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Volume 131, Issue No. 4 July/August 2016
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ISSN 0033-3549
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NEPHC Abstracts

Sustainability 1

Health Co-Benefits from Reducing Transportation Emissions: Evaluating Bicycling Scenarios for 11 US Midwestern Cities

  • M. Grabow , University of Wisconsin–Madison
  • S. Spak , University of Iowa
  • J.Sledge , University of Wisconsin - Madison
  • T. Holloway , University of Wisconsin - Madison
  • B. Stone, Jr. , Georgia Institute of Technology
  • S. Ventura , University of Wisconsin - Madison
  • J. Patz , University of Wisconsin - Madison

This study examines changes in human health impacts of air pollution resulting from transportation mode choice across midwestern US cities. Transportation related air pollutants, including particulate matter, ozone precursors, and greenhouse gases, are increasing due to a rising number of miles driven worldwide, in spite of technological improvements to vehicles and fuels. Automobile dependence in the near term leads to physical inactivity, as well as air pollution–related morbidity and mortality associated with high levels of vehicle emissions in urban areas. A shift toward multimodal transportation systems that encourage use of bus, train, bicycling, and walking will lessen US reliance on passenger vehicles and reduce these adverse health consequences. We analyze the respiratory health effects (and associated monetary savings) of replacing short-distance car trips with bicycle trips across the 11 largest midwestern metropolitan areas. Using the Environmental Protection Agency (EPA) MOBILE6 emissions factor model and CMAQ (Community Multiscale Air Quality) modeling system, we estimate vehicle emissions associated with current vehicle miles traveled (VMTs) over the study areas. Applying alternative scenarios of VMT reduction and increased bicycling for the cities, we calculate the change in fine particulate matter and ozone, and input these derived pollution values into EPA's Benefits Mapping Analysis Program (BenMAP). BenMAP analyzes human health and monetary outcomes associated with changes in ambient air pollution. The models reveal that health and environmental co-benefits from increased bicycling (and associated reduction in VMT) are substantial. This evidence lends support for implementing public policies that encourage nonmotorized transportation systems, providing evidence that transportation mode choices could play an important role in meeting targets for air quality improvements concomitantly with greenhouse gas emissions reductions.


Sustainability 1

Paying a Higher Price: Association Between Gas Price, Vehicle Travel, and Air Quality

  • T. Boehmer , Centers for Disease Control and Prevention
  • S. Horn , Centers for Disease Control and Prevention
  • W.Flanders , Centers for Disease Control and Prevention
  • F. Yip , Centers for Disease Control and Prevention

Background: Exposure to traffic emissions is associated with adverse health. Motor vehicles contribute >50% to urban air pollution, and vehicle miles traveled (VMTs) continue to rise. This study sought to determine if elevated gas prices during 2008 were associated with reduced VMT and traffic-related air pollution in metropolitan Atlanta. Methods: The monthly average price/gallon of unleaded gasoline, VMT, and ambient concentrations of particulate matter with a diameter =2.5µm (PM2.5), ozone, and nitrogen dioxide (NO 2 ) were obtained for 5 Atlanta counties (VMT represents all Georgia urban arterials) during 2006–2008. Wilcoxon rank sum test was used to determine if variables differed between 2008 and 2006. Generalized estimating equations with an autoregressive correlation structure were used to assess the relationships between: gas price and 2-month lagged VMT, controlling for season and year; and VMT and each pollutant, controlling for season and temperature. Results: In 2008, gas price was 30% higher (P = 0.01) and VMT was 5% lower (P = 0.06) compared with 2006. Ambient concentrations of PM2.5, ozone, and NO 2 were lower, but not statistically different. Gas price was negatively associated with VMT (P = 0.02); every $1.00 price/gallon increase was estimated to reduce VMT by 5% 2 months later. VMT was positively associated with 24-hour average ozone concentration (P = 0.02); every 10 million VMT decrease was estimated to reduce ozone by 0.05 ppb (parts per billion). VMT was not associated with PM2.5 and NO 2 . Conclusions: These preliminary data suggest that higher gas prices might be associated with reduced VMT and lower ambient ozone concentration in metropolitan Atlanta. Additional analyses will examine potential impacts on respiratory and cardiovascular health. If true, pricing interventions that aim to reduce VMT might have important public health implications.


