Welcome to Module 2: The National Tracking Network and Program Overview. 1
We are going to start this module off with a brief review of Environmental Public Health Tracking terminology. We will then move on to a brief look at the history of the national program Explore data collection, standardization and presentation. We will include the different ways to view the data, including metadata, and provide an overview of the national secure portal. From there we take a look at the national network and program -- what components make up each of them and what they have to offer. We will finish up this module learning about the National Tracking partners. You will hear from two partners on how they contribute to Tracking and what they offer state and local health departments. As a reminder, if you would like more detailed information on the National Tracking Network, please visit Tracking 101, which is available free of charge on this e-learning site. 2
We are going to start out with a brief terminology review. As we covered in the last module, Tracking is public health surveillance with some key enhancements. The Tracking Network refers to the online information and data query system that allows for investigation into health effects and environmental hazards and exposures. The Tracking Program includes not only the Tracking Network but the people, resources, and program management involved in building this network. And finally, when we are talking about Grantees, we are referring to the states and city that receive support from CDC to build, maintain and expand their tracking networks and programs. All of the Tracking references in this module will refer to CDC s National Tracking Network and Program. Additionally, we will briefly talk about Metadata. Metadata are "data about data". Metadata describe the content, quality, and context of a dataset and provide links to additional information such as quality assurance documents and data dictionaries. The Tracking Network contains metadata records for datasets used to create the Tracking Indicators and for datasets maintained by national, state, and local environmental health partners. The CDC National Network Secure Portal is currently under development. When it is open, it will allow registered users to access restricted data. You can find a link to more information regarding the National Secure Portal in the resources section. More information can be found in CDC s Guide to Building an Environmental Public Health Tracking Network. A link to this publication can be found in the resources section. 3
Since funding began for the National Tracking Network & Program in 2002, the program has grown to 23 states and 1 city with 5 Academic Partners for Excellence. The National Network went online in the summer of 2009. The National Network Implementation Plan was published in August 2006 and outlined the vision for how the network would come together through content, access, functionality, and services offered. This plan provides an overview of the history of the tracking program and the direction in which it is headed. It is a good historical document to provide context to the overall Tracking Program and Network. There is a link to this document in the references section. As we mentioned, there are currently 23 states and 1 city that are grantees in the tracking program. Since the National Tracking Program involves New York City, we will refer to the NYC Tracking Program and all state tracking programs as grantees. This module will be focusing on the national program. Grantee programs will be discussed in Module 3. In addition to the grantees there are currently 5 academic partners for excellence. These programs are a great resource to the tracking program and provide useful research and analysis of tracking network data. For more detailed information on the Tracking Program and Network, please visit the Tracking 101 course available on this website. You can also visit the National Tracking Fact Sheet that is available online. A link to the factsheet can be found in the resources section. 4
An environmental public health indicator provides information about a population's health status with respect to environmental factors. Tracking Indicators on the national network were decided on in collaboration with national, state, and local environmental public health partners. Data for the networks are gathered and refined in a way to meet nationally consistent data and measures that have been adopted or developed for the network. Tracking data collected by grantee programs are submitted to the National Network. These data are included on grantee tracking networks as well. As you move between the national and grantee networks, you will notice they are not set up exactly the same. There are some basic parameters that are given to grantees, that will be discussed in the next module, but how they are implemented is up to the grantees. In addition to the tracking data supplied by grantees, the National Network contains data and measures from national partner agencies that are not found on grantee portals. Information about the data or metadata is also available on the national network. Metadata describe the content, quality, and context of a dataset and provide links to additional information such as quality assurance documents and data dictionaries. The Tracking Network contains metadata records for datasets used to create the Tracking Indicators and for datasets maintained by national, state, and local environmental health partners. To address the needs of health departments for more detailed data, CDC is developing a secure portal to provide access for certain users. Access to this data will be restricted and registration will be required by all users. You will be able to find more information about the secure portal through the link located on the Resources page. 5
