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Tracking in Action: Minnesota
Identifying Trends, Protecting People, & Saving Lives
The MN Tracking Program's success stories show how we work to protect, maintain, and improve all Minnesotans' health by delivering data on health trends and the distribution of diseases, environmental threats, and the often complex relationships between them.
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State agencies have a wealth of health and environment data that are important to inform public health action. Despite this, data are often difficult to access or use by policy makers, public health professionals, and the public. In addition, state agency data are commonly provided to the public on an individual-request basis through custom data requests, which can be time consuming and expensive.
To address this gap, the Minnesota Tracking Program (MN Tracking) developed Minnesota Public Health Data Access - an online data portal that includes health and environment data on 22 topics. The Data Access portal provides around the clock access, presenting statewide health and environment data on a variety of topics in one centralized and user-friendly location.
In December 2013, the MN Tracking Data Access portal team received a Governor’s Award for Continuous Improvement. This award recognized outstanding achievement through increasing the efficiency, quality, and value of state services. At the time, the Data Access portal had information on 18 topics and received approximately 2,000 unique visitors each month. Through this award, Governor Dayton commended the Data Access portal for its intuitive web design and plain language. Additionally, the award applauded the portal’s comprehensive, integrated data and commitment to broad-scale data accessibility.
MN Tracking continues to make improvements to the Data Access portal. Since 2013, portal enhancements include a new mobile-friendly design and County Health Profiles for all 87 Minnesota counties. Currently, the portal receives over 9,500 page views each month.
MN Tracking estimates the annual costs avoided for handling data requests to be $3.6 million. Furthermore, maintenance and future development of the Data Access portal are predicted to result in continuous cost savings for the state through the integration of health and environment data in this central system. By providing public access to data that is available in a variety of formats around the clock, the Data Access portal delivers cost effective and timely information to protect public health throughout the state of Minnesota.
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Click on a topic below to read a success story.
- Understanding air quality and health:
Tracking data informs local air quality and health initiatives
Exposures to air pollutants, including fine particles, ozone, and nitrogen oxides, are a concern to urban communities and public health officials in Minnesota. While Minnesota is in compliance with the US EPA National Ambient Air Quality Standards, air pollution concentrations in some areas of the state trigger health alerts, and are a concern for communities, especially where rates of heart and lung diseases are elevated. However, local data on air quality, health, and social-demographic factors, such as poverty, are often difficult to access by communities and policy-makers.
To address this issue, MN Tracking, in collaboration with the State’s lead environmental regulatory agency, developed new interactive ZIP code maps for asthma and chronic obstructive pulmonary disease hospitalizations in the Twin Cities area. These maps complement existing data on the MN and CDC National Tracking Network by providing access to health and air quality data at the community level. MN Tracking also developed ZIP code level poverty data which is displayed together with health data to illustrate the important relationship between poverty and these important and costly chronic diseases. MN Tracking’s new online data visualization tool allows community members to see how their ZIP code compares to others and the relationship between measures of air pollution, health and poverty.
In 2015, the new maps and data from the Tracking Network were published as part of a state report, “Life and Breath: How Air Pollution Affects Public Health in the Twin Cities.” The report revealed large disparities across the Twin Cities on the impacts of air pollution and was used to inform the development of a new online Be Air Aware toolkit. The toolkit empowers communities, businesses and individuals with actions they can take to reduce air pollution and protect health. The data are also being used in a community Health Impact Assessment to incorporate health in local planning decisions. The report and the toolkit have engaged the media, state agency and community leaders on this issue, and strengthened commitments by top officials to address the pollution sources, and to advance health and environmental equity.
- Life and Breath report (pdf)
- Be Air Aware: web toolkit
- Minnesota Public Health Data Access: webmaps for asthma and chronic obstructive pulmonary disease
- Economic Burden analysis:
Supporting local initiatives to prevent lead exposure
Lead exposure is a significant concern in Minnesota, particularly in areas where poverty levels are high and housing conditions are poor. Public health and medical professionals agree that there is no safe level of lead exposure, yet Minnesota finds elevated blood lead levels in many children each year. Any level of lead in a child’s blood has a detrimental impact on a child’s IQ and, subsequently, his or her potential lifetime earnings.
