Abstracts Selected and Presenters Confirmed!!

Abstract selection is complete! To see which abstracts were selected, click here. We are continuing to add more sessions to the website as we finalize presentation details. Executive Director, Nelson Fabian, highlights a few sessions here.  Pre-conference workshops selected include:

1. Can Justice Prevail? Where Outbreak Investigations and Lawsuits Collide
2. Conflict Analysis and Resolution in the Practice of Environmental and Occupational Health
3. How to Make Public Participation Work For You 
4. National Environmental Health Aquatic Symposium: Launch of Version 1.0 of the Model Aquatic Health Code (MAHC)
5. Environmental Health Training in Emergency Response (EHTER) Awareness Level Course
6. Industry-Foodborne Illness Investigation Training-Recall Response (I-FIIT-RR) Workshop

 We're proud of the educational program we've created and look forward to your participation in DC on July 7-11, 2013!

A Critical Review of Health Impact Assessment Guidance Documents

Over the last twenty years, health impact assessment (HIA) has been developing as an analytical tool, typically as part of an environmental impact assessment process during the planning phase, to evaluate proposed projects and policies. A number of guidance documents have emerged to help enhance the application of HIA tools and concepts to various types of projects and policies (or in various contexts). In this presentation we will provide a critical review of North American and select international HIA guidance documents. The documents will be compared as to methodology, range of options presented, applicability, and other key criteria. Suggestions will be offered as to which documents would be best referenced depending on the specific purpose of the HIA to be performed.

Do you know the player? - Waterborne Illness investigation and surveillance a regulatory perspective

ABSTRACT
In the regulatory development of the Safe Drinking Water Act the public health goals (outcomes) are defined in the preamble of the proposed rule by the number of illnesses prevented, deaths avoided, etc. A risk factor of (10 -4 to 10-6) is typically used. In very simple terms, successful implementation and compliance with the provisions of the SDWA equals public health goals being achieved. While waterborne disease investigation and surveillance are not directly written in these rules, successful implementation of these regulations can play a role in reducing and preventing waterborne illness and outbreaks from occurring.

So why do outbreaks continue to occur? Why do the majority of outbreaks occur at groundwater non-community public systems? Why are many of those outbreaks associated with seasonal licensed establishments?

The SDWA is not intended to and does not allow us to measure the health of individuals, but the health of the public water supply serving the individuals. The questions raised previously have had an influence on the regulatory tools used by Minnesota’s Drinking Water Program to implement the SDWA, and allows us to better understand and identify environmental factors that may reduce and prevent waterborne illness and outbreaks, as well as being in a better position to participate and respond should an outbreak occur. In this presentation we will touch on key events and how they influenced our program, and how we have come to know our “players”.

Understanding the Food Recall Process: Regulators and Industry Tools for an Effective Response

Though food producers use many controls to ensure the safety of their products, sometimes unsafe food products, or those that do not meet legal requirements, find their way into the marketplace. There have been hundreds of cases of foodborne illness and increasing numbers of deaths each year from foods that have been recalled, affecting a wide variety of foods and microorganisms with a potential to cause illness.

One of the priorities of FDA and the Food Safety Modernization Act is to improve industry and regulatory response in the event of a food recall. However navigating the food recall process can be confusing to regulators, and also to food operations, which vary in training and the sophistication of their recall programs. Often the larger chains, box stores, institutions do have proactive recall plans in place, removing products swiftly from store shelves and notifying customers of the recall. But the greatest challenge to health departments might be the smaller, independent stores and markets who don’t receive recall notices and are often not even aware of the recall, putting consumers at risk. The inspector’s role therefore becomes critical in ensuring the swift removal of recalled goods and working in cooperation with these food establishments.

In order to help facilitate the recall process in Massachusetts, the MA Food Protection Program (in cooperation with FDA) developed a training video for inspectors so they may be better prepared to conduct an effective recall response and assist food establishments in need. The purpose of this video is to assist state and local regulators’ understanding of the 3 classes of food recalls, common reasons for a recall, recall notices, and the government agencies and parties involved in issuing them. The goal is to give regulators step-by-step guidance on identifying and segregating recalled products, conducting recall effectiveness checks, and working cooperatively with food establishments and managers during a food recall.