Sustainability 1

Public Health Impacts of Climate Change in Washington State: Projected Mortality Risks due to Air Pollution

  • C. Karr , University of Washington

Background: Illness and mortality related to worsening air quality is a core public health concern associated with climate change projections. Methods: We applied established national ozone concentration–mortality response data with Washington county-level mortality data, measured and projected ozone concentrations, and population expansion data to provide a quantitative assessment of potential mortality impacts in the current decade and in the mid-century (2045–2055). Exposure to ozone (E1997–2006) in the recent decade of each county was assessed based on 8-hour maximum daily ozone ppb (parts per billion) concentration data drawn from the state monitoring network for the months May–September (warm season). Daily 8-hour maximum daily average ozone concentration for May–September of the mid-century decade (2045–2054) were derived by coupling a global climate model projection with regional meteorology and chemistry models for the 36 km grids that coincide with these counties. Results: Ozone concentrations are projected to be 16–28% higher in the mid-century compared to the recent decade 1997–2006. We estimated that the total nontraumatic ozone mortality rate by mid-century for King County would increase from baseline (0.026 per 100,000; 95% confidence interval: 0.013–0.038) to 0.033 (95% confidence interval: 0.017–0.049). For the same health outcome in Spokane County, the baseline period rate was 0.058 (0.030–0.085) and increased to 0.068 (0.035–0.100) by mid-century. Conclusions: The availability of regionally downscaled climate models and meteorological and air pollution models provides an opportunity for initial public health assessment of climate change and air pollutants at the county level. Despite recent regulatory achievements in ozone reduction, climate change–related effects may threaten the gains that have been made. A better understanding of climate change impacts on ambient air quality is critical to prepare for and alleviate public health consequences.


Sustainability 2

Framing Climate Change as a Public Health Issue: The Reactions of Six Audience Segments

  • E. Maibach , Center for Climate Change Communication
  • M. Nisbet , American University
  • P.Baldwin , George Mason University
  • K. Akerlof , George Mason University

In their communication, advocates of a public response to climate change often characterize—or frame—global warming as a serious threat to the environment, and their opponents, in turn, often counterframe the proposed responses as a serious threat to our economy. These opposing message frames, which have defined the American dialogue about climate change since the late 1990s, have left large portions of the American people essentially on the sidelines, watching but not participating. We are currently conducting a program of research to investigate if an alternative framing of the issue—climate change as a serious threat to human health and well-being—has potential to help coax people out of the bleachers and onto the field as active participants. To that end, in late 2008 we conducted an extensive nationally representative survey of 2,164 American adults to assess people's global warming beliefs, behaviors, and policy preferences. Using latent class analysis, we identified 6 distinct audience segments that we now call “Global Warming's Six Americas.” In summer 2009, we conducted in-depth interviews with approximately 10 people in each of the 6 Americas. At the conclusion of those in-depth interviews, we had participants read and react to a one-page essay that characterized global warming as a public health issue. In our presentation, we will introduce conference participants to the 6 Americas, summarize their reactions to the public health framed essay, and suggest some potential opportunities for the public health community to play a larger role in the public dialogue about climate change.


Sustainability 2

Physician Knowedge on Climate and Health

  • M. Sarfaty , Thomas Jefferson University
  • S. Abouzaid , Thomas Jefferson University
  • E.Yuen , Thomas Jefferson University
  • E. Frank , University of British Columbia

Climate change will likely have substantial impact on patient health. The level of physician knowledge about the health effects of climate change is unknown; assessment is needed to determine the need for education programs that have the potential to generate knowledgeable medical professionals who can anticipate medical needs, provide appropriate medical care, and support an intelligent preparedness agenda and a rational policy process. A pilot survey was administered to 2 groups of physicians (N1 = 50, N2 = 49) in June 2008: academicians attending the AMA's Section Council on Medical Schools, and Pennsylvania family physicians. There were questions on knowledge, attitudes, and medical conditions related to global warming; data were analyzed in SAS. Surveys were returned by 50/65 (77%) of the first group and 49/68 (75%) of the second; the first group were older, more likely to be male and urban, and less likely to practice primary care. A majority of both groups agreed than global warming is happening (80% and 69%) and is a threat to future generations' well-being and safety (77% and 60%). Fewer of each group were concerned about the effects of climate change on the health of their patients (47% and 52%), or agreed that global warming is associated with increases in mosquito-borne diseases like dengue fever or malaria (33% and 33%), or infectious diarrhea from drinking water contaminated by heavy rains (35% and 25%). Awareness was higher regarding associated heat stress (60% and 49%) and asthma/chronic lung disease (60% and 65%). Only about half (60% and 46%) had received environmental health training. This pilot demonstrates knowledge deficiencies and points to the need for education of physicians about climate and health.


Sustainability 3

Possible Impacts of Low Frequency Wind Turbine Noise on Public Health

  • R. Messing , Minnesota Department of Health
  • C. Herbrandson , Minnesota Department of Health

