Success Stories - Informing Policy

California - Heat Wave Preparedness

What is the problem?

During the California 2006 heat wave, there were 140 confirmed deaths and an additional 515 suspected deaths due to extreme heat. An estimated $133 million in health-related costs was attributed to the heat wave, along with an estimated $500 million in agriculture-related costs from the loss of livestock. Heat waves have and will continue to impact all regions of California, including urban, rural, inland, and coastal areas. In California, heat waves are expected to become longer and more frequent over time.

What did Tracking do?

The California Environmental Health Tracking Program worked with the Bay Area National Weather Service (NWS) regional office to conduct a study to determine if heat alerts accurately predicted times when people suffered the most heat illness. NWS monitors temperature and issues heat alerts. The heat alerts serve as triggers for cities and counties to take preventative action, such as opening cooling centers where the public can gather for life-saving relief from the heat. The California Tracking Program showed that heat-related emergency room visits peaked immediately following heat alerts for the San Jose area and subsided when the heat alerts were discontinued. Due to budget cuts, the City of San Jose wanted scientific evidence from NWS to show there was a need for cooling centers during heat waves. Without this proof, decision-makers would not approve the opening of cooling centers as part of the city's heat alert response plan for the upcoming summer.

Improved public health

NWS presented the California Tracking Program study findings to City of San Jose decision-makers. Based on this evidence, the city decided to allow cooling centers to open as part of the city's heat alert response. The California Tracking Program is partnering with NWS to conduct similar studies for other regions in California, including Los Angeles. This information will help cities to make decisions about heat wave preparedness policies and help NWS refine its heat alert system for each region.

Maine - Reducing carbon monoxide poisoning

What is the problem?

Every year, an estimated 15,200 people seek medical care in an emergency department or miss at least one day of work due to exposure to carbon monoxide(CO) in the U.S. Correctly installing, maintaining, and operating carbon monoxide-emitting devices and appropriately using carbon monoxide detectors can help prevent CO poisoning. Even though no national surveillance system exists for acute CO poisoning, a body of literature describes excess cases of CO poisoning due to power outages from storms, floods, and hurricanes. However, Maine did not have an active tracking system capable of identifying risk factors for CO poisoning.

What did Tracking do?

The tracking program developed a state-wide surveillance system for CO poisoning. This system uses multiple data sources as well as geographic information to identify groups at a higher risk for potential exposure. In addition, tracking staff developed a module for the state's Behavioral Risk Factor Surveillance System that allows them to track CO detector use. Tracking staff were able to amend the mandates for the Maine CDC's public health activities to make environmentally related health conditions reportable. In 2008, CO poisoning became the first condition to be included under this mandate.

Improved public health

With data from the CO poisoning surveillance system, the Maine Tracking Program found that almost every case of CO poisoning in the state was associated with not having a CO detector. These data led to new legislation requiring CO detectors in all rental units and in single family homes when there is an addition or renovation and whenever a property is sold.

The law went into effect in September 2009, and the Maine Tracking Network is working to measure the effect of the law on CO poisoning prevention.

Massachusetts - Examining the relationship between cancer rates and proximity to a nuclear power plant

What is the problem?

Franklin County residents expressed concern about the number of new cases of cancer in their towns because they are close to the Vermont Yankee Nuclear Power Plant. This plant is less than 5 miles from the Massachusetts state border.

Nuclear power plants produce ionizing radiation. Exposure to radiation has been associated with certain cancers such as bone, brain, central nervous system, thyroid, leukemia, and multiple myeloma.

What did Tracking do?

The tracking program reviewed available cancer data for five cancer types with possible associations to radiation. The data covered a span of 23 years for 17 Massachusetts communities located within a 20-mile radius of the power plant. They did not find any unusual patterns for cancer in Franklin County.

Improved public health

The Massachusetts Tracking Program used data from the state's tracking network to address community concerns about cancer risks. They shared their findings with the community in a report. Over time, the tracking program has noticed a decrease in the number of questions they receive related to this power plant.
Because data are readily available on the tracking network, answering inquiries like this one take less time and resources. This ensures that public health responses are efficient and economical.