Helpful tips for industry will be discussed, including resources for receiving accurate, complete recall information, communication and supplier recommendations, so that industry and regulators may be proactive and work together towards a more efficient, effective recall process.

Reduction of Major Health Violations Thru Education

Seeing repeated major violations at your aquatic venues each year can be frustrating. Sacramento County’s Environmental Health Division (EHD) decided to do something about this. Since 2010, Sacramento County's Environmental Health Division (EHD) has held "Swimming Pool/Spa Workshop" training classes and offered them at no cost to pool operators and service companies in Sacramento County. EHD held two-hour classes on at least six different dates each pool season.

The curriculum focused on

• Virginia Graeme Baker Pool and Spa Safety Act (VGB) compliance,
• recreational water illnesses,
• inspection requirements, and
• how to avoid reinspections through compliance.

The goal of providing these classes was to educate operators/service companies in order reduce the occurrence of major violations that are related to recreational water illnesses and accidents in the over 2200 public pools in Sacramento County. Since starting in 2010, over 130 facilities have attended the classes.

After three seasons of training, our department saw a reduction in major violations from attendees’ facilities by 52% in 2010, 38% in 2011, and 24% in 2012. EHD has seen an overall decrease in major violations of 47% since beginning these educational workshops.

Because of the great success, EHD will continue expanding this educational program to

• increase the frequency of classes
• share model with other jurisdictions
• expand education outreach to pool users
• focus education on major violations with the highest frequency

How the Corporate Board Room Uses YOUR Inspection Data: Ecolab ActiveView HDI - Trusted Health Department Intelligence

Foodservice operators aim to serve safe, delicious food and also to build their brand reputation. Health department inspections are becoming more visible in restaurant windows and on websites across the country – but not everyone gets an “A”.

Inconsistent health inspection regulations and scoring make it difficult for multi-state operators to spot issues across the 3000+ Health Departments in the U.S. Ecolab’s ActiveView HDI system is designed to provide insight to a chain’s health department scores nationwide, drive action, and deliver results that help operators protect their brands.

Learn how Ecolab gathers the valuable data collected by Health Department inspectors from across the country, standardizes it against the U.S. Food Code to create consistent reporting and uses it to identify critical issues through trend analysis and reporting. See how this information is presented to restaurant chains and hear how they use it.

How a local health department in Colorado got involved in regulatory oversight of a $2.4 billion dollar Superfund Cleanup Program the Rocky Mountain Arsenal (RMA) that is now transitioned into Wildlife Refuge and has led to other related projects.

The RMA was established by the Army in 1942 as an industrial complex to manufacture chemical weapons for use during World War II. The 27 square mile site is located 10 miles northeast of downtown Denver. The Army used the site to manufacture mustard gas, napalm and sarin nerve gas. During the1950’s through 1970’s Shell Chemical Company leased the site to manufacture pesticides.

Over the 40-year use of the site as a production facility a variety of waste disposal means were utilized including unlined solid waste disposal trenches, lined and unlined evaporation lagoons, piping leaks, accidental spills and un-permitted landfills that led to contamination of structures, soils and groundwater on a large scale. In 1982, all manufacturing activities ceased and in 1987, the EPA listed the Arsenal as a Superfund cleanup site. Tri-County Health Department (TCHD), which serves Adams, Arapahoe and Douglas Counties, along with the EPA and State of Colorado provide regulatory oversight of the cleanup program.

Today, over 30 years later, all of the major cleanup is completed (except for groundwater) with the waste contained in on-site landfills and consolidation areas. As the soil/surface cleanup was nearing completion, the Regulatory Agencies collaborated with the PRP’s to develop long-term monitoring strategies to verify continued protectiveness of the remedy. The Regulatory Agencies continue to monitor the two hazardous waste landfills, over 773-acres of integrated covers, and on-post and off-post groundwater systems. Tri-County has also played an integral role as liaison with the surrounding communities in the development of the Arsenal’s remediation program, cleanup designs and transition into a National Wildlife Refuge.

