Minnesota Department of Health
Environmental Health Tracking and Biomonitoring
Advisory Panel Meeting
June 10, 2014
1:00 p.m. – 4:00 p.m.
The American Lung Association in Minnesota
490 Concordia Avenue
St. Paul, Minnesota
Environmental Health Tracking and Biomonitoring Program
June 10, 2014 Advisory Panel Meeting Agenda
Time
Agenda Items
Presenters
Description/expected outcome
1:00
Welcome & Introductions
Patricia McGovern, Chair
Panel members & audience are invited
to introduce themselves.
1:05
Sustaining Minnesota
Biomonitoring: Workgroup
Progress Report
Kristin Van Amber, Senior
Management Consultant,
Management Analysis
Division, Minnesota
Management & Budget
Discussion item: Kristin will report on
the Sustaining MN Biomonitoring
Workgroup meetings. Panel members
are invited to comment on the funding
strategies proposed.
1:15
Discussion
Questions to the panel:
•
•
1:25
MN FEET Protocol Review
1:40
Discussion
Jessica Nelson
Discussion item: Jessica will review
progress on the MN Family
Environmental Exposure Tracking (MN
FEET) protocol development.
Questions to the panel:
•
•
•
1:55
Biomonitoring Updates
•
•
•
•
2:15
Lab Update
East Metro PFC3
Biomonitoring
East Metro Cancer
Report Update
Mercury Updates
What advice would you give the
workgroup as they set out to
develop an action plan?
Are there other sources of funding
not listed here that they should
consider?
Paul Moyer,
Environmental Manager,
Public Health Laboratory,
Christina Rosebush
Do you agree with our proposed
plan for recruitment, consent, and
data collection?
Do you have advice on the key
questions posed in Figure 1? Are
there other questions we should be
asking?
Does the data analysis plan seem
reasonable given the study design?
Information Item: Paul will give an
update on the MDH lab; Christina will
give a brief update on the PFC3 project.
Panel members are invited to ask
questions and comment on all updates.
Refreshments
2
Time
Agenda Items
Presenters
Description/expected outcome
2:30
MN Tracking report: The
Economic Burden of the
Environment on Childhood
Disease in Minnesota
Jean Johnson
Discussion item: Jean will present a brief
overview of the report purpose,
findings, and limitations.
2:45
Discussion
Questions for the panel:
•
•
3:05
Environmental Justice in
Minnesota: MPCA’s
Approach
3:20
Discussion
Ned Brooks,
Environmental Justice
Coordinator, MPCA
Discussion item: Ned Brooks will give an
overview of a new Environmental Justice
initiative at the MPCA.
Questions for the panel:
•
•
3:45
Tracking Updates
•
•
•
•
•
CDC Renewal
Application
Portal Updates
New HIA Toolkit
Health and Climate
Video
Urban Air and Health
Project
3:50
New Business
3:55
Audience Questions
4:00
Motion to adjourn
Given the limitations, what is the
primary value of this report? How
well does it serve its intended
purpose?
Should this report be updated or
modified in the future to add other
diseases or conditions? If so, what
changes are needed?
How can the MN Tracking program
best support the MPCA’s work?
What data would be beneficial for
informing the screening process and
the evaluation of outcomes that is
planned?
Information Item: Tracking updates have
been provided in report form. Panel
members are invited to ask questions or
comment on updates.
Note to audience: The panel asks that audience members hold comments and questions on discussion items
until the end of the meeting, when the chair will invite questions from the audience. Audience members are
asked to identify themselves when they speak, and to please record their names and affiliations on the list at
the sign-in table. Meetings are recorded on audiotape.
3
Table of Contents
June 10, 2014 Advisory Panel Meeting Agenda ............................................................................... 2
Section Overview: Sustaining Minnesota Biomonitoring: Workgroup Progress Report ...... 5
Section Overview: MN FEET Protocol Review ............................................................................. 13
Section Overview: Biomonitoring Updates ..................................................................................... 18
Section Overview: MN Tracking report: The Economic Burden of the Environment on
Childhood Disease in Minnesota........................................................................................................ 25
Section Overview: Environmental Justice at the MPCA ............................................................. 36
Section Overview: Tracking Updates ............................................................................................... 41
Section Overview: Other Information.............................................................................................. 46
2014 Advisory Panel Meetings ................................................................................................. 47
Environmental Health Tracking & Biomonitoring Program Summary: February 11, 2014
Advisory Panel Meeting ............................................................................................................ 48
Environmental Health Tracking & Biomonitoring Advisory Panel Roster .............................. 59
Biographical sketches of advisory panel members ................................................................... 61
Staff Biosketches ....................................................................................................................... 64
Environmental Health Tracking and Biomonitoring Statute..................................................... 67
Section Overview: Sustaining Minnesota Biomonitoring: Workgroup
Progress Report
Kristin Van Amber, Senior Management Consultant, Management Analysis & Development
Division of Minnesota Management & Budget, will report on the Sustaining Minnesota
Biomonitoring Workgroup meetings and progress since February. Panel members are invited to
comment on the funding strategies proposed.
The workgroup met on May 5, 2014, to review the estimated costs for sustaining a state
biomonitoring program that would meet the vision, purpose, and strategies described in the
strategic plan for “Protecting Future Generations”. The plan would focus biomonitoring on
newborns, children, pregnant women, and disadvantaged communities.
Vision: Minnesotans will lead healthier lives in safer environments
Purpose
•
•
•
Identify differences in the levels of chemicals among Minnesota's diverse
populations, which may differ by income, ethnicity, culture, or geographic
location
Assess the need for public health policy and action
Track changes over time to find out whether actions taken to reduce chemical
exposures have been effective
Members reviewed a list of potential funding sources and strategies. Kathleen Schuler,
Conservation Minnesota, attended and gave her perspective on funding strategies. At the next
meeting (July), the task force will develop an action plan from the list of strategies that are
deemed most likely to be effective and feasible within existing resources.
Questions to the panel:
•
•
What advice or suggestions would you give the workgroup as they set out to develop an
action plan?
Are there other sources of funding not listed here that they should consider?
5
Sustaining Minnesota Biomonitoring: Workgroup Progress Report
Summary of May 5th Workgroup Meeting
Workgroup Members: David DeGroote, Jill Heins Nesvold, Debra Hendricks, Lisa Yost
MDH: Jean Johnson, MaryJeanne Levitt, Mary Manning, Jessica Nelson, Christina Rosebush,
Janis Taramelli
Guests: Kathleen Schuler, Conservation Minnesota; Kris Van Amber, Management Analysis &
Development Division of Minnesota Management & Budget
Meeting overview
Welcome & Meeting Goals: The meeting began with an overview of the agenda by Kris Van
Amber. Jean Johnson welcomed the group back for the third meeting of the MN Biomonitoring
Work Group.
Introductions & Agenda Overview: The members were asked to provide their name,
organization and to check in on any thoughts, concerns, or ideas they had around this effort.
Program Cost Overview: Jean provided an overview on the MDH estimated cost levels for a
biomonitoring program. The group responded by sharing their insights on how others would
see this investment. Costs ranged from $750,000 to $780,000 per year and would collect data in
repeated cycles of 3-4 years. Costs are “scalable” based on the number of analytes, specimen
types, and participants.
Members’ comments:
•
•
•
•
•
•
•
•
Consider the return on Investment and how this is communicated.
The observation was made that this effort does not have an economy of scale. There is
not a greater return on investment when adding more participants or the number of
analytes.
Need to articulate the public health benefit of getting a statewide base; the purpose for
community and population (numbers) and result.
It is important to consider the use of terminology: surveillance vs research vs
monitoring.
Look into the amount of money used to monitor chemicals in air and water and
compare to the cost of biomonitoring.
Make an argument for public health prevention strategies (saving in costs) by using lead
and other toxic chemical risks as examples.
Build on PRAMS and other existing surveys for cost savings. These programs are already
up and running.
Other parts of MDH and other state agencies can partner to conduct additional analysis.
Examples would be in the areas of nutrition and behavior (eg smoking).
Funding Source Strategy Overview
Center for Disease Control (CDC): Laboratory Grant Proposal: Jessica provided an overview of
the recent MDH proposal for the next round of State-based Public Health Laboratory Grants,
which meets our strategic plan goals.
6
•
•
•
5 grantees
o MDH proposed to focus on population disparities in pregnant women and
children (3-11)
o Incorporates a longer list of analytes (PAH, metals, phalates, pesticides, personal
care products)
o Rural vs urban comparison
o 3 to 11 yrs. old
o Pregnant women on urban side
Will be awarded in September – Due May 6
$5 million for 5 years is the maximum award per grantee
Christy provided a review of other funding sources (see Table 1).
Perspectives from Conservation Minnesota -- Kathleen Schuler
Consider outreach to:
1. Public health community to create a general awareness
a. Minnesota Public Health Association (MPHA) – legislative agenda
b. Minnesota Environmental Health Association (MEHA)
c. Minnesota Environmental Partnership (MEP)
2. Legislators
a. Cost effectiveness
i. Examples, i.e. lead and flame retardants
b. Concern by some that this will generate more regulation, hurt economy.
i. Counter: this is a real measure rather than an unreliable prediction (many
times measure is more conservative)
ii. Need to be clear about intent and connection to monitoring
1. Can draw correlation to activities- “Things are working”
2. Provide reassurance that chemicals in body do not always harm
community
3. Environmental organizations
a. Minnesota Environmental Partnership (MEP)
b. Minnesota Center for Environmental Advocacy (MCEA)
4. Support of communities
Consensus that foundations generally should be considered as a source of supplemental
funding for MN Biomonitoring
Ways to build on the current infrastructure and people
• Mobile system like the blood mobile or mobile science lab
• Nursing programs
• Trusted partners
• At risk populations
• PRAMS
• DHS Child & teen check-ups
7
The group then listed strategies for funding in 3 categories: (see Table 2)
•
•
•
Short term: strategies to sustain funding over the next 1-2 years
Mid-term: strategies to sustain funding over the next 3-5 years
Long term: strategies to sustain funding over the next 5-10 years
Meeting adjourned. Next meeting: July
Sustaining Minnesota Biomonitoring Workgroup
DRAFT Funding Strategy
May 5, 2014
Funding Sources
The MN Biomonitoring group compiled a list of potential funding sources. These funding
sources are represented in the Potential Funding Sources table. The funding sources were
identified using targeted searches and suggestions received at 2011-2012 Strategic Planning
meetings with Environmental Health Tracking & Biomonitoring Program stakeholders.
Funding Strategies
How to sustainably fund each of the program strategies by considering the funding sources and
program cost estimate?
Evaluation Criteria
The following criteria were developed to evaluate the funding sources represented in the table.
The Task Force will be invited to add their ideas to the lists of evaluation criteria and funding
strategies for sustaining MN Biomonitoring.
•
•
•
•
•
•
•
•
Is MN Biomonitoring eligible for this funding?
Does this funding strategy independently meet the cost needs of MN Biomonitoring?
or
Does this funding strategy complement other strategies on the list to meet the cost
needs of MN Biomonitoring?
Does this strategy fit well with the MN Biomonitoring Strategic Plan? (please see
document Strategic Plan: Protecting Future Generations)
Is pursuing this strategy realistic?
Will pursuing this strategy result in a good return on investment? Does the funding
merit the amount of staff time needed to obtain it?
What steps are needed to pursue this strategy? How many months/years are required
to implement the funding?
How long can this funding source be sustained?
8
Table 1. Potential Funding Sources: Sustaining Minnesota Biomonitoring Task Force
Funding
Type
Funding source
Is MN Bio
eligible?
Funding focus
Are there current funding
opportunities?
National
Funding
CDC
yes
Varies
Funding Opportunity inprogress: State-Based Public
Health Laboratory
Biomonitoring Programs ($5
million)
NIH
yes
-Varies;
NIEHS has funded work on
pregnancy exposure to
environmental
contaminants;
Children’s Environmental
Health & Disease
Prevention
no
EPA
yes
Varies
Air, Climate, and Energy (ACE)
Research Centers (Spring 2014);
Monitoring for Communities
(Summer 2014);
STAR Grants
State Legislation
yes
Varies
Legacy Funds (Clean Water
Fund, Environment & Natural
Resources Trust Fund);
Environmental Fund
LCCMR (LegislativeCitizen Commission
on MN Resources)
yes
Minnesota’s Environment &
Water resources,
environmental ed, air
quality, methods to protect,
restore & enhance land,
water, habitat
Next RFP expected to be issued
in 01/2015 for funds available
07/ 2016. LCCMR will make
recommendations to MN
Legislature for up to 5.5% of
ENRTF.
Blue Cross Blue
Shield Foundation
yes
Growing Up Healthy: Kids
and Communities;
Health equity;
Early childhood
development
Current grantees are funded
through 2014. Planning is
underway for the next phase.
