viernes, 18 de junio de 2010

Preventing Chronic Disease: July 2010: 09_0242 / Environmental Metrics for Community Health Improvement



Volume 7: No. 4, July 2010

SPECIAL TOPIC
Environmental Metrics for Community Health Improvement

Benjamin Jakubowski; Howard Frumkin, MD, DrPH
Suggested citation for this article: Jakubowski B, Frumkin H. Environmental metrics for community health improvement. Prev Chronic Dis 2010;7(4).

http://www.cdc.gov/pcd/issues/2010/jul/09_0242.htm. Accessed [date].

PEER REVIEWED

Abstract
Environmental factors greatly affect human health. Accordingly, environmental metrics are a key part of the community health information base. We review environmental metrics relevant to community health, including measurements of contaminants in environmental media, such as air, water, and food; measurements of contaminants in people (biomonitoring); measurements of features of the built environment that affect health; and measurements of “upstream” environmental conditions relevant to health. We offer a set of metrics (including unhealthy exposures, such as pollutants, and health-promoting assets, such as parks and green space) selected on the basis of relevance to health outcomes, magnitude of associated health outcomes, corroboration in the peer-reviewed literature, and data availability, especially at the community level, and we recommend ways to use these metrics most effectively.



Introduction
Metrics (or indicators) are powerful tools for tracking community health determinants and outcomes. Optimal metrics are measurable, simple, sensitive, robust, credible, impartial, actionable, and reflective of community values (1-3). Metrics can help identify problems, define community priorities, drive policy development, compare different communities, assess health disparities, and monitor progress over time in reaching goals.

Environmental metrics are a key part of the community health information base. Environmental factors greatly affect human health, both directly and proximately (eg, the quality of air people breathe) and indirectly and “upstream” (eg, the sources of energy a community uses). Environmental metrics may measure both unhealthy exposures, such as pollutants, and “salutogenic” exposures, such as parks and greenspace.

Three efforts help inform thinking about environmental metrics for community health. First, many communities identified quality of life indicators (also known as livability indicators) beginning in the 1980s (4). These frequently reflect environmental factors relevant to health. Second, sustainability indicators have recently found wide use (4). Many sustainability indicators pertain to environmental factors with clear relevance to human health (5). Third, the Council of State and Territorial Epidemiologists (6), collaborating with the Centers for Disease Control and Prevention (CDC), has addressed environmental public health indicators, emphasizing drinking water, air quality, asthma, and climate change.

We draw on each of these efforts to discuss environmental health metrics at the community level. Our logic model is based on the standard toxicologic sequence: exposure (in the environment) leads to dose (in the body), which leads to health effect. Since “exposure” can be either dangerous or salutary and either proximate or upstream, we consider several “exposure” metrics. These metrics fall into 4 major categories: measurements of contaminants in environmental media, such as air, water, and food; measurements of contaminants in people (biomonitoring); measurements of features of the built environment that affect health; and measurements of “upstream” environmental conditions relevant to health (Table). We selected metrics on the basis of relevance to health outcomes, magnitude of associated health outcomes, data availability (especially at the local level), and corroboration in the peer-reviewed literature. Finally, we discuss ways to integrate environmental data with other data and to apply them to public health action.



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Preventing Chronic Disease: July 2010: 09_0242

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