Table Of Content

O UR M Primer on Health & ONTANA Environmental Determinants E NVIRONMENT Montana Environmental Public Health Tracking Program 2005 Foreword Montana is associations between disease and the known for environment. A primary goal of the its beauty and EPHT program is to better monitor wide open spaces. patterns and changes in chronic Our environment diseases, environmental health hazards, contributes to our and human exposure to hazards. quality of life and Through improved monitoring of state of health. trends we can better guide prevention Environmental Public The Montana efforts and policy decisions. While this Health Tracking seeks Department of initiative will not provide all the to protect the quality Public Health and answers, it will allow the departments of life in Montana Human Services to use existing data for investigations through monitoring (DPHHS) and the Montana Department and research concerning health and the trends in health and of Environmental Quality (DEQ) seek environment. environmental to protect the quality of life in Montana hazards. by monitoring trends in health and We look forward to working environmental health hazards. In 2002, together and with other agencies the departments jointly began to efficiently monitor changes in health developing a collaborative and the environment to improve the “Environmental Public Health quality of life and protect the health of Tracking” program. This initiative is Montana’s citizens. part of a nationwide planning effort led and administered by the Centers for Disease Control and Prevention (CDC). Dr. Robert Wynia Environmental Public Health Director, Montana Department of Public Health and Human Services Tracking (EPHT) initiates collaborative efforts between public health and environmental protection Richard H. Opper Director, Montana Department of Environmental Quality departments to examine the 1 Foreword Executive Summary There is a lack of coordination The Environmental Public Health Contents between environmental regulatory Tracking (EPHT) initiative is in its 3 The Environmental Health Gap agencies and public health agencies to initial stages. This report describes the 4 EPHT Vision and Guiding Principles connect the monitoring of goals of the tracking initiative and 5 The Environment and Our Health environmental health hazards with outlines key environmental health 6 Montana in Perspective trends in certain chronic diseases, birth concerns in Montana. defects, and learning disorders. This 7 Environmentally Related Diseases disconnect hinders national and state The lack of comprehensive data is 8 The Cost of Environmentally Related efforts to reduce and eliminate diseases not only an issue in Montana, but Diseases that might be prevented through better is endemic in our country’s system of 9 Monitoring Trends of Environmentally management of environmental factors. monitoring health and envrionmental Related Diseases & Conditions health hazards. Data collected by 10 Tracking Hazards & Human Exposure to Environmentally related diseases environmental and health entities Environmental Hazards were estimated to cost Montanans within the state are neither 11 Occupational Illnesses $404.6 million dollars in 2003. This is a comprehensive nor standardized. 12 Public Perceptions of Environmental Health conservative estimate determined by Developing the capacity to enhance assigning only a fraction of the costs of surveillance of health and Risks environmentally related diseases and environmental trends will take time. It 13 Priority Environmental Health Concerns conditions to the environment based on can best be achieved through in Montana the current state of knowledge. interagency collaboration and 14 Statewide Environmental Health Surveys partnerships with local and tribal 15 County and Tribal Environmental Health The development of a national health departments, universities, and Assessments environmental public health tracking advocacy groups. A strategic planning 16 Pilot Project: Particulate Matter & Asthma, program will improve our ability to session held in February 2005 assisted Western Montana examine the relationships between disease in providing direction for EPHT in 17 Environmental Justice & Vulnerable and the environment. The Centers for Montana for the next five years. Populations Disease Control and Prevention (CDC) is leading this effort. Montana is one of the 18 Summary of Needs & Recommendations pilot states funded to participate in 19 Definition of Terms developing an environmental public 20 References health tracking system. 21 Additional Resources Executive Summary 2 The Environmental Health Gap The Pew Environmental Environmental America needs to focus on Health Commission Health Commission learning how pollutants released a report in September recommended the impact chronic disease, birth 2000 titled “America’s establishment of a defects, and human Environmental Health Gap: nationwide health development. Why the Country Needs a tracking network. Nationwide Health Tracking Network.” The report notes In response to the feasibility study was completed by that America needs to focus on Pew report, Montana DPHHS in August 2002. how pollutants impact chronic the U.S. Congress disease, birth defects and passed Senate Bill The early passage of state legislation human development. This lack 2045, “The and completion of a feasibility of focus hinders national efforts to Nationwide Health Tracking Act,” in study in Montana led to it being one of reduce or eliminate diseases that might March 2002. Congress appropriated 17 states initially selected to receive be prevented through better $17.5 million in fiscal year 2002, $27.5 funding from the CDC Environmental management of environmental factors. million in fiscal year 2003, and $27.4 Public Health Tracking Branch. This million in fiscal year 2004 for CDC to funding allowed Montana to begin Recent advances in mapping the develop a nationwide Environmental planning and capacity-building human genome have given Public Health Tracking system. activities