TCHD has continuing responsibility for remedy and groundwater cleanup verification activities. To this day, the RMA and Regulatory Agencies continue to have an active community involvement and outreach programs.

As a result of TCHD’s involvement at RMA, other opportunities have arisen that has allowed TCHD to be involved in performing oversight on various landfills throughout the TCHD jurisdiction and also serve to protect the community interests on these projects. In addition, TCHD has become involved with the Army and the local water agency on the investigation of an emerging groundwater contaminant 1,4-Dioxane. These are examples of other activities that have availed themselves through TCHD’s involvement/experience with the RMA project.

21st Century New Technologies – How can Environmental Health respond?

Dramatic advances are being made in novel sciences such as nanotechnology, synthetic biology, advanced materials and digital technology which will have an impact on the daily lives of our communities. Yet still little is known publicly about the substances these novel sciences will produce which will have new and different chemical and biological structures and functions. Many of which will bring significant benefits but some may also carry significant risks to human health and the environment. As products containing these new materials emerge onto the open market, the public are likely to turn to the environmental health professionals for their advice and assistance where there is uncertainty concerning product content and safety. There is now a greater need to inform our profession of the emergence of these new substances and their products, their potential benefits and risks, and the future actions environmental health practitioners may be called upon on to take.

The paper will examine the current policy, technical, and scientific thinking on the benefits and risks posed by the products of these 21st century technologies to human health and the environment, and consider the role which environmental health practitioners will have to play in informing and safeguarding their communities.

Why do I get funny colors when I test sometimes?

Field-testing of recreational water poses no difficulty as long as no unexpected things happen to the water. If only people would not use the water for bathing, maintaining recreational water would be easy. But the unexpected is always happening in indoor and outdoor pools. This seminar will identify how to overcome some potential test interferences at the site and to obtain accurate test results, despite the unexpected.

A Simple Tool to More Objectively Evaluate Housekeeping\Cleaning Activities for Health, Safety and Aesthetics in Community Institutions

image: www.mint.com

Housekeeping in institutions, whether they be day care centers, university dorms, nursing home rooms, hospital rooms, or jail and prison housing, rely on in-house labor and simplified methodologies to minimize health and safety risks; while providing some level of aesthetic cleanliness is most desirable. Epidemiological studies have detailed minor disease outbreaks in correctional facilities linked to common-touch and chronically wet surfaces such as showers and toilet areas. In addition, analysis of injury and incident reports involving trips, slips and falls within hospitals and correctional settings focus on housekeeping methods and outcomes, and to a lesser degree, maintenance.

In a recent court case involving plaintiffs, defendants and court-appointed monitors (all Registered Sanitarians), the evaluation of housekeeping activities by all parties was widely disparate; with less than 50% agreement because of subjectivity and personal bias precluding objective outcomes. The parties conducting the inspections initially agreed to use a simplified sampling strategy adapted from MIL-STD-105E (ANSI/ASQ Z1.4) and develop a matrix of ten readily-observable cleaning and cleaning-related parameters as an inspection tool. The matrix parameters were constructed to easily conform to a Boolean logic (it was clean or it was not clean)(+/-); definitions and inspection methodologies were precisely detailed and acceptable quality levels (AQL) established for each separate facility inspected.

The outcomes demonstrated both the precise strengths and weaknesses in the overall housekeeping programs. In turn, these were used for quality improvement and ultimately, for quality assurance such as modifying the institution’s existing Standard Sanitation Operating Procedures (SSOP). The inspection matrix was designed so that all inspectors would be within a ≥80 percentile agreement. The methodology for this exercise can be adapted to any institutional program where environmental health and safety parameters are evaluated.

