Environmental Health Tracking & Biomonitoring Program
Summary: February 11, 2014 Advisory Panel Meeting
Advisory Panel: Fred Anderson, Alan Bender, David De Groote, Melanie Ferris, Tom
Hawkinson, Jill Heins Nesvold, Pat McGovern, Geary Olsen, Gregory Pratt, Cathy Villas-Horns,
Lisa Yost
MDH staff: Jeanne Ayers, Betsy Edhlund, Carin Husit, Jim Kelly, Tess Konen, Myra Kunas, Jean
Johnson, Aggie Leitheiser, MaryJeanne Levitt, Mary Manning, Rita Messing, Paul Moyer, Jessica
Nelson, Christina Rosebush, Chuck Stroebel, Lisa Strong, Paul Swedenborg, Janis Taramelli,
Stephanie Tucker, Joseph Zachmann
MAD consultant: Kris Van Amber
Welcome and introductions
Patricia McGovern, chair, welcomed the attendees, and invited the panel members and
audience to introduce themselves.
Tracking Updates
Chuck Stroebel, Program Manager for the MN Tracking Program, reviewed the latest portal
updates, beginning with the launching of new data on drinking water from private wells and
community water systems; updated data on air quality (ozone, PM2.5); and reproductive and
birth outcomes portal updates.
Next, he informed the panel about the national project teams and the upcoming CDC National
Tracking Network and renewal opportunity, with the Funding Opportunity Announcement
expected in March. Chuck also announced the proposed release of the TPT Climate & Health
Documentary that would happen in conjunction with Earth Day.
Last, Chuck announced that the tracking portal team recently received a Governor’s Award for
Continuous Improvement, which recognizes outstanding achievement in reforming state
government and saving taxpayers’ dollars. Honored at a reception at the State Capitol, the
portal team from the Minnesota Department of Health (MDH) was one of just six through
Minnesota’s state government agencies to receive this award.
New Pesticide Poisoning Data Demonstration
Tess Konen, CSTE/CDC Epidemiology Fellow in MN Tracking, gave a brief preview of new
tracking pesticide poisoning data. She presented rates of pesticide poisoning hospitalizations
and emergency department visits by sex, age, seasonal variation, and geographic location.
Additionally, she displayed the number of poison control center calls for pesticide exposure by
month, pesticide type, gender, and age group. She welcomed any feedback on the data.
Q&A:
Fred Anderson asked if there was any race data associated with the information. Tess replied
that the Minnesota Hospital Discharge Data does not have that available and she did not have it
in the MN Poison Control System Data; however, maybe she could request it.
1
Jill Heins Nesvold asked if Tess searched for the pesticide poisoning ecode in primary or
secondary diagnosis. Tess answered that pesticide poisoning ecodes listed in any of the
diagnoses were included in the analysis.
Pat McGovern wondered if we could combine non-occupational and occupational pesticide
poisonings to get a broader, more comprehensive idea of the impact from pesticide poisonings.
This would be interesting to the Medical School regarding pesticides and Parkinson’s disease.
Tess responded that this was a start and she could build on that. Tess added that this could
easily be done, but the purpose of this pesticide indicator was to focus on acute, community
exposure to pesticides.
Alan Bender wondered if Tess had seen any literature following a cohort to see how many
ended up in these systems (hospitalized, ED, call data). Do these numbers just represent the tip
of the iceberg? Tess responded that she did not see any literature regarding this and added that
we really don’t know the full extent of pesticide poisonings in Minnesota.
Jill Heins Nesvold suggested Tess review the Minnesota Farmsteads Study that examined
pesticides in farmers and their wives, which began 20+ years ago and ran out of money. She
suggested we look at that, from 25 years to 15 years ago to see a comparison of what you are
seeing now.
Assistant Commissioner, Aggie Leitheiser, had a question regarding the denominator for the
calculated rates; she wondered if the total number of hospitalizations/ED visits was used as the
denominator. Tess replied that she used the total Minnesota population number from the 2000
U.S. Census to calculate the rates for the hospitalizations and ED visits.