Robert Wood
Johnson
Foundation
yes
Providing all Americans
with opportunities to live
healthy lives (education,
housing, employment,
environment)
Current calls for proposals focus
on health care financing
HealthPartners
Institute for
Education &
Research
maybe, through
research
partnerships
Clinical outcomes
no
State
Funding
Foundation
Funding
UCare Foundation
yes
Preventive health care,
Quality initiatives for
chronic disease
management, promoting
healthy lifestyles,
disabilities, seniors, diverse
populations
Grant application period for this
year ends 5/30/2014
The United Hospital
Foundation (Allina)
maybe
Technology, community &
programs that help United
Hospital
no
Bush Foundation
maybe
Problem-solving processes
that lead to more effective,
equitable and sustainable
solutions
Community Innovation Grants
open August 2014;
Prizes for Community
Innovation open 4/18 – 6/5
United Health
Foundation
maybe
Improving health system &
enhancing well-being of
local communities
no
United Hospital
Foundation (Allina)
maybe
Technology, community &
programs that help United
Hospital
no
McKnight
Foundation
yes, only special
projects complementing customary public
functions
Improving the quality of life
for present and future
generations
By inquiry only
The Kresge
Foundation
yes
Community health
partnerships, healthy
environments
Community health partnerships, healthy environments,
homes and foods all accepting
applications
Doris Duke
Charitable
Foundation
yes
Four programs: Arts, Child
Well-being, Environment,
Medical Research
no
Foundation
Funding
Turner Foundation
maybe
Clean Air, Clean Water,
Environmental Health
(Featured Grantee:
American Lung Association)
By invitation only
Other
Greater Twin Cities
United Way
maybe
Children, poverty, domestic
abuse, education: currently
funds public health efforts
for UMN and City of
Bloomington
no
UMASH (Upper
Midwest
Agricultural Safety
& Health) Center
maybe
Occupational health and
safety issues in agriculture
no
10
MN Biomonitoring is not eligible for the following funding sources:
The Pew Charitable Trusts, Fairview Foundation, Wilder Research Foundation, Headwaters Foundation for
Justice, The Lawrence Foundation, PGA Foundations, The Skoll Foundation, The Rockefeller Foundation, The
Hewlett Foundation, Andrew W. Mellon Foundation, John D. and Catherine T. MacArthur Foundation, The
David and Lucile Packard Foundation, Flora Family Foundation, Jack D. Hidary Foundation, Lindbergh
Foundation, CS Fund, Warsh/Mott Legacy, and CSE Fund, The Moriah Fund, Cottonwood Foundation, Steven
and Michele Kirsch Foundation, The Hitachi Foundation, The Arca Foundation, Adolf Coors Foundation, AFLAC
Foundation, Alexander & Margaret Stewart Trust, Baxter Int’l Foundation, California Endowment, Caring
Foundation, Dyson Foundation, Duke Endowment, Hugh Kaul Foundation, JSM Charitable Trust, LaNasa-Greco
Foundation, Lawrence J. & Florence A. DeGeorge Charitable Trust, Leon Levine Foundation, LK Whittier
Foundation, Marguerite Casey Foundation, Michael & Susan Dell Foundation, Robert W Woodruff Foundation,
Summit Foundation, Allegis Group Foundation, Inc., Allen Foundation, Inc., American Legion Child Welfare
Foundation, Anheuser-Busch Corporate Giving, Caterpillar Foundation, CIGNA Foundation, The Goodrich
Foundation, Inc., Healthy Tomorrows Partnership for Children Program (HTPCP), Kroger Co. Foundation, May
Department Stores Foundation, The McKenzie Foundation, Inc., The Medtronic Foundation, Northwest Health
Foundation, The PMI Foundation, PPG Industries Foundation, Public Welfare Foundation, Prudential
Foundation, The Square D Foundation, Target Stores Community Giving Grants, W.M. Keck Foundation
11
Table 2. Sustainable Funding Strategies
Short Term (1-2 years)
Mid Term (3-5 years)
Long Term (5-10 years)
PCA conversation to position for next
legislative funding discussion
Reinstate ongoing
appropriation for
biomonitoring
Research how other long term
programs sustain themselves:
Air/water/biomonitoring in other
states
Brand MN Biomonitoring Chemicals
in People
CDC Grant
Ongoing appropriation (comparable to
birth defects)
Focus group the brand
Publish- previous project
Public Health Studentscommunication, web design, etc.
work support
Students support: publish
Frame communication for the
audience
Senior project practicum: test
MDH ideas
Advocates request legislative hearing
Explore targeted pilot project
Education & outreach of legislative
and others
Align pilot projects with
foundation funding and
community needs
Communication Plan
Environmental Funding Fee
for biomonitoring
Tell the Story
Lay the base for the importance of
program (infrastructure/do)
Communicate the capacity, what has
been done, compare to other states
and explain the importance.
Teleconference or webinar with all
organizations to learn
Communicate the voluntary nature
of program and it is transparent and
beneficial
Keep dedicated communication in
budget
Compare the money that goes into
monitoring air/ water and fish & the
money for people
State Lab Grant Award Determined
Investigate fee based funding and
where the money goes
12
Section Overview: MN FEET Protocol Review
Jessica Nelson will provide an update on the progress being made on the development of the
MN FEET Protocol.
Questions to the panel:
•
•
•
Do you agree with our proposed plan for participant recruitment, consent, and data
collection?
Do you have advice on the key questions posed in Figure 1? Are there other questions
we should be asking?
Does the data analysis plan seem reasonable given the study design?
MN FEET Protocol Review
Background/update
Minnesota Family Environmental Exposure Tracking (MN FEET) will test mercury and other
metals in 400-500 pregnant women and newborns from diverse Minnesota populations. Staff
presented a start on a draft protocol at the February 2014 Advisory Panel meeting. This writeup provides an update since February and fills in a few more pieces of the protocol.
Current plan for study design and outstanding questions
The basic study design is described in Figure 1, below. The figure also includes remaining key
questions for MDH and our clinic partners. Our plan is to recruit pregnant women from diverse
communities through prenatal clinics in the Metro area. We will ask for consent to test the
leftover portion of their baby’s newborn bloodspot for mercury and to ask a short list of
questions about mercury exposure (which will happen by trained interviewers over the phone).
We will also ask all participants for consent to test cord blood and maternal urine samples
(collected by hospital staff); this will be optional. All analyses will be performed by MDH’s Public
Health Laboratory.
Summary of Outreach meetings with Clinics and Communities
Much of our work since February has been conducting outreach about the project. A summary
of these meetings is below. Overall, feedback from these meetings has been positive and very
helpful in shaping project design and plans for outreach.
Health care providers. We met with these groups to explore the feasibility of partnering with
them on the project. Feedback included that clinic time with pregnant women is very limited; if
we want recruitment and consent to happen through clinic staff, we have to keep our message
and information short. One clinic recommended that we do more outreach to the community
first; this caused us to shift focus in our meetings slightly. Due to limited time availability in the
clinic, one suggestion was to recruit women at hospitals after birth. We explored this
possibility, but concluded that the initial contact about the project should be at the clinic, for a
variety of reasons. At this point we have not finalized partnerships with clinics/hospitals, but we
have talked with some who are interested and are planning more meetings to finalize these
relationships soon. Meetings included:
•
•
MN Council of Health Plans
community health committee
West Side Community Health
Services
•
•
•
•
Community University Health Care
Center
Regions Hospital
HealthPartners Wabasha
Northpoint Clinic
Local public health. These groups are open to collaborating with us on follow-up with
participants found to have elevated levels, pending more discussion of logistics. They also have
many helpful resources and ideas for community outreach, including community health
workers, health educators, and visiting nurse programs. Meetings included:
14
•
St. Paul-Ramsey County Public
• Minneapolis Health Department
Health
Community and advocacy groups. Feedback from these groups included useful ideas on
messaging and how best to recruit women from our target populations. A number stressed that
engaging community groups early for feedback is key and said they would be happy to review
survey questions and messaging. They warned that translation can be complicated, and that we
should be very clear on how we will share and use results at the end of the project. They
recommended using people from the community in our outreach, as recruitment will be most
effective through relationships that women have. Meetings included:
•
•
•
Isuroon
Midwest Community Resources Inc.
Hmong Health Care Professionals
Coalition
•
•
•
•
Somali Health Coalition
SoLaHmo
Conservation Minnesota
Women’s Environmental Institute
Other states. We spoke with public health programs in other states that have experience with
biomonitoring for mercury (specifically urine mercury that was traced to use of skin-lightening
creams). They shared ideas and wording for survey questions, and relayed experiences with
follow-up with participants with elevated levels. Phone meetings included:
•
New York City
•
California
MDH. We received many helpful ideas and connections to clinics that serve our populations of
interest and have established relationships with MDH. We also gained insights and ideas for
working with our target populations, including messaging, connections with community
leaders, and ideas on project design. Meetings included:
•
•
•
SAGE program
Diabetes program
Refugee Health Program
•
•
•
Office of Minority and Multicultural
Health
Community and Family Health
Newborn Screening Program
Exposure Survey:
Each participant will answer a survey over the phone, which will include questions on possible
sources of mercury exposure and demographics. We are still working to develop draft survey
questions. The general topics will include:
•
•
•
•
•
•
•
Use of skin-lightening creams,
frequency
Fish consumption, local and storebought
Mercury thermometer/light bulbs
broken in home
Dental amalgams
Occupation
Use of herbal medicines
Other diet
•
•
•
•
•
•
Smoking
Maternal age
Race/ethnicity
Income
Education
Occupation
15
Once we have questions drafted, we will ask for input from community groups about wording, content, and
usability.
Data analysis Plan
The data analysis for this project will have a number of goals.
1. Characterize exposure to mercury. For all three sample types (newborn bloodspot, cord blood,
maternal urine), we will determine percent detection, geometric mean (if appropriate), median, and
upper percentiles. We will also determine percent with elevated levels. We will compare results to
those from other MDH studies, where appropriate, including Mercury in Newborns in the Lake
Superior Basin, Pregnancy and Newborns Exposure Study, NCS Newborn Mercury Biomarker Validation
Supplemental Methodological Study, and Riverside Newborn Mercury Project. We will also compare
results to studies in other places, including statewide bloodspot testing in UT; urinary mercury testing
in NHANES and other states such as CA and New York City; and other cord blood studies.
2. Identify disparities that may exist. We will analyze differences in mercury concentrations in all three
sample types by race/ethnicity. We will also analyze differences by measures of socioeconomic status.
In addition to geometric means/medians, we will look at differences in upper percentiles and percent
elevated. We hope to have sufficient sample size to be able to make comparisons between these
groups:
a. Somali/other African
b. Hmong/other Asian
c. Latino and African American – if sample size allows
d. Non-Hispanic White
3. Investigate sources of exposure. We will study the relationship between mercury concentrations in all
three sample types and survey responses. We will also analyze cord blood mercury speciation results
to shed light on this question.
4. Assess methods for measuring newborn mercury exposure. We will assess the relationship between
mercury concentrations in paired spot-cord-urine samples, all collected within 24-48 hours of each
other. We will look at both ratios and correlations, sensitivity and specificity.
5. Additional analytes. We will conduct similar analyses as in 1 & 2 for lead and cadmium concentrations
in cord blood.
16
17
Section Overview: Biomonitoring Updates
Paul Moyer, Environmental Manager, Public Health Laboratory, will give an update on the
Minnesota Department of Health Lab; Christina Rosebush will provide a brief update on the
East Metro PFC3 Biomonitoring Project. Other written updates in this section include:
•
•
East Metro Cancer Report Update
Mercury Updates
Information Item:
After these brief presentations, panel members are invited to comment and ask questions on
any of the updates in this section.
18
Biomonitoring Updates
Lab Update
Public Health Laboratory Submits Grant Proposal
The Public Health Laboratory submitted an application to the CDC in response to a funding
opportunity announcement (FOA). PHL proposed to collaborate with the state-funded
Minnesota Biomonitoring Program (EHTB) and the Environmental Health Division’s
Environmental Surveillance and Assessment Section at MDH to conduct this project. The project
abstract and tables describing the proposed analytes selected are provided in this section.
The target populations are children aged 3-11 (preschool to adolescence) and pregnant women
from urban and rural communities. The communities selected for the Urban Project are diverse
urban communities that include people from a wide array of racial/ethnic and socioeconomic
backgrounds, and a number of large immigrant groups. The Urban Project will work with clinics
in Hennepin and Ramsey Counties, which are home to the cities of Minneapolis and St. Paul,
respectively. The communities selected for the Rural Project are Hubbard, Otter Tail, and
Wadena counties, located in the Central Sands region. Most of the land area in these counties is
classified as “small rural” and “isolated” i 1
1F
0F
This project proposes to use the existing EHTB Advisory Panel and establish new Community
Advisory Committees for Urban and Rural Projects.
•
•
Work with EHTB Advisory Panel for scientific guidance on project design, activities, and
results interpretation.
Establish Community Advisory Committees for Urban and Rural Projects, comprised of
community members and other local stakeholders, to meet regularly throughout project
to review plans and materials and offer guidance on topics related to community
involvement, participation, and results communication.
Abstract
Minnesota Public Health Laboratory Biomonitoring for Improved Exposure Assessment of
Vulnerable Populations
Minnesota is a unique state with diverse peoples, industries, and geology. As a result,
Minnesotans’ exposures to environmental chemicals of concern may be different than
exposures measured in national biomonitoring studies such as the CDC’s National Report on
Human Exposure to Environmental Chemicals. In 2013, Minnesota’s state-funded
biomonitoring program conducted a strategic planning process to gather feedback from key
state biomonitoring stakeholders on their vision for a future state biomonitoring program.
Stakeholders concluded that children, pregnant women, and newborns are key target
populations for biomonitoring, and that disadvantaged populations (racial/ethnic minorities
1
Rurality defined by Rural-Urban commuting areas.
19
and people with lower incomes) and agricultural/rural communities are also an important
focus.
While MDH’s extensive current and past biomonitoring work has allowed us to begin answering
important questions about environmental exposures in Minnesotans, key concerns remain
about exposures in our most vulnerable populations: children and pregnant women from rural
as well as diverse urban communities. Therefore, there is a need to increase Minnesota’s
capability to conduct biomonitoring in order to measure state-specific chemicals of concern in
exposed populations in geographically distinct and geologically vulnerable areas of the state.
The purpose of this project is to increase the capacity of MDH’s Environmental Laboratory
Section (ELS) to conduct high-quality biomonitoring science and to assess human exposure in
vulnerable populations to environmental chemicals of local concern. Improved exposure
assessment will enable MDH to accurately identify at-risk population groups and implement
data-driven strategies to reduce or eliminate exposures of concern. To increase capacity, ELS
will build on current skills and proficiencies developed for LRN-C and previous biomonitoring
analyses to utilize expertise from CDC. ELS will work with CDC to expand current methodology
to add analytes as well as bring additional CDC methods online at ELS using current analytical
platforms. MDH proposes to measures this suite of analytes in biospecimens collected from
children aged 3-11 and pregnant women from select urban and rural communities within
Minnesota.