Integrating Health in All Policies into Environmental Health Agency Work: Examples of Successful Cross-Sectoral Collaborations

Health in All Policies (HiAP) has recently emerged as a new way to describe a collaborative approach that integrates and articulates health considerations into policy making across sectors, and at all levels, to improve the health of all communities and people. In state, territorial and local environmental health departments, HiAP approaches have been utilized for decades due to the multidisciplinary nature of environmental health work. Very often, the jurisdiction or authority for addressing a multitude of environmental health issues lies outside the health department and thus necessitates inter-agency coordination and collaboration. For example, environmental health departments work with environmental agencies on air and water quality, and with housing agencies on lead and healthy homes issues. This presentation will describe some of the HiAP work occurring in state environmental health departments in the key topic areas of food, water, energy, housing and transportation. Case studies from states will be used to highlight a variety promising strategies being used to implement HiAP across the country. The implementation strategies presented will include examples of partnership building through program development, assessment and data sharing, program development and policy approaches. The goal of this presentation is to educate and empower state, territorial and local health agencies to promote HiAP.

Food Borne Outbreak Prevention: Is Inspection Timing the Key? [POSTER]

Public Health, Seattle & King County uses a risk based inspection and consultation system for winning food safety compliance in food service establishments. The utility of inspection scores as predictors of Foodborne outbreaks has been the subject of numerous studies. Although inspection scores are risk based, several of the studies found no correlation between inspection scores and the implication of establishments in Foodborne outbreaks. This study sought to test the hypothesis that temporal distribution of inspection visits influences risk for operator preventable food borne outbreaks. The study was designed to explore possible correlations between temporal distributions of food service operation, inspection visits, and service of meals associated with operator preventable food borne outbreaks. Retrospective data was collected and compared for two groups of food service establishments matched by risk category, postal code, and date range: those with operator preventable food borne outbreaks which were classified as confirmed or probable and those of matched food establishments that had never been implicated in foodborne outbreaks.

Health Promotion through Community Gardening in the Texas- New Mexico Desert Region: Implications for Community Health, Land use and Sustainability [POSTER]

Three Pilot Community Garden projects were funded in the Texas- New Mexico border region in 2011 in order to foster healthy homes and communities. This region is characterized by high obesity rates, inadequate access to health care and household food insecurity. Overall, four gardens- two in city neighborhoods in El Paso, TX and two in schools in Anthony and Las Cruces, NM were established. These pilot projects aim to positively impact community nutrition by increasing access to healthy foods through sustainable and environmentally sensitive food production. Program participants included school children, youth in juvenile probation programs, and the elderly. A mixed methods research study evaluated the immediate health outcomes for participating children and adults, and the sustainability of these gardens. Specifically, program process related to community capacity building to produce food, efficacious land and water use, and outcomes related to physical and mental health were examined through 25 individual interviews, 10 focus groups and customized Community Food Security Coalition (2006) surveys (N= 142) among participating youth, community members and parents of participating youth.

Process evaluation measures reveal regionally and culturally sensitive community-based approaches undertaken to gain community ownership in the gardens, and land use approaches related to land ownership, irrigation and soil quality in order to sustain these gardens beyond the funding period. Over 80% of community members indicate increased community involvement and donating food to others in the community due to their participation in the garden. Outcome evaluation indicators show that over 80% of community members surveyed report being better able to provide food for their families, eat healthier and, being more physically active due to the community gardens while a majority of youth (< 75%) report eating more fruits and vegetables and, trying new varieties of the same due to program participation. The design, evaluation methodology and results of the pilot gardens with emphasis on land use strategies and community health outcomes will be addressed during this poster presentation. The best practices and lessons learned from these pilot gardens have implications for health promotion through environmentally sensitive community garden design in arid regions.     

Does regulation support economic growth or it just red tape?