Background: The Minnesota Department of Commerce requested that the Minnesota Department of Health evaluate health impacts associated with low-frequency vibrations and noise arising from large wind energy conversion systems (LWECS). The purpose of the evaluation is to guide decision making of Minnesota regulatory agencies responsible for permitting future wind projects. Issue: Several unreviewed case studies have documented annoyance and health complaints from people living near wind turbines. Complaints include sleep disturbances, fatigue, depression, decreases in cognition and performance, increased anxiety, migraine, various effects on the cardiovascular system (e.g., changes in blood pressure and heart rate), and other autonomic effects (gastrointestinal effects, vertigo). Some of these may be outcomes of sleep disturbance. Results: Reported health impacts appear to be strongly associated with annoyance from pulsating low-frequency audible sound originating from rotation of turbine blades; low frequency activation of the vestibular system has also been hypothesized to account for some symptoms. As compared to higher frequencies, low-frequency sound is attenuated less as distance increases, and more readily penetrates structures. Common methods of evaluating sound intensity underweight low frequencies. Noise impacts may be greater in places where there are unstable atmospheric conditions. Lessons Learned: Noise standards often do not require assessment of low-frequency noise in addition to full spectrum noise, and plans for LWECS may not assess likely atmospheric conditions that could affect noise impacts. Thus, setback distances to occupied residences may be inadequate to prevent annoyance and associated health complaints.


Sustainability 3

Building the Linkage Between Clean Energy and Green Chemistry: No Time Like the Present

  • M. Wilson , University of California–Berkeley

Background: The rapid development of clean energy technologies is critical to addressing 2 of the greatest challenges of the 21st century: climate change and economic inequality. These technologies, however, are not by definition safer or cleaner for workers, communities, or ecosystems. As the United States prepares to spur a new era of economic growth in clean energy technologies and energy efficiency, it has an opportunity to generate important co-benefits by simultaneously reshaping antiquated policies governing the production and use of industrial chemicals. Issue: The photovoltaic (PV) industry is at the leading edge of the clean energy sector, yet it relies on an array of hazardous substances, opening the possibility that this important industry could face the same problems with occupational exposures and environmental pollution that have accompanied the growth of other industry sectors. The PV industry in particular runs the risk of introducing a new wave of hazardous electronic waste flowing into Asia and Africa. Results: By acting early, it may be possible to influence the trajectory of the PV industry with new policies that provide the industry with (1) chemical hazard information, (2) incentives to choose safer substances, and (3) technical assistance in the principals of green chemistry, design for environment, and extended producer responsibility. Lessons Learned: These changes will not be accomplished through voluntary initiatives; they will require a combination of market incentives, direct regulation of substances of highest concern, and support for research and training. Taking these steps would (1) reduce health and environmental harms caused by chemical exposures and pollution, (2) build a sustainable footing for the PV sector, and (3) open new opportunities for investment and employment in green chemistry.


Sustainability 4

Heat Vulnerable Communities and Climate Change

  • H. Margolis , University of California–Davis
  • P. English , California Department of Public Health
  • AlexanderGershunov , Scripps Institution of Oceanography

Background: Health risks associated with heat waves vary across communities and population vulnerabilities and change over time. Heat-related morbidity and mortality is preventable; identification of at-risk populations can target strategies and resources to diminish risk. Issue: Criteria to assess community vulnerability were required. We evaluated (1) past heat waves and published literature to identify risk factors for heat-related illness; (2) a selected set of environmental, health, and demographic risk “indicators”; and (3) readily available data sources, such as US Census data or other survey data. Results: California communities have varying indicators of risk, including high proportions of elderly, socially isolated populations, children, outdoor workers, the poor, the chronically ill, and the medically underserved. County/local health officials need to identify vulnerable communities within their jurisdiction and target interventions accordingly. Urban areas have the largest absolute numbers of people vulnerable to heat, such as children and the elderly, yet other areas away from major urban centers also have high proportions of at-risk groups, such as socially isolated elderly. Strategic planning and resources are needed to build public health response and surveillance infrastructure, including heat warning systems, and heat-related disease surveillance systems. Lessons Learned: Policies should be implemented at the local level in preparation for heat waves, such as establishment and availability of transportation to cooling centers, and education on personal cooling strategies and first aid for heat illness. It is recommended that further detailed evaluation of community risk is conducted and that in the interim local health officials must focus efforts to prepare areas of the state not historically accustomed to heat that have already been observed to be vulnerable, such as the San Francisco Bay Area.


Sustainability 4

Increasing Frequency of Extreme Heat Events in Sprawling U.S. Cities

  • B. Stone , Georgia Institute of Technology
  • J. Hess , Centers for Disease Control and Prevention
  • H.Frumkin , Centers for Disease Control and Prevention

Annual trends in the occurrence of unusually hot days or “excessive heat events” (EHEs) in large US cities indicate a growing exposure of urban populations to hazardous levels of ambient heat. Numerous studies have documented a statistical association between the occurrence of excessive heat events and emergency room visits for heat-related conditions. To assess the influence of the built environment on rising trends in EHEs over 50 years, we measured the association between rates of change in EHEs in 55 of the most populous US cities with a widely cited index of urban “sprawl,” which quantifies the physical pattern of land use in terms of population density, land use mix, the structure of the road network, and the number of employment and retail centers within each city. The results of this analysis show that while the average annual number of EHEs increased during this period across all cities, the rate of increase in EHEs in the most sprawling cities was more than double that of the most compact cities—an association found to be independent of city population size or regional climate. We further find the most sprawling metropolitan areas to be associated with statistically higher rates of regional deforestation than the most compact cities.


