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.

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.

The 2013 State Legislative Landscape: Political and Fiscal Implications for Environmental Health Policymaking

Image: esa.org

This session will explore how recent electoral, economic and budgetary developments will affect state environmental health policy-making in 2013 and beyond. Following the 2012 elections there is an unprecedented number of new lawmakers serving in state legislatures around the country. While the budgetary situation in many states has begun to improve, economic and fiscal uncertainty will continue to impact states’ ability to implement new environmental health programs and policies. Yet despite these changes and uncertainties, state legislatures continue to address a number of important environmental health concerns. This session will begin with an in-depth analysis of the 2012 election results and how they have changed the political landscape in many states. Next, the session review the fiscal health of the states, highlighting state budgetary conditions and measures states are taking to manage funding gaps. With this background, we will review the major environmental health laws that state legislatures have acted on in the past year and prospects for new policies moving forward. Major topics that will be covered include children's environmental health; lead hazards; food safety; indoor air quality issues, including carbon monoxide and radon; mercury; pesticides; and toxic substances in consumer products. Finally, the session will identify innovative environmental health policies that are emerging in the states.

A Systems Based Approach to Policy Making: Integrating Health Whenever We Can

Governments, nonprofits, utilities and homeowners will upgrade millions of homes in the coming years to increase energy efficiency. Upgrades can lower costs, preserve resources, safeguard the environment, and advance national security. The incentive for government investment is clear, particularly for low-income residents who cannot afford upgrades on their own but benefit enormously from energy savings. However, in its current incarnation, residential energy policy leaves significant benefits on the table, and actually risks creating harm when work does not adequately address risks (e.g., radon and mold). Synergistic policy that integrates environmental health and energy goals makes it possible to reduce energy use and improve health. And because government energy programs target low-income communities, and prioritize the elderly, people with disabilities and families with children, they offer a huge potential impact on health disparities.

Integrating environmental assessment and mitigation into energy interventions can deliver health and energy outcomes, jobs creation and reduce program costs. Programs that serve populations at greatest risk of environmentally-mediated disease and train workers to deliver structural interventions are ideal targets for such integrated policy-making. One simple tool to help integrate health in energy policy is the U.S. Environmental Protection Agency’s Healthy Indoor Environment Protocols for Home Energy Upgrades. The Protocols provide assessment and mitigation guidance for energy upgrade practitioners focused on the most serious indoor environmental health risks typically encountered or exacerbated during upgrades, retrofits or remodeling. This integrated approach is simple and feasible – clear evidence-based guidance exists; training programs can easily be repurposed; and resources are available through innovative cross-agency budgeting. We anticipate not only health and energy outcomes, but also economic benefits from cross-training a workforce on energy and basic community health/environmental assessment theory and practice.

Advancing Environmental Justice at HHS

image: serendip.brynmawr.edu

“A nation that equitably promotes healthy community environments and protects the health of all people” is the vision of the 2012 Department of Health and Human Services (HHS) Environmental Justice (EJ) Strategy and Implementation Plan. Recognizing that disproportionate exposure to environmental hazards with negative health effects persists in minority and low-income populations and Indian tribes, HHS developed the Strategy with input from multiple stakeholders. Such community engagement was central to the development of the four elements of the Strategy, which are the following:

1. policy development and dissemination,
2. education and training,
3. research and data collection, analysis, and utilization, and
4. services.

Outlined within these elements are actions that promote and advance research and training that will inform policies to improve health among EJ communities. Similar to its development, the Strategy is being implemented with stakeholder input to enhance HHS efforts that help reduce environmental and health disparities among communities across the nation. Stakeholder engagement includes active solicitation and consideration of community concerns and discussion of best practices and model programs that promote collaborations to resolve ongoing and/or emerging EJ issues. The Strategy builds on HHS’s commitment to disease prevention and health promotion and to reducing racial and ethnic health disparities.

This integrated panel presentation will highlight key actions outlined in the Strategy, the process by which it was developed, progress to date, and the actions moving forward. Presenters will focus on approaches to strengthen the application of health and environmental statutes and integrate the concept of EJ into programs across the HHS so its workforce may better serve EJ communities, strengthen research and advance data collection related to the health and well-being of people living in EJ communities, and improve access to and quality of care and services in EJ communities. In addition, panelists will also invite, engage, and consider input about implementing the Strategy from participants at the National Environmental Health Association Educational Conference and Exhibition.