starting in October 2002. researchers a better understanding of how genetic predisposition interacts Montana was one of the first states with behavioral and environmental to pass health tracking-related factors leading to chronic diseases. legislation. In 2001, Montana House Bill However, we lack the essential ability 582, authored by Representative Gail to comprehensively track information Gutsche, required a feasibility study to on who has chronic diseases and who investigate the need for a chronic has been exposed to environmental disease registry. While the title used in pollutants - information essential to 2001 focused on chronic disease, the advancing our knowledge of disease concept included monitoring related prevention. Accordingly, the Pew environmental hazard data. The 3 The Environmental Health Gap EPHT Vision and Guiding Principles The Vision of Environmental Public Health Tracking: Healthy Informed Communities The Statewide Environmental Public Health Tracking Advisory Council recommends the following guiding principles for the development of the EPHT initiative in Montana: 1. All Montanans have the right to information on disease factors to optimize their health and the health of future generations. 2. Prevention is a priority in promoting environmental health. 3. Collaboration is essential to the success of this effort. 4. Data utilized by the tracking network are precise, accurate, and standardized to track known and suspected environmental hazards. 5. Interpretations of data and recommendations are based on the preponderance of the best science and the precautionary principle.* 6. Information gained can facilitate the formulation of public policy. *Precautionary Principle: The ethical theory that if the consequences of an action, especially concerning the use of technology, are unknown but are judged by some scientists to have a high risk of being negative from an ethical point of view, then it is better not to carry out the action rather than risk the uncertain, but possibly very negative, consequences. (Definition from http://en.wikipedia.org) Vision and Guiding Principles for Montana 4 The Environment and Our Health Many factors Exposure to hazards in the contribute environment also interacts with to human health. other factors to determine our health. Some factors can be For example, exposure to asbestos can modified and some lead to chronic lung disease; lead cannot. We are exposure can result in mental born with a given retardation and learning disabilities; mercury and arsenic exposure can set of genes. Those Exposure to hazards in damage the nervous system; and air genes determine the environment can pollution can damage lungs and our predisposition affect our health...It is exacerbate asthma and other chronic for how important to monitor lung diseases. environmental and trends of environmental lifestyle factors may impact our health. hazards and health Vulnerability to environmental Research has shown that a family hazards is not the same in all effects to ensure that history of diabetes, cancer, or heart individuals, given the interaction of future generations can disease can increase the risk of multiple factors. Age is also a reach their full potential. developing any one of these diseases. consideration. Young brains and nervous systems are still developing, An individual’s lifestyle interacts so a small exposure can produce with genetic predisposition to greater harm. If for no other reason determine health. Tobacco use, poor than that, it is important to monitor diet, lack of exercise, stress, and trends of environmental hazards and excessive alcohol use are known to health effects to ensure that future contribute to an increased risk of chronic generations can reach their full disease. While behaviors are often the potential. result of personal choices, they may be influenced by poverty, isolation, and lack of education or lack of preventive health care. 5 The Environment and Our Health Montana in Perspective The state of Montana covers 146,000 The population in square miles and is known for its Montana has vast open spaces and mountain valleys. grown steadily in It is a place of extremes in temperature recent decades from and moisture. Historian K. Ross Toole fewer than 700,000 wrote, “The land itself is at once residents in 1970 to mountainous and flat, hot and cold, over 926,000 in 2004. beautiful and terrible, and benign and Some areas have malevolent.” There are over fifty experienced growth mountain ranges across the state, rates of 20-44% in mostly in western Montana. The central the past decade. and eastern parts of the state are Overall, Montana predominately semi-arid plains, with a remains rural in character with the few scattered smaller mountain ranges. majority of the population clustered in and around small cities. Only one city, The history of economic Billings, has a population over 85,000. development since statehood was There are eleven American Indian often marked by “exploitation, tribes with seven reservations Montana Counties & Tribal Lands overexpansion, boom and bust” scattered across the state. (Toole). Mining, logging and ranching American Indians make up were once the dominant sources of 6.2% of the population livelihood. The state provided an according to the 2000 census. abundant source of gold, copper, and The 2000 census also shows that vermiculite along with other natural 14.6% of Montanans live below resources. Today, the contribution of the poverty level, compared to agriculture, forestry and mining 12.4% nationwide. According to a combined make up only 6.5% of the report by the United Health state gross domestic product. The Foundation in 2004, 19.4% of economy is now dominated by trade, Montana citizens are without health American Indian Reservations financial activities, healthcare, and care insurance. This compares with tourism (Montana Census and a national rate of 15.6% uninsured. Economic Information Center, 2004). Montana in Perspective 6 Environmentally Related Diseases Since 1900, the average lifespan has increased by 30 years in the U.S. Ninety-five percent of this increase is a result of improved environmental conditions. Improved sanitation, water quality, and waste disposal have allowed infectious diseases to decline as the leading causes of death. Now chronic diseases have become the major killers. Worldwide, 40% of all deaths can be attributed to environmental exposures such as tobacco use, water pollution, and land degradation. While some ties between chronic disease and the environment have been well-studied (such as air quality and breathing difficulties), others are under investigation. Some of the environmentally related diseases that are being studied include: asthma, cancer, respiratory illnesses, cardiovascular disease, neurological diseases, autoimmune diseases, and learning disabilities. Some birth defects are also known or suspected to be related to environmental exposures. 