Sustainability 5

Vulnerable Communities and Climate Change: Air Pollution in Metro NY

  • K. Knowlton , Natural Resources Defense Council and Columbia University
  • M. Rotkin-Ellman , Natural Resources Defense Council
  • G.Solomon , Natural Resources Defense Council and University of California - San Francisco

Background: A substantial body of literature links climate change to increasing ground-level ozone concentrations, absent controls on precursor emissions. Another emerging line of evidence links rising carbon dioxide concentrations and temperatures to increasing allergenic plant pollen production. Observed effects of climate change already include earlier onset of spring pollen in several North American species, raising concerns about a prolonged allergy season. The combined effects of climate change on air pollution could put millions at increased risk of harmful health effects. Issue: Regional and local models that can assess the impact of climate change on air pollutants are only recently becoming available at scales that are relevant to adaptive planning. One such community is the New York City metropolitan region, for which climate change effects on ground-level ozone concentrations have been projected to the 2020s and 2050s. Results: Climate change alone could increase premature air pollution–related mortality by 4.5% across the region by the 2050s. Climate change–related alterations in plant pollen production could increase allergy and asthma morbidity prior to that, however, and interactions between ozone, diesel exhaust particulate, and pollen could increase health risks in some of the most vulnerable communities, resulting in or exacerbating health disparities. Lessons Learned: Further degradation of air quality due to climate change will amplify occurrence and severity of air pollution–related adverse health effects. Regional studies are valuable in understanding large-scale pollutant source variations. However, population vulnerabilities to air pollution vary locally, and local studies are needed to help identify communities where health preparedness education and outreach should be targeted. Improved public and practitioner education on climate-health impacts and potential synergies between exposures may help reduce vulnerabilities.


Sustainability 5

Potential Health Impacts of Climate Variability and Change: Assessing the Weight of Evidence

  • A. Oluyomi , University of Texas
  • S. Marquez , University of the Sciences in Philadelphia

The accumulation of evidence of human contributions to global climate change and variability suggests that guided changes may mitigate potential threats to our ecosystem, economy, and public health. Since critical assessment of the health impacts of climate change through empirical studies is in its infancy, reviewing the state of the science for objective assessment of climate–health relationship is of scientific relevance. In this paper, we examine climate–health connections on 2 fronts: (1) identify evidence of potential relationship between climate change and health and (2) examine the potential health effects from combating global warming. While health effects are expected from increased temperatures, altered hydrological cycles, and increased climate variability, debates abound on the details of how these atmospheric changes may affect public health. Nonetheless, broad estimations about climate change and health have been postulated. These estimations suggest that climate change produces regional weather changes that generate environmental effects that ultimately lead to human health effects. This paper describes potential health impacts under 2 categories: “easy-to-define/-quantify” (e.g., thermal stress, extreme weather events, and infectious diseases); and “less-easy-to-define/-quantify” (e.g., fluctuating food yields, disruption of fisheries, and population displacements). Regarding potential health impacts from measures that should limit anthropogenic contributions to climate variability/change (contemporary alternative energy sources), it is clear that very little is known in this area. The potential health, environmental, and safety issues that may arise from (1) the carcinogenicity of elemental cadmium used in the production of solar panels and (2) the possible emission of hydrogen sulfide from geothermal plants are highlighted in this paper. Issues addressed here are relevant to ongoing efforts by governments to tackle climate change more forcefully and mitigate its potential effects.


Sustainability 5

Climate Crisis and Chronic Disease: Common Causes, Common Solutions

  • J. Stein , Greater Boston Physicians for Social Responsibility

Background: Climate change and chronic disease both pose urgent challenges to our health. The burden of chronic disease includes alarming rates of diabetes, obesity, and metabolic syndrome, magnified by increasing prevalence in younger age groups, even as the aging population expands and becomes more vulnerable. While families, communities, and the health care system struggle beneath this burden, our environment is also reaching a crisis. Climate change is “the biggest global health threat of the 21st Century” ( Lancet , 2009) and impacts on food and water systems, among others, are likely within decades. While chronic disease and climate change are thought of as unrelated, both arise largely from the same environmental factors, including the industrial food system, sedentary, automobile-centered lifestyles, and fossil fuel pollution. The good news is that both chronic disease and climate change can be profoundly reduced by addressing these environmental drivers. Issue: This presentation, based on research in the report Environmental Threats to Healthy Aging , clarifies how environmental drivers that lead to greenhouse gas emissions also alter biochemical pathways at the cellular and subcellular levels, causing oxidative stress, inflammation, and disrupted insulin signaling that lead to chronic disease. Solutions include a spectrum of cross-cutting interventions that improve health while mitigating climate change. An ongoing campaign is underway to educate scientists, policy makers, and the public about the profound health benefits of greening the drivers of chronic disease and climate change. Results: Transformative action is needed to avert tipping points of accelerated climate change that are rapidly approaching. Educating the broader public about the dramatic health benefits of climate change prevention will help achieve the personal and policy actions that are urgently needed. Lessons Learned: Diverse interventions afford a wide variety of opportunities to profoundly improve climate and human health.