Addressing Disparities Via Community Health Workers

Community health workers, also known as promotores de salud, peer leaders, patient navigators, or health advocates, serve as a model for addressing health disparities in vulnerable, low income, and under-served communities. Community health workers play an important role in promoting community-based health education and prevention in a manner that is culturally and linguistically appropriate, particularly in communities and for populations that have been historically under-served and uninsured. As members of the communities, they usually share the language, socioeconomic status, and experiences of the community they serve, which enable them to have a trusting relationship to serve as a liaison between health and health services to facilitate health communication and education. In addition, community health workers have provided useful information about workplace environment exposures. Community health workers are on the front lines, educating their community peers to ensure that everyone stays healthy and safe by building capacities of disadvantaged communities.

Presenters on this panel will define community health workers and their role in addressing environmental health and health disparities. Presenters will also describe the successes of community health workers through evidence-based programs by highlighting accomplishments of successful programs. They will conclude by establishing the link between community health workers, health disparities, and environmental health.

Protecting the Public Health: The Critical Importance of Cooperation Between Industry and Investigators During The Course Of An Emerging Outbreak Investigation

Over the last decade, foodborne illness outbreak surveillance has improved significantly. As a result of improved surveillance, more illnesses are being identified and more outbreaks are being investigated. In turn, with more illnesses requiring investigation, public health officials often find themselves being asked to do more with limited or finite resources. For this reason, stronger cooperation between industry and public health during an emerging outbreak investigation is more important than ever.

Although foodborne illness outbreak investigators have always demanded and expected cooperation from industry during the course of an investigation, historically the level of cooperation between public health and industry has in many cases been less than transparent and in some cases adversarial.

This presentation will borrow from 12 years of experience working through many high-profile outbreak investigations, and will focus on the critical importance (and direct advantages) to both public health and industry when key stake holders are encouraged to embrace an open, intimate and transparent relationship during the course of an emerging investigation. The presentation will also explore and compare alternate scenarios (and the negative consequences) where close cooperation does not exist.

Developing Future Leaders in Environmental Health Science

Environmental health professionals provide practical knowledge for application of curriculum to real world problems. The purpose of this learning lab is to learn how the environmental health professional helps to influence academic preparation in environmental health through leadership opportunities in the National Environmental Health Science & Protection Accreditation Council (EHAC). EHAC builds future leaders by providing a forum for environmental health faculty and practitioners to develop and evaluate the curriculum of accredited environmental health degree programs and programs seeking accreditation. Accreditation is important to ensure a qualified environmental health workforce. As the only accrediting body for environmental health degree programs in the nation, the EHAC Council serves a critical role in developing future environmental health practitioners. Attendees will discuss ways to build future leaders in the field of environmental health and how to become key players in Council activities.

Enhancing Graduate Education in Environmental Health

An adequate supply of trained environmental public health professionals is critical to protecting human health and the environment. The continuing declines in the size and capabilities of the environmental health workforce have left the nation’s environmental health infrastructure inadequately prepared to effectively manage the myriad of existing and emerging environmental public health challenges.

Since 1967 the National Environmental Health Science & Protection Accreditation Council (EHAC) has been working to enhance, support, promote and evaluate environmental health science academic programs.

The purpose of this lecture is to present the current general requirements for graduate programs accredited by EHAC and to discuss current trends in the environmental health workforce to identify topics and preparation needed in graduate program curricula. The workshop will synthesize feedback to come up with general recommendations for EHAC to upgrade graduate curriculum.

Using Public Health Governance to Advance Health in All Policies and Environmental Public Health

The external and environmental influences on health have been long documented and addressing these health effects often requires work outside of traditional public health arenas. Health in All Policies (HiAP) looks to consider health impacts of policies in sectors outside of health and healthcare. Boards of health and other governing entities have a unique position to advance HiAP and cross-sector collaboration to improve health in their community. This presentation will give a brief overview of HiAP, discuss how HiAP can improve environmental public health, and detail how public health governing bodies and the public health governance functions can promote HiAP. It will also include examples of how HiAP has been implemented in local communities in the United States and give strategies for cross-sector collaboration.