To do so, ELS will leverage current collaborative partnerships with MDH programs within the
Chronic Disease and Environmental Epidemiology (CDEE) and Environmental Surveillance and
Assessment (ESA) Sections. These collaborations have applied state and federal funding to
conduct biomonitoring studies in a varying scope of complexity from small pilot projects to
larger scale multi-method, multi-analyte studies of 500 participants or larger. ELS will also
leverage a strong history of collaborations with stakeholders including local public health
agencies, advocacy and community groups, and other state agencies to improve efficiency of
biomonitoring efforts and enhance partnerships. Biomonitoring work at MDH is based on sound
science, supported by state legislative initiatives, and provides a solid foundation upon which to
expand capabilities and capacities for future biomonitoring that will improve the health of all
Minnesotans
20
Table 3. Overview of Proposed Study Chemicals
Analyte Class
(exposure concerns)
Healthy
People 2020
Link to State Policy
NHANES comparison
Metals, blood and urine
(diet, drinking water,
housing, products, smoking)
Yes
1)Toxic Free Kids Act
2) Multi-agency mercury reduction
3) Fish consumption advice
4) Skin-lightening creams outreach
5) 2014 lowering of MDH definition of an elevated
blood lead from 10 μg/dL to 5 μg/dL
6) Recent lowering of MDH health-based values1 for
Mn and Cd in drinking water
Children 1-5
(blood lead, mercury,
cadmium)
Children 6-11 Adults
PAHs (urban air, smoking)
Yes2
1) Multi-agency air pollution reduction efforts
Children 6-11 Adults
Phenols (diet, products)
Yes
1)Toxic Free Kids Act 2) BPA ban
Children 6-11 Adults
Phthalates (diet, products)
Yes
1)Toxic Free Kids Act
Children 6-11 Adults
Pesticides (air, diet,
residential use)
Yes
1) State impacts from recent EPA actions on
chlorpyrifos, 2,4-D, and methyl parathion (EPA 2010;
2012; 2014b)
2) 2014 MDA Best Management Practices (BMPs) to
reduce chlorpyrifos water contamination (Minn. Stat.
103H.275, subd. 1.(a))
Children 6-11 Adults
Atrazine (drinking water)
No
1) 2011 MDA BMPs to reduce ATZ water
contamination (Minn. Stat. 103H.275, subd. 1.(a))
No3
Cotinine (smoking)
Yes4
1) Freedom to Breathe amendments to the
Minnesota Clean Indoor Air Act (Minn. Stat. 144.411417) 2) Smoking reduction efforts
No5
PFCs (diet, products,
drinking water)
No
MDH Health Risk Limits (HRLs) for PFCs in drinking
water:
PFOA: 0.3 μg/L
PFOS: 0.3 μg/L
PFBS: 7 μg/L
PFBA: 7 μg/L
Adults
__________________
1
Under the Groundwater Protection Act of 1989, MDH establishes health-based guidance values for all contaminants in drinking water.
Reduction of toxic air emissions; reduced exposure to secondhand smoke among children.
3
Atrazine mercapturate measured in NHANES is not highly relevant to environmental exposures (Barr et al., 2007)
4
Reduced exposure to secondhand smoke among children
5
NHANES measures cotinine in serum, not urine; percent exposed to secondhand smoke can be extrapolated and compared.
2
21
Table 4. Proposed Expanded and New Laboratory Method Development
Method
Current analytes
Expanded analytes
Urine Metals
As, Be, Co, Sr, Mo, Sn,
Sb, Ce, Ba, W, Pt, Th, Pb,
U, Cd, Mn
Blood Metals
Pb, Cd, Hg
Speciated As (urine)
As3+, As5+, DMA, MMA,
AB, AC
Speciated Hg (blood)
Inorganic mercury,
methyl mercury
Hydroxy-PAHs (urine)
1-PYR
1-NAP, 2-NAP, 9-FLUO, 2-FLUO, 3FLUO, 1-PHEN, 2-PHEN, 3-PHEN, 4PHEN
Environmental phenols (urine)
BPA, TCS
BZP, MePB, EtPB, PrPB, BuPB, 4-t-OP
PFCs (serum)
PFBA, PFPeA, PFHxA,
PFOA, PFNA, PFBS,
PFHxS, PFOS
Mn
Table 5. Proposed MDH ELS New Methods
Method
Analytes
Urine Mercury
Hg
Universal Pesticides (urine) (specific
OP pesticides, synthetic pyrethroids &
select herbicides)
PNP, TCPY, MDA, IMPY, DEAMPY, 2,4-D, 2,4,5-T, 3-PBA, 4-F-3PBA, cis-DCCA, trans-DCCA, cis-DCBA
Phthalate metabolites (urine)
(phthalates and phthalate
alternatives)
MMP, MCPP, MEP, MiBP, MBP, MBzP, MEHP, MECPP, MEHHP,
MEOHP
Atrazine (urine) (ATZ and ATZ
degradates/metabolites)
ATZ, DEA, DIA, DAA, ATZ-Mer, DEA-Mer, DIA-Mer, DAA-Mer, ATZOH, DEA-OH, DIA-OH, DAA-OH
22
East Metro PFC3 Biomonitoring Project Update
Christy Rosebush, MPH, and Jessica Nelson, PhD
Recruitment Update
As of the printing of this book, 151 members of the Original Cohort (those who participated in
the previous studies) have consented to participate in PFC3. This represents an 86%
participation rate that will likely increase by completion of the study. Recruitment of New
Residents (individuals who moved to Oakdale after the public health intervention and have not
participated in the previous studies) is entering its second phase. Up to three mailings were
sent to 1,000 randomly selected Oakdale households that began city water service after
October 2006. Follow-up phone calls were made to all households that did not respond to the
mailings and for which a phone number was available. Overall, household survey response was
~35% and resulted in 402 eligible individuals. Of those eligible, 225 new residents were
randomly selected and invited into the study.
Timeline
Collection of blood samples from the Original Cohort and New Residents is scheduled to be
completed by August 2014. The Original Cohort began giving blood samples for the project in
March, and New Residents will give their samples beginning in June. The MDH Public Health
Laboratory will analyze samples, and participants will receive their individual blood PFC results
as they become available in early fall 2014. We will seek input from the Panel on the
community results at our February 2015 meeting before presenting them to the public in
March 2015. Community results will include analyses of PFC levels and questionnaire responses
among our study groups and comparisons of levels to the U.S. general population.
New Renters Sample
There is concern that the sampling strategy for New Residents –using city water billing records
– will result in an underrepresentation of renters disproportionately (low income and
minorities) in the final study population. Therefore, we are currently planning an add-on to the
project that will measure PFCs in a small group of new Oakdale renters (~50 people who moved
in after October 2006). We are working with local public health partners to determine the best
way to reach renters, but we will likely contact them through the Washington County Housing
and Redevelopment Authority (HRA) or property managers at a small number of multiunit
complexes. Because there is not a comprehensive list of rental property tenants, our results will
not be representative of all Oakdale renters.
East Metro Cancer Report Update
MN Tracking and the Minnesota Cancer Surveillance System (MCSS) have continued work on a
report that details cancer rates among residents of Dakota and Washington Counties between
2000 and 2009. This report is an update to a 2007 report released by MCSS. It will provide
Standardized Incidence Ratios for select types of cancer and for all cancers combined down to
the zip code level for 8 communities where PFCs have raised health concerns. The report is
being reviewed by MDH staff, and we anticipate that it will be released in summer 2014.
Mercury Projects Update
Pregnancy and Newborns Exposure Study
23
This project partnered with researchers at the University of Minnesota to measure mercury
concentrations in paired cord blood and newborn bloodspots from 48 newborns in the
Minneapolis area. The MDH Public Health Laboratory (PHL) is still investigating whether the
higher mercury levels found in cord compared to spot blood could be related to the lab
method; analyses are underway and will hopefully be completed in May. Once these analyses
are done, we plan to resubmit a manuscript on the relationship between mercury levels in
paired newborn bloodspot and cord blood samples to another journal. Cord blood samples with
mercury levels >1
g/ L will
eciated
mercury.
also be Once
analyzed
all analyses
for sp are
complete, we will summarize the results and post them on the web site.
NCS Newborn Mercury Biomarker Validation Supplemental Methodological Study
This project will measure mercury and other metals in matched cord blood, newborn
bloodspot, and maternal blood samples from National Children’s Study participants enrolled by
South Dakota State University’s Original Vanguard Center serving Brookings SD, and Yellow
Medicine, Pipestone, and Lincoln Counties, MN. All samples (83 pairs of matched newborn
bloodspot and cord blood samples, with maternal blood samples at birth from 49 of these
mothers) have been received by the PHL. Samples will be analyzed for total mercury and cord
blood will also be analyzed for speciated mercury, lead, and cadmium. Staff are still finalizing
Data Use Agreements with the NCS. Lab analysis will hopefully be completed this summer, and
results will be summarized and posted on the web site.
Riverside Newborn Mercury Project
This project will measure mercury in newborn bloodspots from participants in the University of
Minnesota’s Riverside Birth Study. The PHL has received 160 newborn bloodspot samples. Lab
analysis for total mercury will hopefully be completed this summer, and results will be
summarized and posted on the web site.
24
Section Overview: MN Tracking report: The Economic Burden of the
Environment on Childhood Disease in Minnesota
In this section, Panel Members are invited to review and provide comment on excerpted
sections of a new report currently being drafted by the Minnesota Tracking program called: The
Economic Burden of the Environment on Childhood Disease in Minnesota. The sections cover
only the introduction, methods and findings for two child health conditions that are known to
be related to environmental risks: asthma exacerbations and blood lead poisoning.
This report is a collaborative effort of several state partners in the National Tracking program.
The report demonstrates one way that Tracking data can be used for informing environmental
public health policy at the state level. It adopts methods published and used previously in
similar national and state reports, and updates them with current disease and cost information.
The outline for the full report that is currently planned is as follows:
Executive Summary
Introduction*
Methods Overview (brief)*
The Cost of Childhood Asthma*
The Cost of Childhood Blood Lead Poisoning*
Limitations of this Analysis*
Public Health Actions for Addressing Childhood Disease and Environmental Risks
References*
Appendix: About the Data (technical notes and detailed methods)*
*Excerpted sections included in this review.
Questions to the panel:
•
•
Given the limitations, what is the primary value of this report? How well does it serve its
intended purpose of informing public health policy?
Should this report be updated or modified in the future to add other diseases or
conditions? If so, what in the future? If so, what changes are needed?
25
MN Tracking report: The Economic Burden of the Environment on Childhood
Disease in Minnesota
A report from Minnesota Environmental Public Health Tracking, 2014
Introduction
Several reports published over the past decade have estimated the costs to individuals and to
society due to chronic diseases and developmental disorders in children (WHO’s Preventing
disease through healthy environments; EPA’s America’s Children and the Environment).
Childhood diseases have substantial impacts on families and communities. In a previous report,
childhood conditions caused or aggravated by exposure to environmental pollutants in
Minnesota were estimated to be in the range of $1.4 to $1.9 billion (Schuler et al., 2006).
This report focuses on two important environmentally-related health conditions in children:
asthma, and blood lead poisoning. It documents the economic cost of these conditions in one
year, 2010, from current surveillance data and estimates the fraction that is attributable to
environmental risks. The report is intended to inform decisions by the public, policy-makers and
advocacy groups so that policy decisions and resources are directed towards actions that will
have the greatest impact both in reducing the amount of childhood disease and in saving
money.
MN Tracking was established in 2007 by the Minnesota Legislature (MN Statutes, sections
144.995-998) and, in 2009, joined 23 other states as part of the Centers for Disease Control and
Prevention (CDC) National Tracking Network. For this report, MN Tracking is collaborating with
CDC and other states with tracking programs including California, Connecticut, Florida, New
Hampshire, and Oregon. The Tracking Network is committed to making quality public health
data more accessible and useful to the public for informing and evaluating environmental
public health action and policies.
Methodology Overview
This study adopts methods established in previously published works (Landrigan et al., 2002;
Trasande et al., 2009) and updates these methods with current state data and information.
The formula
The basic method for estimating the economic burden of environmentally-related disease relies
on the following formula, the components of which are described below:
Economic burden = disease counts x cost per case x environmentally attributable fraction
(EAF)
Economic burden is estimated as the number of cases of disease in a defined population and
specified time period, multiplied by the environmentally attributable fraction (EAF) and the
estimated cost per disease case. The time period used was the 2010 calendar year.
Counts of disease cases
MN Tracking staff worked closely with data partners, the Minnesota Asthma Program and the
Minnesota Lead and Healthy Homes Program to determine the number of disease cases in
2010. Data for asthma hospitalizations and emergency department visits were obtained from
26
Minnesota Hospital Association, in collaboration with the Minnesota Asthma Program.
Estimates of average blood lead levels in children were calculated based on MN Blood Lead
Information System data.
Estimating costs per disease case, direct and indirect
For asthma, cost estimates were derived from the literature for direct medical care costs per
case in 2010 including the costs of hospitalizations, emergency department visits, and
medications. In addition, some indirect costs are calculated for asthma, including wages lost
from a parent who cares for a case child. For childhood lead poisoning, cost estimates were
calculated using wages lost from the impact of a lower IQ on lifetime earning capacity.
The environmentally attributable fraction (EAF)
The environmentally attributable fraction, or EAF, is the estimated proportion of disease cases
that are that are thought to be causally associated with environmental risks. Environmental
risks for this report include modifiable physical and chemical factors in air, water, home and
community environments, and generally exclude naturally occurring pollutants and behavioral
risk factors such as smoking, diet or product use. It is also limited to risk factors that could be
quantified based on the available scientific evidence.
EAF estimates the fraction of the disease that would be avoided or eliminated, if the
environmental risk were removed or reduced to the lowest level possible. Published relative
risk estimates from the epidemiological literature and the prevalence of the exposure in the
population are used to calculate the EAF. This study will rely on the EAF estimates first
published by Landrigan et al. in 2002 and updated by Trasande et al. in 2011.