Sustainability 6

The Upstream Approach to Climate Change and Public Health: Building an Empowerment and Health Equity Framework

  • K. Lyons-Eubanks , Multnomah County Health Department
  • J. Li , National Association of County and City Health Officials
  • D.Overfield , Orange County Health Department

The Centers for Disease Control and Prevention (CDC) has stated that “the public health effects of climate change remain largely unaddressed.” During the development of climate action strategies and climate-related policies, public health perspectives are often limited to managing downstream adaptation plans in response to disease outbreaks and extreme weather conditions. However, public health officials can play a much larger role in helping to shape policies and plans by bringing a health equity perspective to the table; ensuring health co-benefits are a part of the planning dialogue; and advocating that the implementation of plans and policies are done in a meaningful way that engages impacted communities. Multnomah County Health Department, in Oregon, is playing a key role in raising awareness around climate change and public health issues. Some of these efforts include helping to shape the updated City of Portland/Multnomah County Climate Change Action Plan. This is being accomplished by (1) ensuring upstream public health principles and practices (the core principles of public health and the essential services of public health) are understood and adopted by climate planning stakeholder groups; (2) developing a public health framework that demonstrates the direct impact of climate change on vulnerable communities, and includes a health equity review tool for planners and policy makers; and (3) establishing formal relationships with transportation, sustainability, and planning departments in the jurisdiction. By engaging in this work, we will improve the prevention and preparedness infrastructure around climate change health impacts and decrease health disparities.


Sustainability 6

Uniting the Clans: Building Capacity to Tackle Climate Change and Public Health in the States

  • G. Marinucci , Association of State and Territorial Health Officials

While there is scientific consensus that climate change will have significant effects on human health, there are significant challenges for public health agencies in being able to anticipate, prepare for, and respond to the effects. In response to the need for a comprehensive approach to tackle the health effects of climate change, in October 2008 the Association of State and Territorial Health Officials formed the Climate Change Collaborative (CCC). The CCC has the mission of supporting and building the capacity of state and territorial health agencies (STHAs) to tackle the public health challenges presented by climate change. The CCC membership consists of leaders from varied disciplines/roles within public health agencies that can help STHAs to prepare for, mitigate, and react to the effects of climate change. The CCC also includes representatives from other governmental and nonprofit groups that can add to the depth of wisdom needed to fulfill its mission. The CCC's objectives include developing strategies and recommendations to enable STHAs to attain the capacity to confront the public health challenges associated with climate change; to research, compile, develop, enhance, critique, and disseminate promising practices, success stories, tools, and information to support policy and programs in STHAs; to increase the cohesion and coordination of the different aspects and disciplines within STHAs to enable a comprehensive and integrated approach to tackling climate change; and to provide technical assistance to STHAs regarding climate change. The presentation will highlight the evolution of the CCC, its makeup, detail about its planned activities, and a point-in-time summary of progress toward meeting its objectives.


Sustainability 6

An Action Plan for Public Health—Initial Recommendations for Involving Public Health in Climate Change Policy

  • R. Salsburg , Public Health Law & Policy

Climate change may well be the greatest threat to human health this century. Because climate change may result in significant public health emergencies, an important opportunity exists to articulate a health-based climate change strategy that will improve health outcomes and reduce greenhouse gas emissions. To assist the public health community develop a comprehensive approach to climate change, Public Health Law & Policy (PHLP) gathered a diverse group of 150 participants for a multidisciplinary exchange of ideas with the goal of better engaging public health networks and agencies in climate change work. From the convening, 4 broad categories for immediate action emerged: (1) Communicate the public health message. Fully articulate the connections between climate change and health—for public health practitioners, policy makers, and the general public. (2) Develop infrastructure to support the work. Build the capacity and leverage resources to support public health's involvement in climate change planning. (3) Begin work on climate change now. Immediately integrate a climate change component into 2 areas of existing public health work—food systems and land use planning—because both have significant climate change implications. (4) Advocate for and protect vulnerable populations. Ensure that marginalized communities are not negatively impacted by proposed climate change mitigation measures. A consistent theme runs through the plan's recommendations: Pursue strategies that result in "co-benefits" where outcomes improve both health and reduce greenhouse gas emissions. Such an approach alters the economic calculus of climate change policy by incorporating previously unaccounted for health care savings and costs associated with different greenhouse gas reduction measures.