Advancing Health Equity and Portal Data Demonstration
Assistant Commissioner Jeanne Ayers discussed the handout, Advancing Health Equity in
Minnesota: Report to the Legislature: February 1, 2014, and how it was developed. She
described disparities as differences; health inequities connect disparities to systemic processes,
which are socially determined. Therefore, they are avoidable, unjust, and actionable. The
Health Department framed the question as how do we begin to create conditions for improving
health outcomes. We needed to have a public understanding of what creates health and health
disparities. We needed a process to name how some groups are disadvantaged, and to start to
look at policies, outcomes, disparities, and the related pathways to health, social determinants,
and work to build public awareness of this. The numbers are upsetting; we are looking into how
to move toward engaging people to take action.
These included disparities in birth outcomes, mortality, and health behavior, and we decided to
lead with race, which is the hardest one to address. We created an inquiry tool to examine
what we intended to do versus what actually happened. An example from MDH in what we
intended to do versus what actually happened is lead/radon. We created these programs built
on home ownership, and 75% of whites own their own homes, but the number is much lower
for other races; there’s the inequity.
2
Assistant Commissioner Ayers said the report includes a lot of community input. She listed the
seven recommendations to move forward that are part of the 160-page report, which had been
signed onto by all other state commissioners:
1.
2.
3.
4.
5.
6.
7.
Advance health equity through a health in all policies approach across all sectors.
Continue investments in efforts that currently are working to advance health equity.
Provide statewide leadership for advancing health equity.
Strengthen community relationships and partnerships to advance health equity.
Redesign the Minnesota Department of Health grant making to advance health equity.
Make health equity an emphasis throughout the Minnesota Department of Health.
Strengthen the collection, analysis, and use of data to advance health equity.
Assistant Commissioner Aggie Leitheiser commented that she had looked at these issues for
years; looking through a new lens and with more support was a great experience. Chair Pat
McGovern applauded the entire group effort, saying the report was a very frank and
courageous discussion.
Jeanne Ayers said the important piece is the modeling of MDH not being perfect, not knowing
every answer. The purpose is to change the narrative about what creates health--to move away
from individual and healthcare systems only. We need muscle memory within the agency to ask
these questions of ourselves, to build agency and community capacity to address these issues.
Chuck Stroebel highlighted data on the portal that reveals health disparities by race and
ethnicities, and sub-county level data. With hospital discharge data, there is no race or ethnicity
data available or reported. Jean Johnson suggested that biomonitoring has the potential to
show disparities in exposure.
Questions for the panel:
•
•
Over the next 3-5 years, how could data on the portal be enhanced to inform actions
that advance health equity?
Over the next 3-5 years, what could the biomonitoring program be doing to inform
actions that advance health equity and environmental justice?
Discussion
In discussion, Gregory Pratt commented that they are also having this important ongoing
discussion at MPCA. Health inequities are avoidable, but at what cost? An example would be
the Rondo Neighborhood, where we built I-94 right through that neighborhood and we could
remedy that, but at what cost? Assistant Commissioner Ayers said that doing something now
would probably not fix anything, but what we need to do is create a venue to ask disparity
questions when these ideas are being talked about, so that we are not pitting one person’s
interest against another’s; it’s in all our best interests.
3
Alan Bender commented that these are old issues, but we are moving forward with support
(moral, not yet financial) from the legislature now. Over 30 years ago, MCSS thought that race
and ethnicity should be included in medical records. Now MCSS, next generation, will collect
data from the census. It makes no sense for someone to identify another’s race. We need
people to self-identify across the state; otherwise, the numerator and denominator in census
data do not match. MDH needs to take the lead in having race and ethnicity reported. Jeanne
Ayers said there are recommendations that we use self-identification of race, but institutions
may not follow these recommendations. The hospitals collect it in a way that does not match
the census well. Legislation may be needed to build public will.
Division Director Mary Manning mentioned that Representative Clark questioned the PFC3
study using household water records as a way to identify the eligible community, as renters are
excluded from the water records. This may disproportionately exclude people who are a
minority. Is there a way to look at this, a way to work with the community to sample renters?