To support local efforts in preventing childhood lead poisoning, MN Tracking worked closely with the state health department’s Lead and Healthy Homes Program and national partners to estimate the economic burden of childhood lead exposure in Minnesota. They calculated an average peak (highest) blood lead concentration for a group of Minnesota-born children who were followed up to 6 years of age. The analysis showed that childhood lead exposure in Minnesota costs approximately $1.9 billion in potential lifetime earnings due to IQ deficits for children born in a single year. In fact, this likely underestimates the total cost of lead poisoning because of factors not included in the analysis, such as the costs of special education provisions and housing remediation efforts.
The release of MN Tracking’s economic burden report followed Minnesota’s implementation of a revised state definition of an elevated blood lead level, lowering the threshold from 10 to 5 micrograms per deciliter. This new threshold, along with the report, supported local actions to expand lead prevention education and follow-up testing, particularly in areas at high-risk for lead poisoning in the Twin Cities. Local health officials in Minneapolis, for example, now conduct home assessments at lower blood lead levels. MDH estimates that statewide, the lowering of the threshold increased the number of children considered to have elevated blood lead levels by 350%. MN Tracking’s economic burden analysis provided cost estimates that help communicate the future costs of childhood lead exposure, and support local efforts to prevent poisonings and increase public health protection for children.
The MN Tracking economic burden report also has been assisting other states’ efforts to curb lead poisonings. The Indiana Department of Health referenced the MN Tracking economic burden report as a resource as they are working to define estimates of their state economic burden of lead. The report has also been shared with the National Center for Healthy Housing as an example of the importance of state lead surveillance programs.
MN Tracking continues to work with the state Lead and Healthy Homes Program to develop and update maps and charts available on Minnesota Public Health Data Access, MN Tracking’s data portal. These data show trends and geographic patterns for childhood lead poisoning, along with data on older housing and childhood poverty, two known risk factors for lead poisoning. With these data and the economic burden analysis, MN Tracking is preventing childhood lead poisonings, protecting lives and saving money.
- Economic Burden of the Environment: Asthma and Lead Poisoning in Children
- MN Public Health Data Access: Childhood Lead Poisoning
- Chronic Obstructive Pulmonary Disease:
Using data for better treatment and management
Chronic obstructive pulmonary disease (COPD), which includes emphysema and chronic bronchitis, is the 5th leading cause of death in Minnesota. COPD is estimated to effect 24 million men and women in the US – but as many as half remain undiagnosed. Few states track COPD hospitalizations. And prior to 2011, no national-level surveillance data on COPD prevalence existed. Given the public health and economic impacts of COPD in the U.S., this was an important gap in information needed to inform public health actions and policy.
Starting in 2010 the Tracking Program developed and published state-specific data and measures for COPD hospitalizations on MDH’s data portal, Minnesota Public Health Data Access. The Tracking Program developed these data using methods that are consistent with the CDC National Tracking Network, making them easily adaptable by other states and at the national level.
In addition, Minnesota was one of the first states in the country to measure COPD prevalence statewide using the Minnesota Behavioral Risk Factor Surveillance System. Together these data provide useful information to evaluate trends and spatial patterns over time, and to inform health professionals and the public about important risk factors and public health actions.
The American Lung Association in Minnesota is working with the Tracking Program to use COPD data to inform and evaluate plans to prevent and treat COPD in Minnesota. This activity has started discussions with key partners regarding ways to raise awareness about this poorly recognized, costly, and underestimated public health issue, and resulted in additional media coverage of COPD in the state. In 2013, the Tracking Program and the American Lung Association in Minnesota published a joint report, The Scope of COPD in Minnesota (PDF: 1.9 KB/4 pages).
In addition, the Tracking Program is working with other states and the CDC to share surveillance methods and develop a national standard for defining COPD hospitalizations. To view tracking data and learn more about COPD, see Minnesota Public Health Data Access: Chronic Obstructive Pulmonary Disease.
