| Can Lessons from Public Health Disease Surveillance Be Applied to Environmental Public Health Tracking? Beate Ritz,1 Ira Tager,2 and John Balmes3 1Department of Epidemiology, University of California, Los Angeles, California, USA; 2Division of Epidemiology, and 3Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, California, USA Abstract
Disease surveillance has a century-long tradition in public health, and environmental data have been collected at a national level by the U.S. Environmental Protection Agency for several decades. Recently, the Centers for Disease Control and Prevention announced an initiative to develop a national environmental public health tracking (EPHT) network with "linkage" of existing environmental and chronic disease data as a central goal. On the basis of experience with long-established disease surveillance systems, in this article we suggest how a system capable of linking routinely collected disease and exposure data should be developed, but caution that formal linkage of data is not the only approach required for an effective EPHT program. The primary operational goal of EPHT has to be the "treatment" of the environment to prevent and/or reduce exposures and minimize population risk for developing chronic diseases. Chronic, multifactorial diseases do not lend themselves to data-driven evaluations of intervention strategies, time trends, exposure patterns, or identification of at-risk populations based only on routinely collected surveillance data. Thus, EPHT should be synonymous with a dynamic process requiring regular system updates to a) incorporate new technologies to improve population-level exposure and disease assessment, b) allow public dissemination of new data that become available, c) allow the policy community to address new and emerging exposures and disease "threads," and d) evaluate the effectiveness of EPHT over some appropriate time interval. It will be necessary to weigh the benefits of surveillance against its costs, but the major challenge will be to maintain support for this important new system. Key words: environmental health, evaluation, intervention, registries, surveillance. Environ Health Perspect 113:243-249 (2005) . doi:10.1289/ehp.7450 available via http://dx.doi.org/ [Online 2 December 2004]
Address correspondence to B. Ritz, Department of Epidemiology, University of California at Los Angeles, 650 Charles Young Dr., Room 73-320 CHS, Los Angeles, CA 90095 USA. Telephone: (310) 206-7458. Fax: (310) 206-6039. E-mail: britz@ucla.edu We thank J. Mann for her comments and all members of the Center for Excellence in Environmental Public Health Tracking for their involvement in discussions of some of the issues presented here. This work was partially funded by a Centers for Disease Control and Prevention grant for a Center of Excellence for Environmental Public Health Tracking at the University of California at Los Angeles, University of California at Berkeley, and University of California at San Francisco, grant U50/CCU922409-03. The authors declare they have no competing financial interests. Received 27 July 2004 ; accepted 2 December 2004.
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