Jean Johnson replied that it is a legitimate question to ask; the sampling frame is homeowners
listed on city water billing records.
Alan Bender commented that there is a tension between social and political goals and scientific
design, given limited sample size and public health resources. Pat McGovern added that change
can happen bottom-up and top-down. She asked that even if it is just baby steps, what could
we (MDH) do? What kind of creative problem solving can the group come up with? We need to
bring this up every time agency heads get together. This situation is analogous to the return on
investment with early childhood education. It is a reframed issue now as an investment in
workers, not just investing money in preschool. We need to frame our issues in that same kind
of way.
Geary Olsen commented that he had read the full report, and the private sector is mentioned in
the Appendix, but out of 180 organizations, not one was a private sector organization. Assistant
Commissioner Ayers responded that they were invited to the discussions, but they didn’t come.
Geary Olsen added that most private sector people are happy to work on this, so the next
round of discussions needs to look at why are we missing the private sector in this? It’s a huge
problem of jobs and income as a driver of inequity, as well as unemployment. Assistant
Commissioner Ayers responded that MDH doesn‘t have the relationships with the private
sector organizations. Geary Olsen suggested that MDH should think of how to find those
organizations. His take of larger organizations is that they are their own little states, with their
own complete populations, doing their own health care programs, etc., and they may not see
the bigger picture, so just starting the conversation would help. David DeGroote asked how well
represented the private sector is in LifeScience Alley®, a Minnesota-based trade association.
Assistant Commissioner Ayers offered that she would be glad to meet with any group to discuss
this. Geary Olsen brought up the example of the neighborhood person who had a small grocery
store, who didn’t have stainless steel appliances, so he was told that he was out of business.
And he was the local grocer, so how do you keep the private sector going? Pat McGovern
wondered about the group that dealt with the connection of health care and the private sector,
4
business and community, a coalition of large and small employers (the Business and Community
Partnership). Maybe all of us could brainstorm and feed up to Jean industry groups who have a
stake in the conversation and who have the political will to want to participate.
Jill Heins said that health inequities can go beyond Minnesota. She highlighted the fact that
Native American groups suffer more burden than other groups, but so many of the issues of
health inequity are beyond the state of Minnesota. We have so much institutionalized racism
for the Native Americans. So we know that 10 percent of the sickest people spend 90 percent of
the health care dollars. If we really want to make an impact, in the long term improve health
and save money, we need to rethink how we treat Native Americans in Minnesota and in other
states. Assistant Commissioner Ayers replied that MDH is reviewing the SHIP tobacco-free grant
process. We are taking a one-year pause to discuss with the tribal communities in Minnesota
what would work for them. Jill Heins mentioned that there is a conversation happening at the
federal level about this same topic. EPA had the Bureau of Indian Affairs and the Indian Health
Service together and they are looking at how they interact with tribes and what barriers do
they put in front of them. Jill said there is a conference in May in Washington State on this
topic, and they’ve asked her to be one of their presenters, on how the federal government
becomes the barriers to the tribes. It might be interesting to look at what the federal
conversation is and how that will apply to Minnesota. Rita Messing, MDH Environmental Health
Division, said that they will be publishing a blood metals in Native Americans report this spring
for the Fond du Lac community, the findings of their EPA Great Lakes Restoration Initiative
(GLRI) study, and the rest of the analyses will probably have to wait for about a year for more.
Chuck Stroebel added that this is the start of the conversation. When we put out the report, it
was very clear from the Commissioner that this is going to be an ongoing effort, creating the
health equity center. He referred to the great work the Wilder group has done on this issue in
the Twin Cities, and that the PCA is thinking about environmental justice issues. Jean Johnson
said we will have PCA talk about the environmental justice issue at our June meeting and
continue this discussion.
Chuck Stroebel commented that this was a broad topic, but he welcomed ideas of what more
we could be doing with the portal—being mindful of the amount of resources it takes to
maintain the portal. If there are maps that we could create, overlays we could do, multiple
comparisons by income along with health variables, he’d be very interested in that, so please
share your ideas.
