Little is known about interactions between lifestyle and environmental factors and the role of the contemporary environment in health is complex and multifaceted. Innovative methods are required for assessment and management of public health interventions recognising the change in public attitudes to environmental contamination.

The Health Protection Agency (HPA) has a goal to minimise the preventable burden of disease attributable to radiation, chemical, and environmental hazards. Strengthening environmental hazard and exposure surveillance has now been identified by the HPA Executive Group as one of four priorities to be taken forward as the initial phase of implementation of the HPA Surveillance Strategy.

This is fully addressed in the wider strategic aims set out in the current HPA 2010-2015 Vision Statement:

"To develop comprehensive public health surveillance and environmental health tracking systems for toxic hazards and health effects to provide the essential context for risk assessment by:

• Tracking the health impact of hazards
• Evaluating the effectiveness of control measures
• Understanding the natural basis of disease
• Improving clinical and public health practice".

In development of the new HPA Surveillance Strategy the Evaluation Panel concluded that the two current environmental surveillance systems provided public health benefit, but that neither delivered a truly comprehensive national picture of environmental hazards and exposure incidents, nor did they provide sufficient insight into the health effects of exposure incidents. The Chemical Hazards and Poisons Programme Board concluded that the lack of a comprehensive national monitoring system represented an important gap in the Agency's surveillance function.

What is Environmental Public Health Tracking?

Environmental Public Health Tracking (EPHT) has been defined by the US Centers for Disease Control and Prevention (CDCP) as: "The ongoing collection, integration, analysis, and interpretation of data about environmental hazards, exposure to environmental hazards and human health effects potentially related to exposure to environmental hazards.  It includes dissemination of information learned from these data". 

It is considered appropriate to expand the definition to reflect the differences in the Health Protection Agency (HPA) approach and to reinforce the systematic nature of the process. The component parts are set out below and encapsulate:

• Hazard identification and mapping;
• Exposure assessment and quantification;
• Development of biomonitoring;
• Systematic review of health outcomes and disease surveillance;
• Horizon scanning;
• Development of environment and health indicators.

In order to demonstrate the concept of EPHT and show its individual components in a functional mode, the HPA Project Board has agreed to conduct two "proof of concept" studies. The two proof of concept studies chosen are: carbon monoxide poisoning in private dwellings which is an example of outcome tracking and arsenic in private drinking water supplies which is an example of hazard tracking.

This project is a precursor to the full scale introduction of an Environmental Public Health Tracking Programme as a core activity of HPA environmental surveillance capacity.

The objective of this project will be to explore and develop a methodology for addressing environmental hazards that will deliver integrated local and national surveillance of those hazards, exposure assessment and relating health effects of environmental exposures to those hazards. This is expected to provide evidence of the health burden represented by such hazards and exposures, inform the response to new exposures, and support the ongoing development of environmental epidemiology and toxicology in the HPA.

The project is intended to explore the feasibility of expanding the pilot tracking work into an ongoing tracking programme for many hazards. Following a successful pilot the project will develop a network of interested parties (the network), both providers and users of data, and scope a technological solution (the hub) to store all relevant raw data as well as analyses, discussion and other pertinent information.

The project will build on the experience and expertise developed through the design and operation of systems currently used by the HPA, in particular by CRCE and LaRS SW, for environmental surveillance, utilising elements of the existing national Chemical Incident Surveillance System in England and Wales and the South West Environmental Surveillance System.

Project aims

"To develop comprehensive public health surveillance and environmental health tracking systems for toxic hazards and health effects to provide the essential context for risk assessment by: 

• Tracking the health impact of hazards
• Evaluating the effectiveness of control measures
• Understanding the natural basis of disease
• Improving clinical and public health practice".

Project objectives

The key objectives of the project are to: 

• Create a structured approach to providing evidence of the health burden represented by non infectious hazards and exposures
• Establish a robust methodology for informing policy development on reducing the burden of disease attributable to non infectious hazards
• Provide a single focus for investigation and research into links between non infectious hazards and health outcomes
• Inaugurate a centralised facility for co-ordination and collaboration with partners and stakeholders on investigation and research into non infectious hazards
• Generate protocols and agreements for information and data exchange between stakeholders and partners including NHS Connecting for Health 
• Agree specification for new first generation national environmental surveillance system and reporting tools 

Project Scope

The project aims to produce a methodology that facilitates the identification and collection of data required for tracking non infectious hazards and their relationship with health outcomes. The project scope includes collection of data from NHS, HPA sources, Public Health Observatories, Office of National Statistics, collaborating partners and other stakeholders.

The HPA Surveillance Strategy vision stipulates that Surveillance activities and outputs should be determined by stakeholder requirements (internal and external).

EPHT resources

EPHT activities are a concerted effort of several HPA staff in different parts of the organisations, supported by a small team at CRCE. If you are involved in a project relevant to Environmental Public Health Tracking, please get in touch.

Comments or queries

If you have any comments or questions about the project please contact: Dr Giovanni Leonardi (Giovanni.leonardi@hpa.org.uk) Head of Epidemiology, Mike Studden (mike.studden@hpa.org.uk), Project Manager or Becky Close (Rebecca.close@hpa.org.uk) Environmental Public Health Scientist.