Asthma hospitalizations for Minnesota children
Asthma hospitalization rate
per 10,000 children
The Costs of Childhood Asthma
Asthma burden and trends in
Minnesota
About one in 14 children and
one in 12 adults in
Minnesota currently have
asthma, adding up to more
than 410,000 Minnesotans
directly impacted by the
disease.
Twin Cities Metro
Greater Minnesota
25
20
15
10
5
Asthma hospitalization rates
0
among children (ages 0-17
years) in the seven-county
Twin Cities metro area have
decreased dramatically since
2000; however, they remain the highest in the state.
Many of the indicators of the burden of asthma in Minnesota are improving. Asthma
hospitalization rates continue to decline in the seven-county Twin Cities metropolitan area,
particularly among children. Rates of asthma-related emergency department (ED) visits have
27
remained relatively stable since 2005. After a dramatic decrease through 2006, statewide
asthma mortality rates have been rising slowly, with a small decline in 2011.
Disparities observed (race, ethnic, urban/rural, income)
Asthma prevalence in Minnesota is currently lower than the national average; however, there
are significant disparities in prevalence by race/ethnicity. According to data from the Minnesota
Student Survey, 21% of American Indian and 24% of African American youth report an asthma
diagnosis compared to 16% for White and Hispanic students, and 13% for Asian students.
Among adults, asthma prevalence is higher among Blacks (14%) than Whites (8%). Disparities in
asthma prevalence by race/ethnicity are also evident among enrollees in Minnesota’s medical
assistance programs, with the highest prevalence among Blacks.
There are striking geographic disparities in rates of asthma-related ED visits and hospitalizations
in Minnesota. Asthma hospitalization rates among children living in the Twin Cities
metropolitan area are 54% higher than among children living in Greater Minnesota. Rates of
asthma-related ED visits are nearly twice as high among children in the Twin Cities metro area
compared to children in Greater Minnesota.
Risk factors for asthma and the environmental attributable fraction
Most acute asthma episodes (exacerbations), including those resulting in hospitalizations, are
preventable if asthma is properly managed according to established medical guidelines, which
include reducing exposures to environmental triggers (NHLBI, 2007). A variety of factors can
trigger an asthma episode, including viral respiratory infections; exposure to allergens (e.g. dust
mites, (dander) protein particles shed by cats and dogs and pollen); exercise; tobacco smoke;
air pollution; strong emotional expressions; chemical irritants; and drugs (aspirin and beta
blockers).
The association between ambient air particulate matter (PM) concentrations and asthma,
including increased hospital admissions, is well documented (Jörres, 1998; Trasande, 2005).
Researchers have shown 5-20% increases in respiratory-related hospitalizations per 50µg/m3 of
PM10 and 5-15% per 25µg/m3 of PM2.5 or PM10-2.5, with the largest effect on asthma
hospitalizations (US EPA, 2004). In the Eastern U.S., summer ozone pollution has been shown to
be associated with more than 50,000 hospital admissions per year for asthma and other
respiratory conditions. U.S. and Canadian studies have shown warm season ozone-associated
increases in respiratory hospital admissions ranged from 2-30% per 20 ppb (24 hours), 30 ppb
(8-hours) or 40 ppb (1-hour) (US EPA, 2006).
EAF for asthma
Estimate: 30% (ranges from 10% to 35%)
•
•
According to Landrigan 2002, a panel of experts determined 30% of asthma episodes
(exacerbations of childhood asthma) can be attributed to outdoor air pollution (e.g.,
vehicle exhaust and power plant emissions).
This estimate does not include exacerbations due to insects, mold, secondhand
cigarette smoke, pollen, or respiratory infections.
28
Economic Burden
The methods and data used to estimate costs for asthma are based on previous research and
the CDC Chronic Disease Cost Calculator. The cost calculator estimates costs accrued over the
course of one year for medical and indirect costs (2010) for children 0-17 years. All costs were
adjusted to 2014 dollars. CDC has developed this cost calculator to provide state-level
estimates of medical expenditures and absenteeism costs.
The number of deaths in Minnesota children due to asthma is quite small and can vary from
year to year. Therefore, a five year average (2007-2011) was used to calculate annual average
number of premature deaths. Mortality cost for the premature death of a child was estimated
using the present value of lifetime earnings (Max, 2000). Values were averaged for both boys
and girls for 0-17 years of age.
Types of costs estimated included for this report:
•
•
•
Direct medical and non-medical costs
Indirect costs, such as lost parental earnings due to school absenteeism
Lost potential earnings due to premature death
Table 6: Cost of childhood† asthma in 2010 attributable to the environment in Minnesota.
Total
Annual cost EAF
EAF
EA Cost
EA Cost
1
Type of cost
Included in cost
(2014$)
(low) (high)
(low)
(high)
Physician visits,
ED,
Direct medical hospitalizations,
$80,190,000 0.10 0.35
$8,019,000
$28,066,500
prescription
medication
Indirect
Lost earnings due
to missed school
days
Deaths2
2 premature
deaths
$23,840,000
$1,400,000
0.10
0.35
$2,384,000
$8,344,000
0.10
0.35
0
$2,800,000
Total
$10.4 million $39.2 million
1
Cost data from CDC Chronic Disease Cost Calculator
Annual count based on 5-year average (2007-2011)
†
Children aged 0-17 years.
2
29
The Costs of Childhood Blood Lead Poisonings
Disease burden in Minnesota
Lead poisoning is a medical condition that occurs when lead builds up in the body. Elevated
blood lead levels (EBLLs) in young children are associated with adverse health effects, including
learning impairment, behavioral problems, and even death at very high levels.
The proportion of children with lead poisoning has declined over time in Minnesota, from about
2% of children born in 2000 to less than 1% of children born in 2009, among children tested
before 3 years.
Threshold for EBLLs lowered
There is no safe level of exposure to lead. The threshold for an “elevated blood lead level” in
Minnesota was recently lowered from 10 to 5 µg/dL (in 2014). The CDC also recently lowered
the threshold to 5 µg/dL, and future reductions are likely. This threshold is used to trigger
actions for investigation and remediation
of sources of lead in the home.
Minnesota will begin tracking this new,
lower threshold for EBLLs in 2014.
Elevated blood lead levels are declining
in Minnesota
It is important to test for lead poisoning
because it often occurs with no
identifiable symptoms. The percentage
of tested children with elevated blood
lead levels, previously defined by the
state of Minnesota as a level of 10 µg/dL
or higher, has been decreasing.
Because blood lead testing in Minnesota
is targeted and not universal, this
measure is not generalizable and cannot
be used to interpret the prevalence or
incidence for the overall population of
children living in Minnesota.
Disparities observed (income and region)
Children in poverty are at greater risk for
lead poisoning. Although the percent of children living in poverty in Minnesota is lower than
the national average, there are still many children living in poverty in the state and, therefore,
at increased risk for childhood lead poisoning. About 15% of all children (<18 years) and about
17% of all children under age 5 in Minnesota are living in poverty. The majority of counties in
northern Minnesota have a higher percentage of children living in poverty, compared to the
state average of 15%, as do Hennepin and Ramsey Counties.
30
Risk factors for childhood lead poisoning and the environmental fraction
Children less than 6 years of age living in homes built before 1978 are most at risk for lead
poisoning. Younger children are more at risk because their bodies absorb lead more easily and
their brains are still developing. Lead-based paint is a common cause of lead poisoning. People
can be exposed to lead by ingesting dust from deteriorated lead paint, consuming other
materials contaminated with lead, or breathing aerosolized lead paint dust. Young children
frequently put their hands or other objects, which may be contaminated with lead, into their
mouths. The U.S. Environmental Protection Agency (EPA) estimates that more than 80% of all
homes built in the U.S. before 1978 contain lead-based paint.
EAF for childhood lead poisoning
According to Landrigan 2002, all cases of lead poisoning are assumed to be of environmental
origin. Therefore, the EAF is 100%, and no range was calculated.
Economic Burden
This analysis included children born in 2004 and tested up to age 6. About 54,000 Minnesota
children born in 2004 were tested before the age of 6, or about 76% of the 2004 birth cohort.
The average peak blood lead level (BLL) among children born in 2004 and tested up to age 6 is
2.5 micrograms of lead per deciliter of blood (µg/dL). This BLL was converted into lost IQ points,
then into lost lifetime earnings for boys and girls, separately. The total economic burden of
childhood lead poisoning in Minnesota on lifetime earnings is $1.9 billion (in 2014$), due to lost
lifetime earnings.
Table 7: Calculation of percent lifetime earnings lost due to childhood lead poisoning in
Minnesota.
Mean peak BLL
IQ points lost
due to lead
poisoning
Total IQ points lost
due to lead
poisoning
Lifetime earnings lost
due to IQ points lost
Total lifetime
earnings lost
2.5 µg/dL
0.47 IQ points
1.19 IQ points
2.39%
2.85%
per 1 µg/dL
per IQ point lost
Table 8: Cost of childhood lead poisoning as of 2010 attributable to the environment in
Minnesota.
Lifetime
earnings
per child
(2007$)
$1,055,542
(boys)
$622,653
(girls)
Lifetime
earnings lost
due to lead
poisoning
(see Table 3)
Lifetime
earnings lost
per child
Number
of
children in
2004 birth
cohort
Lifetime
earnings lost
for 2004 birth
cohort
Sum of
lifetime
earnings lost
for 2004
birth cohort
2.85%
$30,117
(boys)
35,988
boys
$1,083,833,838 $1.7 billion
(boys)
(2007$)
$1.9
billion
2.85%
$17,765 (girls)
34,626
girls
$615,145,548
(girls)
$1.9
billion
$1.7 billion
(2007$)
Final
economic
burden
(2014$)
31
Limitations of this analysis
This report addresses specific costs related to medical care that are measurable with the
available data at MDH and CDC. Several costs are not included in the estimates for these
childhood diseases. For example, the costs to treat childhood lead poisoning or conduct
environmental assessments of lead exposure are not included in this analysis, either because
the cost is at least an order magnitude smaller than the cost of lost lifetime earnings or because
the cost cannot be estimated. This report does not capture the longer term effects of
environmental exposures that occur at young age, but do not appear as disease until later in
adult life. Therefore, the costs calculated in this report likely underestimate the true cost to
Minnesota’s economy of environmentally-related diseases in children.
The EAFs for asthma used in this report are based on published scientific studies that measure
the relationship between specific risks and disease in populations. However, estimating the EAF
is itself not a scientific measurement, but is based on judgment by experts. The studies are not
specific to Minnesota populations, and the estimates do not include the most recent science
published in the past few years. The true fraction of these diseases that is attributable to
environmental factors in Minnesota is unknown. The EAF is specific to population, time and
place. It can change over time in a given population, and it can be different from one
population to the next. The EAF can also be modified over time by better population health
care that leads to reduced population vulnerability, and environmental interventions that
reduce exposure.
We know that the burden and cost of environmentally attributed disease in Minnesota’s
children is not shared equally across all communities of the state. Ample evidence points to
significant disparities in our state with respect to the occurrence of childhood asthma
exacerbations, and the prevalence of blood lead poisoning, both of which are known to be
greater in lower income communities. In addition, environmental exposures to pollutants are
not shared equally. For example, residential communities located close in proximity to high
traffic corridors experience greater pollutant levels from vehicle exhaust. Communities that are
economically disadvantaged are less able to take actions to avoid environmental risks in their
homes and neighborhoods, which further leads to a disparate burden.
References
Primary references:
This report is based on methodology developed by the National Academy of Sciences, and by
Philip Landrigan and colleagues, and published in Environmental Health Perspectives in 2002;
the method was later updated by Leonardo Trasande and Yinghua Liu in 2011.
Landrigan PJ, Schechter CB, Lipton JM, Fahs MC, Schwartz J. Environmental pollutants
and disease in American children: estimates of morbidity, mortality, and costs for lead
poisoning, asthma, cancer, and developmental disabilities. Environmental Health
Perspectives 110(7): 721-8, July 2002.
Trasande L and Yinghua L, Reducing the Staggering costs of Environmental Disease in
Children, Estimated at $76.6 Billion in 2008. Health Affairs, 30 no. 5 (2011):863-870.
32
Other selected references:
CDC Chronic Disease Cost Calculator Version 2.
www.cdc.gov/chronicdisease/resources/calculator/
Consumer Price Index Inflation Calculator: http://data.bls.gov/cgi-bin/cpicalc.pl
Jörres RA, Magnussen H. Atmospheric pollutants. In PJ Barnes, IW Rodger and NC Thomson
(Eds.), Asthma: Basic Mechanisms and Clinical Management (3rd Ed.). London: Academic Press,
1998, pp. 589-596.
Max, Wendy Ph.D.; Rice, Dorothy P; Sung, Hai-Yen; & Michel, Martha. (2004). Valuing Human
Life: Estimating the Present Value of Lifetime Earnings, 2000. Center for Tobacco Control
Research and Education. UC San Francisco: Center for Tobacco Control Research and Education.
Retrieved from: http://escholarship.org/uc/item/82d0550k
MDH, Minnesota Department of Health. Asthma Program. Asthma in Minnesota: 2012
Epidemiology Report.
www.health.state.mn.us/divs/hpcd/cdee/asthma/documents/asthmaepireport2012.pdf
MDH, State of Minnesota Childhood Lead Poisoning Elimination Plan. August 2010.
www.health.state.mn.us/divs/eh/lead/reports/2010report.pdf.
MDH, Minnesota Department of Health. Commissioner’s finding.
www.health.state.mn.us/divs/eh/lead/commfind14.pdf
National Heart, Lung, and Blood Institute. Expert Panel Report 3 (EPR-3) Full report 2007:
Guidelines for the diagnosis and management of asthma. Washington, DC, U.S. Department of
Health and Human Services, 2007
Schuler, K., S. Nordbye, S. Yamin, et al. 2006. The Price of Pollution: Cost Estimates of
Environment-Related Childhood Diseases in Minnesota. Minnesota Center for Environmental
Advocacy.
Trasande L, Landrigan PJ, Schechter CB. Public health and economic consequences of methyl
mercury toxicity to the developing brain. Environmental Health Perspectives 113(45): 590-6,
May 2005.