East Metro PFC3 Biomonitoring Project Update
Christina Rosebush presented the status of the PFC3 project, including updates on IRB approval,
community outreach, participant recruitment, project timeline, and the East Metro Cancer
Report. She reminded the panel of the project’s key questions about the effectiveness of public
health interventions in reducing PFC exposures through drinking water:
•
Have PFC levels continued to decline in our long-term residents?
5
•
•
Are PFC levels in new Oakdale residents comparable to the US general population?
Is there an association between length of residence in Oakdale since the October 2006
public health intervention and blood PFC levels?
Christina informed the panel that we have met with many east metro legislators and local
public health officials, and overall the response has been very positive and supportive. Two
issues have come up recently. One legislator is concerned that MDH is not adequately
addressing racial and ethnic disparities, specifically with renters and Hmong farmers who sell at
the local farmers’ markets. Jim Kelly addressed the concern about farmers at the last advisory
panel meeting and mentioned that the PFCs in the Homes and Gardens Study (PIHGS) showed
that produce and soil levels appear to be safe. Regarding renters, we decided when planning
the project that it is not feasible to randomly sample renters because there is not an allinclusive list of renters to use as a sampling frame. It is consistent with the original East Metro
PFC Biomonitoring Pilot Study to use water billing records as our sampling frame. Most
importantly, we do not expect that farmers living in Oakdale or renters have drinking water
habits that are different from those of homeowners.
Additionally, Christina reported that a legislator is concerned that MDH is not testing people
drinking from unfiltered city water supplies in areas with known low levels of PFCs, specifically
Cottage Grove. Christina presented background information on PFC water levels in Oakdale and
Cottage Grove, noting that in both communities PFC levels are well below health risk levels.
When planning the project, we considered including Cottage Grove city water drinkers. We
decided against it because, unlike in Oakdale, city water in Cottage Grove is not filtered.
Including Cottage Grove residents would not address our primary question about the
effectiveness of the intervention to reduce PFC exposures in drinking water. Christina noted
that we met with Cottage Grove local public health and they were satisfied with our plan to
sample new residents from Oakdale. If funds are available, it might be possible to pursue a
small Cottage Grove sample in a second phase of the project. If we do so, we will need to think
about what the benefit to the community would be if we find elevated PFC levels in some
Cottage Grove city water drinkers. The Cottage Grove water is currently deemed safe to drink
by MDH standards.
Pat McGovern asked Geary Olson what he thought about the legislative concerns. Geary Olson
asked about PFC water levels in Cottage Grove and whether all measured levels are below the
health concern values. Christina responded that that is correct. Geary reiterated that MDH has
decided that the levels are not above the levels that are safe to drink for a lifetime. Fred
Anderson said that he has not heard about any interest in expanding on current efforts from
legislators, local public health, or others.
Alan Bender said that we can always add on, but at a cost; the cost should not sacrifice the
scientific utility of the results. Jean Johnson said that MDH will proceed as planned unless we
receive a recommendation from the panel. Tom Hawkinson said a disadvantage of including
renters is that they are a more transient population, so their likely exposure to the actual
6
contaminant would be lower on average. A larger sample would be necessary to achieve
statistical significance. Mary Manning added that the legislator's concern involved a number of
renters who had been there for eight years or longer, and that they were precluded from
participation. Tom Hawkinson asked if we could limit the sample to people who were similar to
the householders in terms of tenure. Christina said that sampling renters could be considered
down the road if funds are available. David DeGroote commented that the underlying question
is whether renters somehow drink water differently than anybody else. This seems unlikely.
Alan Bender asked Geary if there was any information in the literature that suggests that the
metabolism of these compounds differs among ethnic groups. Geary was not aware of any,
though the NHANES data show that higher socioeconomic status is associated with higher
blood levels.
Biomonitoring Updates
Paul Moyer, Environmental Manager, Public Health Laboratory, updated the panel on the early
January water damage to the lab. Contracts for building recovery repair have been expedited.
