Katrina Smith Korfmacher

Public health and high volume hydraulic fracturing.

High-volume horizontal hydraulic fracturing (HVHF) in unconventional gas reserves has vastly increased the potential for domestic natural gas production. HVHF has been promoted as a way to decrease dependence on foreign energy sources, replace dirtier energy sources like coal, and generate economic development. At the same time, activities related to expanded HVHF pose potential risks including ground- and surface water contamination, climate change, air pollution, and effects on worker health. HVHF has been largely approached as an issue of energy economics and environmental regulation, but it also has significant implications for public health. We argue that public health provides an important perspective on policy-making in this arena. The American Public Health Association (APHA) recently adopted a policy position for involvement of public health professionals in this issue. Building on that foundation, this commentary lays out a set of five perspectives that guide how public health can contribute to this conversation.

The Environment in Pediatric Practice: A Study of New York Pediatricians’ Attitudes, Beliefs, and Practices towards Children’s Environmental Health

Chronic diseases of environmental origin are a significant and increasing public health problem among the children of New York State, yet few resources exist to address this growing burden. To assess New York State pediatricians self-perceived competency in dealing with common environmental exposures and diseases of environmental origin in children, we assessed their attitudes and beliefs about the role of the environment in children’s health. A four-page survey was sent to 1,500 randomly selected members of the New York State American Academy of Pediatrics in February 2004. We obtained a 20.3% response rate after one follow-up mailing; respondents and nonrespondents did not differ in years of licensure or county of residence. Respondents agreed that the role of environment in children’s health is significant (mean 4.44 ± 0.72 on 1–5 Likert scale). They voiced high self-efficacy in dealing with lead exposure (mean 4.16–4.24 ± 0.90–1.05), but their confidence in their skills for addressing pesticides, mercury and mold was much lower (means 2.51–3.21 ± 0.90–1.23; p < 0.001). About 93.8% would send patients to a clinic “where pediatricians could refer patients for clinical evaluation and treatment of their environmental health concerns.” These findings indicate that New York pediatricians agree that children are suffering preventable illnesses of environmental origin but feel ill-equipped to educate families about common exposures. Significant demand exists for specialized centers of excellence that can evaluate environmental health concerns, and for educational opportunities.

What's the Point of Partnering? A Case Study of Ecosystem Management in the Darby Creek Watershed

The ecosystem approach to managing the environment requires significant changes to our current environmental management system. However in many cases, financial and political realities may prevent full adoption of the approach. It is important to consider what partial implementation can contribute to improved coordination of management efforts. This article examines the effectiveness of a voluntary coordinating body as a first step toward ecosystem management. The Darby Partnership is a decade-old ecosystem management institution that brings together representatives of government, industry, and the public to protect one of the most pristine stream systems in Ohio. The partnership has no explicit goals, formal planning process, independent funding, or authority. Thus, it is an extremely skeletal version of ecosystem management. This article analyzes the accomplishments of this coordinating institution and explores how the partnership might become more effective in the future.

Invisible successes, visible failures: Paradoxes of ecosystem management in the Albemarle‐Pamlico estuarine study

Ecosystem management has been deemed a promising approach to environmental management in many settings. The ecosystem approach promises improved use of scientific information, better management coordination, and more meaningful public participation in environmental decision making. Yet, there is little evidence for how well ecosystem management efforts actually achieve their goals. This article presents an in‐depth analysis of one ecosystem management effort, the Albemarle‐Pamlico Estuarine Study (APES), which was part of the National Estuary Program. The APES failed to meet the objectives of ecosystem management in several visible ways. However, this case study reveals that the APES also had many positive results that were less visible to participants and observers. The performance of the APES is explained with reference to seven paradoxes inherent in the concept of ecosystem management. These findings have implications for appropriate expectations and evaluation of other ecosystem management efforts.

Blood lead levels of refugee children resettled in Massachusetts, 2000 to 2007.

OBJECTIVES We described elevated blood lead level (BLL; ≥ 10 μg/dL) prevalence among newly arrived refugee children in Massachusetts. We also investigated the incidence of BLL increases and BLLs newly elevated to 20 μg/dL or higher in the year following initial testing, along with associated factors. METHODS We merged data from the Massachusetts Department of Public Healths Refugee and Immigrant Health Program and the Childhood Lead Poisoning Prevention Program on 1148 refugee children younger than 7 years who arrived in Massachusetts from 2000 to 2007. RESULTS Elevated BLL prevalence was 16% among newly arrived refugee children. The rate ratio for BLL elevation to 20 μg/dL or higher after arrival was 12.3 (95% confidence interval [CI] = 6.2, 24.5) compared with children in communities the state defines as high-risk for childhood lead exposure. Residence in a census tract with older housing (median year built before 1950) was associated with a higher rate of BLL increases after resettlement (hazard ratio = 1.7; 95% CI = 1.2, 2.3). CONCLUSIONS Refugee children are at high risk of lead exposure before and after resettlement in Massachusetts. A national surveillance system of refugee childrens BLLs following resettlement would allow more in-depth analysis.