- Carbon monoxide poisoning:
Hospitalizations data show fewer poisonings since implementation of CO alarm law
Each year in Minnesota, especially in winter, unintentional carbon monoxide (CO) poisonings result in emergency department visits, hospitalizations, and even deaths. CO poisonings are tragic and costly, and many poisonings may have been prevented with proper use and maintenance of CO alarms.
Recognizing this important public health issue, the Minnesota Legislature implemented a state law requiring CO alarms in all single family homes and multi-dwelling units. However, there was no system for tracking CO poisonings in Minnesota, and no way to evaluate the impact of the law.
To address this gap, the Minnesota Environmental Public Health Tracking Program (MN Tracking) developed data to track unintentional CO poisonings state-wide. These data show a decline in the hospitalization and emergency department rates since implementation of the CO alarm law.
CO poisonings continue to be a public health concern in Minnesota, particularly in the winter season when residential heating sources are operating. MN Tracking’s CO poisoning data help raise awareness through news stories, training and continuing education materials for relators, and outreach to the public about healthy homes. Public health officials and legislators now have a way to measure and track the positive impact of their actions.
Learn more about CO poisoning from MDH at:
- Tracking health insurance coverage:
Evaluating implementation of the Affordable Care Act
Access to health insurance helps people get the health care they need. Research shows that lacking health insurance is associated with poor health outcomes for several common diseases including asthma, stroke, and some cancers. When the Affordable Care Act (ACA) was signed into law in 2010, health professionals needed an easier way to get data on health insurance coverage to evaluate the impact of this legislation.
To meet these needs, the Minnesota Environmental Public Health Tracking Program (MN Tracking Program) analyzed two data sources: the Minnesota Health Access Survey and the U.S. Census Bureau's Small Area Insurance Estimates. With these two sources, the Minnesota Tracking Program created charts, graphs, and maps to highlight important disparities in health insurance coverage by age, gender, geography, and race/ethnicity. Additionally, the Minnesota Tracking Program created a data query so that health professionals can get state- and county-level data on health insurance coverage.
With these data available on Minnesota Public Health Data Access, the MN Tracking Program and our partners are evaluating the impact of the Affordable Care Act. For example, the data show that since implementation of the ACA, the proportion of adults ages 18 to 25 without health insurance has decreased in Minnesota, especially among males. The MN Tracking Program will regularly update these data to continue to track the legislation's impact on health insurance coverage.
Identifying rising rates of this dangerous skin cancer
Melanoma is the most dangerous form of skin cancer and one of the most rapidly increasing cancers among Minnesotans. Since 1988, incidence of melanoma in Minnesota has doubled for both males and females, with a notable increase among young women (20-49 years of age) over the last 15 years.
These increases are likely the result of exposure to ultraviolet (UV) light, from both sunlight and tanning beds, and better medical detection. The CDC estimates that UV light causes 65 to 90% of all melanoma. And, use of tanning beds has been common in Minnesota: in 2013, nearly 30% of female 11th grade students reporting having used an indoor tanning device at least once in the past year.
This provided a unique opportunity to use tracking data to drive outreach and inform new policy. The MN Tracking Program published interactive maps and charts showing trends and geographic patterns of melanoma, and the widespread use of tanning beds among teenagers. With these data now publicly available, the Tracking Program collaborated with state cancer prevention programs and other partners, including the American Cancer Society in Minnesota and the MN Cancer Alliance, to issue a press release in January 2013, "Melanoma rates on the rise in Minnesota," which led to statewide media coverage.
These and other tracking data help to support cancer prevention initiatives, including the UV Video Challenge – a Minnesota Department of Health sponsored initiative for students to create videos about the dangers of UV exposure, as well as the new policy initiative in Minnesota.
In July 2014, Minnesota passed Tan-Free Teen legislation that prohibits children under age 18 from using indoor tanning beds. This bill puts Minnesota among the few states implementing such an aggressive melanoma-prevention policy. Though this trend in melanoma has been evident for a while, the powerful public health potential of this piece of public policy stemmed in part from the Tracking Program’s surveillance and collaboration on data publication, outreach, and work with partners.