The current blood metals ICP-MS instrument has been tested and appears to have not suffered
any damage. By the end of April, the lab hopes to have an additional new biomonitoring ICP-MS
instrument in-house in the renovated metals analysis suite. Paul introduced Dr. Lisa Strong, an
APHL (Association of Public Health Laboratory) fellow; she has studied bioremediation and
fracking chemistry at the University of Minnesota. Projects that the lab will be working on once
the lab is renovated include several small-scale mercury projects, the large FISH (Fish are
Important for Superior Health) project, and mercury speciation method development. For
Environmental Health (GLRI), with respect to metals, there is selenium and mercury speciation
yet to do. The selenium analysis will be subcontracted to expedite other analyses. For EHTB,
Paul is confident that with the dedicated new instrument, the lab will be able to move through
samples at a good pace after the backlog.
A CDC Funding Opportunity Announcement for biomonitoring (2014 - 2019) was announced, a
continuation of a presently funded (2009 – 2014) biomonitoring grant for three states. There
are five new opportunities with the new FOA. The application goes through the public health
lab, but the application is expected to be an effort inclusive of EHTB and EH. The deadline is
May 6th, and Paul was wondering whether there was time before that deadline to get feedback
on potential ideas from the panel or a panel subset to help shape the best-qualified proposal.
Alan Bender thinks the existence of this group and a state funded program and infrastructure
will help the application; only Minnesota and California have state legislation for the program.
Paul responded that the foundation is solid; it’s coming up with ideas to improve Minnesota
with biomonitoring that is welcome. Jean Johnson added that we could build off the work
already done. Jill Heins asked about the gist of the proposal. Paul Moyer explained that it
expands the number of states who can do biomonitoring, to build capacity, and it discourages
infrastructure. It is more the idea of programs in place to identify populations of concern and to
evaluate interventions and things that are very practical; it cannot be research in nature. Jean
Johnson identified it as surveillance. Paul Moyer said they will have knowledge transfer, build
7
capacity and capability, so the program should have staff and instruments, but the CDC can
help with methods. Pat McGovern was impressed with the planning and asked Jean Johnson to
reach out by email for anyone who would be interested in being a subset that could meet and
give ideas on this FOA. Paul described it as helping refine ideas or narrow down ideas. Jean
Johnson mentioned that the strategic plan was a good start, and that this will fund five new
states or fund three existing states and two new states. Jean will pass along the ideas to the
panel by email when she receives them. David DeGroote asked staff to share the Funding
Opportunity Announcement with the panel.
Geary Olsen offered congratulations on submitting a manuscript to a journal [referring to TIDES
collaboration study], even though it wasn’t accepted. Jean Johnson replied that the PFC1 paper
has been accepted for publication in December within the Journal of Environmental Health. The
arsenic paper is in draft form and the PFC2 will be in draft soon.
Newborns’ Biomonitoring Protocol: Community Selection
Jessica Nelson reviewed the draft protocol and rationale for the community selection and
consent process that is proposed.
Discussion questions to the panel:
•
•
•
•
Does the panel agree with the proposed clinic-based community selected for this
project?
How might we might best engage the community, and recruit participants?
Should enrollment be open to all women seen for prenatal care in the community
clinics, or should eligibility be further limited by race/ethnicity?
Given that urine is a better biomarker for inorganic mercury found in skin-lightening
creams, should we also collect a maternal urine sample?
Discussion
Jill Heins commented that Panel members may have helpful clinic contacts and encouraged
staff to reach out to the Panel for them.
Gregory Pratt wondered what we will use as a comparison population to determine if
disparities exist in mercury exposure given this targeted approach. Jessica replied that the study
will be open to all groups that come to the clinic, so we will have different populations for
comparison. We will also have results from approximately 200 bloodspots from predominantly
white, higher-income babies delivered at a Minneapolis hospital to use for comparison. She
agreed that we should be more explicit about the comparison in our planning and
communicating. Pat McGovern asked if there are NHANES data that we could use to compare,
and Jessica replied that the NHANES data are not great for this purpose as they don’t collect
newborn or cord blood and comparing to maternal blood is complicated.