Trasande L, Thurston GD, The role of air pollution in asthma and other pediatric morbidities. J
Allergy Clin Immunol 2005; 115: 689-99.
U.S. EPA. America’s Children and the Environment, Third Edition (ACE3). www.epa.gov/ace/
World Health Organization (WHO), 2006. Preventing disease through healthy environments.
www.who.int/quantifying_ehimpacts/publications/preventingdisease/en
33
Appendix: About the Data (Technical Notes)
Childhood Asthma Data Analysis
Methods for Asthma
The data for asthma analysis were obtained from the Chronic Disease Cost Calculator (version
2). The cost calculator was developed to provide state level estimates of medical expenditures
for certain chronic diseases. Expenses included direct medical costs (physician visits, emergency
department visits, hospitalizations, and prescription medicine) as well as indirect costs resulting
from absenteeism. Data for children in the cost calculator are only available for asthma and
depression. The methods utilized by the cost calculator are described in great detail in their
technical appendix. Briefly, data were collected from multiple sources to estimate the treated
population and per-person medical and absenteeism costs. Complex survey weights were used
to incorporate data from Medicaid Statistical Information System, Current Population Survey,
and Medical Expenditure Panel Survey. Regression models were used to estimate the costs
associated with asthma. The number of children that died from asthma was obtained from the
Asthma Program and the Minnesota Department of Health (Asthma Epi Report, 2013).
Death from asthma in children is a rare event. To deal with some annual variation in the
numbers, an annual average was calculated over 5 years of data: 2007-2011. The estimate of
the economic cost of premature death in children used data from Center for Tobacco Control
Research and Education, University of California, San Francisco. Their methods are described in
detail in Valuing Human Life: Estimating the Present Value of Lifetime Earnings. The appendix of
this paper contains present value of lifetime earnings by age. For asthma, the values for 0-17
years were averaged to get one value to assign for a premature death of a child.
All costs were converted to 2014 dollars using the Consumer Price Index Inflation Calculator.
The low and high end estimates of the EAF were applied to the costs to show a range of
estimates of the economic burden.
Childhood Lead Poisoning Data Analysis
Methods for Mean Peak Blood Lead Level (BLL)
This analysis included children born in 2004 and tested up to age 6 (2004-2010 test years), and
therefore represents the status of average peak BLLs as of 2010, using the cumulative incidence
of children exposed to lead up to age 6, similar to Landrigan et al (2002). Blood lead testing is
not universal in Minnesota. Instead, high-risk children are targeted. Because testing is not
random, this measure is not generalizable and cannot be used to interpret the prevalence of
lead poisoning for the overall population of children living in Minnesota.
If there were multiple lead tests between 2004 and 2010 for a child, the highest (peak) BLL was
selected. Venous lead tests were selected over capillary tests because capillary tests have a
greater rate of false positives. Detectable results were preferred over BLLs below the limit of
detection (LOD), also known as nondetects. The LOD changes depending on the laboratory due
to differences in analytic methods, equipment, and reporting limits. Nondetects were
addressed using robust linear regression on order statistics (ROS) methods, which applies a
theoretical distribution to the data in order to calculate a mean and confidence interval.
34
Results for Mean Peak BLL
The average peak blood lead level (BLL) among children born in 2004 and tested up to age 6 is
2.5 micrograms of lead per deciliter of blood (µg/dL). This estimate is specific to Minnesota
children testing for blood lead.
About 54,000 Minnesota children born in 2004 were tested before the age of 6, or about 76%
of the 2004 birth cohort. Lead testing is not universal in Minnesota. Instead, high risk children
(such as those that live in older housing that may have lead-based paint) are targeted for lead
testing. Because lead testing in Minnesota is targeted and not random, any measures calculated
using lead testing data are not generalizable and cannot be used to interpret the prevalence or
incidence for the overall population of children living in Minnesota.
Methods for Economic Cost (see Table 3)
The measurable costs of lead exposure include crime due to lead exposure as well as health,
earnings, and welfare use due to loss of IQ from lead exposure (Muenning, 2009). Landrigan
only includes the direct effect of lost IQ points on lifetime earnings, as does the MN Center for
Advocacy’s The Price of Pollution. Therefore, we calculated the economic burden of lead
poisoning using only lost lifetime earnings.
Using Canfield 2003 to convert BLLs into loss of IQ points, there is an estimated loss of 0.47 IQ
points (ranging from 0.25 to 0.70 IQ points lost) for every 1 µg/dL increase in BLLs (see Table 3,
unadjusted estimate of IQ loss using the peak blood lead at 5 years of age). Therefore, the 2004
birth cohort in Minnesota has lost an average of approximately 1.25 IQ points per child due to
the cumulative incidence of lead poisoning up to age 6.
According to Landrigan 2002, there is a loss of 2.39% of lifetime earnings for every IQ point loss.
Therefore, the 2004 birth cohort in Minnesota has lost an average of 2.98% of lifetime earnings.
Market productivity data for boys and girls separately were obtained from Grosse 2009. The
total lifetime earnings (in market productivity) was $1,055,542 for boys and $622,653 for girls
(2007$). Multiplying those amounts by 2.85% in lifetime earnings lost equates to $30,117 lost
per boy and $17,765 lost per girl. There were 35,988 boys and 34,626 girls in the 2004 birth
cohort in Minnesota, which equates to $1.1 million lost in lifetime earnings for boys and $615
thousand lost in lifetime earnings for girls in the 2004 birth cohort overall. That sums to $1.7
billion (2007$), and by applying an inflation index from the Consumer Price Index calculator, the
total economic burden of childhood lead poisoning in Minnesota on lifetime earnings comes
$1.9 billion (in 2014$). In summary, the mean peak blood lead level in the 2004 birth cohort,
through a decrease in IQ points due to lead exposure and a subsequent loss in lifetime earnings,
resulted in a total economic burden of $1.9 million (2014$).
35
Section Overview: Environmental Justice at the MPCA
Ned Brooks is the Environmental Justice Coordinator at the Minnesota Pollution Control
Agency, a role he has served in since 2013. During 2011-2012 while on leave from the MPCA,
Ned worked with the North American Commission for Environmental Cooperation managing
projects to reduce persistent and bio-accumulating toxic substance in North America. Prior to
that, Ned worked as the MPCA's Mercury Reduction Coordinator.
Ned will present an overview of the MPCA's current focus area: Integrating Environmental
Justice into MPCA work. He will also describe their current process for developing a screening
methodology to identify areas of potential concern for environmental justice and for tracking
the effectiveness. Key to this discussion will be for Panel Members to consider how the MN
Tracking program can assist MPCA and how data could help, both with screening and with
measuring the effectiveness of MPCA's actions as they work with EJ communities.
Questions to the panel:
•
•
How can the MN Tracking program best support the MPCA’s work?
What data would be beneficial for informing the screening process and the evaluation of
outcomes that is planned?
36
Environmental Justice in Minnesota: MPCA’s Approach
May 2014
Introduction and Background
In the fall of 2012, the MPCA renewed its commitment to practice environmental justice (EJ) in
its day-to-day work and updated its policy to strive for the fair treatment and meaningful
involvement of all Minnesotans. While similar to past efforts in its wording, the current
approach is envisioned to be significantly more robust in terms of commitment and results. To
oversee this work, the Commissioner established an internal Environmental Justice Steering
Team. In addition, the MPCA has included an environmental justice goal in its 2013-2017
Strategic Plan.
Early in 2013, the Steering Team developed an initial action plan and identified four pilot
projects to explore the deployment of environmental justice strategies and inform integration
into the Agency’s day-to-day work. The MPCA is also striving to more proactively engage
citizens and external stakeholders (including other state agencies) to understand their concerns
about EJ and to jointly explore and define our role.
During 2014, the MPCA is working with stakeholders to formalize a comprehensive and
enduring framework for integrating environmental justice, including the core principles of fair
treatment and meaningful involvement, into our day-to-day work. This plan will delineate
specific MPCA strategies and procedures; identify the role of others, including state and local
entities; identify stakeholder engagement and coordination methods; and establish a plan for
regular communication and dialogue. MPCA’s EJ integration plan will build on approaches and
tools developed and adopted at the national level, and will also draw on the experience of
other states, the work of partner state agencies, and the input of stakeholders.
This document outlines key assumptions, the current condition, and the desired future
condition as the agency develops its plan to transition to ongoing, institutionalized integration
of EJ strategies and measures.
Assumptions
• The MPCA has a responsibility to all stakeholders – from the public affected by
environmental stressors, to regulated parties, to other governments (local, national,
Tribal) – to exercise our authority and make regulatory decisions that support healthy
communities, a healthy ecosystem, and a strong economy.
• Effective integration of EJ relies on building a common understanding of the MPCA’s
obligations to all Minnesotans, the MPCA’s role, available tools and where and when we
have authority to act or intervene.
• All stakeholders must have opportunities for meaningful involvement; one goal of the EJ
efforts is to pay particular attention to those communities that may not previously have
had meaningful involvement and address barriers that have limited their ability to
engage in the Agency’s work.
• Improving EJ stakeholder engagement is part of an overall agency effort to build our
capacity and practice of authentic civic engagement.
37
•
•
The impacts of pollution vary across the state. Due to a wide variety of factors, lowerincome and minority Minnesotans in some areas of the state are disproportionately
burdened by pollution. While the MPCA may not have ability to address all the factors
contributing to these impacts, identifying and communicating about disproportionate
impacts can help foster broader efforts, including participation by those who have
authority and ability to address the problem.
The MPCA seeks to incorporate environmental justice principles across the agency in a
“foundational” manner. This is not an initiative to be completed in a short timeframe
but rather a permanent framework that will be implemented on an ongoing basis.
Current Condition
The MPCA’s Strategic Plan includes this goal: “Pollution does not have a disproportionate
negative impact on any group of people.” However, we do not have a clear, uniform
understanding of what it means to integrate environmental justice principles into our day-today work. Consequently, there are no standard processes and procedures for implementation
of this strategy. The MPCA typically has been reactive, responding to environmental justice
concerns when they arise around permitting or other agency actions. Furthermore, the agency
has not been as systematic and proactive in engaging the public as it would like to be –
particularly in identifying and addressing the barriers to meaningful involvement that some
segments of the public may face.
The result is that there may be lack of confidence in and trust of the Agency’s effectiveness in
protecting Minnesotans and our environment. As with our internal lack of clarity regarding our
role and process, the public often does not fully understand our decision-making process, our
interaction with EPA, the areas where the MPCA has or lacks authority, and their opportunities
to be involved in a meaningful way. There may be some optimism about the Agency’s recent
decision to move forward on environmental justice issues, but it is cautious.
Future Desired Condition (within 2-3 years)
• The MPCA understands, and has articulated to all stakeholders, what it means to
implement its environmental justice policy.
o All stakeholders are aware of the opportunities for meaningful involvement and
of MPCA tools available to support their involvement.
o Communication to all stakeholders is frequent, clear, and audience-driven. With
respect to EJ communities, the MPCA has made significant progress in
establishing awareness and trust; communication about Agency decisions that
may affect impacted communities is more credible.
o MPCA actions are predictable. Stakeholders understand when and where the
Agency is likely to consider EJ concerns, what analysis will be completed, and
how the results of that analysis may be used (in the context of the MPCA’s
authority).
o Stakeholders recognize that while the MPCA has an important role in actions
related to environmental and health issues, they also appreciate that there are
multiple aspects and decisions involved. They understand the MPCA’s specific
role, our policies and priorities, and the abilities and limitations of our authority.
38
•
•
The Agency has developed and deployed procedures and tools to evaluate EJ issues, to
facilitate meaningful public involvement in our activities and to work towards reducing
disproportionate environmental and human health impacts.
o Agency management and staff are aware of these procedures and tools, and
have incorporated implementation into their programs.
o The MPCA employs its data and analysis tools, along with information from other
state and federal partners, to help identify areas that may experience
disproportionate impacts from environmental pollutants, and factors that
information into agency strategies and activities.
o The Agency engages with EJ communities in order to ensure all stakeholders
meaningfully involved in decisions that may affect their community. The MPCA
continually strives to understand and address the barriers to meaningful
involvement that stakeholders may experience.
State government is coordinated in its approaches to reduce disparity across multiple
agencies and to foster meaningful involvement in its work.
Action Steps
The EJ Steering Team has identified these broad categories of work:
1. Integrate Environmental Justice strategy into MPCA program areas and procedures.
a. Establish procedures and develop tools. Work with Agency functions (permitting,
compliance and enforcement, rules, assistance and education, etc.) to develop
tools, procedures, and best practices to integrate EJ. At a minimum, this
includes:
i. Screening and Analysis of EJ “Areas of Concern” – Procedures and criteria
for evaluating environmental and demographic information to highlight
areas of potential concern for environmental justice. This will include
evaluating existing EPA and state tools and criteria.
ii. Guidance for Enhanced Outreach during MPCA Actions – Procedures and
steps that will be taken during permitting, environmental review,
rulemaking and other actions to ensure meaningful involvement of all
citizens in areas with potential environmental justice concerns. This
includes seeking public comment on decisions and providing information
to the public.
iii. Limited English Protocols – Procedures for evaluating language
proficiencies within a community and determining actions to take to
ensure meaningful access and communication.
iv. Consideration of Cumulative Impacts – Establish a framework for
identifying the need and applying specific processes to analyze the
cumulative risk from multiple pollution sources to inform MPCA decisions
and actions.
b. Work with agency programs to apply function-specific tools, and to develop
program-specific strategies, procedures, and tools to support integration of
39
MPCA’s EJ strategy into all applicable program areas. Support integration of
these procedures and tools and ensure that they are appropriately used.
c. Note: All program areas in the agency will be involved in evaluating the extent to
which integration applies. Certain programs may be asked to do more than
others to integrate EJ strategies.
2. Develop external relationships to inform and support meaningful participation of all
Minnesotans in MPCA decisions and actions.
a. Develop an external stakeholder communication plan and engagement strategy.
