Chapter 2: Collect and Use Information on Chemicals and Population Health to Enable Effective Public Health Protection

Public Health Problem

 

The prevention and control of adverse health outcomes related to chemical exposures requires the ongoing collection, integration, analysis, and interpretation of data about chemicals, including their sources, uses, associated exposures, and potential health outcomes. Although many federal, tribal, state, and local entities collect, analyze, and interpret data on the presence and uses of chemicals in the United States, the nation’s knowledge can best be characterized as partial, uneven, and minimally integrated. To protect public health, the nation requires enhanced information collection in at least four key areas: chemical use and release, environmental concentrations, levels in humans and other species, and health outcomes.

Challenges

Obtaining sufficient data on chemical use, release, and exposure is difficult. Understanding cumulative exposures is particularly challenging, given the large number of chemicals and variations in environmental mixtures. In addition, information on potential chemical exposures is collected through different systems for different reasons. Important information, such as on chemical exposures in indoor environments, is lacking (EPA, 2010). Further, the last national survey on human exposures in the workplace is 30 years old, resulting in a severely compromised understanding of risks related to occupational exposures.

Biomonitoring (i.e., measuring concentrations of chemicals in humans) has significant potential but remains challenging to implement. Laboratory methods for some chemicals can detect only large concentrations or are costly to conduct for large populations. For many chemicals, biomonitoring methods are not yet available. At present, biomonitoring often can verify only the occurrence of an exposure without providing useful information on the likelihood of specific health effects, although the method does have potential for being part of a monitoring system designed to answer such questions.

 

Data sets with potential to track health effects of chemical exposures also have limitations. These include a lack of standardized information to identify high-risk groups and vulnerable populations, determine health effects in small communities, and monitor trends. A particular challenge in use of health data sets is how to identify environmental causes of the many health conditions that are known to be associated with genetic and behavioral factors as well as chemical exposures. Finally, data sets developed for administrative or other purposes not specific to tracking of environmental diseases are often fragmented and not easily integrated with other data sets, making it difficult to monitor diseases related to chemical exposures.

New Directions

Data on all important chemicals for all relevant populations — including data on chemical source (including imports), uses, environmental and biological concentrations, and toxicity — should be collected with valid sampling and analytical methods in a manner that facilitates analysis, data integration, interpretation, and most important, prevention-focused actions. Such data would enable communities to understand local patterns of chemical production and use as well as chemical exposure and risk. An integrated system that incorporates sound, comparable data quality practices across media and agencies, combined with improved understanding of the toxic effects of chemicals and the doses at which they can cause harm, will facilitate decision making and help address the difficulties in attributing cause and effect that arise from the incomplete information collected under the current system.

 

The development of a comprehensive national monitoring program must be accompanied by a thorough discussion of ethical issues related to the collection and release of data. For example, achieving optimal data utility may require access to confidential information such as personal medical information protected under the Health Insurance Portability and Accountability Act (HIPAA) or confidential business information. Release of information may adversely affect individuals and communities on whom data may not have been directly collected (e.g., data on local pollution or local health issues) by, for example, lowering property values or increasing anxiety.

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