Using Community-Based Participatory Research to Build Capacity for Environmental Emergency Preparedness and Disaster Resilience

As natural and man-made emergencies or disasters have negative repercussions on the environmental health and safety of those affected, it is imperative that the Environmental Health and Emergency Preparedness/Response (EHEPR) programs of local public health departments coordinate their efforts to engage with communities in discovering solutions to disparities in emergency preparedness. In this mixed methods, quasi-experimental study, we are comparing the conventional expert-driven approach to public health emergency preparedness by the San Bernardino County EHEPR workforce to an environmental health emergency preparedness (EHEP) community-based participatory approach by the Riverside County EHEPR workforce. These adjacent counties have the greatest land mass in the nation, but are two of the most resource poor. Almost half of their population is Latino, many being low English proficient. A great proportion of the residents of these two counties live adjacent to the largest railyards east of the Los Angeles port cities. In addition to the chronic earthquake threats endemic to all of California, their health and safety is endangered by environmental hazards including high levels of air pollution due to train and truck exhaust and potential hazardous materials spills resulting from train derailments. Formative research was conducted with EHEPR and community residents of both counties using key informant interviews, validation focus groups, windshield surveys, and GIS demographic mapping. The qualitative data set was transcribed, coded, and analyzed for emerging themes. Next, the EHEPR workforces were surveyed to examine personal and collective efficacy, capacity, and readiness to engage community organizations and members in environmental health emergency preparedness. Community capacity to deal with emergencies was captured in a household survey administered in both counties. Baseline assessment findings lead to the creation of a culturally-appropriate EHEP community program for Riverside County. Such alliances are essential for public health to effectively move forward in these challenging times.

State Environmental Health Policy

The National Conference of State Legislatures (NCSL) is the trade association for state legislatures, meaning both the elected officials and the staff that serves them.  NCSL is the only organization that provides an open, bipartisan, national forum for lawmakers to communicate with one another and share ideas. NCSL's tracks state legislation, policies and chaptered laws to identify legislative trends and needs of the state legislative audience.  Most substantive state policies and programs require legislative approval, funding, and oversight.  As well, the most innovative or unique state policies come from state legislatures.  This session will review the state environmental public health legislation that was introduced and enacted during the 2011 state legislative sessions, including laws on food safety (particularly the cottage food industry), water and waste water (including private well and waste water use), natural gas fracking, chemical regulations (green chemistry) and zoonotic rules.  NCSL covers legislation from the 50 states, territories and the district of Columbia.  

Legislatures also hold the purse strings in state government and determine the funding levels of state agencies and programs.  Many legislatures appropriate federal funds designated for state and local programs and make policy decisions about their use.  As in Washington, D.C., health policy initiatives at the state level require legislative approval before they become policy.  For example, many innovative health initiatives and pilot programs sponsored by private foundations or federal grants require state legislative involvement, understanding, and approval if they are to succeed in the long term.

Onsite System Management without meaningful public involvement is like a septic tank without an effluent filter. Neither will work at peak efficiency and both will yield disappointing results.

Built on the experiences of a suburban municipality in central Pennsylvania, this presentation will detail the successful local policy development, citizen communications, and program implementation processes that resulted in an onsite system management program.  Roughly 1,200 onsite systems are covered in this program. Located in the land of the self-proclaimed, self-important, the elected officials successfully transferred more than 90% of the ongoing management program implementation costs to the landowners while achieving a 100% participation rate.  In the first three years of the program, no court actions were needed to achieve participation.

Basic principals of governmental leadership and program ownership, effective public communications and involvement, and a strong public-private linkage were the crisscrossing paths that led to success. Keeping government officials off residents’ land leveraged support and amplified acceptance.  Appealing to self interest, personal financial benefit and residents’ propensity toward frugality were key and intentionally unstated ingredients.

These concepts and their underlying principals can be used in any municipality where a potentially controversial public policy issue will be raised. When the intention is for there to be some sort of public intervention into what are held to be individual rights, the process described can overcome obstacles and garner support.

The goals of this program were repair/replace malfunctioning onsite systems, identify under performing systems for enhanced scrutiny, identify areas of concern where future sewer extensions may be needed, establish and continue a septic system focused communications program with landowners, and avoid costly state mandates.

This presentation will also detail program components which can benefit from a robust industry-government-public dialog.  For success, it is essential to remove all aspects of the  “I’m in it for my advantage” agenda. Weaknesses and missing links in current PA statute will be presented as they are likely missing elsewhere.

An Introduction to the CORE Network: FDA’s New Approach to Managing Foodborne Outbreak Surveillance, Response and Post-Response Efforts

This presentation is intended to illustrate how the new Coordinated Outbreak Response and Evaluation (CORE) Network coordinates, conducts, and has improved FDA’s preparedness, response, and post-response efforts involving human and animal foodborne outbreaks of illness, both within the Agency and in collaboration with our partners. In April 2010, FDA Commissioner Hamburg announced the intent to streamline the foodborne outbreak process within FDA to better work with our partners. Subsequent to this announcement, FDA formed a small group of subject matter experts to design, analyze, develop, and implement the new process.  In July 2011, the CORE Network launched,  addressing outbreak signals, response, and post-response activities, and improving the way we work with other operational areas of FDA, with the field staff, with our stakeholders, with other federal agencies, even with the public in promoting food safety education. 

The CORE Network builds upon FDA’s established best practices, incorporating lessons learned, expanding FDA’s monitoring and post-response capabilities, investigates and documents underlying causes, to drive prevention-based food safety policies.

Developing a Bayesian approach to dose response assessment: an application to regulating trihalomethanes in drinking water

Pervasive uncertainty is a dominant analytical difficulty that continues to hinder the EPA's risk assessment process for setting standards for environmental contaminants, particularly within the dose-response step.

Currently, the EPA handles this by applying deterministic factors referred to as safety or uncertainty factors. This approach has long been criticized as arbitrary, obscuring the true uncertainty, and limiting the ability of policy-makers to make adequately informed risk management decisions. We propose a hierarchical Bayesian model approach to synthesize evidence from toxicological and epidemiological studies, allowing for explicit statement of uncertainty assumptions in the prior distributions, and pre-processing data using Bayesian Model Averaging (BMA) to account for model uncertainty. We apply this model to a case study of chloroform, a disinfection byproduct, in drinking water. We use the same data set considered by the EPA when setting their regulatory standards for chloroform, exploring four different health outcomes that were either cancer or considered pre-cursors to cancer. Final model estimates demonstrated that incorporating more scientific information into the priors had minimal impacts on mean estimates, but reduced the uncertainty surrounding the final estimates.

Benchmark dose (BMD) and lower-bound benchmark (BMDL) dose estimates from the model were mostly lower than those estimated by the EPA, indicating that not considering the full body of scientific evidence fails to capture the true uncertainty surrounding the final estimate. As a result, Maximum Contaminant Level Goal (MCLG) estimates using the Bayesian model were consistently lower than EPA estimates, and in particular were lower than the MCLG standard for chloroform currently in place. This Bayesian model provide an alternative approach to incorporating and quantifying various sources of uncertainty in the dose-response step, and may be applicable in other aspects of risk assessment.