While focused on all key groups, special emphasis will be on communities that
may not have previously had meaningful involvement in decisions that affect
their community. This will include developing best practices and standards of
engagement, and identify and addressing barriers to meaningful involvement.
b. Members of the EJ Steering Team and the Environmental Justice Coordinator
continue to meet with individual stakeholders to understand their expectations
and desired outcomes and to communicate MPCA’s role. Attempt to identify
additional stakeholders not currently represented.
c. Meet periodically with stakeholders as a group. Explore establishment of an
external advisory group.
3. Ensure state government-wide coordination of efforts to reduce disparity among
Minnesotans with respect to health, environment, and other programs.
a. Continue Commissioner-level communication and staff follow-up.
b. Explore establishing cross-agency coordination group.
4. Track effectiveness. Develop measures to track progress in reducing disproportionate
impacts and increased engagement. Measures include:
a. Air pollution in areas of potential EJ concern:
i. Monitored levels
ii. Modelled non-cancer risks
iii. Emissions
b. Asthma healthcare utilization rates
c. Stakeholder engagement/participation
40
Section Overview: Tracking Updates
Chuck Stroebel and Jeanette Sample have provided tracking updates in the following pages.
•
•
•
•
•
CDC Renewal Application
Portal Updates
New Health Impact Assessment Toolkit
Health and Climate Video
Urban Air and Health Project.
Information Item:
Tracking updates have been provided in this section. Panel members are invited to ask
questions or comment on updates.
41
Tracking Updates
CDC Renewal Application
The MN Tracking Program applied for competitive renewal of MDH’s cooperative agreement
with CDC in May 2014. This funding would support maintenance and enhancement of the state
and national Tracking Network, including MN Public Health Data Access
(https://apps.health.state.mn.us/mndata). This funding opportunity is for 3 years of funding,
starting August 1, 2014.
Proposed activities for the five focus areas of the application include:
1. Content
a. New Data Development (Table 9)
Content
Partner
Traffic indicators
MPCA, Environmental Analysis and Outcomes Division
Radon testing indicators
MDH-EH Division, Indoor Air Program
Diabetes indicators
MDH-HPCD Division, Diabetes Program
Lead poisoning indicators (test year, <5
ug/dl)
MDH-EH Division, Childhood Lead Poisoning Prevention
Program
Maternal and child health indicators
(Pregnancy Risk Assessment and
Monitoring survey)
MDH-CFH Division, PRAMS
Childhood obesity
MDH-CFH Division, Women, Infants, and Children Program;
MN Center for Health Statistics
b. Existing Data Enhancements (Table 10)
Content
Geography
(proposed)
Partner
Heat-Illness (hospitalizations, ED)
County
MDH-EH Division, Climate and Health
Program
Cancer (incidence)
Census Tract
MDH-HPCD Division, MN Cancer
Reporting System
Childhood Lead Poisoning
Census Tract
MDH-EH Division, Lead Poisoning
Prevention Program
Childhood Obesity
TBD
MDH-CFH Division, OSHII
Socio-Demographic Data
(race/ethnicity)
TBD
MN Center for Health Equity
42
2. Data Utilization
(projects to promote use of Tracking Network data and tools)
a. Health Impact Assessment Toolkit: provide portal and custom data to support Health
Impact Assessments in Minnesota; promote a health in all policies approach through
land use, transportation, housing, and other sectors. Serve on the MN HIA Coalition
to identify data gaps and needs of HIA practitioners.
b. Climate Change Adaptation, All-Hazard Response Plans: use state and county data
on heat-related illnesses and demographic data to support local health departments
in developing climate change adaptation plans; collaborate with the MDH Climate
and Health Program on outreach to the University of MN and students, including use
of the new Twin Cities Public Television MDH documentary on Health and Climate.
c. Minnesota Cities Data Pilot Project: use Tracking Network data in collaboration with
the City of Minneapolis and other partners to inform assessment, planning, and
policy.
3. Collaboration
a. Great Lakes Inter-Tribal Epidemiology Center and Tracking Program Pilot Project: a
joint Minnesota and Wisconsin Tracking project with the Center and CDC to establish
indicators from environmental and health priorities, explore data sharing between
the Center and Tracking Programs, and build epidemiology capacity within the
Center.
b. State Urban Air Quality and Respiratory Health Initiative: Tracking funding would
support supplemental activities to use available Tracking Network Data to measure
the impacts of air quality on health.
c. Rapid Response Registry: develop and implement an electronic survey, IRBapproved, for deployment after a catastrophic event to collect data on persons who
are potentially exposed to harmful agents facilitate long-term surveillance after an
emergency. This would be accomplished in collaboration with the MDH Office of
Emergency Preparedness and national partners.
4. Technology
a. Develop and update maps/GIS to apply innovative data visualization techniques, codisplays of health and socio-demographic data together
b. Enhance the MN County Profiles, including profiles of health and environment data
by race/ethnicity category
c. Make technical upgrades as needed
d. Test and make enhancements to the secure portal, including a fillable form for
custom data requests; and role-based access to access custom data sets
e. Enhance web analytics to collect additional data on queries and maps
f. Implement cross network search functionality
43
5. Communications
a. Conduct outreach to new audiences: Health care organizations, students,
communities
b. Provide training and demonstrations to increase skills in the public health
workforce
c. Review and update portal and program web site messaging (to improve usability,
apply Plain Language standards)
d. Distribute data utilization tools, promote success stories, case studies
6. Supplemental Project:
Evaluating Innovative Approaches for Utilizing Electronic Health Record Information
a. If provided with supplemental funding beyond the core cooperative agreement, the
MN Tracking Program would work with CDC, awardees, to evaluate innovative
approaches for utilizing electronic health record information within the Tracking
Program. This project would include hiring a new staff person with expertise in
public health informatics, collaboration with state/national partners, including the
MDH Office of Health Information Technology and CDC.
b. This supplemental project is for 1 year only, to be completed by July 31, 2015.
Portal Updates
Since the last Advisory Panel meeting, the MN Tracking Program has implemented the following
on the data access portal:
•
•
•
•
•
New COPD and asthma hospitalization maps, including poverty by ZIP code
New data and measures for developmental disabilities: autism, ADHD, special health
needs
New data and measures for pesticide poisonings: hospitalizations, emergency
department visits, and poisoning center calls
Enhancements to the MN County Profiles: incorporated additional indicators for private
wells (arsenic), childhood immunizations; currently working on a mobile-friendly portal
design
Updates to drinking water data (2013), childhood immunizations (2013), birth defects
(2010)
View MN Public Health Data Access: https://apps.health.state.mn.us/mndata
New Health Impact Assessment Toolkit
In April, the MN Tracking Program launched new materials to promote the use of Tracking
Network data in Health Impact Assessments, including a data user guide, infographic, and other
materials for grantees to work with state/local partners. These materials, developed in
collaboration with the CDC, state/local Tracking Programs, and the MN HIA Program are on the
MN Tracking Program web site at: http://www.health.state.mn.us/divs/hpcd/tracking/hia/hia.html
44
Health and Climate Video
The MDH Health and Climate video is now available on the MDH web site. This video was
produced by Twin Cities Public Television with funding provided by the MDH Health and
Climate Program and MN Tracking Program (CDC). The video was developed for middle-school
students, teachers, and parents to highlight the impacts of climate change on public health in
Minnesota. Topics include heat-illness, vector borne disease, active living and exercise,
agriculture and sustainability, as well as impacts on air and water quality. Additional materials
are currently being developed to support outreach and education activities in classrooms. View
video on the MDH web site:
http://www.health.state.mn.us/divs/climatechange/climatevideo.html
Urban Air Quality and Health
Rates of hospitalizations and emergency department visits for chronic respiratory and
cardiovascular diseases are affected by a number of factors, including ambient air quality. More
information is needed to inform actions at the community level to protect health.
The MN Tracking Program is participating in a joint initiative with the MN Pollution Control
Agency (MPCA) to address air pollution and adverse health impacts in the Twin Cities. As part of
this initiative, a report is being developed that uses air quality and health outcomes data that
MPCA and MDH have in the Twin Cities metro area. The report will identify health effects in the
7-county metro area attributed to fine particulate matter and ozone; predict expected health
benefits from future air quality improvements in the area; and provide context for
environmental justice.
The MN Tracking Program is also collaborating with staff from MPCA on an update of the EPA
STAR Grant project. The new project adds an additional 3 years of air quality, hospitalizations,
and emergency department visits data to track the impact of local and regional air pollution
reduction strategies with respiratory and cardiovascular diseases in the Twin Cities. Results
from the project will be used to complete a manuscript and update web materials.
45
Section Overview: Other Information
This section contains documents that may be of interest to panel members.
•
•
•
•
•
•
2014 Upcoming Advisory Panel Meeting dates
February 14, 2014 Advisory Panel Meeting Summary
Advisory Panel Roster
Biographical Sketches of Advisory Panel Members
Biographical Sketches of Staff
Environmental Health Tracking and Biomonitoring Legislation
46
2014 Advisory Panel Meetings
Tuesday, October 14
1-4 pm
The American Lung Association of Minnesota
490 Concordia Avenue
St. Paul, Minnesota
47
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.
48
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 do not 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 is the inequity.
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:
49
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.
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
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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 did not
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 is 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 did not 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,
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 Nesvold 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
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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 have 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 would 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?
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
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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
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
53
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 is 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
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 was not 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.
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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 do not 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 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
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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 had not 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.
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 do not 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 is much harder to sustain funding without a buzz or stories.
56
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.
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 is 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.
57
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 are not 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 was not 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
Announcement and the funding is not renewed, that does not 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.
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Minnesota Department of Health, April 2014
Environmental Health Tracking & Biomonitoring Advisory Panel Roster
Bruce Alexander, PhD
School of Public Health
University of Minnesota
Environmental Health Sciences Division
MMC 807 Mayo
420 Delaware Street SE
Minneapolis, Minnesota 55455
612-625-7934
[email protected]
At-large representative
Fred Anderson, MPH
Washington County
Dept. of Public Health & Environment
14949 62nd St N
Stillwater MN 55082
651-430-6655
[email protected]
At-large representative
Alan Bender, DVM, PhD
Minnesota Department of Health
Health Promotion & Chronic Disease
Division
85 East 7th Place
PO Box 64882
Saint Paul, MN 55164-0882
651-201-5882
[email protected]
MDH appointee
David DeGroote, PhD
St. Cloud State University
740 4th Street South
St. Cloud, MN 56301
320-308-2192
[email protected]
Minnesota House of Representatives
appointee
Melanie Ferris, MPH
Wilder Foundation
451 Lexington Parkway N
St. Paul, MN 55104
651-280-2660
[email protected]
Nongovernmental organization
representative
Thomas Hawkinson, MS, CIH, CSP
Toro Company
8111 Lyndale Avenue S
Bloomington, MN 55420
[email protected]
952-887-8080
Statewide business org representative
Jill Heins Nesvold, MS
American Lung Association of Minnesota
490 Concordia Avenue
St. Paul, Minnesota 55103
651-223-9578
[email protected]
Nongovernmental organization
representative
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Pat McGovern, PhD, MPH
School of Public Health
University of Minnesota
Environmental Health Sciences Division
MMC Mayo 807
420 Delaware St SE
Minneapolis MN 55455
612-625-7429
[email protected]
University of Minnesota representative
Geary Olsen, DVM, PhD
3M Medical Department
Corporate Occupational Medicine
MS 220-6W-08
St. Paul, Minnesota 55144-1000
651-737-8569
[email protected]
Statewide business organization
representative
Lisa Yost, MPH, DABT
ENVIRON International Corporation
333 West Wacker Drive, Suite 2700
Chicago, IL 60606
Local office
886 Osceola Avenue
St. Paul, Minnesota
55105
Phone: 651-225-1592
Cell: 651-470-9284
[email protected]
At-large representative
Steven Pedersen, MPH
8403 Mississippi Boulevard NW
Coon Rapids, MN 55433
612-850-1058
[email protected]
Minnesota Senate appointee
Gregory Pratt, PhD
Minnesota Pollution Control Agency
Environmental Analysis & Outcomes
Division
520 Lafayette Road
St. Paul, MN 55155-4194
651-757-2655
[email protected]
MPCA appointee
Cathy Villas-Horns, MS, PG
Minnesota Dept. of Agriculture
Pesticide & Fertilizer Management Division
625 Robert Street North
St. Paul, Minnesota 55155-2538
651-201-6291
[email protected]
MDA appointee
60
Biographical sketches of advisory panel members
Bruce H. Alexander is a Professor in the Division of Environmental Health Sciences at the
University of Minnesota’s School of Public Health. Dr. Alexander is an environmental and
occupational epidemiologist with expertise in cancer, reproductive health, respiratory disease,
injury, exposure assessment, and use of biological markers in public health applications.
Fred Anderson is an epidemiologist at the Washington County Department of Public Health and
Environment and has over 30 years of public health experience. He holds a Master’s of Public
Health (MPH) in environmental and infectious disease epidemiology from the University of
Minnesota and is a registered environmental health specialist. For over 20 years, he has led
county-wide disease surveillance and intervention programs, including numerous
multidisciplinary epidemiologic investigations.
Alan Bender is the Section Chief of Chronic Disease and Environmental Epidemiology at the
Minnesota Department of Health. He holds a Doctor of Veterinary Medicine degree from the
University of Minnesota and a PhD in Epidemiology from Ohio State University. His work has
focused on developing statewide surveillance systems, including cancer and occupational
health, and exploring the links between occupational and environmental exposures and chronic
disease and mortality.
David DeGroote is a Professor of Biological Sciences at St. Cloud State University. He has been
at St. Cloud State University since 1985, initially as an Assistant Professor in Biological Sciences.
He served as Department Chair from 1996 to 2003 and Dean of the College of Science and
Engineering until June 2013. As Dean, he focused on providing up-to-date academic
programming and facilities to serve the needs of Minnesota employers in the health sciences,
engineering, computing, biosciences, and STEM education. He is currently a special advisor to
the Provost for industrial collaboration and curriculum alignment with workforce needs.