Tracking data are collected in two main groups, environmental indicators and health effects. The data come from many different state, local, and national sources. Examples of the environment data include outdoor air quality, climate change, and water quality. Air quality data focus on ozone and particulate matter, specifically PM 2.5. Climate change data currently focus on heat-related indicators including: heat vulnerabilities, heat-related mortality, and temperature distribution. Water quality data currently focus on contaminants in community water systems with well-water information coming in the near future. Contaminants include arsenic, disinfection by-products, and nitrates. Health effects data focus on issues with a connection to the environment. Examples include asthma, a selection of adult and childhood cancers, birth defects, and poisonings from carbon monoxide and lead. Population data are included as well. These data contribute to a better understanding about how public health is affected by the environment. Current indicators include demographic, socioeconomic, and population exposure (or biomonitoring) data. The indicators and outcomes that we just discussed are only a small segment of the data that can be found on the national and state portals and more is being added all the time. To find out more about the data, visit the CDC tracking program online or the grantee program that you are interested in. The web addresses are found in the resources section. 6
On the National Network, users can compare data within their state or, depending on content area, across state boundaries. After a query or search is made, the resulting data can be displayed in maps, graphs, and tables, depending on the content area. Users can customize their results display by selecting from multiple viewing options, changing the layout of graphs, showing and hiding data, or sorting and re-ordering columns in tables. Results from the query can be shared by printing, emailing, or exporting the data as CSV file. 7
This is an example of data presented in map format. You are looking at an Air Quality query for PM 2.5 that has both monitored and modeled data for the year 2006. This is the most current data available at the time this module was created. Due to the time it takes to gather, refine and then model the data, there is a lag period between gathering data and being able to present the data in a reliable and usable format. This map shows annual average ambient concentrations of PM 2.5 in micrograms per cubic meter and is broken down to the county level. As you can see, there is a legend on the left side of the screen showing the different colors that relate to a range of PM 2.5 levels. Counties where only modeled data is available are identified with hash marks. Additionally, there is a magnifier scale to make the map larger or smaller as needed. Data for the different health indicators or environmental concerns are not always available at the county level. As we will see in the next slides, data are sometimes only available on the Tracking Network at the state or national level. 8
This is an example of what you can do within the map-view of the data. When you move your mouse over individual counties, the exact PM 2.5 level is provided along with the county name. This allows viewers to easily compare the PM 2.5 levels of different counties. In the upper right corner, you will see the different ways to share the information displayed. Data presentations, whether maps, graphs or tables can be printed, shared via URL link, or exported to an Excel spreadsheet. 9
Our next query looks at climate change, specifically heat vulnerability. The search parameter selected was population density from the 2000 census by county. These data can be exported and shared in the same ways as the air quality data that was just discussed. 10
On each of the different data views, map, chart, and table, you are able to find more information about the data, like where it came from and how it was captured. This screen shows what pops up when you click on Options and Info. You can find out more about the data you are viewing through this quick link. For more detailed information about each set of data, you can choose the Indicators and Data link that is shown when you click for more information. 11
This screen shows data in chart form. The data that are being displayed is an example of data that are currently only available at the state level. The graph is displaying the annual number of cases of lung and bronchus cancer in 2008. As with the map display, you can move your mouse over each state s bar to get the exact counts for that state, the state name, and the time frame. These data can be shared via the same methods as the other examples -- print, url link, and exported to a spreadsheet. 12
Now that you have an idea of the data included on the Tracking Network, we will talk about the information and resources available. The Tracking Network is designed to be useful to many different kinds of users, from public health professionals, to decision makers, to the public. This is why CDC includes different levels of information in addition to the data, on the Tracking Network. For each of the data content areas included on the Tracking Network, there is corresponding contextual information. This information provides users with background information about the topic, explains why the content area is relevant to tracking, describes the environment-health relationship, and includes risk and prevention messages as appropriate. CDC has a variety of materials that support grantee programs and inform users of the network. There are outreach and public awareness tools that can be used to inform health department workers and community members on what is available on the network. You can listen to trackingrelated podcasts that with interviews from CDC and grantees, that answer frequently asked questions. Visit the communication tools page of the Tracking Network to explore communication materials There are fact sheets for the National program and tracking grantee programs. On this page you can also view and download web buttons, a great promotional piece to add to your website. There is also information about how to download the Tracking Widget to your own website. You can connect with the Tracking Network through CDC s Tracking Facebook and Twitter accounts or by joining the CDC Tracking list-serv. CDC also has an introductory video to tracking that is available on youtube and their Facebook site. We will take a look at it on the next slide. 13