The Relationship and Benefits of Codes, Regulations, Standards and Certification

The presentation provides an overview of the legal adoption process of codes, regulations/ordinances, and standards by state and local agencies having jurisdiction. The presentation will describe what the certification of a product by an accredited organization actually means.
This will provide the insight to an understanding of how these components can enhance one another to provide a more comprehensive protection to the public’s health. This understanding of the relationship will then provide the differences between codes, regulations and standards. The NSF standards development and product certification processes will be discussed along with the value of product certification marks and listings by an ANSI accredited organization during Plan Reviews and Approvals.

The presentation will also address the process to file a complaint with a certification body as well as what happens in a complaint investigations and routine certification monitoring and how environmental health professionals can leverage these as resources to enhance their public health programs. The presentation will have applicability to products encountered by the environmental health professionals such as food equipment, pool equipment, drinking water treatment devices and wastewater systems.

Introducing Environmental Health to K-12 [POSTER]

Effective environmental health policy largely depends on advocacy of informed citizenship. At the present, time environmental health is not taught as a school subject. However, hardly a day goes by when there isn’t something in the news about chemicals or pollution in our environment, and teachers and parents are coming to recognize the importance of environmental health to science education. Teaching students about environmental health topics and complex concepts such as risk and exposure requires quality educational resources. For years, the National Library of Medicine (NLM) has been developing authoritative, engaging Web pages and classroom tools for students at the elementary, middle, and high school levels. Web resources include: ToxMystery, an educational game for elementary students; Environmental Health Student Portal for middle school students; and Tox Town for middle and high school students.

In addition to covering major areas of environmental health, ToxMystery and Tox Town also include sections about careers in environmental health. Recently, NLM also created a curriculum for an after school environmental health club, entitled Discovering the Connection: Your Environment, Your Health, which introduces middle school students to issues around water and air quality and chemicals in food and household products. Students research information, conduct hands-on experiments, and participate in communication and social action activities. The curriculum culminates in a debate, where students argue about whether the school’s primary source of drinking water should be bottled or tap. NLM also maintains a K-12 listserv and newsletter for educators that highlight resources and tools related to environmental health. This poster will highlight these environmental health resources and make suggestions about how to use and promote them in the community.

Lessons from a Collaborative Effort- The 2012 Democratic National Convention

A case history of the successful collaborative effort of 15 different local, state and federal jurisdictions to address food safety and other public health concerns at the 2012 DNC utilizing Incident Command Structure. The approach taken could easily be used for any large special event. Presentation will include a timeline of the 1 1/2 year advance planning and training as well as a discussion of the challenges and successes of the DNC Incident Team.
Lecture Description/Teaser: Bedbugs, BBQ and Bouts of Rain- learning to work well with all agencies involved with food safety at the 2012 DNC.

Seeking Stakeholder Input:Methods, Findings and Lessons in Change Management

Is your program in the midst of a significant change? Are you interested in performance regulations for onsite sewage systems? Do you need meaningful data and input from stakeholders before change happens? What options should you explore to get stakeholder feedback? This lecture will describe several different, real world examples of how one state agency connected with stakeholders to implement big programmatic change.

This presentation will provide a walk-through of the changes directed in the onsite sewage program by General Assembly actions, outline the stakeholder input processes used to understand stakeholder mental models and biases, provide lessons learned from change management in an environmental program, and discuss on-going conflicts from the changes made.

Building Capacity at Local Public Health Departments Around Climate Change and Human Health

Climate change has been identified as an area of concern for public health officials by the world’s leading public health authorities, including the World Health Organization, the U.S. Centers for Disease Control and Prevention, the American Public Health Association, the National Association of County and City Health Officials, and the National Environmental Health Association. Adverse effects on human health have been documented around the world and are predicted to continue to grow in severity. Local public health departments are the “first line of defense” in our public health system. As such, it is critical that the public health community has both the expertise and the resources to identify and respond to the challenges presented by climate change.

