Environmental public health tracking: piloting methods for surveillance of environmentally related diseases in England and Wales

An effective environmental public health tracking system integrates data and intelligence on environmental hazards, exposures, and health outcomes to focus interventions on reducing the impact of environmental contamination on public health. Most work in this area in the UK has focused on assessing data on hazards that are relatively easy to obtain. However, most hazards will present no actual risk and information on exposure is required to make an effective risk assessment. Obtaining exposure data is technically challenging, expensive, and potentially raises ethical concerns. Consequently, the Health Protection Agency is exploring methods for targeting geographical zones for efficient detailed environmental assessment (including exposure assessment). This paper describes and assesses three methods (indirect standardization, statistical process control (SPC) and kernel density contouring) for the surveillance of potentially environmentally related diseases for this purpose. While the evaluation demonstrates the utility of the three methods, particularly SPC, the comparison was limited due to ethical approval issues