Minnesota - Preventing Melanoma NEW

What is the problem?

Melanoma is the most dangerous form of skin cancer. It is one of the most rapidly increasing cancers among Minnesotans. CDC estimates that exposure to ultraviolet (UV) light causes 65-90% of all melanoma. UV light comes from the sun but can also come from tanning beds. Despite the risks for melanoma, tanning bed use remains common in Minnesota.

What did Tracking do?

The Minnesota Tracking Program published interactive maps and charts on their state tracking network showing trends and geographic patterns of melanoma across the state. They also collaborated with the state cancer registry to add county-level melanoma data to MN County Health Tables, a resource used by state and county public health officials to guide program planning and evaluation.

Improved public health

Since making melanoma data easy to find and use, tracking program staff have worked with state programs and other partners, such as the American Cancer Society of MN and the MN Cancer Alliance, to use tracking data to support program and policy initiatives to prevent melanoma. For example, these partners identified reducing the use of artificial UV light for tanning as a key objective in Cancer Plan Minnesota: 2011-2016, a framework for preventing and controlling different types of cancer. In addition, tracking data will be used to evaluate the effectiveness of melanoma prevention program and policy initiatives over time.

Minnesota - Evaluating Indoor Smoking Ban Legislation to Protect Residents from Secondhand Smoke NEW

What is the problem?

Secondhand smoke, also known as environmental tobacco smoke, causes cancer and other health problems in both children and adults. To help reduce exposure to secondhand smoke, Minnesota passed Freedom to Breathe legislation in 2007. The legislation banned smoking in almost all indoor public places and indoor work sites, including bars and restaurants. In 2011, some legislators worked to repeal the legislation.

What did Tracking do?

The Minnesota Tracking Program maintains data on secondhand smoke among nonsmokers for the state. Tracking staff analyzed state data to determine if Freedom to Breathe legislation helped reduce residents' exposures to secondhand smoke. Tracking staff found that since 2007, exposures to secondhand smoke decreased among non-smokers. In addition, children's exposures decreased by 20% and adults' exposures decreased by 25%.

Improved public health

Freedom to Breathe legislation remains in place because the tracking program demonstrated that the legislation was associated with a decrease in exposures to secondhand smoke and because there is strong support to keep the smoking bans in Minnesota. In addition, tobacco prevention programs and others have been able to use the tracking data to plan more effective smoking cessation and awareness activities.

Minnesota - Tracking the impact of a statewide carbon monoxide (CO) alarm law

What is the problem?

Each year, accidental CO poisonings result in several deaths and hospitalizations in Minnesota. The highest number of CO poisonings occurs during the winter months. Minnesota took an important step to prevent CO poisonings when the state passed a law that requires CO alarms in all single-family homes and multi-dwelling units. The law was put into effect from 2007 to 2009. However, with no system to track CO poisonings, the Minnesota Department of Health could not know whether the law helped lower the number of CO poisonings in the state.

What did Tracking do?

Minnesota's Tracking Program worked with the National Tracking Network to gather data and create ways to measure CO poisonings in the state. The programs put this information into a tracking report that local newspapers used to inform readers about CO poisoning prevention.

Minnesota's Tracking Program and the state Behavioral Risk Factor Surveillance System (BRFSS) are working together to collect data on the number of Minnesota homes that have CO alarms. Using data from years before and after the CO alarm law, the tracking program can follow changes in the use of CO alarms and the impact on CO poisonings and exposures.

Improved public health

The CO alarm law and the system for tracking CO poisonings are examples of the way tracking data can have an effect on state and local policy.

Minnesota state and local health agencies will use CO tracking and BRFSS data to measure the effectiveness of the state CO alarm law. Indoor air and healthy homes programs will also use tracking data to determine the effectiveness of activities to improve public health.

New Hampshire - Measuring the Impact of Climate Change

What is the problem?

