Protect public from chronic diseases, Pew Commission urges

Diseases, environmental exposures must be tracked to save lives.

provided by Pew Environmental Health Commission

he Pew Environmental Health Commission at the Johns Hopkins School of Public Health has called on Congress and the White House to protect Americans from chronic diseases the No. 1 cause of death in the United States by tracking where and when these health problems occur and possible links to environmental factors.

In its third report, the Commission charged that the nation faces an environmental health gap and proposed a Nationwide Health Tracking Network to provide the critical information now lacking in nearly every state. Without this Network, the Commission said the United States will remain unable to mount effective prevention efforts for asthma, birth defects, developmental disabilities, cancers, and neurological disorders such as Alzheimer's and Parkinson's, among other chronic diseases.

"We responded quickly to the threat of West Nile virus, tracking and monitoring every report of infected birds and people, but 20 years into the asthma epidemic this country is still unable to track where and when attacks occur and what environmental links may trigger them," said Lowell Weicker Jr., the Commission chairman and former US senator and Connecticut governor.

The recommended Network would include the following components:

  • Nationwide baseline tracking of priority diseases - asthma and chronic respiratory diseases; birth defects; developmental disorders; cancers, especially childhood cancers; and neurological diseases such as Alzheimer's, multiple sclerosis and Parkinson's nd priority exposures such as PCBs, and dioxin; heavy metals such as mercury and lead; pesticides and water and air contaminants.
  • Monitoring of immediate health crises such as heavy metal and pesticide poisonings to serve as an early warning system.
  • Establishing 20 state pilot tracking programs to address regional environmental health concerns.
  • Developing a federal, state and local rapid response capability to investigate clusters, outbreaks and emerging threats.
  • Supporting community interests and scientific research to further health tracking efforts.

The Commission estimated that the Network will cost $275 million annually - less than one-tenth of a percent of the $325 billion that chronic disease costs the United States annually in health care and lost productivity.

"It is time to make the investment in our public health that matches the threat from chronic disease," Weicker said.

As examples of the environmental health gap, the nation's failure to deal with chronic diseases and their potential links to environmental hazards, the Commission noted:

More than half the states (27) lack ongoing tracking and monitoring of asthma even though it is a rapidly growing national epidemic. Most states fail to track developmental disabilities such as autism and mental retardation despite an estimated 50 percent rise nationwide in these disabilities in the last decade, and research indicating that 25 percent are related to environmental exposures. California, District of Columbia, Kentucky, Mississippi, Nebraska, New Jersey, North Carolina, South Carolina and South Dakota reported tracking at least some of these disorders.

Only four states reported tracking autoimmune diseases such as lupus, even though rates for these diseases are rising. The four states are: Arizona, Massachusetts, New Mexico and South Dakota.

Less than half the nation's population is covered by birth defect registries even though birth defects are the leading cause of infant mortality in the US and rates for certain birth defects and related conditions are increasing.

"This is Public Health 101, and as a nation we are flunking," said Louis Stokes, former 15-term US House member from Ohio and a member of the Pew Environmental Health Commission.

In calling for the Nationwide Health Tracking Network, the Commission has the support of many voluntary disease support groups and national public health organizations, including: Allergy and Asthma Foundation of America; Allergy and Asthma Network; Mothers of Asthmatics; American Academy of Pediatrics; American Autoimmune and Related Diseases Association; American Cancer Society, Inc.; American Lung Association; American Public Health Association; Association of State and Territorial Health Officials; Candlelighters Childhood Cancer Foundation; Council of State and Territorial Epidemiologists; Joint Council of Asthma, Allergy and Immunology; National Association of City and County Health Officials; and Public Health Foundation.

"The support for health tracking is broad and deep. It should command the attention of every candidate for President and every candidate for Congress," Weicker said.

"Tracking on a nationwide basis will enable our medical system to focus on a critical area of health care that has long had insufficient emphasis, the prevention of the diseases that cause the most suffering and death," said Dr. Neil Schlackman, the senior corporate medical director for Aetna US Healthcare and a member of the Commission.

The Commission's recommendations were based on an analysis conducted under the guidance of Thomas A. Burke, associate professor at the Johns Hopkins School of Public Health and chairman of the Director's Advisory Committee to the National Center for Environmental Health at the Centers for Disease Control and Prevention (CDC). The analysis examined public health tracking capacity at the national, state and local levels.

"We need to know when and where diseases occur, what are the environmental hazards, and what are the actual exposures we have to those hazards," said Burke. "This is a basic right to know issue for our communities and our public health professionals."

"Americans have a right to this information about the health of their communities," said the Rev. Michael D. Place, STD, president and chief executive officer of the Catholic Health Association of the United States, representing the nation's largest group of not-for-profit healthcare systems, facilities and related organizations, and a member of the Commission. "These recommendations will enlighten our research and make possible disease prevention efforts that will save lives and spare much suffering."

Later this year, the Commission will release its final recommendations on improving the ability of the public health system to combat environmental threats to health. Its two previous reports examined the increases in birth defects and related conditions and the asthma epidemic, focusing on the need for national environmental health tracking.

The Pew Environmental Health Commission was launched in May 1999 to develop recommendations on improving the nation's ability to track and prevent health problems linked to environmental conditions. Its members include leaders from the public policy, health industry, environment, government, academic and nonprofit communities. The Commission is funded by a grant from the Pew Charitable Trusts to the Johns Hopkins School of Public Health.