and children's exposure to mercury; assisted in setting research priorities for studies on how phthalates, compounds found in consumer products, are entering the population's blood stream.

What's Important: The report represents an initial effort to track the U.S. population's exposure to environmental chemical for use in research, program development, and policy initiatives. It establishes "reference ranges" for 24 previously undocumented environmental chemicals. The references ranges will serve as background exposure levels or baseline levels for the general population which physicians and researchers may use to test elevated exposure for targeted community populations or individual patients.

Caveat: The annual sample size for NHANES is relatively small. In addition, in 1999, data was collected from only 12 locations across the country. Findings from additional years will need to be combined in order to confirm the validity of the findings.

Find This Study: This report is available online at http://www.cdc.gov/nceh/dls/report/default.htm

HEALTH TRACKING

The Need for a Nationwide Health Tracking Network

Study and Results: This testimony from Dr. Lynn Goldman to the U.S. Senate Environment and Public Works Committee outlines the need and recommends approaches for establishing a national health tracking system. Dr. Goldman, with the Johns Hopkins Bloomberg School of Public Health, examined the increase of chronic disease in America and the inability to adequately collect and analyze nationwide data. They base the proposed Nationwide Health Tracking Network is based on the principles of building a standard, coordinated collection system; providing for analysis by local health departments; immediate response to problems identified through the system; and national leadership at the federal level to prevent program isolation.

What's Important: The report stresses the need for a tracking network for preventive purposes. The study found that comprehensive analysis of chronic disease is impossible due to inconsistent tracking and a lack of uniform state-to-state data collection standards or no tracking whatsoever. The proposal calls for tracking not only chronic diseases such as asthma, cancers and birth defects, but also environmental factors such as exposure to heavy metals, and pesticides and drinking water contaminants. The report outlines five basic components a tracking system would need, as well as some of the costs associated with initiating such a project.

Find This Study: This report is available online at http://www.senate.gov/~epw/gol_0611.htm

Testimony of Philip J. Landrigan, M.D., Before the U.S. Senate Committee on Environment and Public Works

Study and Results: This testimony highlights a study by Dr. Philip Landrigan on chronic disease, particularly the occurrence of cancers, and the need for more adequate tracking. Dr. Landrigan's study examines environmental factors contributing to the occurrence of cancers and the rise in cancer rates during the previous century. The testimony offers a "Blueprint for Cancer Prevention in the United States," consisting of disease and exposure tracking; premarket testing of all new chemical compounds for toxic and carcinogenic potential; a right-to-know policy for full public information of their communities' environmental safety; adjustment of regulatory standards to protect infants and children; and further research on cause, treatment and prevention.

What's Important: Although the knowledge base on cancer prevention and treatment is growing, the effort to implement a prevention strategy remains stagnant. The study calls for tracking, analysis and education as a cost-effective method to prevent further rise in cancer rates. This report provides a sound, quick view of the qualitative and medical evidence for its policy proposal.

Find This Study: This report is available online at http://www.senate.gov/~epw/lan_0611.pdf or at http://www.senate.gov/~epw/stm1_107.htm#06-11-01

Short of Breath: Our Lack of Response to the Growing Asthma Epidemic and the Need for Nationwide Tracking

Study and Results: This study from the Trust for America's Health examines Centers for Disease Control and Prevention data on state-level asthma tracking. The CDC data revealed that 27 states do not track the disease at all, with 12 of the 20 states with the highest exceedences of federal standards of air pollution levels among this group. The study highlights the need for a system that can determine disease prevalence and mortality rates at the local level; identify emerging problem clusters and provide quick response; reveal potential causes for further investigation; and plan, enact and evaluate long-term policies for mitigation. The report proposes a three-year action plan for the federal government to establish the Nationwide Health Tracking Network.

What's Important: The Trust for America's Health study found that, although while health officials are receptive to the establishment of a health tracking system, many lack the resources to begin such an undertaking. The report proposes establishment of a standardized, nationwide system, using the New England Asthma Tracking Initiative as a pilot study. This pilot study then could serve as the framework for a national asthma tracking system within a broader chronic disease network

Find This Study: This report is available online at http://healthyamericans.org/resources/reports/shortofbreath.pdf

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