New Hampshire's climate is changing because of greenhouse gas emissions. Greenhouse gases come from daily activities like driving a gasoline powered car or using a lawnmower. As a result of climate change, scientists are now seeing warmer winters, less snowfall, rising sea levels, more rainfall, and more floods. These kinds of changes may affect New Hampshire's natural resources over time and could cost the state millions of dollars in lost revenue.

What did Tracking do?

The New Hampshire Tracking Network helped the Governor's Climate Change Policy Task Force describe the effects climate change could have on NH. The results were printed in the New Hampshire Climate Action Plan: A Plan for New Hampshire's Energy, Environmental and Economic Development Future.

The plan identifies policies and actions needed to help people and groups who could be most affected. The New Hampshire Department of Environmental Services also worked with the New Hampshire Division of Public Health Services to develop a Climate Change and Public Health Adaptation Plan for New Hampshire. This was paid for by a grant from the Association of State and Territorial Health Officials.

Improved public health

The New Hampshire Tracking Network is now developing indicators to track illness, death, and people or groups most affected by climate change. These data will help New Hampshire respond to and evaluate future public health issues caused by environmental changes. This information will be placed on the New Hampshire Tracking Program Web site.

New York City - Guiding policy on pesticide use

What is the problem?

Every year the media reports on fires and explosions triggered by indoor pesticide foggers, also known as "bug bombs." Yet little information is available about the type and number of bug bomb-related injuries and health effects.

What did Tracking do?

The NYC Tracking Program studied short-term bug bomb related health effects and injuries. After reviewing available national and local data, the NYC tracking program and partners published the results. The report included many kinds of bug bomb injuries and illnesses: severe irritation of the eyes and throat, nausea, and shortness of breath. In NYC, people using bug bombs in large, multi-unit apartment buildings without telling their neighbors caused many of these events.

NYC Tracking Program studies showed that people living in low-income neighborhoods are more likely to use bug bombs and sprays rather than safer choices like bait stations or gels.

Improved public health

This information led the Health Department, in conjunction with the NY State Department of Environmental Conservation, to pursue restricting bug bombs to the public. In New York, these devices would only be available for purchase and use by licensed pest control professionals. NYC has also encouraged the U.S. Environmental Protection Agency to restrict nationwide the use of total-release foggers.

New York City - Improving public health responses to climate change

What is the problem?

On average, heat waves cause more deaths than other natural disasters in the United States. Because of climate change, natural disasters are likely to get worse and happen more often. Public health guidance for heat wave response will require better information on how summertime heat relates to health.

What did Tracking do?

NYC Tracking staff analyzed the number of illnesses and deaths related to NYC weather. They also looked at individual and neighborhood factors such as poverty and the proportion of seniors without access to air conditioning. NYC Tracking staff found that their heat advisories needed to include information on cooler, but still potentially dangerous heat waves.

Improved public health

Following the lead of the tracking program, NYC government has taken several actions to protect public health during heat waves. One example is an agreement with the City's Office of Emergency Management and the National Weather Service to revise definitions for heat advisories and for emergency response.

New York City - Making restaurants safer

What is the problem?

Foodborne illness is a common, costly—yet preventable—public health problem across the United States. The New York City (NYC) Tracking program estimated that foodborne illnesses in the city are responsible for

• about 7,000 hospital stays each year,
• about 20,000 emergency department visits each year, and
• thousands of cases of diarrhea every day.

Approximately half of all foodborne outbreaks reported to CDC can be linked to restaurants. In NYC, more than half of all foodborne outbreaks are restaurant related.

What did Tracking do?

NYC's Tracking Program shared this information with the NYC Board of Health. The Board of Health used the data to revise the health code to require that all restaurants post letter grades of A, B, or C in public view. The letter grades show how well or poorly a restaurant was rated during sanitary inspections. The goal of this new rule is to provide diners with easy-to-read information about the safety of their food and to motivate restaurants to maintain good food-safety practices.