This video is an example of some of the outreach tools mentioned previously that CDC has developed to increase awareness about the Tracking Network. The video is available on the Tracking Network, the CDC Tracking facebook page, and YouTube. 14
CDC has a number of partners that assist with the tracking program outside of the grantees. The national partners, including NEHA, assist with a wide range of projects and initiatives. The partners consist of a variety of federal government entities, national organizations, and other key groups to ensure that the Tracking Network and Program meet the needs of a wide range of individuals and that the data contained on the Network is the best that is available. These partnerships enhance CDC's ability to: Build a sustainable National Tracking Network, Enhance Tracking workforce and infrastructure, Disseminate information to guide policy, practice, and other actions to improve the nation's health, Advance Environmental Public Health science and research; and Foster collaboration among public health and environmental programs 15
As you can see, the partners focus on a large variety of topics - some directly working with public and environmental health programs, some working more with specific diseases or data. Next, we will hear from one of the National Partners on how they interact with the national tracking program and how they involve health departments in those activities. 16
ASTHO Association of State and Territorial Health Officials is introduced by Ify Mordi, Environmental Health Analyst for ASTHO. 17
Peer Fellowship Program was established shortly after the official launch of CDC s National EPHT Network in 2009 to help bridge the gap between CDC grantees and states not presently funded to conduct tracking activities. Since the launch of its fellowship program, ASTHO has helped build capacity in at least 18 non-funded state and local health agencies to improve their state readiness for tracking. The Fellowship Program, which is offered on a yearly basis, presents a great stepping stone for Environmental Health Professionals to: Attend a National Tracking Workshop to learn from established EPHT programs and build peer networks; pilot a small tracking project that would advance tracking in his or her state, and most unique of all, form mentor-mentee relationships with CDC Grantees who have compatible Tracking Programs and offer valuable advice and guidance for developing a customized approach to Tracking. 18
Through the fellowship, principal investigators from non-funded states have launched internal tracking workgroups, begun to engage with data stewards, IT departments, and other potential stakeholders, and have conducted preliminary collection and spatial analyses of environmental and public health data Here are some examples: As part of the 2009 Fellowship Program, Louisiana conducted a demonstration project that tracked blood mercury and fish-tissue mercury levels to evaluate the feasibility, limitations and potential applications of a GIS-based surveillance system. Louisiana successfully competed for the CDC EPHT Network Planning and Implementation Grant and in 2009 became part of CDC s National Tracking Network. The Kentucky Department of Public Health (KY DPH) conducted a pilot project to examine the relation of criteria air pollutant levels with the prevalence rates of chronic respiratory diseases, such as asthma, chronic obstructive pulmonary disease (COPD) and lung cancer seen in KY. KY DPH has established an internal EPHTN Workgroup to assist with formalizing the data collection process and intends to use results to demonstrate the benefits of EPHT to legislators, policy makers, and other stakeholders. 19
North Carolina piloted the project, "Climate Indicators for Harmful Algal Bloom (HAB) Events to focus on the predictive nature of climate indicators for cyanobacterial (a.k.a blue-green algae) blooms in North Carolina. Results could inform strategies for protecting vulnerable populations, public water supplies, and recreational sites, such as lakes. NC has begun work towards establishing a server to display well water data. As part of the fellowship program, the Cincinnati Health Department created an Environmental Public Health Tracking portal based on vital statistics data. The website showcases information about the total number of births of Cincinnati residents, low birth weight data, maternal risk and health outcome data, as well as fun facts about city residents including most popular names and Cincinnati neighborhoods with the highest number of births. As part of phase II, CHD has begun to enrich its portal with birth defects, population and mortality data and is currently working towards developing an EPHT implementation plan and designing a technical advisory committee (TAG) orientation program to help TAG members understand the purpose of environmental tracking and how it can be useful. 20
Even after the completion of the fellowship year, ASTHO continues to provide its fellows with lasting support and resources to aid in their efforts to remain engaged in tracking through its Tracking Alumni Group. Examples of activities pursued by former Tracking Fellows include: Launching of internal EPHT workgroups, Engaging with data stewards and other potential stakeholders, Conducting demonstration projects for the preliminary analyses of environmental health and public health data, and Pilot testing CDC s How to Guide, a manual that provides guidance to new and experienced health professionals looking to initiate and develop a Tracking program in their state or locale. ASTHO Alumni Group members also participate on webcast trainings and meet regularly meet via teleconference to discuss and share capacity-building strategies, discuss the latest developments in the National Network, and learn about new GIS software and funding opportunities. 21
