10th September, 2002
More than 1,000 calls are placed to state public health officials each year regarding suspected clusters of diseases ranging from childhood leukemia to multiple sclerosis. But disease cluster investigations are often delayed or deterred because most states lack adequate tracking for chronic diseases, according to a report released by U.S. PIRG, a public interest advocacy organization. At the same time, some cluster investigations are aided by the presence of good information on disease and environmental exposures.
"Few situations are as troubling as rising rates of cancer or birth defects in a community. Poor or nonexistent tracking of disease rates and environmental exposures means that communities can't get questions answered and health problems addressed," said Jeremiah Baumann, environmental health advocate with U.S. PIRG. "Good environmental health tracking can help communities address disease clusters."
The report highlights 14 communities affected by disease clusters. While notoriously difficult even under the best of circumstances, disease cluster investigations play an important role in protecting health. Investigations help public health officials target resources for disease prevention and treatment, spur the discovery and cleanup of environmental pollution, and enable researchers to identify links between environmental exposures and chronic disease.
The difficulty of investigating disease clusters is often exacerbated by incomplete, out-of-date, or entirely absent information on disease rates and environmental exposures. While most states have cancer registries, the registries sometimes don't meet national standards. More than half of the states recently received a grade of 'C' or lower for their birth defects monitoring programs from the Trust for America's Health, a public health advocacy organization.
Only three states—California, Iowa, and Massachusetts—have both cancer and birth defects registries that meet the highest standards of quality and also have systems for tracking asthma. Almost no states conduct systematic tracking of neuro-developmental disorders such as multiple sclerosis, Alzheimer's, and Parkinson's, metabolic diseases like diabetes, or autoimmune disorders such as lupus. According to a 1998 study by a researcher at the University of Missouri, 37 states have less than one full-time person available to handle cancer cluster concerns.
According to the U.S. PIRG report, the lack of adequate information on disease rates and environmental exposures hinders investigations in several ways: missing information delays investigations; it prevents health officials from identifying disease trends; it reduces the number of clusters investigated, leaving many clusters uninvestigated; and it deters communities from getting the information and help they need when a suspected cluster arises.
The report highlights 14 case studies of cluster investigations. Several of the cases, including a childhood leukemia cluster in Toms River, N.J., a multiple sclerosis cluster in El Paso, Texas, and a cluster of cleft lip cases in Dickson County, Tenn., show investigations delayed or otherwise hindered by inadequate or missing disease tracking information. Missing information on environmental exposures hindered investigations of cancer clusters in Hazleton, Pa., and Calcasieu Parish, La.
However, aggressive monitoring of birth defects in Laredo, Texas, caught an emerging cluster and led to proactive public health intervention, and active surveillance for breast cancer in New York provoked an investigation into the role of environmental factors in breast cancer rates on Long Island. The California Birth Defects Monitoring System has enabled researchers to correlate maternal exposure to air pollution and residence within a quarter-mile of a Superfund toxic waste site with the development of certain birth defects.
The Centers for Disease Control and Prevention (CDC) is initiating a nationwide environmental health tracking project to set up consistent disease and exposure tracking across the country, starting this fall with pilot projects in a handful of states. This month, the House of Representatives will consider whether to increase funding for the program so that it can extend to all 50 states.
The full text of Health Tracking And Disease Clusters: The Lack Of Data On Chronic Disease Incidence And Its Impact On Cluster Investigations is available online.
U.S. PIRG is the national lobbying office of the state Public Interest
Research Groups. State PIRGs are state-based, nonpartisan, nonprofit public
interest advocacy organizations.
Copyright © 2002 Capitol Reports