Improved public health

Now NYC diners can make informed decisions about which restaurants to choose. A survey conducted in July 2011, and repeated in February 2012, showed that 90% of all New Yorkers approve of grade posting and most of them consider grades when deciding where to eat. The inspection grading system was designed to encourage restaurants to improve their food-safety practices rapidly. If a restaurant does not receive an A on its initial inspection, the Health Department conducts a surprise second inspection about a month later. The tracking program evaluated this approach and found that restaurants greatly improved their food-safety practices between the first and second inspections. Preliminary reports also suggest that reported Salmonella cases in NYC are down.

New York City - Informing local laws to reduce health problems caused by air pollution

What is the problem?

Some older heating systems in New York City (NYC) burn low-grade oil called residual oil (also called fuel oil). Burning residual oil releases much more harmful small particles called particulate matter (PM_2.5) into the air than other heating fuels. Exposure to PM_2.5 can cause serious illnesses and deaths, especially from lung and heart diseases.

What did Tracking do?

NYC's Tracking Program studied PM_2.5 pollution and found that the highest levels were in parts of the city with the highest number of residual oil-burning boilers. The tracking program used methods developed by the U.S. Environmental Protection Agency to estimate the effects of PM_2.5 exposure on the numbers of deaths, hospital stays, and emergency department visits in NYC. The tracking program showed that many hospital visits and deaths could be prevented by reducing the PM_2.5 levels by phasing out residual heating-oil use in the city.

Improved public health

NYC leaders used the tracking program's findings to support a local law that was enacted in 2010 and new regulations that were finalized in 2011 to begin reducing and ultimately phase out the use of residual oil in NYC by the year 2030. The tracking program estimated that, when fully implemented, this law will prevent about 200 deaths caused by PM_2.5 exposure in NYC each year.

New York City - Supporting prevention of carbon monoxide poisonings

What is the problem?

Carbon monoxide (CO) poisoning is a serious but preventable environmental health threat. In 2004, New York City (NYC) enacted the Carbon Monoxide Alarm Law requiring building owners to provide CO alarms in all residential and many public buildings. CO alarms, like smoke alarms, have a short lifespan of a few years and need to be replaced when they expire. In November 2011, the Mayor's Office and NY City Council proposed an amendment to the local law to address this issue and requested data related to CO poisoning from the NYC Health Department.

What did Tracking do?

NYC's Tracking Program provided a report to the Mayor's office detailing the CO poisoning and incident information from the NYC Tracking Network. The report showed that shortly after the 2004 law went into effect, the Fire Department of New York (FDNY) investigated five times more CO hazards than before because more of the residents had CO alarms to detect the hazards. The report included a neighborhood map showing the reported CO hazards that FDNY investigated; more CO hazards occurred in low-income areas than in other areas. The report also included a graph showing that when residents more frequently reported using back-up heat sources, such as kitchen stoves, overnight there were higher rates of CO incidents in the neighborhood.

Improved public health

The City Council passed the amendment to the NYC Carbon Monoxide Alarm Law in December 2011. The law continues to require that all new CO alarms comply with UL 2034, the Standard for Safety of Single and Multiple Station Carbon Monoxide Alarms, which requires audible alerts when the alarm expires. Under the amendment, building owners and home owners are responsible for quickly replacing expired CO alarms.

Oregon - Understanding indoor air quality in businesses that serve liquor

What is the problem?

In the United States, environmental tobacco smoke (ETS) causes about 3,000 lung cancer deaths in non-smokers each year. ETS is also linked to heart disease, nasal and sinus cancer, sudden infant death syndrome, asthma, middle ear infections in children, and other illnesses that affect breathing. Although data show ETS exposure is going down in the U.S., it is still a major public health concern. In 2006, only 12 states passed clean indoor air regulations that cover nearly all indoor worksites, including bars and restaurants. Oregon was not one of them.

What did Tracking do?