ASTHO is proud to announce that it has taken its Peer Fellowship Program to the next level by officially launching a second phase to the fellowship program. Recently launched in February 2012, this new program, entitled Phase II Capacity Building Program for Environmental Public Health Tracking and made possible by the Centers of Disease Control and Prevention, is the first of its kind that aims to prepare past fellowship recipients with in-depth, hands-on experience and technical assistance for developing Tracking Programs and/or initiating EPHT-related activities within their jurisdictions. For more information on ASTHO s Tracking Fellowships and Phase II Grant Program, please visit ASTHO s Tracking Environmental Health Hazards webpage. 22
Now we are going to hear from Jennifer Li, Director, Environmental Health, Health and Disability with the National Association of County and City Health Officials. Ms. Li will be providing information on programs and initiatives that NACCHO has developed in regards to the Tracking Program and Network. 23
The National Association of County and City Health Officials (NACCHO) is the national non-profit organization representing nearly 2,800 governmental local health departments (LHDs) across the nation, including counties, cities, districts, and townships. NACCHO s vision is health, equity, and well-being for all people in their communities through public health policies and services. NACCHO s mission is to be a leader, partner, catalyst, and voice for local health departments in order to ensure the conditions that promote health and equity, combat disease, and improve the quality and length of all lives. NACCHO provides timely local health department perspective on a wide range of public health issues including the following: Community Health topics such as chronic disease prevention, tobacco control, health and disability, infectious disease prevention and control, immunization, injury prevention, maternal and child health, adolescent health, and health equity. Environmental Health topics such as the public health effects of climate change, food safety, environmental health tracking and assessment, and environmental justice. Public Health Infrastructure and Systems topics such as: accreditation and quality improvement, community health status indicators, public health informatics, performance standards, public health law, and regionalization of public health services. Public Health Preparedness topics such as local readiness for pandemic influenza, Medical Reserve Corps, Project Public Health Ready, and Strategic National Stockpile. More specifically, NACCHO s Environmental Health Program aims to: Increase the strength of LHD environmental health programs; Increase health equity through improved environmental public health policies and practices; Decrease morbidity and mortality from environmental risk factors; Support new and improved policies for healthy living; Increase wellness activities and programs; and Increase sustainability of communities. 24
NACCHO offers the local health department perspective by providing strategies for strengthening collaboration and communication between state grantees and local health departments (LHDs) working to understand the links between key environmental health indicators and the development of disease. As such, NACCHO has engaged in the following strategies: Conducted facilitated discussions in CA, FL, MA, MD, NY, OR, UT, WA, WI. Most recently, NACCHO conducted facilitated discussions with LHDs on environmental public health tracking in Minnesota and Iowa in collaboration with the CDC and the respective state departments of health (May 2012). NACCHO also hosted a previous series of webinars on Tracking. Most recently, NACCHO and CDC hosted webinars on the utility of the National Tracking Network in connection to health impact assessments and children s health. NACCHO convenes the Environmental Public Health Tracking Workgroup which is comprised of LHD representatives in various positions (as well as from different jurisdictional sizes and locations) located in both funded and unfunded states of the Tracking program. Through quarterly conference calls and in-person meetings, this group provides feedback on NACCHO, CDC, and partner organization strategies and deliverables from the LHD perspective. If you are interested in participating in this workgroup, please contact NACCHO staff. 25
Another recent strategy included conducting key informant interviews with select LHD representatives that had participated on previous NACCHO Tracking webinars. The key findings include both positive feedback and information on barriers facing LHDs interested in applying tracking resources to drive community health outcomes. LHDs appreciate how CDC and state tracking programs standardize data, provide points of comparison, improve access to local data that LHDs do not collect, make data available, provide a clear point of contact for data, and link health outcomes with hazards data. Additionally, LHDs identified key barriers preventing their full engagement in tracking resources: The lack of localized data that provide insight to geographic units smaller than the county level; The linkages among hazards, exposure, and health outcomes are not clear enough. LHDs wanted the link to be stronger and also requested examples of effective communication strategies to explain the link to the public and local policymakers; Insufficient time and staff capacity to interpret and use the data. LHDs need data to be communicated in manner that is easier to understand; and Uncertainty among LHD staff about how to apply and use tracking data and resources. A final report will be available on NACCHO s website. 26
State and local health departments should work together to develop strategies on how best to use tracking data and resources that meet the specific needs of LHDs, including: Workgroups; Facilitated discussions; In-person meetings; Statewide meetings; Direct and in-person trainings; Mini grants; Mechanism for LHDs to collect tracking data; Site visits; and Direct communications. 27
For more information, please contact NACCHO staff and/or visit NACCHO s website to learn more about NACCHO s role and materials about the LHD perspective on the National Tracking Network and related activities. 28
Thank you for viewing Module 2: National Tracking Network and Program Overview. The next module will explore the grantee tracking programs and networks and how they work with and benefit local health departments. 29