Pat McGovern asked how this project relates to the FOA. Was this a standalone project or part
of a larger effort? Jessica replied that our vision is for an ongoing program that will use
8
targeted biomonitoring over time and in different groups. Pat McGovern said this is a good idea
because it is consistent with all the things the group has talked about, with the synergy the
group has with the lab, and it perfectly coincides with the Health Equity report. If local clinics
and primary care become engaged, it is a win-win.
Geary Olson wondered if there had been mercury testing of these creams. Jessica stated that
MDH, St. Paul Ramsey Public Health, and MPCA have done sampling; 11 out of 27 creams
tested positive for mercury and some at high levels of mercury. Interviews with women have
found that pregnant and breastfeeding women are using these products. Geary also asked
about cultural sensitivity--whether local public health people are talking about the risks with
the public before the levels are tested? Pat McGovern replied that they have been pulling it
from the shelves but products are still available. Awareness is needed, not just compliance.
Tom Hawkinson added that these products are illegal. Paul Moyer said that mercury (inorganic)
is the active ingredient, with the ones that work better containing more mercury. Jean Johnson
added that Ramsey County has been working to educate and inform people, and EHTB is
presenting a brown-bag talk on the subject March 12th, and it will be available on WebEx as
well.
Melanie Ferris wondered about interventions for those who have elevated levels. Jessica
replied that the main intervention is to reduce exposure; chelation is not recommended at the
levels we expect to see. Melanie added that the benefit must be part of the messaging in
recruitment. She also wondered whether this could be used as an opportunity to survey a
larger group of patients at the clinic for more information about potential exposures and to
guide future studies. (For example, do Karen women use skin-lightening cream?) Jessica
responded that we hadn’t discussed this, but it’s a good idea to keep in mind.
Alan Bender wondered whether an issue would be that participants have been culturally
sensitized to the concerns and may lie about usage in the survey questions. Pat McGovern
suggested having members of the community on an advisory board or as a paid consultant so
that someone from inside that community can help figure out how to talk to women and assess
the problem. Jill Heins Nesvold proposed that if skin lightening is so important, we need to
provide information about a safer alternative instead of telling them not to use anything. Rita
Messing said that creams with less mercury have other harmful ingredients. Pat McGovern
suggested that this could involve a toxicologist and dermatologist working together, and
wondered whether we could pilot test an intervention if we could get experts to decide on the
best alternative. Gregory Pratt suggested that the message could be that you not try to lighten
your skin.
Jessica asked if there were any objections to the plan. David DeGroote said that if the
underlying assumption is that these are groups with the highest exposure, then go forward.
Collecting a urine sample seems to make sense given the half-life of inorganic mercury.
9
Sustaining Minnesota Biomonitoring: Workgroup Progress Report
Kristin Van Amber reported on the first two meetings of the Sustaining Minnesota
Biomonitoring Workgroup, (Alan Bender, David DeGroote, Melanie Ferris, Lisa Heins Nesvold,
and Lisa Yost) and shared the group’s draft charter, work plan, and draft action plan.
Discussion questions to the panel:
•
•
Does the charter and plan fit with your understanding of the group’s charge?
What suggestions do you have to assist them in developing an action plan for sustaining
Minnesota Biomonitoring?
Discussion
Pat McGovern commented that there should be some linkage between the CDC Funding
Opportunity Announcement and sustainability committee, because the federal government is
very interested in movements at the local level to encourage sustainability. Jean Johnson added
that whether the state can sustain the effort at the end of the grant is mentioned in the
Funding Opportunity Announcement.
Alan Bender suggested that putting a financial number on the cost of ongoing capacity and of
NOT having capacity is important. What infrastructure do we need to create in order to deal
with emergency situations if we don’t have a base program--staff in place, continuity of training
and experience? Kris Van Amber stated that when you talk about funding, what you are looking
at is, in the absence of this program, what would be the implications. This involves fiscal,
political, and public health implications.
