Assessing population health

Humans may be exposed to 2-hexanone through contaminated air in the workplace and in the vicinity of hazardous waste sites and consumption of and dermal contact with contaminated water, especially in the vicinity of hazardous waste sites. Epidemiological studies that followed populations exposed to 2-hexanone, either in the vicinity of hazardous waste sites or in the workplace, would be useful in assessing adverse health effects in humans. In any such studies, emphasis should be placed on neurological, hematological, immunological, reproductive, and developmental effects. Similarly, human dosimetry studies of these populations would be useful in associating 2-hexanone levels with the reported effects. 

Crow, J.F. The evaluation of chemical mutagenicity data in relation to population risk Impact of various types of genetic damage and risk assessment. Environ. Health Perspect. 6 1-5, 1973. 

EnHealth Council (2004) Environmental health risk assessment guidelines for assessing human health risks from environmental hazards. Canberra, Commonwealth of Australia, Department of Health and Ageing, Population Health Division, June (http //www.health.gov.au/intemet/wcms/publishing.nsf/Content/ohp-ehra-2004.htm). 

Joosting, P., and M.Verberk. 1974. Emergency population exposure A methodological approach. Pp. 2,005—2,029 in Recent Advances in the Assessment of Health Effects of Environmental Pollution, International Symposium Proceedings, Vol. 4. Commission of the European Communities, World Health Organization, U.S. Environmental Protection Agency. NTIS PB261 480. 

Few well conducted epidemiology studies of exposed populations exist. A recently published epidemiology study of a population with chronic exposure to two NPL hazardous waste sites illustrates the problems inherent in assessing adverse health effects from waste site exposure (Dayal et al. 1995). 

Noninvasive validation of tobacco smoking behavior is necessary for large population health studies. Moreover, a main problem in the risk assessment of passive smoking is the lack of a suitable methodology for the quantification of exposure. Measurements of nicotine in hair could prove to be a reliable marker for passive exposure. Several reports have presented data on nicotine in hair. ° Some have included the monitoring of cotinine, the major metabolite of nicotine. 

Pest Management Regulatory Agency, Health Canada and the R. Samuel McLaughlin Centre for Population Health Risk Assessment, Ottawa, Ontario, Canada... 

One of the most important public health tasks in the immediate aftermath of a disaster is to conduct a rapid and comprehensive assessment of population health requirements. Responders should conduct a health assessment of the community as soon as possible within the first few days following the event (Connolly, 2005). This is a multifaceted process that consists of several key elements (1) data collection for assessment of needs, (2) identification of available resources that match to defined needs, (3) prevention of further adverse health effects associated with the event, (4) implementation of disease control strategies, (5) evaluation of the effectiveness of the application of these strategies, and (6) improvement in contingency planning for future disasters. 

Successful interventions require rapid assessment by health care providers to determine where the breakdown in the public health infrastructure occurred and to identify and prioritize the health needs of the population. All immediate and potential health hazards must be identified. Outbreak management can quickly become disaster management if the number of patients exceeds the capability and resources of the responders (Moralejo, Russell, Porat, 1997). 

Monitor Health Status to Identify and Solve Community Health Problems. This service includes accurate diagnosis of the community s health status identification of threats to health and assessment of health service needs timely collection, analysis, and publication of information pertaining to access, utilization, costs, and outcomes of personal health services attention to the vital statistics and health status of specific groups that are at higher risk than the total population and the management of integrated information systems in successful collaboration with private providers and health benefit plans. 

Rapid assessment of health needs in populations affected by disasters is critical. This scientifically valid information enables health care providers and emergency management officials to prioritize resources and make decisions about responding to natural disasters. 

Health systems researchers and public health experts need to address the requirement for rapid assessments of health care infrastructure that quickly identifies the status of the critical assets for providing care (facilities, medical supplies, and the workforce) during a disaster. Natural disasters are not predictable and there are rarely more than a few days warning of an impending event. Time does not allow for testing and retesting of tools or analysis of definitions and measures, and therefore they must be established in advance. Because needs assessments should be done as rapidly as possible it leaves little time for refining the processes. Further, the uniqueness of each disaster complicates research because of the variable populations, socioeconomic status, health care availability, and environmental conditions in every community. 

On November 18-20, 1998, a workshop on Scientific Issues Relevant to the Assessment of Health Effects from Exposure to Methylmercury was conducted in Raleigh, North Carolina. The workshop was jointly sponsored by the U.S. Department of Health and Human Services (DHHS), the National Institute of Environmental Health Sciences (NIEHS), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the U.S. Environmental Protection Agency (EPA), the National Oceanic and Atmospheric Administration (NOAA), the Office of Science and Technology Policy (OSTP), the Office of Management and Budget (OMB), and ATSDR. The purpose of this workshop was to discuss and evaluate the major epidemiologic studies that associated methylmercury exposure and the results of an array of developmental measures in children. These studies monitored and evaluated exposed populations in Iraq, the Seychelles Islands, the Faroe Islands, and the Amazon River Basin. A number of animal studies were also considered in support of a human health risk assessment. 

The studies of the Iraqi, Amazon, Seychelles, and Faroe Islands populations were reviewed by an expert panel that met in Raleigh, North Carolina, at the Workshop on the Scientific Issues Relevant to Assessment of Health Effects from Exposure to MeHg. A report of that workshop has been published (NIEHS 1998). In suggesting possible explanations for the discrepant findings of the Seychelles and Faroe studies, the panel pointed to differences in sources of exposures or exposure measures, differences in the neurobehavioral tests used or their administration or interpretation, influences of confounders and covariates, and biostatistical issues involved in the analysis of the data. The differences between those studies are discussed further in Chapter 6. 

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