This session will introduce attendees to the new guidebook, Building Capacity at Local Public Health Departments Around Climate Change and Human Health, through a series of hands-on activities that provide step-by-step guidance for how to build capacity within a local health department to both reduce community greenhouse gas emissions and prepare for the health effects of climate change.

The activities will address the following topics:

1. How to build a case within a local health department for responding to the health effects of climate change.
2. How to integrate climate planning throughout existing programs.
3. How to initiate or strengthen collaborations for greater efficiency and effectiveness. And,
4. how to incorporate climate messaging into community outreach and regulatory activities.

At the end of the session, attendees will be able to employ the results of the tabletop exercises to help their local health departments launch climate change programs — whether housed internally or forming a piece of a larger, interdepartmental climate change program.

Building a Food Safety Culture

Each food company has its unique and individual food safety culture created during the years of its existence and most influenced by its leadership. The food safety culture advocated is one of learning, teaching, communicating and empowering. The differences in these elements separate an adequate food safety culture and a company culture that does not have food safety as one of its core philosophy and practical values.

Developing a food safety culture based on human behavior blended with the hard sciences involved with food safety may be the difference in whether a food safety hazard is eliminated immediately or lingers with the potential threat of producing an unsafe product that eventually finds its way to a consumer.

Building a food safety culture based on human behavior is not a foreign concept to the regulatory world. Environmental health specialists have traditionally taught prevention as a tactic for addressing hazards. Companies invest in equipment and training, an example being that the company will install a hand sink, provide employees training in its use, but often they eventually they forgo or forget to enforce its use and neglect to empower employee to take action even when they are aware of misuse of that hand sink. Many companies embrace the concept of HACCP, a food safety preventive control program based on hard science, that can greatly assist in the prevention/control of food safety hazards. However and regardless of the cost of that plan, a company culture that is not accepting and empowered to act when a critical control is not operational can easily render the plan useless.

Collectively uniting hard science and behavior science into a quality process built on continuous improvement is key to reducing the incidence of foodborne illness. This presentation will explore defining a food safety culture, the challenges of building that culture, and provide examples of companies that have embraced the concept of taking a top-down, bottom-up approach to building their “food safety culture.”

Using Formal and Informal Networks in Environmental Health Emergency Response

Although well prepared and trained, Environmental Health professionals are constantly challenged by responding to new or different situations. Often, demanding scenarios come during an emergency, when having access to existing materials, checklists, resources and best practices can assist in appropriate and rapid situational assessment and response.

In these economic times, many agencies are faced with reduced resources and multi-tasking personnel, which create a manpower gap in routine duties, and also an increasing need for competent environmental health personnel in emergency and disaster response. Shrinking staffs and budgets may also hinder the ability to locate or create an essential tool to assure public health and prevent or mitigate a current situation. Often, the needs or resources that an EH professional is seeking already exists, but locating such resources can be difficult in the midst of emergency response. Integrating informal connections and personal contacts into an environmental health professional's toolbox helps address this gap, and can expand one's ability to respond promptly and adequately to a community's emergent environmental health needs.

United by a common professional passion, environmental health professionals can trade insights and provide resources and best practices that are timely and appropriate to emergent response needs. Using formal and informal networks, professionals can create newfound ways to significantly cut the time and cost involved in developing or procuring needed environmental health materials by increasing the pool of experience that they could draw upon, tapping insights from different disciplines, and recycling design ideas from other projects. Such relationships and reciprocity have demonstrated improved and timely practice in emergent situations such as Hurricane Irene sheltering, flood related environmental response, pre-disaster connectivity, the sharing of trainings and fact sheets, and dissemination of public emergency information and warning messages.

This panel presentation of EH experts will provide examples of actual situations where formal and informal networks expedited the accrual of needed policies and resources to immediately enhance emergency EH response. This session will also provide the opportunity for attendees to create an applicable and convenient resource and contact list that will be a valuable and usable tool to take home from this AEC.

Essential Communication Strategies for Environmental Public Health Professionals Who Don’t Have a Background in Communication

Many in environmental public health (epidemiologists, interns, project officers, program managers) engage in some degree of health communication, whether formally trained in the field or not. Furthermore, as budgets and funding sources tighten, more and more public health practitioners in understaffed offices are tasked with a wide scope of duties, including health communication, that may go beyond their areas of expertise and experience.