Regulation has become a political football on both sides of the Atlantic with red tape being cast as the major inhibitor to economic growth. This session will explore the truth of this statement using UK examples starting with the core principles of better regulation which were used as a touchstone for the last UK Government and cross government policies including "one in one out", reducing administrative burdens and regulatory budgeting.The experience of attempts by the current government to reduce red tape and the tensions between European Union regulation and UK regulation will be explained. The success or otherwise of these initiatives will be evaluated. This is contrasted with business views of regulation and how regulators are continuing to provide protection to both the public , workers and companies by aligning their work to the economic growth agenda. This is finding favour with both large and small businesses and examples of initiatives including advice for inward investors, life cycle regulatory support and working with business facing organisations will be covered. Dependent upon who the President is, reference will be made to the USA programme and lessons which can be transposed between the 2 continents. How professional bodies can advocate for sensible regulation will also be covered.

An Innovative Web-Based Initiative to Educate Homeowners with Private Wells

Homeowners in small communities and rural areas without a public water supply often lack appropriate understanding of best practices for managing, operating, and protecting their private well. In this new nationwide technical assistance and training initiative, funded by the Rural Community Assistance Partnership (RCAP), through a grant from the US Environmental Protection Agency, a step-by-step education framework has been developed to assist well owners and other stakeholders in understanding groundwater hydrology, well fundamentals, well care best practices, and finding assistance locally. It will also help well owners understand how to sample their well, how to interpret sample results, and what they can do to protect their well and source water from contamination. The program leverages web-based content, including video, an email newsletter, and social media marketing to reach and educate homeowners on this important health topic. Outreach to public health officials, well drillers and other stakeholders is a significant component of the project. The material will be freely available on the web and will be highlighted in a repeated series of three live web-based training events that provide well owners the opportunity to ask questions and get practical answers. The Illinois State Water Survey and the Illinois Water Resources Center, at the University of Illinois, have collaboratively developed the curriculum for this program, under contract with RCAP.

Confronting climate change heat-health risks in the Pacific Northwest

Photo: Gilbert W. Arias/Seattle Post-Intelligencer / SL

Climate change is projected to have serious and long-term consequences for public health. One of the more important and measurable impacts is an increase in extreme heat events, particularly in moderate climates. Researchers at the University of Washington have already investigated and reported the heat-health outcomes of climate change in three Pacific Northwest counties. Now, their research continues with the overall objective to evaluate two tools: health outcomes projection modeling and heat-risk mapping. These tools have the potential to be quite useful in informing the public health discussion of, and preparation for, climate change-related extreme heat events. Using this research, local health departments may opt to focus on reducing the factors that contribute to climate change (mitigation), on reducing the severity of health impacts (adaptation), or a combination of the two.

Pool Chemical Storage and Handling

Do you know how to Safely Store and Handle Pool chemicals? Have you ever experienced a Pool Chemical reaction ? We will discussion real life experience of “What happens IF pool products are stored and handled incorrectly.” Discuss why people handle pool products in an at risk manner, then close out the discussion with tools and information to improve safe handling and storage of pool products.

Rainwater Harvesting Systems in Residential and Commercial Applications

image: aumusiclibrary.wordpress.com

The concept of capturing rainwater and storing it for later use is well documented from pre-Roman times and on all major continents. Rainwater Harvesting systems are a sustainable method of water collection that can be utilized effectively as a supplementary water supply without the construction of additional infrastructure. The ability to calculate the potential harvest of a given catchment area and then apply that water to the correct use (irrigation, toilet water, drinking water, etc.) will be an important part of construction in the 21st century around the world.

This presentation will seek to inform the audience as to the potential rewards and pitfalls of rainwater harvesting systems. It will specifically detail methods for designing high efficiency roof and conveyance systems, proper filtration for different treatment levels, pest prevention, sizing and selecting a storage tank, and proper pump/alarm systems. In addition this lecture will provide the basic tools necessary to calculate the effective harvest month by month for any application in relation to its climate, average rain/snowfall, catchment area/roof size and type, and other limiting factors. In addition it will go over the typical applications of rainwater and how to calculate estimated use of water for the application so as to provide a method for developing a cost/benefit analysis of rainwater harvesting for any given business or residence. Rainwater is practically a free, clean and quality source of water - the only cost is to collect and treat it. It can be used to help supplement a low producing well and storage of rainwater provides an emergency supply of water for fire protection, natural disasters, or loss of power. Most systems are flexible, adaptable, and easy to maintain as they can be retrofitted to an existing structure or designed and built during new home construction. In many cases, using collected rainwater will help decrease water and utility bills. It is a reliable water source to supplement costly irrigation. On top of everything else, collecting rainwater is socially acceptable and environmentally responsible.