Sustainability 7

Healthy Communities and the Central Corridor Light-Rail Transit Line

  • J. Kelly , Minnesota Department of Health
  • T. Eshenaur , Minnesota Department of Health
  • J.Korinek , Minnesota Department of Health

Background: The Central Corridor Light-Rail Transit (LRT) line is scheduled to begin construction in 2010, through the historic heart of the Twin Cities. The LRT will serve as a vital connection between the downtowns of Minneapolis and St. Paul, Minnesota. In collaboration, local communities along the LRT route, local government partners, Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry, and the Minnesota Department of Health (MDH) will establish baseline measures of community health and quality of life. These measures will be used to track the impact of changes that result from the construction of the LRT and associated redevelopment on public health. Methods: Input will be sought from the community through meetings, workshops, and other avenues to identify specific areas of health concern. Data on the following and other measures of community health to be determined will be collected: asthma events, lead poisoning in children, the number of lead abatements, levels of air pollutants, education levels, and employment and economic status statistics. Information on environmental contamination sites along the planned LRT route will also be evaluated. Results: Baseline measure data will be included in a report that will be made available to the community, local planning agencies, developers, and interested parties. The information will be extremely valuable in guiding redevelopment efforts and in allocating resources to address identified environmental and public health concerns. Conclusions: Working with local communities to determine which factors related to the LRT might affect the health of people living and working nearby and collecting baseline data will allow for recommendations to be made that will improve people's health, and build capacity at a local level for further assessment.


Sustainability 8

Redesigning the Food System for Public Health and Sustainability

  • M. Conard , Columbia University
  • T. Albright , Collaborative Initiatives at MIT
  • K.Kaplan , Collaborative Initiatives at MIT
  • R. Plunz , Columbia University
  • E. Carlough , Collaborative Initiatives at MIT
  • K. Ackerman , Columbia University

It has been shown that once a child has become obese, this situation is nearly impossible to reverse. At this point it becomes a lifetime struggle, challenging the individual and families, taxing the medical system, and driving health care costs to unsustainable limits. These pressures make it imperative that national programs to prevent the incidence of childhood obesity populationwide be developed. In September 2007, with the support of the United Health Foundation, the Urban Design Lab at the Earth Institute at Columbia University and the Collaborative Initiatives at MIT joined together to study childhood obesity through a design lens. The goal of the project was to take a comprehensive systems-based view to assess gaps in the methods being used to combat the dramatic rise in childhood obesity and to develop new approaches to curbing the epidemic. The team targeted the challenge of the food system as the key to mounting a sustainable national effort to change the childhood obesity tide. While many groups around the country are working to address childhood obesity, successful programs are often limited by the larger food environment. For example, a successful school program is limited by a child's home environment or the community environment; a successful community program is limited by the surrounding retail environment. Isolated interventions are working upstream. A strong national integrated regional food system based on access, affordability, quality, and health is required to support community interventions taking place across the country and enable long-term change. Achieving this goal will require new collaborations among industry, health, agriculture, academia, nonprofits, and government domains as well as the development of new business models focused on providing a healthy food supply.


Sustainability 9

Go Green, Get Healthy: An Agency-wide Effort Toward Sustainability

  • K. York , Centers for Disease Control and Prevention

Americans look to the Centers for Disease Control and Prevention (CDC) to lead by providing an example of healthy people in healthy environments. CDC's mission drives collaborative work toward creating information and tools that people need to protect their health. With the launch of the Go Green, Get Healthy (GGGH) initiative, the agency has emphasized to the American public the connection between our health and the health of the environment. The GGGH initiative is a coordinated campaign for widespread cultural change and includes healthier worksite campaigns, quality of work/quality of life programs, and internal environmental protection efforts. Tackling the immense challenge of actively engaging an entire agency in the environmental stewardship movement requires a vision with leadership support, education of every individual, good communication around successes, and the collecting of data. The GGGH initiative, led by the Office of Sustainability, relies on policy, procedure, and programmatic changes throughout the agency in order to achieve its vision of “a green and healthy CDC.” The campaign works effectively by breaking down the task of greening our agency into sectors. Each sector needs support of CDC leadership and the work of responsible offices, complemented by the grassroots dedication of individuals in the GGGH workgroups and collaborative external partnerships. Through targeted communication efforts, GGGH reaches individuals across the agency and encourages them to make positive change. The Office of Sustainability has learned how to marry defined roles and responsibilities with built-in flexibility and management involvement at all levels. These lessons can be used to help other organizations discover a model for their sustainability and wellness efforts that can help make their organization greener and healthier.


Sustainability 9

Healthy Food, Healthy Connections: Emory's Sustainable Food Initiative

  • P. Barlett , Emory University

Institutional engagement with the food system is a central component of a healthy future. Emory University's Sustainable Food Initiative takes a comprehensive approach designed to affect both individual choice and the provision of healthy food options for students and employees. With a goal that 75% of all food served in hospitals and cafeterias be either sustainably grown or locally grown by 2015, Emory is making good progress in regional purchases of fresh fruits and vegetables throughout the year. In addition, educational food gardens, a weekly farmers market, an annual sustainable food fair, lecture series, cooking classes, a food summit, food labeling efforts, and new catering options shift institutional awareness. Emory also seeks to create more awareness about the health impacts of our food choices beyond our borders, as we increase the purchase of fair trade and internationally produced organic food. Addressing the “toxic environment” of conventional dietary choices and supporting systems thinking in “foodways,” the university seeks to contribute to a healthier workforce and student population and a healthier planet.


