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Epidemiol Prev 2018; 42 (5-6): 11-20
DOI: https://doi.org/10.19191/EP18.5-6.S1.P011.084

Environmental and health data needed to develop national surveillance systems in industrially contaminated sites

  • Piedad Martin-Olmedo1,2

  • Rebecca Hams3,4

  • Michele Santoro5

  • Andrea Ranzi6

  • Gerard Hoek7

  • Kees de Hoogh8,9

  • Giovanni S. Loenardi10

  1. Escuela Andaluza de Salud Pública, Granada (Spain)
  2. Instituto de Investigación Biosanitaria (ibs.GRANADA), Granada (Spain)
  3. UK Field Epidemiology Training Programme, Public Health England (UK)
  4. Environmental Epidemiology Group, Centre for Radiation, Chemicals and Environmental Hazards, Public Health England (UK)
  5. Unit of Environmental Epidemiology and Disease Registries, Institute of Clinical Physiology, National Research Council, Pisa (Italy)
  6. Environmental Health Reference Centre, Regional Agency for Environmental Prevention of Emilia-Romagna, Modena (Italy)
  7. Institute for Risk Assessment Sciences, Utrecht University (The Netherlands)
  8. Swiss Tropical and Public Health Institute, Basel (Switzerland)
  9. University of Basel, Basel (Switzerland)
  10. Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London (UK)
Piedad Martin-Olmedo -

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BACKGROUND: public health surveillance (PHS) of industrially contaminated sites (ICSs) is likely to play a role in supporting the monitoring of harmful aspects of ICSs and related interventions. Environmental public health tracking (EPHT) has been proposed and developed as an approach to PHS when environmental factors affecting health are involved.
OBJECTIVES:
to identify existing arrangements for continuous collection and analysis of environmental and health data to guide the development of an optimal EPHT approach which would support the characterization of the impact on health of ICS.
METHODS:
a literature search was conducted in PubMed following a structured approach to identify methodological aspects relevant to surveillance of ICSs. In addition, eight further studies on this topic, mainly from three European Countries (Spain, Italy, and France), were included by the research team.
RESULTS: the identified 17 examples of surveillance studies include a heterogeneous variety of industrial activities, covering from cross-national to local scenarios. Continuous monitoring systems for gathering environmental data related to ICSs were used only in two cases; a qualitative approach and/or punctual sampling for soil, air, and water of local foodstuff took place in the rest. Exposure assessment was conducted according to four main methods: qualitative definition for the presence/absence of a source, distance to a source, dispersion modelling, and biomonitoring. Health data relied on routinely vital statistics, hospital admission records, specific morbidity registers, and cancer and congenital abnormalities registries.
DISCUSSION: our revision identified an overall lack of national surveillance programmes of ICSs, rather than gaps in individual dimensions of surveillance. The epidemiological approaches reviewed provided methods, some of which could be adopted for an EPHT in ICSs. However, a large proportion of examples suffers from poor exposure characterization, relying on a qualitative definition approach, which cannot account for the multiple pathways that take place in ICSs. Use of more individual data from health registries combined with improved environmental data collection and exposure assessment would improve future surveillance.

Keywords: public health surveillance (PHS), environmental public health tracking (EPHT), routine health data, industrially contaminated sites (ICS)

KEYPOINTS
What is already known

  • Industrially contaminated sites (ICSs) represent a long-term legacy of past and current development, and a probable lasting cause of preventable non-communicable disease.
  • Environmental public health tracking (EPHT) could be a valuable approach to monitor the evolution of the health profile of populations residing close to industrially contaminated sites (ICSs) and to assess the efficacy of remediation and preventive actions.

 

What this paper adds

  • Further improvements for gathering and/or getting access to specific environmental data and exposure assessment models in ICSs seem crucial for improving the validity of environmental epidemiology and surveillance programmes.
  • Great governmental stewardship would be required for allowing disparate public agencies to make progress in collecting routine exposure and health data sets with their linkage for future epidemiology research and EPHT in the context of ICSs.