Melanie Ferris is a Research Scientist at Wilder Research, a nonprofit research organization
based in St. Paul, Minnesota. She conducts a variety of program evaluation and applied
research projects focused primarily in the areas of public health and mental health. She has
worked on a number of recent projects that focus on identifying disparities across populations
and using existing data sources to develop meaningful indicators of health and wellness.
Examples of these projects include a study of health inequities in the Twin Cities region related
to income, race, and place, development of a dashboard of mental health and wellness
indicators for youth living in Hennepin County, and work on local community health needs
assessments. She has a Master’s of Public Health degree in Community Health Education from
the University of Minnesota’s School of Public Health.
Tom Hawkinson is the Corporate Environmental, Health, and Safety Manager for the Toro
Company in Bloomington, MN. He completed his MS in Public Health at the University of
Minnesota, with a specialization in industrial hygiene. He is certified in the comprehensive
practice of industrial hygiene and a certified safety professional. He has worked in EHS
management at a number of Twin Cities based companies, conducting industrial hygiene
investigations of workplace contaminants and done environmental investigations of subsurface
61
contamination both in the United States and Europe. He has taught statistics and mathematics
at both graduate and undergraduate levels as an adjunct, and is on the faculty at the Midwest
Center for Occupational Health and Safety A NIOSH-Sponsored Education and Research Center
School of Public Health, University of Minnesota.
Jill Heins Nesvold serves as the Director of the Respiratory Health Division for the American
Lung Association in Iowa, Minnesota, North Dakota, and South Dakota. Her responsibilities
include program oversight and evaluation related to asthma, chronic obstructive lung disease
(COPD), lung cancer, and influenza. Jill holds a master’s degree in health management and a
short-course master’s degree in business administration. Jill has published extensively in a
variety of public health areas.
Pat McGovern is a Professor in the Division of Environmental Health Sciences at the University
of Minnesota’s School of Public Health. Dr. McGovern is a health services researcher and nurse
with expertise in environmental and occupational health policy and health outcomes research.
She serves as the Principal Investigator for the National Children’s Study (NCS) Center serving
Ramsey County, one of 105 study locations nationwide. The NCS is the largest, long-term study
of children’s health and development in the US and the assessment of environmental exposures
will include data collection from surveys, biological specimens, and environmental samples.
Geary Olsen is a corporate scientist in the Medical Department of the 3M Company. He
obtained a Doctor of Veterinary Medicine (DVM) degree from the University of Illinois and a
Master of Public Health (MPH) in veterinary public health and PhD in epidemiology from the
University of Minnesota. For 27 years, he has been engaged in a variety of occupational and
environmental epidemiology research studies while employed at Dow Chemical and, since
1995, at 3M. His primary research activities at 3M have involved the epidemiology,
biomonitoring (occupational and general population), and pharmacokinetics of
perfluorochemicals.
Gregory Pratt is a research scientist at the Minnesota Pollution Control Agency. He holds a
Ph.D. in Plant Physiology from the University of Minnesota, where he worked on the effects of
air pollution on vegetation. Since 1984, he has worked for the MPCA on a wide variety of issues
including acid deposition, stratospheric ozone depletion, climate change, atmospheric fate, and
dispersion of air pollution, monitoring, and occurrence of air pollution, statewide modeling of
air pollution risks, and personal exposure to air pollution. He is presently cooperating with the
Minnesota Department of Health on a research project on the Development of Environmental
Health Outcome Indicators: Air Quality Improvements and Community Health Impacts.
Cathy Villas Horns is the Hydrologist Supervisor of the Incident Response Unit (IRU) within the
Pesticide and Fertilizer Management Unit of the Minnesota Department of Agriculture. Cathy
holds a Master of Science in Geology from the University of Delaware and a Bachelor of Science
in Geology from Carleton College and is a licensed Professional Geologist in MN. The IRU
oversees or conducts the investigation and cleanup of point source releases of agricultural
chemicals (fertilizers and pesticides including herbicides, insecticides, fungicides, etc. as well as
wood treatment chemicals) through several different programs. Cathy has worked on complex
sites with Minnesota Department of Health and MPCA staff, and continues to work with
interagency committees on contaminant issues. She previously worked as a senior
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hydrogeologist within the IRU, and as a hydrogeologist at the Minnesota Pollution Control
Agency and an environmental consulting firm.
Lisa Yost is a Principal Consultant at ENVIRON, an international consulting firm. She is in their
Health Sciences Group, and is based in Saint Paul, Minnesota. Ms. Yost completed her training
at the University of Michigan’s School of Public Health and is a board-certified toxicologist with
expertise in evaluating human health risks associated with substances in soil, water, and the
food chain. She has conducted or supervised risk assessments under CERCLA, RCRA, or state-led
regulatory contexts involving a wide range of chemicals and exposure situations. Her areas of
specialization include exposure and risk assessment, risk communication, and the toxicology of
such chemicals as PCDDs and PCDFs, PCBs, pentachlorophenol (PCP), trichloroethylene (TCE),
mercury, and arsenic. Ms. Yost is a recognized expert in risk assessment and has collaborated in
original research on exposure issues, including background dietary intake of inorganic arsenic.
She is currently assisting in a number of projects including a complex multi-pathway risk
assessment for PDDD/Fs that will integrate extensive biomonitoring data collected by the
University of Michigan. Ms. Yost is also an Adjunct Instructor at the University of Minnesota’s
School of Public Health.
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Staff Biosketches
Wendy Brunner, PhD, serves as surveillance epidemiologist for the MDH Asthma Program since
2002, and joined Minnesota’s Environmental Public Health Tracking and Biomonitoring Program
(MN Tracking) program on a part-time basis in fall 2009. Previously, she worked on
occupational respiratory disease studies for MDH. She has a master’s degree in Science and
Technology Studies from Rensselaer Polytechnic Institute and a master’s degree in
Environmental and Occupational Health from the University of Minnesota. She received her
doctorate in the Division of Epidemiology and Community Health at the University of
Minnesota.
Betsy Edhlund, PhD, is a research scientist in the Environmental Section of the Public Health
Laboratory at the Minnesota Department of Health. She works in the metals laboratory
developing methods and analyzing samples for both biomonitoring programs and emergency
response. Betsy received her PhD in chemistry from the University of Minnesota where her
research focused on the photochemistry of natural waters.
Jean Johnson, PhD, MS, is Program Director/Principal Investigator for MN Tracking. Dr. Johnson
received her Ph.D. and M.S. degrees from the University of Minnesota, School of Public Health
in Environmental Health and has 25 years of experience working with the state of Minnesota in
the environmental health field. As an environmental epidemiologist at MDH, her work has
focused on special investigations of population exposure and health, including studies of
chronic diseases related to air pollution and asbestos exposure, and exposure to drinking water
contaminants. She is currently the Principal Investigator on an EPA grant to develop methods
for measuring the public health impacts of population exposure to particulate matter (PM) in
air. She is also an adjunct faculty member at the University of Minnesota School of Public
Health.
Tess Konen, MPH, graduated from the University of Michigan’s School of Public Health with a
master’s in Occupational Environmental Epidemiology. She completed her thesis on the effects
of heat on hospitalizations in Michigan. She currently is a CSTE/CDC Epidemiology Fellow in MN
Tracking working on birth defects, pesticides, climate change, and a follow-up study of the
Northeast Minneapolis Community Vermiculite Investigation cohort.
Mary Jeanne Levitt, MBC, is the communications coordinator with MN Tracking. She has a
Master’s in Business Communications and has worked for over 20 years in both the public and
non-profit sector in project management of research and training grants, communications and
marketing strategies, focus groups and evaluations of educational needs of public health
professionals. She serves on 3 institutional review boards which specialize in academic
research, oncology research, and overall clinical research.
Paula Lindgren, MS, received her Masters of Science degree in Biostatistics from the University
of Minnesota. She works for the Minnesota Department of Health as a biostatistician, and
provides statistical and technical support MN Tracking for data reports, publications, webbased portal dissemination, and presentations in the Chronic Disease and Environmental
Epidemiology section. Ms. Lindgren has also received training in the area of GIS for chronic
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disease mapping and analysis. In addition to her work for MN Tracking, she works for various
programs within Chronic Disease and Environmental Epidemiology including the Asthma
program, Center for Occupation Health and Safety, Minnesota Cancer Surveillance System, and
Cancer Control section.
Jessica Nelson, PhD, is an epidemiologist with MN Tracking, working primarily on design,
coordination, and analysis of biomonitoring projects. Jessica received her PhD and MPH in
Environmental Health from the Boston University School of Public Health where her research
involved the epidemiologic analysis of biomonitoring data on perfluorochemicals. Jessica was
the coordinator of the Boston Consensus Conference on Biomonitoring, a project that gathered
input and recommendations on the practice and uses of biomonitoring from a group of Bostonarea lay people.
Christina Rosebush, MPH, is an epidemiologist with MN Tracking. Her work includes the
development and coordination of biomonitoring projects that assess perfluorochemicals (PFCs)
and mercury in Minnesota communities. She also works on collection and statistical analysis of
public health surveillance data for MN Tracking, with a focus on behavioral risk factors.
Christina received her Master’s degree in epidemiology from the University of Minnesota’s
School of Public Health, completing research in PFC biomonitoring for the Minnesota
Department of Health in partial fulfillment of her degree.
Jeannette M. Sample, MPH, is an epidemiologist with MN Tracking at the Minnesota
Department of Health, working primarily with the collection and statistical analysis of public
health surveillance data for MN Tracking. She also works on research collaborations with
academic partners relating to reproductive outcomes and birth defects. Prior to joining MN
Tracking, she was a CSTE/CDC Applied Epidemiology Fellow with the MDH Birth Defect
Information System. Jeannette received her Master’s degree in epidemiology and biostatistics
from The George Washington University in Washington, DC
Blair Sevcik, MPH, is an epidemiologist with MN Tracking at the Minnesota Department of
Health, where she works on the collection and statistical analysis of public health surveillance
data for .MN Tracking. Prior to joining MN Tracking in January 2009, she was a student worker
with the MDH Asthma Program. She received her Master of Public Health degree in
epidemiology from University of Minnesota School of Public Health in December 2010.
Chuck Stroebel, MSPH, is the MN Tracking Program Manager. He provides day-to-day direction
for program activities, including: 1) development and implementation of the state network, 2)
development and transport of NCDMs and metadata for the national network, and 3)
collaboration and communication with key EPHT partners and stakeholders. Chuck received a
Masters of Public Health in Environmental Health Sciences from the University of North
Carolina (Chapel Hill). He has over 15 years of expertise in environmental health, including
areas of air quality, pesticides, climate change, risk assessment, and toxicology. Chuck also
played a key role in early initiatives to build tracking capacity at the Minnesota Department of
Health. Currently, he is a member of the IBIS Steering Committee (state network), the MDH
ASTHO Grant Steering Committee (climate change), and the Northland Society of Toxicology. He
also serves on the Minnesota EPHT Technical and Communications Teams.
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Janis Taramelli, TTS, is the Community Outreach Coordinator for MN Biomonitoring, responsible
for communications with the MN Tracking Advisory Panel and study participants. A tobacco
treatment specialist, she has 20 years of experience working on research studies, surveys,
group facilitation, and one-on-one counseling in both the public and private sectors. Her
background includes development and coordination of statewide QUITPLAN at Work programs,
metro area QUITPLAN centers, piloting tobacco cessation and heart healthy programs for
Minnesota’s Sage (Breast and Cervical Cancer Screening) and SagePlus (Heart Health Screening)
programs, funded by the Centers for Disease Control.
Allan N. Williams, MPH, PhD, is an environmental and occupational epidemiologist in the
Chronic Disease and Environmental Epidemiology Section at the Minnesota Department of
Health. He is the supervisor for the MDH Center for Occupational Health and Safety. For over 25
years, he has worked on issues relating to environmental and occupational cancer, cancer
clusters, work-related respiratory diseases, and the surveillance and prevention of work-related
injuries among adolescents. He has served as the PI on two NIOSH R01 grants, as a coinvestigator on four other federally-funded studies in environmental or occupational health,
and is an adjunct faculty member in the University of Minnesota’s School of Public Health. He
received an MA in Biology from Indiana University, an MPH in Environmental Health and
Epidemiology from the University of Minnesota, and a PhD in Environmental and Occupational
Health from the University of Minnesota.
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Environmental Health Tracking and Biomonitoring Statute
$1,000,000 each year is for environmental health tracking and biomonitoring. Of this amount,
$900,000 each year is for transfer to the Minnesota Department of Health. The base
appropriation for this program for fiscal year 2010 and later is $500,000.
144.995 DEFINITIONS; ENVIRONMENTAL HEALTH TRACKING AND BIOMONITORING
(a) For purposes of sections 144.995 to 144.998, the terms in this section have the
meanings given.
(b) "Advisory panel" means the Environmental Health Tracking and Biomonitoring
Advisory Panel established under section 144.998.
(c) "Biomonitoring" means the process by which chemicals and their metabolites are
identified and measured within a biospecimen.
(d) "Biospecimen" means a sample of human fluid, serum, or tissue that is reasonably
available as a medium to measure the presence and concentration of chemicals or their
metabolites in a human body.
(e) "Commissioner" means the commissioner of the Department of Health.
(f) "Community" means geographically or nongeographically based populations that
may participate in the biomonitoring program. A "nongeographical community" includes, but is
not limited to, populations that may share a common chemical exposure through similar
occupations, populations experiencing a common health outcome that may be linked to
chemical exposures, populations that may experience similar chemical exposures because of
comparable consumption, lifestyle, product use, and subpopulations that share ethnicity, age,
or gender.
(g) "Department" means the Department of Health.
(h) "Designated chemicals" means those chemicals that are known to, or strongly
suspected of, adversely impacting human health or development, based upon scientific,
peer-reviewed animal, human, or in vitro studies, and baseline human exposure data, and
consists of chemical families or metabolites that are included in the federal Centers for Disease
Control and Prevention studies that are known collectively as the National Reports on Human
Exposure to Environmental Chemicals Program and any substances specified by the
commissioner after receiving recommendations under section 144.998, subdivision 3, clause
(6).