Land Use Planning/Design: A Key Core Competency for Environmental Health Practitioners

Environmental health practitioners protect the public’s health. This involves making sure that physical, chemical, biological and radiological stressors do not generate hazards that adversely impact public health. Sometimes this involves preventing exposure entirely, or in cases such as indoor air and air pollution, setting and enforcement of standards to ensure that public health is protected. In addition to protecting people from the environment, environmental health practitioners help ensure that ecosystems provide support clean water, clean air, open spaces, and uncontaminated food.

Land use planning recognizes that developments generate social and economic impacts, as well as positive and negative effects. Density of land uses can improve transportation options. The design of landscaping and mix of land uses can encourage walkability, and generate retail sales activity as well as attractive public spaces.

Copyright 2012, R. Steven Konkel

Development of competency and user-based curriculum in Land Use Planning has many benefits for skill-building in collaborative problem solving among colleagues with different disciplinary backgrounds. The location, nature of, and probability of realizing certain hazards are a focus in land use planning, much more than constructing a zoning map. A comprehensive plan deals with all of the elements, from housing, commercial and industrial developments, to community facilities and transportation, air quality, water quality, hazardous waste, solid waste and access to green spaces and natural resources, that are important to the quality of life in a neighborhood, city, or region. It provides a snapshot of environmental conditions and a canvas for improving the way a city works.

Land use planning deals with sharp human conflicts over management of land. Charles Haar, who wrote a casebook on Land Use Planning over 40 years ago, noted the “deep social and philosophical issues related to property interests, human rights, and the principles of the common venture” are central to understanding healthy communities and sustainable development. There is a role for governments to make strategic investments in infrastructure and public goods that produce benefits to the community as a whole, while encouraging responsible development and promoting green spaces and access to natural environments. The authors also address implications for academic programs educating environmental health practitioners.

Climate Change and Sustainability: Environmental Health Practitioners Can Lead in Developing Solutions to Protect Public Health

Copyright 2012, R. Steven Konkel

In addition to traditional roles in food safety inspection, providing clean drinking water, injury prevention, ensuring proper wastewater disposal, ambient air, terrorism and all-hazards response, disaster/emergency response, workplace health and safety, hazardous materials/toxic substances, vector control and zoonotic diseases, and a myriad of other roles, today’s sustainability challenges require environmental health practitioners to be knowledgeable in the design of healthy living environments. By making investments in more sustainable communities, we can protect people from environmental stressors that adversely impact public health. As the impacts of climate change become more prevalent, environmental health practitioners can work in teams with other public health professionals, engineers, scientists and planners, crafting solutions to build more sustainable communities. This will have an ancillary benefit of making possible choices that enhance the quality of life as well as address some of the public health issues driving the increases in healthcare costs, such as obesity and Type II diabetes. Sustainable communities work for all of us. Investment in prevention saves resources as well as lives.

This presentation provides an overview of the accumulating evidence on the impacts of climate change on environmental conditions. Based on research on the design parameters for healthy communities, environmental health and land use planning skills can lead to effective adaptation responses to key impacts of climate change. We can also expand public health choices and invest in sustainable utilities that move us towards environmental sustainability. We can build on environmental health knowledge in critical areas such as managing water and wastewater resources, and collaborate with other disciplines to design solutions for sustainable energy as well as sustainable communities.

Our contributions to climate change and sustainability will be facilitated by the way we think about our role and the role of the institutions where we work, the academic training and education that we offer, and our efforts in practice to create the future.