Tom Hawkinson said from a political perspective, it is always easier to get funding with a group
of excited people around a topic; it’s much harder to sustain funding without a buzz or stories.
He wondered whether we could sustain the funding on an ongoing, non-crisis basis. He also
suggested that quantifying the cost in the face of rising health care costs might be an idea. Jill
Heins described the methodology as comparing the cost of a crisis situation in the past versus
an ongoing program cost, and said it was probably the best you could do without making too
many assumptions. Alan Bender added that to start and stop a program is terribly inefficient.
Pat McGovern brought up the Health Department’s health economics group that took a couple
of the cases of things you’re most concerned about—like the neuro-cognitive effects of
mercury exposure and what might we save? If we can prevent “x” number of mercury
poisoning cases (higher level(s) cases/year), what cost would we save in health effects? If you
did that with a couple of the major agents that people are exposed to, that might help.
Jill Heins suggested asking legislators first what figure, results would be attractive to them. Let’s
not make an assumption as to what the study is that would helpful and attractive to a decision
maker; let’s go ask them. They’ll give us a very clear picture. We need to introduce this to the
legislature next month in order to lay the foundation for funding next year.
10
Gregory Pratt suggested that we might want to go back and look at, historically, how often have
we required mobilization of resources and services, and project that into the future and say, in
the next 10 years, we expect “x” number of crisis events that require us to have significant
activity.
Kristin Van Amber handed out her compilation from the meetings of end users, partners,
beneficiaries, customers, and the SWOT analysis sheet. This helps us to understand all who are
involved; where the money shifts between these groups and how it gets there; and the
different funding strategies you can look at depending on the group. An example would be cost
sharing; how could we use similar services and bring down our costs. You could also look at
having a fee associated with the data from the users, depending on who they are. The other
way of looking at it was a SWOT analysis, the strengths, weaknesses, opportunities, and threats.
One of the reflections was that there is a lot of opportunity in the state for expanding
biomonitoring; there’s a lot of possibility with clinics. Kristin asked if there is anything else that
the group should be looking at.
Jill Heins said we need a short-term and a long-term plan. Right now, we have a 15-month
source of funding. Short term would be the legislature and the CDC FOA, but we have to act
now on those. Then this summer we could look at the long-term partners and relationships.
Fred Anderson talked about current partners—purchasers of service or collaborators, are there
any adjacent states or provinces we could partner with? An example is Ontario tribal
populations and blood spot mercury; whether they have the same interest in populations at
risk. Jean Johnson talked about the summit and collaborating with other states on tracking
opportunities. Utah and Wisconsin are both doing similar biomonitoring work; we could
mention that in the upcoming tracking grant.
Rita Messing said the First Nation biomonitoring pilot results are out. They saw just enough to
see mean exposure to a variety of things; they didn’t see anything very remarkable in the
studies. The CDC Funding Opportunity Announcement is for capacity building. CDC money to
states could show the value of state biomonitoring.
New Business
Geary Olsen noted that we have gone to meeting three times this year, but the statute states
that this panel shall meet quarterly. Mary Manning explained that this has been discussed and
when statutes aren’t funded, we sometimes find it necessary to scale back unless we can find
alternative funding. Jean Johnson explained that we are supporting this piece with other
resources because the panel’s recommendations are very important to the legislature. She
added that the legislature had reviewed a sunset date for the panel, but it is now extended for
another five years. Pat McGovern suggested that we discuss this at the next meeting and in the
interim Jean should have someone talk to her attorneys and clarify this. David DeGroote asked
if the funding wasn’t renewed before, what are the prospects of it being renewed in the
upcoming legislative session? David DeGroote noted that if we go for the Funding Opportunity
11
Announcement and the funding is not renewed, that doesn’t look good to the CDC. Gregory
Pratt saw no real negative consequences to the Legislature by the panel not meeting four times
a year. Jean Johnson will check into it and get back to the panel.
Adjournment
Pat McGovern adjourned the meeting. The next Advisory Panel meeting will be held on June 10,
2014, from 1:00–4:00 PM, at the American Lung Association.
12