Environmental Public Health Tracking in Massachusetts
I.
Suzanne K. Condon, Associate Commissioner Massachusetts Department of Public Health Center for Environmental Health August 25, 2006
Outline
Introduction to Center for Environmental Health Community Partnerships
II.
III. HIPAA, FERPA and Commonwealth of Massachusetts Regulations IV. Using Science to Enhance Public Health Protection in the Regulatory Environment
I. Center for Environmental Health
Ø The Center for Environmental Health has a broad mission of protecting the public health from a variety of environmental exposures. The Center responds to environmental health concerns and provides communities with epidemiologic and toxicological health assessments. Ø The Center comprises nine programs, four which ensures regulatory compliance related to food and radiation safety, as well as the state sanitary code.
Center for Environmental Health
Community Assessment Program Emergency Response Indoor Air Quality Program Environmental Epidemiology Program Environmental Health Education and Outreach Program Environmental Toxicology Program Community Sanitation Program
Food Protection Program
Radiation Control Program
Childhood Lead Poisoning Prevention Program
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II. Community Partnerships
ØCity of Woburn ØLupus & the City of Boston ØDevelopmental Effects in Berkshire County ØAsthma statewide
Pew Environmental Health Commission
The Public Believes That Environmental Factors Are A Major Cause of Health Problems and Disease
Not Important 11%
Don't Know 2%
Very Important 42%
Important 45%
Potential Environmental Exposures & Health Outcomes
ØIndoor Air Quality and Pediatric Asthma ØHazardous Waste Sites and SLE ØPCB Contamination and Developmental Effects
III. HIPAA, FERPA & CMR’s
ØHealth Insurance Portability and Accountability Act (HIPAA) ØFamily Educational Rights and Privacy Act (FERPA)
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HIPAA
Ø Applies new safeguards to protect the privacy, security & confidentiality of health information. Ø Applies equally to private sector & public sector covered entities. Ø Limits the ways that covered entities can use patients ’ personal medical information. Ø Permits disclosure for public health needs and research that involves limited data or has been independently approved by an IRB or privacy board.
Response to HIPAA Barrier
Ø Amended regulations that define diseases dangerous to public health with Surveillance of Diseases Possibly linked to Environmental Exposures (105 CMR 300.192) 2004. Ø 8 diseases/outcomes (ALS, aplastic anemia, asthma, autism, MS, myelodysplastic syndrome, scleroderma & SLE)
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FERPA
Ø Protects the privacy of educational records. Ø Applies to all educational records maintained by educational institutions that receive funding from the federal Department of Education (DoE). Ø Massachusetts DoE regulation allows DPH access to records. Ø New DPH regulations allow access to records for certain outcomes. Ø But FERPA takes precedence Ø Thus, DPH can’t access DoE records Ø Unable to access DPH Early Intervention (EI) records. The Individuals with Disabilities Education Act (IDEA), which covers EI, states that the protections of FERPA apply.
IV. Using Science to Enhance Public Health Protection in the Regulatory Environment
EPHT Data Uses
To respond to public concerns (e.g. community & legislative) • Asthma rates in Malden • Air pollution & impacts on respiratory & cardiovascular diseases • SLE rates in Boston (legislative mandate) • Childhood cancer & public water contamination (legislative mandate) • Birth defects & disinfectant by-products • IAQ in schools & pediatric asthma
Schools with moisture/mold problems1
Asthma Prevalence in Massachusetts Schools with Moisture/Mold Problems1 2003/2004 - 2005/2006 School Years2
Low Asthma Prevalence 0% - 8% # 20 % 51.3 Moderate Asthma Prevalence 8.1% - 12% # 32 % 74.4 High Asthma Prevalence 12.1% - 22% # 19 % 90.5
Schools without moisture/mold problems
Chi square 10.8 p value < 0.01
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19
48.7
11
25.6
2
9.5
Schools with moisture/mold problems are those where at least one classroom or library had water damaged ceiling tiles or carpet or visible mold growth on ceiling or carpet.
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Prevalence of asthma in a school represents the prevalence during the school year during which the IAQ was assessed
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EPHT Data Uses
To Drive Policy to Protect Public Health
Ø Develop new IAQ guidelines to determine feasibility of new regulations to control mold & moisture in schools. Ø Propose new standards based on results of childhood cancer, birth defects and drinking water.
Summary
• Environmental Public Health is an incredibly broad area with many laws and regulations. • Research advances are ongoing. • New privacy concerns and associated laws & regulations present new challenges/barriers. • Strategies, such as amendments to get beyond such barriers are sorely needed.
“In Public Health, we can’t do anything without surveillance …that’s where public health begins.”
Dr. David Satcher, Former U.S. Surgeon General
www.mass.gov/dph/ceh
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