Collaborating for primary prevention: Rochester's new lead law.

In December 2005, the City Council of Rochester, New York, passed an amendment to its municipal code requiring inspection for and correction of lead hazards. Local lead poisoning prevention advocates had long recognized the need for stronger lead policy to address Rochesters high rate of childhood lead poisoning. Between 2000 and 2005, a diverse coalition of educators, healthcare professionals, community members, researchers, government officials, and many others worked to develop a strategy for ending childhood lead poisoning in Rochester by 2010. Their experience in defining the issue, mustering resources, and structuring their decision-making processes is informative for other communities seeking to overcome barriers to improved primary prevention policy.

Are local laws the key to ending childhood lead poisoning

Although lead paint was banned by federal law in 1978, it continues to poison children living in homes built before that time. The lifelong effects of childhood exposure to even small amounts of lead are well established by medical research. Federal and state laws have reduced rates of lead poisoning significantly in the past three decades. However, pockets of high rates of lead poisoning remain, primarily in low-income urban neighborhoods with older housing stock. Recently, several municipalities have passed local lead laws to reduce lead hazards in high-risk areas. There has been no systematic attempt to compare the design and effectiveness of these local policies. To address this gap, we conducted comparative case studies of eight innovative lead laws promulgated since 2000. The laws used a wide variety of legal structures and tools, although certain elements were common. The impact of the policies was intertwined with local housing, economic, and legal environments. While data do not yet exist to systematically evaluate the impact of these laws on lead poisoning rates, our analysis suggests that local laws hold great promise for reducing lead hazards in childrens homes.

Rochester’s Healthy Home: A community-based innovation to promote environmental health action

Environmental hazards in the home can contribute significantly to disease. These hazards disproportionately affect low-income, urban, and minority children. Childhood lead poisoning and asthma are prime examples of health concerns to which poor housing conditions may contribute. A community-academic partnership in Rochester, New York, created a model Healthy Home, an interactive museum in a typical city home, to help residents, property owners, contractors, and community groups reduce environmental hazards. The Healthy Home project educates visitors about home environmental health hazards, demonstrates low-cost methods for reducing home hazards, and helps visitors develop individualized strategies for action. In its first year of operation, over 700 people visited the Healthy Home. Evaluation surveys indicate that the Healthy Home experience motivated visitors to take action to reduce environmental hazards in their homes. Follow-up phone interviews indicate that most visitors took some action to reduce home environmental hazards. The Healthy Home has established a diverse Advisory Council to share its messages more broadly, invite input into future directions, and recruit visitors. This article presents experiences from the Healthy Homes first year, highlighting the partnership principles that guided its development and lessons learned from the process.

An investigation into porch dust lead levels

Lead in porch dust can expose children through direct contact or track-in to the home, but has not been adequately evaluated. At homes undergoing lead hazard control in Rochester, NY, we sampled settled dust lead on exterior porch floors at baseline, immediately post-lead hazard control and one-year post-work (n=79 homes with complete data) via wipe sampling and collected housing, neighborhood and soil data. Baseline GM porch floor dust lead loading (PbPD) was 68 µg/ft(2), almost four times more than baseline GM interior floor dust lead (18 µg/ft(2)). Immediate post-work PbPD declined 55% after porch floor replacement and 53% after porch floor paint stabilization (p=0.009 and p=0.041, respectively). When no porch floor work was conducted but lead hazard control was conducted elsewhere, immediate post-work PbPD increased 97% (p=0.008). At one-year, GM PbPD continued to decline for porch replacement (77% below baseline) and paint stabilization (72% below baseline), but where no porch floor work was done, GM PbPD was not significantly different than baseline (p<0.001, p=0.028 and p=0.504, respectively). Modeling determined that porch floor replacement had significantly lower one-year PbPD than stabilization when baseline PbPD levels were higher than 148 µg/ft(2) (the 77th percentile) but not at lower levels. Treatment of porches with lead paint results in substantial declines in PbPD levels. It is of concern that PbPD levels increased significantly at immediate post-work when lead hazard control was not conducted on the porch but was conducted elsewhere. Standards for porch lead dust should be adopted to protect children from inadequate clean-up after lead hazard control.

Boundary networks and Rochester’s “smart” lead law: The use of multidisciplinary information in a collaborative policy process

The Rochester, New York, Coalition to Prevent Lead Poisoning formed in 2001 with the goal of eliminating childhood lead poisoning by 2010. The Coalition recruited diverse community stakeholders into a collaborative process committed to using the best available science. The Coalition successfully infused the debate about a new lead poisoning law with local data, national analyses, and the latest medical research. We argue that this was facilitated by a boundary network of individuals who provided technical input throughout the process. As a result of the Coalitions advocacy, in 2005 the Rochester City Council unanimously passed an ordinance that has been hailed as one of the nations “smartest” lead laws. Many communities are looking to Rochesters new lead ordinance as a model. Both the process and outcome of this case provide valuable lessons for collaborative efforts to promote scientifically sound local environmental health policy.