The Oregon Tracking Program worked with several partners to conduct the Oregon Air Monitoring Project. This project examined indoor air quality in 107 hospitality locations in the state and looked at how indoor smoking affected indoor air pollution. Results of the project showed that restaurants, bars, and other hospitality locations allowing indoor smoking had poorer air quality than both indoor-smoke-free sites and outdoor air. Workers in the locations sampled were exposed to pollution levels more than three times higher than the yearly amount of fine particle air pollution that the U.S. Environmental Protection Agency considers safe to breathe. This project showed that Oregon workers and people visiting bars and restaurants are exposed to harmful levels of cancer-causing chemicals and other poisons in cigarette smoke.

Improved public health

This study influenced state legislation passed in 2009, known as the Clean Indoor Air Act of Oregon. With a few exceptions, this legislation makes it illegal to smoke at work and in public places. Policies such as this can reduce ETS exposure and improve public health.

Oregon - Reducing exposure to arsenic from drinking water

What is the problem?

Studies from the 1970s showed elevated levels of arsenic in private wells in the Sutherlin Valley area. The arsenic found in these wells most likely comes from the bedrock and soil. Long-term exposure to arsenic through drinking water is known to cause various types of cancer, including lung, skin, bladder, kidney, nasal passage, liver, and prostate. Arsenic exposure may also affect reproductive organs, the brain and nervous system, the heart and blood vessels, and cause darkening and corns on skin. Since the state has not required water to be tested for arsenic, people living in the area for many years may have been drinking water containing amounts of arsenic that could be harmful to health. Also, new homeowners may be unaware of arsenic in their water supply. Without more current information about arsenic levels, state or local health officials cannot know the best ways to protect peoples' health.

What did Tracking do?

The Oregon Tracking Program, working with several partners, measured arsenic levels in more than 100 home wells in Sutherlin Valley. Several wells were found to have arsenic levels higher than healthy drinking water standards. People using those wells were notified. A community meeting was held to explain the results of the testing and to inform residents about ways to remove arsenic from the well water. The partners also provided fact sheets and health information resources. In addition, local newspapers published articles notifying residents of testing results and encouraging them to test their well water regularly.

Improved public health

This study influenced state legislation, passed in 2009, that added arsenic to the list of substances tested in private wells. Now, every time a piece of property with a private well is sold, the water must be tested for arsenic and other contaminants. This testing will limit exposure to arsenic and lower the possibility for health problems caused by it.

Washington - Preventing Accidental Carbon Monoxide Deaths

What is the problem?

Accidental poisoning from carbon monoxide (CO) causes about five hundred deaths in the U.S. each year. In Washington, about 53 people go to the hospital for symptoms of CO poisoning every year. Many acute CO poisonings are from exposure to CO from fuel burning appliances, portable generators, or charcoal burners brought inside the home. A study of a CO poisoning outbreak in King County, during power outages in 2006, showed that 70% of people had been exposed to toxic levels of CO from generators or charcoal burners brought inside. In response to new state legislation, the Washington Building Code Council wrote draft rules in 2009 requiring the placement of CO alarms in homes. However, the draft rules applied only to homes with fuel-fired appliances or those with attached garages. As a result, many residents were still at a high risk for carbon monoxide poisoning.

What did Tracking do?

Washington Tracking Network scientists led an agency-wide Carbon Monoxide Poisoning Prevention Planning Workgroup. This workgroup coordinated Washington Department of Health actions with the work of the Washington Building Code Council. Washington Tracking Network staff provided data from their network to decision makers for these new rules. These data described not only Washington's burden of preventable deaths and sickness due to CO poisoning, but also the risks – such as indoor use of generators – that cause a large number of CO poisonings. This information helped policy-makers recognize the need to extend the building code rules to more types of homes.

Improved public health

The Washington Building Code Council approved a measure to extend the rule to many types of homes. Other organizations and health advocates successfully lobbied the state legislature for the CO poisoning prevention issue and creating more awareness about the new rules. The Washington Department of Health and Washington Tracking Network provided the facts needed to help craft the rule's language. The Washington Building Code Council now requires all residential buildings in Washington to have carbon monoxide alarms by 2013. The new, stricter rules provide greater protection of public's health.