(i) "Environmental hazard" means a chemical or other substance for which scientific,
peer-reviewed studies of humans, animals, or cells have demonstrated that the chemical is
known or reasonably anticipated to adversely impact human health.
(j) "Environmental health tracking" means collection, integration, analysis, and
dissemination of data on human exposures to chemicals in the environment and on diseases
potentially caused or aggravated by those chemicals.
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144.996 ENVIRONMENTAL HEALTH TRACKING; BIOMONITORING.
Subdivision 1. Environmental health tracking. In cooperation with the commissioner of
the Pollution Control Agency, the commissioner shall establish an environmental health
tracking program to:
(1) coordinate data collection with the Pollution Control Agency, Department of
Agriculture, University of Minnesota, and any other relevant state agency and work to promote
the sharing of and access to health and environmental databases to develop an environmental
health tracking system for Minnesota, consistent with applicable data practices laws;
(2) facilitate the dissemination of aggregate public health tracking data to the public and
researchers in accessible format;
(3) develop a strategic plan that includes a mission statement, the identification of core
priorities for research and epidemiologic surveillance, and the identification of internal and
external stakeholders, and a work plan describing future program development and addressing
issues having to do with compatibility with the Centers for Disease Control and Prevention's
National Environmental Public Health Tracking Program;
(4) develop written data sharing agreements as needed with the Pollution Control
Agency, Department of Agriculture, and other relevant state agencies and organizations, and
develop additional procedures as needed to protect individual privacy;
(5) organize, analyze, and interpret available data, in order to:
(i) characterize statewide and localized trends and geographic patterns of populationbased measures of chronic diseases including, but not limited to, cancer, respiratory diseases,
reproductive problems, birth defects, neurologic diseases, and developmental disorders;
(ii) characterize statewide and localized trends and geographic patterns in the
occurrence of environmental hazards and exposures;
(iii) assess the feasibility of integrating disease rate data with indicators of exposure to
the selected environmental hazards such as biomonitoring data, and other health and
environmental data;
(iv) incorporate newly collected and existing health tracking and biomonitoring data into
efforts to identify communities with elevated rates of chronic disease, higher likelihood of
exposure to environmental hazards, or both;
(v) analyze occurrence of environmental hazards, exposures, and diseases with relation
to socioeconomic status, race, and ethnicity;
(vi) develop and implement targeted plans to conduct more intensive health tracking
and biomonitoring among communities; and
(vii) work with the Pollution Control Agency, the Department of Agriculture, and other
relevant state agency personnel and organizations to develop, implement, and evaluate
preventive measures to reduce elevated rates of diseases and exposures identified through
activities performed under sections 144.995 to 144.998; and
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(6) submit a biennial report to the chairs and ranking members of the committees with
jurisdiction over environment and health by January 15, beginning January 15, 2009, on the
status of environmental health tracking activities and related research programs, with
recommendations for a comprehensive environmental public health tracking program.
Subd. 2. Biomonitoring. The commissioner shall:
(1) conduct biomonitoring of communities on a voluntary basis by collecting and
analyzing biospecimens, as appropriate, to assess environmental exposures to designated
chemicals;
(2) conduct biomonitoring of pregnant women and minors on a voluntary basis, when
scientifically appropriate;
(3) communicate findings to the public, and plan ensuing stages of biomonitoring and
disease tracking work to further develop and refine the integrated analysis;
(4) share analytical results with the advisory panel and work with the panel to interpret
results, communicate findings to the public, and plan ensuing stages of biomonitoring work;
and
(5) submit a biennial report to the chairs and ranking members of the committees with
jurisdiction over environment and health by January 15, beginning January 15, 2009, on the
status of the biomonitoring program and any recommendations for improvement.
Subd. 3. Health data. Data collected under the biomonitoring program are health data
under section 13.3805.
144.997 BIOMONITORING PILOT PROGRAM.
Subdivision 1. Pilot program. With advice from the advisory panel, and after the
program guidelines in subdivision 4 are developed, the commissioner shall implement a
biomonitoring pilot program. The program shall collect one biospecimen from each of the
voluntary participants. The biospecimen selected must be the biospecimen that most
accurately represents body concentration of the chemical of interest. Each biospecimen from
the voluntary participants must be analyzed for one type or class of related chemicals. The
commissioner shall determine the chemical or class of chemicals to which community members
were most likely exposed. The program shall collect and assess biospecimens in accordance
with the following:
(1) 30 voluntary participants from each of three communities that the commissioner
identifies as likely to have been exposed to a designated chemical;
(2) 100 voluntary participants from each of two communities:
(i) that the commissioner identifies as likely to have been exposed to arsenic; and
(ii) that the commissioner identifies as likely to have been exposed to mercury; and
(3) 100 voluntary participants from each of two communities that the commissioner
identifies as likely to have been exposed to perfluorinated chemicals, including
perfluorobutanoic acid.
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Subd. 2. Base program. (a) By January 15, 2008, the commissioner shall submit a report
on the results of the biomonitoring pilot program to the chairs and ranking members of the
committees with jurisdiction over health and environment.
(b) Following the conclusion of the pilot program, the commissioner shall:
(1) work with the advisory panel to assess the usefulness of continuing biomonitoring
among members of communities assessed during the pilot program and to identify other
communities and other designated chemicals to be assessed via biomonitoring;
(2) work with the advisory panel to assess the pilot program, including but not limited to
the validity and accuracy of the analytical measurements and adequacy of the guidelines and
protocols;
(3) communicate the results of the pilot program to the public; and
(4) after consideration of the findings and recommendations in clauses (1) and (2), and
within the appropriations available, develop and implement a base program.
Subd. 3. Participation. (a) Participation in the biomonitoring program by providing
biospecimens is voluntary and requires written, informed consent. Minors may participate in
the program if a written consent is signed by the minor's parent or legal guardian. The written
consent must include the information required to be provided under this subdivision to all
voluntary participants.
(b) All participants shall be evaluated for the presence of the designated chemical of
interest as a component of the biomonitoring process. Participants shall be provided with
information and fact sheets about the program's activities and its findings. Individual
participants shall, if requested, receive their complete results. Any results provided to
participants shall be subject to the Department of Health Institutional Review Board protocols
and guidelines. When either physiological or chemical data obtained from a participant indicate
a significant known health risk, program staff experienced in communicating biomonitoring
results shall consult with the individual and recommend follow-up steps, as appropriate.
Program administrators shall receive training in administering the program in an ethical,
culturally sensitive, participatory, and community-based manner.
Subd. 4. Program guidelines. (a) The commissioner, in consultation with the advisory
panel, shall develop:
(1) protocols or program guidelines that address the science and practice of
biomonitoring to be utilized and procedures for changing those protocols to incorporate new
and more accurate or efficient technologies as they become available. The commissioner and
the advisory panel shall be guided by protocols and guidelines developed by the Centers for
Disease Control and Prevention and the National Biomonitoring Program;
(2) guidelines for ensuring the privacy of information; informed consent; follow-up
counseling and support; and communicating findings to participants, communities, and the
general public. The informed consent used for the program must meet the informed consent
protocols developed by the National Institutes of Health;
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(3) educational and outreach materials that are culturally appropriate for dissemination
to program participants and communities. Priority shall be given to the development of
materials specifically designed to ensure that parents are informed about all of the benefits of
breastfeeding so that the program does not result in an unjustified fear of toxins in breast milk,
which might inadvertently lead parents to avoid breastfeeding. The materials shall
communicate relevant scientific findings; data on the accumulation of pollutants to community
health; and the required responses by local, state, and other governmental entities in
regulating toxicant exposures;
(4) a training program that is culturally sensitive specifically for health care providers,
health educators, and other program administrators;
(5) a designation process for state and private laboratories that are qualified to analyze
biospecimens and report the findings; and
(6) a method for informing affected communities and local governments representing
those communities concerning biomonitoring activities and for receiving comments from
citizens concerning those activities.
(b) The commissioner may enter into contractual agreements with health clinics,
community-based organizations, or experts in a particular field to perform any of the activities
described under this section.
144.998 ENVIRONMENTAL HEALTH TRACKING AND BIOMONITORING ADVISORY PANEL.
Subdivision 1. Creation. The commissioner shall establish the Environmental Health
Tracking and Biomonitoring Advisory Panel. The commissioner shall appoint, from the panel's
membership, a chair. The panel shall meet as often as it deems necessary but, at a minimum,
on a quarterly basis. Members of the panel shall serve without compensation but shall be
reimbursed for travel and other necessary expenses incurred through performance of their
duties. Members appointed by the commissioner are appointed for a three-year term and may
be reappointed. Legislative appointees serve at the pleasure of the appointing authority.
Subd. 2. Members. (a) The commissioner shall appoint eight members, none of whom
may be lobbyists registered under chapter 10A, who have backgrounds or training in designing,
implementing, and interpreting health tracking and biomonitoring studies or in related fields of
science, including epidemiology, biostatistics, environmental health, laboratory sciences,
occupational health, industrial hygiene, toxicology, and public health, including:
(1) at least two scientists representative of each of the following:
(i) nongovernmental organizations with a focus on environmental health, environmental
justice, children's health, or on specific chronic diseases; and
(ii) statewide business organizations; and
(2) at least one scientist who is a representative of the University of Minnesota.
(b) Two citizen panel members meeting the scientific qualifications in paragraph (a) shall
be appointed, one by the speaker of the house and one by the senate majority leader.
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(c) In addition, one representative each shall be appointed by the commissioners of the
Pollution Control Agency and the Department of Agriculture, and by the commissioner of health
to represent the department's Health Promotion and Chronic Disease Division.
Subd. 3. Duties. The advisory panel shall make recommendations to the commissioner
and the legislature on:
(1) priorities for health tracking;
(2) priorities for biomonitoring that are based on sound science and practice, and that
will advance the state of public health in Minnesota;
(3) specific chronic diseases to study under the environmental health tracking system;
(4) specific environmental hazard exposures to study under the environmental health
tracking system, with the agreement of at least nine of the advisory panel members;
(5) specific communities and geographic areas on which to focus environmental health
tracking and biomonitoring efforts;
(6) specific chemicals to study under the biomonitoring program, with the agreement of
at least nine of the advisory panel members; in making these recommendations, the panel may
consider the following criteria:
(i) the degree of potential exposure to the public or specific subgroups, including, but
not limited to, occupational;
(ii) the likelihood of a chemical being a carcinogen or toxicant based on peer-reviewed
health data, the chemical structure, or the toxicology of chemically related compounds;
(iii) the limits of laboratory detection for the chemical, including the ability to detect the
chemical at low enough levels that could be expected in the general population;
(iv) exposure or potential exposure to the public or specific subgroups;
(v) the known or suspected health effects resulting from the same level of exposure
based on peer-reviewed scientific studies;
(vi) the need to assess the efficacy of public health actions to reduce exposure to a
chemical;
(vii) the availability of a biomonitoring analytical method with adequate accuracy,
precision, sensitivity, specificity, and speed;
(viii) the availability of adequate biospecimen samples; or
(ix) other criteria that the panel may agree to; and
(7) other aspects of the design, implementation, and evaluation of the environmental
health tracking and biomonitoring system, including, but not limited to:
(i) identifying possible community partners and sources of additional public or private
funding;
(ii) developing outreach and educational methods and materials; and
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public.
(iii) disseminating environmental health tracking and biomonitoring findings to the
Subd. 4. Liability. No member of the panel shall be held civilly or criminally liable for an
act or omission by that person if the act or omission was in good faith and within the scope of
the member's responsibilities under sections 144.995 to 144.998.
INFORMATION SHARING.
On or before August 1, 2007, the commissioner of health, the Pollution Control Agency,
and the University of Minnesota are requested to jointly develop and sign a memorandum of
understanding declaring their intent to share new and existing environmental hazard, exposure,
and health outcome data, within applicable data privacy laws, and to cooperate and
communicate effectively to ensure sufficient clarity and understanding of the data by divisions
and offices within both departments. The signed memorandum of understanding shall be
reported to the chairs and ranking members of the senate and house of representatives
committees having jurisdiction over judiciary, environment, and health and human services.
Effective date: July 1, 2007
This document contains Minnesota Statutes, sections 144.995 to 144.998, as these sections
were adopted in Minnesota Session Laws 2007, chapter 57, article 1, sections 143 to 146. The
appropriation related to these statutes is in chapter 57, article 1, section 3, subdivision 4. The
paragraph about information sharing is in chapter 57, article 1, section 169.
Current Appropriation for EHTB
Office of the Revisor of Statutes
88th Legislature, 2013, Regular Session,
Chapter 114 Minnesota Session Laws
$913,000 the first year and $913,000 the second year are from the environmental fund to
continue perfluorochemical biomonitoring in eastern metropolitan communities, as
recommended by the Environmental Health Tracking and Biomonitoring Advisory Panel, and
address other environmental health risks, including air quality. Of this amount, $812,000 the
first year and $812,000 the second year are for transfer to the Department of Health.
NEW 2014 Legislation
20.28 Sec. 13. CLARIFICATION OF CONTINUED EXISTENCE.
20.29 This section clarifies that the groups listed in this section did not expire June 30,
20.30 2009. Actions taken by the groups listed in this section and public funds spent on behalf
20.31 of these groups since June 30, 2009, are valid:
21.1
(1) Medical Assistance Drug Formulary Committee, created in Minnesota Statutes,
21.2
section 256B.0625, subdivision 13c:
21.3
(2) Environmental Health Tracking & Biomonitoring Advisory Panel, created
21.4
in Minnesota Statutes, section 144.998:
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21.5
(3) Water Supply Systems and Wastewater Treatment Facilities Advisory Council,
21.6
created in Minnesota Statutes, section 115.741; and
21.7
(4) Prescription Electronic Reporting Advisory Committee, created in Minnesota
21.8
Statutes, section 152.126, subdivision 3,
21.9
EFFECTIVE DATE: This section is effective the day following final enactment
21.10 and applies retroactively from June 30, 2009.
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