We are almost one year into our efforts to implement, in step with national efforts by the Centers for Disease Control and Prevention (CDC), an Environmental Public Health Tracking Network (EPHTN) in California.

Guiding our work is the Tracking Implementation Advisory Group (TIAG), an advisory body composed of our co-investigators who represent data systems, public health and environmental agencies, non-governmental organizations, and community-based organizations. In March, we held the first TIAG meeting in which we began a dialogue around TIAG roles as well as priorities and strategies for the implementation phase. To learn more about the TIAG, please visit: www.catracking.com/sub/tiag.htm.

We have made progress in developing the partnerships and infrastructure needed for the EPHTN. While this takes place somewhat behind the scenes, these efforts are vital to the data, products and services that CEHTP hopes to offer when the EPHTN is operational in September 2008. Below are some highlights of the progress we have made towards our program goals since receiving a 5-yr continuation grant from CDC in August of last year:

GOAL 1: ADVANCE TECHNOLOGY INFRASTRUCTURE

We have been working on Information Technology (IT) and Geographic Information Systems (GIS) infrastructure that will enable us to: (1) enhance the quality of existing data; (2) enhance the ability to analyze data; and (3) generate useful and relevant environmental health information, products, and services. The following services have been developed and are currently being piloted:

*Data enhancement services: enables stakeholders to enhance their data through automated processes such as geocoding.

*Data integration services: enables the linkage and analysis of health indicators and geographically-related exposures to environmental hazards.

*Data visualization and dissemination services: enables the creation of dynamic, custom materials in the forms of maps, charts, and reports.

These are just several examples of the IT/GIS infrastructure that will serve as a foundation for our program and enable us to better carry out the next two goals. I invite you to visit: www.ehib.org/toollist.jsp to explore demonstrations of some of the services. Although they are not in their completed state, I think you will find them fascinating, innovative, and practical.

GOAL 2: IMPROVE THE AVAILABILITY AND UTILITY OF EPHTN DATA

We have initially focused on coordinating data management, consumption, and reporting for the following environmental health indicators, identified by CDC as priorities for the state and national EPHTNs.

*Hospitalizations for Asthma and Myocardial Infarction (Heart Attacks).

*Vital Statistics: Preterm Birth, Low Birthweight, and Sudden Infant Death Syndrome.

Cancers: Short Latency Cancers.

*Particulate Matter and Ozone.

*Water Contaminants.

We anticipate that indicators for each of these topics will be available on our state EPHTN by September 2008. Additional indicators—to be determined by CEHTP, CDC, and stakeholder input—will be phased in during the subsequent 3 years.

Of course, it is not enough just to identify indicators. In order to make this information available on an EPHTN, important work must be done in the development of partnerships, methods, and processes for accessing, managing, analyzing, visualizing, and communicating data. Examples of our progress include:

Obtaining expedited access to hospitalization, emergency room, and vital statistics data for health surveillance functions. CEHTP (through the Environmental Health Investigation Branch of the California Department of Health Services) has obtained a blanket approval from the California Committee for the Protection of Human Subjects to access these data without having to go through repeated approval processes.

Creating an inventory of drinking water service areas. CEHTP is collaborating with multiple local, state, federal, and private stakeholders in order to determine the most appropriate data sources and technologies necessary for creating this inventory. The creation of this inventory is a critical step towards tracking water quality data.

Developing a database management infrastructure for vital statistics data. This forms the basis of the California EPHTN, enabling efficient analysis of data and ensuring higher levels of quality control and assurance. This system will also help us to establish key measures in topic areas such as reproductive outcomes, birth defects, pediatric cancers, and childhood hospitalizations.

Developing and refining methods for spatially visualizing health outcomes. Also know as “disease mapping”, this will help us to better understand and communicate how risk of disease varies across space. We are in process of developing smoothed surfaces (maps) for preterm birth and term low birthweight for all of California.

We have also been exploring ways to add value to an EPHTN via the following activities:

*Validation of pesticide exposure models through biomonitoring: A steering committee has been formed to identify compounds and locations for the project. Next, we will initiate a participatory process for members of the selected community to work with us to design and implement the study.

*Climate change impacts on public health: CEHTP is part of a collaborative working group to develop indicators of and report on population vulnerability to climate change. We will continue to explore measures of climate change such as temperature, disease outcomes, air pollution levels, vulnerability, adaptability, and mitigation.

GOAL 3: INFORM POLICIES, PRACTICES AND OTHER PUBLIC HEALTH ACTIONS

Many of our activities in this arena have been in preparation for when data become available to us and to the public on the EPHTN. We are setting the stage to ensure that we make useful, understandable information available to our stakeholders in an accessible and appropriate manner.

For example, we are assisting CDC in developing a communication strategy for EPHTN data and information. We will work with the TIAG to incorporate this strategy- along with input, feedback, and lessons learned from our past communication activities- to develop a California plan. This plan will guide us in interpreting, presenting, and disseminating EPHTN-generated information in a useful, understandable, and relevant manner.

We will also be working with partners to understand and increase stakeholder knowledge, skills, and abilities to effectively integrate and apply EPHTN information into their work (i.e. translate data/information to policies and actions).

Finally, we are busy developing a web portal for the California EPHTN that will host many of the data/information and services mentioned in this update.

Please stay tuned for more updates on our efforts. We have much more going on, and much more that remains to be done. If you would like to learn more about plans for this implementation phase or about our program’s past activities and accomplishments, please visit: www.catracking.com/sub/nl.htm. And don’t hesitate to call us with questions, comments, and feedback at 510-231-1753 or email us at trackin3@dhs.ca.gov.

Thank you for your support and for your efforts in working towards healthy people in healthy communities.