Sustainability 9

Greening From Within: Translating Internal Sustainability Initiatives Into Innovations in Environmental Health Services

  • A. Houghton , Adele Houghton Consulting, LLC

Increasingly, environmental public health (EPH) departments are looking for ways to integrate sustainability into their work. Clean air, clean water, and access to healthy lifestyle choices are largely determined by a community's infrastructure and built environment. As leaders in sustainability, EPH departments are uniquely positioned to advocate for policies and initiatives that improve the health of the community as well as the environment. This new role brings with it the promise of additional funding, public recognition, and recruitment appeal to the next generation of EPH professionals. Greening a department's internal operations can act as a pilot project toward integrating sustainability on a programmatic level. This presentation will demonstrate how departments can use their “greening the department” program as onsite training in the sustainability topics most relevant to their programmatic work. By designing the internal program as the first step toward greening key departmental programs, ideas can be tested in a safe environment prior to implementation in the field. This approach will establish the EPH department as a leader in the community on key environmental issues while simultaneously acting as a laboratory for identifying the most effective means and methods to incorporate sustainability into EPH programs. Success for both the internal “greening the department” initiatives and the changes to EPH programs will hinge on the ability to measure and track the environmental and public health benefits associated with implementation. The presentation will focus on specific examples of “greening the department” activities that can translate into EPH services such as solid waste, water quality, air quality, and food inspections. Each element of the program can be implemented at its own pace, allowing for gradual overall environmental improvement.


Sustainability 9

The Impact of Sustainability for Program Capacity

  • J. Ralph , Northrop Grumman
  • S. Griffin-Blake , Centers for Disease Control and Prevention

Background: The Steps Program communities at the Centers for Disease Control and Prevention (CDC) have been successful in building capacity across multiple community sectors (such as worksite and health care.) This program development provides communities the ability to promote and sustain their efforts for reducing factors associated with obesity and chronic disease. Issue: Sustainability is a rising concern for community-based programs, because preventive factors, such as lack of funding and loss of leadership support, are more prevalent. The Steps communities have reversed these trends by developing and implementing several financial and nonfinancial innovative strategies to sustain program components. Results: Strategies implemented by Steps communities to sustain 3 core program components—partnerships; community interventions; and policy, systems, and environmental changes—will be highlighted. Strategies for sustaining partnerships include integrating Steps focus areas into existing community coalitions, and embedding partnerships under 501(c) 3 status community coalitions. Interventions include partnering with local task forces to sustain food access and community gardens, having municipalities take ownership of built environment interventions while building capacity, and cross-training. Last, strategies for policy, systems, and environmental changes include encouraging a community champion to manage “complete streets” policy changes, incorporating sustainability when developing green-space work plans, and partnering with local enforcement to maintain and institutionalize policy change. Lessons Learned: Partnerships were instrumental in building success and sustainability to community initiatives. They also assisted with sustaining interventions and policy, systems, and environmental changes by engaging partnerships across multiple sectors to institutionalize their program efforts. Sustaining community-based interventions was critical for continuing health education and health promotion practices related to the built environment. This session will also highlight community challenges and barriers when implementing these strategies.


Sustainability 10

Drought in Georgia: Public Health Response

  • B. Kagey , Georgia Department of Community Health

Background: Due to prolonged exceptional drought conditions in Georgia, the governor declared a state of emergency on October 20, 2007. This declaration established the Drought Response Unified Command and the Drought Response Working Group, and set state emergency response into action. The Georgia Department of Natural Resources Environmental Protection Division (EPD), responsible for access and quality of public drinking water supplies, was the lead response agency. The Georgia Division of Public Health (DPH) response role involved routine surveillance and monitoring the health of the population as well as drought-related guidance to health care facilities, health risk communication, and recommendations for private well owners. Issue: Waterborne disease outbreaks, known to occur with compromises in distribution systems, are monitored by public health on a routine basis. However, other potential health impacts attributed to drought are not as well understood. During the most recent drought, Georgia public drinking water supplies were in compliance with state and federal drinking water standards. However, published relationships between drinking water and health indicate that small changes in water quality within regulatory compliance levels may impact high-risk populations such as persons who are immunosuppressed or on dialysis. Results: Based upon these public health concerns, the Georgia Water Advisory Group comprising EPD, DPH, and the Georgia Department of Agriculture developed the Georgia Drought Response Guidance for Public Health and Food Industry Professionals . Lessons Learned: Public health's role in response to emergency drought conditions include routine surveillance and monitoring of waterborne diseases and public health guidance on potential changes in drinking water quality.