7 Environmentally Related Diseases The Cost of Environmentally Related Diseases Based on current knowledge, the total estimated costs of environmentally related diseases in Montana for 2003 was $404.6 million, a Disease 2003 National Costs 2003 Montana Costs measure reflecting health care costs statewide and lost productivity costs in Child Lead Poisoning $63 billion $188.9 million the Montana economy. These costs for environmentally related diseases Childhood Asthma $2.9 billion $8.7 million represent 10% of total spending on health care in Montana. Neurodevelopment Disorders $13.5 billion $40.5 million The estimated costs were derived by Birth Defects $19.1 billion $57.3 million using an “environmental attributable fraction.” The Cancer $36.4 billion $109.2 million environmental attributable fraction is the percentage of a particular disease category that would be eliminated if Total $134.9 billion $404.6 million environmental risk factors were reduced to their lowest feasible levels. Attributable fractions ranged from 100% in the case of child lead poisoning to 5% for some neurobehavioral disorders (California Environmental Health Tracking, 2002; Montesanto and Hall, 2001; Landrigan, et. al., 2002). The Data Sources: Centers for Disease Control, http://www.cdc.gov/nccdphp/; California Policy Research Center, www.ucop.edu/cprc. complete cost analysis report can be American Cancer Society overall cost estimates of cancer (Centers for Disease Control, http://www.cdc.gov/nccdphp/ ) for the U.S. in 2002 were modified for Montana by a) updating the $170 billion [$110 billion for lost productivity and $60 billion for direct medical costs] to 2003 found at the Montana EPHT website at using 7.1 percent increase in national health care spending between 2002 and 2003; b) applying the 20% environmental attributable fraction; and c) taking Montana share of U.S. population, a value of .3% [decimal form=.003] as a benchmark for deriving the state share of the $36.4 www.dphhs.mt.gov/epht. billion in national 2003 cancer costs. National cost estimates for the environmental related childhood diseases (California Policy Research Center, 2004; Landrigan, et. al. 2004) were modified using a population share approach for child lead poisoning, asthma, neurodevelopment disorders, and birth defects. Montana’s share of national populations in childhood age cohorts [.3% which is the same as Montana’s share of overall national population] were applied to the national cost estimates of environmentally related childhood diseases. The Cost of Environmentally Related Diseases 8 Monitoring Trends of Environmentally Related Diseases & Conditions Birth and death Autoimmune disorders, National surveys have certificates learning disabilities, asthma, found increasing provide a method and neurological conditions evidence that autoimmune to monitor other are increasing nationwide. types of trends. disorders, such as Lupus, They provide learning disabilities, asthma, Hospital discharge data is used in information on and neurological conditions, some states as a surveillance tool reproductive such as migraines and to monitor trends in chronic diseases. outcomes, such as multiple sclerosis, are This data can be useful for examining low birth weights, increasing. Most states, trends of admissions for specific and the primary including Montana, do not diseases and conditions. This data causes of death. require reporting of these does have limitations because chronic Another source of conditions nor other chronic diseases such as asthma often do not information that allows the department diseases such as Parkinson’s disease require hospitalization. Montana’s to monitor health trends is an annual and chronic lung diseases. state public health department does not telephone survey of a representative have access to hospital discharge data A registry is a record of all reported number of adult Montanans. The at this time. Behavior Risk Factor Surveillance cases of a particular disease or System (BRFSS), collects self-reported condition. Montana’s Department of A report called “Montana Measures information on a number of health Public Health and Human Services of Environmental Health” is questions which vary somewhat from maintains a cancer registry and a birth available on the Montana EPHT year to year. The Montana EPHT defects registry. These registries website, www.dphhs.mt.gov/epht. program added additional questions to compile information reported by health This report provides summary the BRFSS telephone survey in 2004 and providers to monitor trends. Registries information on current measures of 2005 related to chronic disease and are expensive to maintain and require environmentally related health effects environmental health issues. While self- diligent reporting and case and environmental hazards collected in reported data have inherent limitations, ascertainment to ensure accuracy. Montana. such data does provide important There is often a lag time of a year or health trend information not available more between occurrence or diagnosis by other means. and entry into a registry. 9 Monitoring Trends of Environmentally Related Diseases & Conditions