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标题：Adequacy of State Capacity to Address Noncommunicable Disease Clusters in the Era of Environmental Public Health Tracking
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作者：Nadia Shalauta Juzych ; Beth Resnick ; Robin Streeter 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2007
卷号：97
期号：Suppl 1
页码：S163-S169
DOI：10.2105/AJPH.2006.096453
语种：English
出版社：American Public Health Association
摘要：Objectives. We sought to assess the capacity of state public health agencies to address noncommunicable disease clusters (NCCs) and to develop recommendations to enhance agencies’ NCC response capacity. Methods. We conducted an inventory of state public health agency Web sites and administered a Web-based survey of state health agency personnel to examine NCC capacity with respect to responsibility and authority, scope, protocols, trends in NCC investigations, and desired assistance. Results. Twenty-six of the state agency Web sites listed an NCC contact, and 12 mentioned a cluster response team. Thirty-seven states completed the Web-based survey, all addressed cancer clusters, and 30 also responded to other NCCs, such as multiple sclerosis, amyotrophic lateral sclerosis, and autism. Conclusions. NCCs are of key concern to communities, and all of the survey respondents indicated that citizen reports were an impetus for investigations; yet, state-level capacity to address NCCs was inconsistent and disjointed. State agency personnel were committed to responding to NCC inquiries but were hampered by lack of personnel, resources, and prescribed protocols, as well as inadequate interagency communication. We offer recommendations to address these challenges. As defined by the Centers for Disease Control and Prevention (CDC), a disease cluster is “an unusual aggregation, real or perceived, of health events that are grouped together in time and space and that is reported to a public health department.” 1 Clusters of infectious disease have long been identified through reportable disease registries, allowing early detection of emerging diseases and establishment of prevention strategies. 2 With its beginnings in the mid-19th century, when John Snow identified cholera contamination in the London drinking water supply, public health tracking has served as an early warning to prevent the spread of infectious disease. 3 ^, 4 Public health response to chronic diseases has been more limited, primarily focusing only on cancer end points. This is largely because sparse data exist to assess hazards and exposure, track chronic diseases, and integrate the information. 5 In 2000, the Pew Environmental Health Commission addressed the environmental public health capacity and found that our nation lacks basic information to document and identify possible links between environmental hazards and chronic disease. 6 The commission recommended establishment of a national environmental public health tracking network to track diseases and exposures, provide an early warning system for critical environmental public health threats, establish federal investigative response capability, and build links between community health and research. In 2002, the CDC established the National Environmental Public Health Tracking Program to expand collection, analysis, and interpretation of tracking data on environmental hazards, exposure to environmental hazards, and health effects potentially related to environmental exposures. 7 ^, 8 This expansion of environmental public health data offers opportunities to identify populations at risk and respond to chronic disease outbreaks, clusters, and emerging disease. 6 Public health agencies will need to be prepared to address public concerns regarding suspected clusters of noncommunicable diseases. Limited information is available on the number of noncommunicable disease cluster (NCC) investigations that are conducted each year; however, more than 1000 requests are made by citizens to state public health agencies for investigations of suspected cancer clusters alone, not accounting for noncancer end points. 9 ^– 11 In 2002, the Council of State and Territorial Epidemiologists (CSTE) evaluated chronic disease epidemiology capacity in state health departments. 12 The CSTE’s findings indicated that many states lack chronic disease epidemiologists and statisticians, clerical support, and access to medical libraries. In 2003, the CDC examined approaches of public health agencies in responding to reports of cancer clusters. The CDC found limitations in current scientific methods, lack of appropriate or insufficient staff, poor data quality, lack of educational materials, and difficulties in establishing appropriate comparison populations. 13 We sought to build on these efforts by evaluating the state-level public health agency capacity to conduct NCC investigations. Our analysis included a review of responsibility and authority for addressing NCC investigations, scope of clusters work conducted by state agencies, protocols used, and an effort to identify trends in cluster studies. We also sought to identify the needs of state public health agencies to enhance capacity in NCC investigations.