Concern about health literacy further amplifies the need for functional knowledge of more than the basic tenets of good communication. The ability to implement key health communication strategies that effectively reach target audiences such as underserved, cross-cultural, and basic-literacy populations is today an essential skill for any public health professional. And the complexity of environmental health topics can make this particularly challenging.

This interactive workshop familiarizes attendees with key research- and evidence-based health communication strategies for plain language, writing for the web, writing for print, and risk communication. The workshop comprises a mix of lecture, instructor-led discussion, individual exercises, and group activity.

The intent of the workshop is to provide practical guidance, experience (through classroom activities), and resources so that attendees can implement what they’ve learned immediately after the learning lab.

Advancing the Business of EH: A look Inside Los Angeles County Environmental Health’s Project to Reengineer its Business Services

In August 2012, the County of Los Angeles, Division of Environmental Health embarked upon a major multi-year project to modernize its business processes and services. The division will transition from paper-based inspection, permit, and licensing flows to a highly-integrated computer software system.

Through three project phases the County will deploy the overarching software solution, EnvisionConnect, to over 800 employees including 450 field inspectors. The effort spans all health programs and all offices. At the same time, the County’s forms and data-flows will be optimized and modernized.

The Division’s goals have a significant impact for the County, its businesses, and the community. The highest level goals include:

• To automate the collection of EH information
• To capture real-time EH information (inspection, violation, and payment information)
• To improve capability to manage information within EH programs
• To integrate with other County of Los Angeles Departments
• To improve the accuracy and integrity of data
• To develop a system consistent with County’s Strategic Plan goal of “Workforce Excellence and Fiscal Responsibility”

We are extremely fortunate to have the LA County Division of Environmental Health Assistant Director, Terri Williams, recount the project’s origins and progress. She will also expand on the significance that this project holds for the County and its objective to be a regional and national leader. Decade Software’s Product Manager, Darryl Booth, will recount the project’s technical successes, hurdles, and expectations going forward.

This presentation is relevant to every health department aspiring to achieve that next level of service and efficiency. Small or large, projects like this require leadership, teamwork, and management of organizational change.

Application of Conflict Analysis and Resolution Theory in EOH Practice

Environmental and occupational health (EOH) professionals work in complex environments including (a) hospitals, (b) health departments, (c) research labs, (d) labor organizations, or in (e) global deployed settings in which they deal with diverse people and situations. These settings consist of diverse professional, political, historical, and cultural values among individuals and groups. In such work situations where EOH professionals are on either side of (a) OSHA or sanitation inspections, (b) in offices, labs or clinics, (c) consulting or auditing firms, or (d) with international stakeholders, conflict will always arise. Involvement in public health leadership today comes with the expectation that frequent conflicts and disputes will often exist between (a) workers, (b) inspector and those being inspected, (c) prevention and treatment priorities, and (d) collaborating agencies.

Conflict causes decided tension and has an adverse effect on (a)productivity, (b) workplace trust, (c) morale, (d) patient or customer service, (e) operational cost, and (f) overall workplace efficiency, and may even lead to (g) litigation or workplace violence.

Managing conflict in the workplace is a time-consuming but vital task for the EOH leader. Techniques commonly used by conflict mediators can easily be used in EOH settings by leadership to (a) form clear agreements between stakeholders, (b) decrease or prevent destructive conflicts, and (c) create healthy working environments that benefit all parties.

This course introduces EOH professionals to the theory of conflict analysis and resolution. Within the 4-hour class, 2 hours are reserved for lecture and class discussion with particular emphasis on conflict analysis models and the integration of (a) conflict analytical skills, (b) negotiation techniques, and (c) conflict resolution methods into the practice of EOH management. The 2 remaining hours of the course are devoted to simulation exercises in which general concepts and methods are demonstrated and practiced. One hands-on hour is reserved for exercises that demonstrate conflict dissection and one is devoted to mediation and negotiation exercises.

By the end of the course, students will have knowledge of the (a) overt and covert causes of conflict, and be able to apply (b) the concepts for analyzing disputes and (c) the methods for negotiating solutions.