Sustainability 10

Watershed Management and Sustainability: A Holistic Approach to Water Quality Attainment

  • M. McNutt , Cuyahoga County Board of Health
  • J. Lis , Cuyahoga County Board of Health

Background: A Watershed Management and Sustainability Program promotes synergy between existing programs, the creation of new programs, and other local organizations that have not typically partnered with the public health sector. Human interaction with the environment is the subject of great scrutiny, especially in terms of climate change, water quality, and compromised community health due to development. Issue: Watershed management has its roots based on dividing land into political jurisdictions; however, watersheds are bound by drainage areas. This reality creates difficulty because watersheds are not neatly divided, whereas human created jurisdictional boundaries are. Political differences between watershed communities can create disparities. If an upstream community does something beneficial to the environment, but the downstream community does not, the overall benefit to the watershed is negated. Watershed coordinators and organizations perform activities where measurable increases in water quality can be achieved, such as stream restoration and stormwater demonstration projects. Although these activities are becoming more commonplace, they may not be enough to bring an impacted watershed into attainment. Results: The creation of a regional-based Watershed Management and Sustainability Program would provide a holistic approach to healing our waters from the inside out. Bio-retention projects, pharmaceutical drop-off events, nutrient trading programs, urban agriculture, and brownfield/vacant property revitalization are vital sustainable functions that must be integrated into watershed management. The watershed-based approach to decision making is an ideological concept in the fact that people have to take ownership and pride in the watershed in which they reside. Lessons Learned: This program will find success through partnership creation, innovative idea implementation, involvement in a developing discipline, and locally based sustainable investments for programs and projects.


Sustainability 10

Disinfection Performance of Iron (VI) for Wastewater Disinfection, Reuse, and Wetland Restoration: Public Health Implications

  • B. Skaggs , Tulane University
  • R. Reimers , Tulane University
  • A.Englande , Tulane University

Background: Hurricane Katrina has forced New Orleans to better utilize water and refocus on coastal restoration. Current wastewater disinfection practices utilize chlorination and discharge to the Mississippi river, a system that contributes to the dead zone in the Gulf of Mexico. Issue: New Orleans has sought innovative ways to combat cypress wetlands loss. One approach investigated by this research team is to disinfect municipal wastewater with ferrate, or iron (VI), and subsequently discharge it to the wetlands. Bench-scale testing has been utilized to test ferrate's efficacy to disinfect for fecal coliform, E. coli , and Enterococci microbial indicators. Reduction of estrogenic hormonal activity by a bioluminescent assay has also been observed. Results: Ferrate is a green oxidant, producing a micronutrient for vegetation and a chemical coagulant (ferric hydroxide). Furthermore, this iron species does not produce the disinfection byproducts commonly associated with chlorination practices. Its resulting oxidative byproducts are nonbiocidal or noncarcinogic, which could lessen the impacts to human health and the environment. Disinfection assays utilizing ferrate indicate 3-log reduction in microbes, or 99.9% inactivation. Ferrate will oxidize endocrine disrupting compounds to inactivate their biological and hormonal activity. Preliminary data indicate a 85% reduction in estrogenic activity. Lessons Learned: Integration of this technology into New Orleans's existing wastewater treatment facility can produce an effluent discharge that can be used to mitigate wetlands loss by displacing salinity intrusion, providing organics and iron for plant growth, reducing pathogens released into the environment, and minimizing the release of disinfection byproducts and hormonally active compounds into environmental media.


Sustainability 11

Minneapolis Sustainability Initiative, Focusing Local Government Action on Environmental Health

  • D. Huff , City of Minneapolis

Background: Starting in 2003, the Minneapolis City Council and Mayor Rybak began integrating sustainability principles into city decision making. The Sustainability Initiative was formed to spur action, track results, and better coordinate activities throughout the city. Methods: Focusing on a 50-year vision for the city's future, city residents, area professionals, and staff worked with the council to adopt 25 sustainability indicators, each with numerical targets. In order to integrate these indicators into city operations, the council amended the city's comprehensive plan and city goals, required every department to incorporate sustainability into business planning, and directed staff to report annually on progress toward numerical targets. A new council committee was created to oversee implementation of the Sustainability Initiative. Existing internal staff environmental coordinating committee meetings and citizens' advisory committee meetings were refocused to track the initiative and, with frequent mayor and council attendance, given increased importance. Results: Focusing on a combination of regulation, best practices modeling, and community engagement, the city of Minneapolis has led a regional movement toward sustainable decision making and program implementation. This has included passing new environmental regulations, green cleaning, purchasing and energy use policies, capital projects focused on transit and energy conservation, community action grants to combat global warming, and community outreach. Lessons Learned: Successful implementation for Minneapolis has resulted from strong leadership and support from the mayor and key city council members and internal structures that provide transparency, accountability, and sharing between elected leaders and departmental staff. Pushing the initiative down into departments is changing the internal culture without relying upon a strong centralized management structure.



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