- Environmental Tobacco Smoke (Secondhand Smoke)
Measuring how we reduce secondhand smoke
Secondhand smoke, also known as environmental tobacco smoke (ETS), is a known human carcinogen (causes cancer). Non-smokers, both children and adults, who are exposed to ETS are at increased risk for adverse health effects, including sudden infant death syndrome (SIDS), exacerbation of asthma, heart disease and lung cancer. The total cost of health conditions attributable to ETS exposures in Minnesota is about $229 million (1).
Freedom to Breathe legislation passed in Minnesota in 2007 banned smoking in almost all indoor public places and indoor work places, including bars and restaurants. In 2011 there were attempts to repeal this legislation for restaurants and bars.
To evaluate the impact of Minnesota's Freedom to Breathe legislation, data was needed to evaluate trends over time and assess the effectiveness of public health actions addressing ETS exposure. The Minnesota Environmental Public Health Tracking Program published new ETS data and measures on MDH’s data portal, Minnesota Public Health Data Access.
The data show a 20 percent decrease in exposure to ETS among children since implementing Freedom to Breathe legislation. The data also show a significant gap in ETS exposure between youth in the Twin Cities metro and non-metro youth which has widened from 5% in 2000 to over 14% in 2011. Non-metro youth continue to have a higher likelihood of ETS exposure (see Youth Exposed to ETS by Region).
Based on these data, it appears that Freedom to Breathe legislation has reduced ETS exposure for nonsmokers in Minnesota. However, a significant number of adults and youth are still exposed to ETS. Based on surveys conducted in 2010-2011, ETS exposure among Minnesota adults and youth is relatively common (e.g., 2010-11 surveys indicate that 37% of nonsmoking adults and 39% of youth in Minnesota report being exposed to ETS).
Tobacco prevention programs and other partners, including the American Lung Association of MN, American Cancer Society, and ClearWay Minnesota use data to evaluate the effectiveness of initiatives and programs. To view tracking data and learn more about ETS, see: Minnesota Public Health Data Access (Environmental Tobacco Smoke).
(1) Source: Waters HR, Foldes SS, Alesci NL, Samet J. The Economic Impact of Exposure to Secondhand Smoke in Minnesota. Am J Public Health. 2009; 99 (4): 754-759 (table 4). Adjusted to 2008 dollars.
- Heat-related Illness
Understanding who's vulnerable
Heat significantly impacts public health in Minnesota. Each year hundreds of emergency department visits and hospitalizations occur due to heat-related illnesses. Nationally, over the last decade, heat claimed more lives on average than any other severe weather event. However, data to evaluate national and state efforts to prevent illnesses and deaths during extreme heat events has been difficult to find.
The Tracking Program, along with the CDC National Tracking Network, has developed data and measures on heat-related illnesses and deaths. These data help to inform state and local strategies to prevent heat-related illnesses and deaths particularly in vulnerable populations; and to evaluate the effectiveness of local actions over time.
For instance, the Tracking Program's data showed that elderly and younger age groups (15-34 years of age) are more likely to visit the emergency department for heat-related illnesses. While the elderly are known to be at an increased risk from heat exposures, these new data helped identify 15-34 years old as an at risk age group. In addition, the data showed higher rates of hospitalizations and emergency department visits in greater Minnesota than the 7-county metro area. While the emphasis historically has been on urban areas (urban heat island effect); these data confirm that areas in greater Minnesota also experience public health impacts from extreme heat events.
These data, together with local maps of vulnerable populations developed at the state and local level, help health professionals and emergency preparedness officials target outreach and education to vulnerable populations.
The MDH Climate and Health Program and Office of Emergency Preparedness use the data to evaluate trends over time and to assess the effectiveness of outreach and planning efforts. To view tracking data on heat-related illnesses, see: Minnesota Public Health Data Access (Heat-related Illnesses).
- Chemicals in People
Measuring PFCs in Minnesota communities
Environmental testing conducted by MDH and other state agencies discovered drinking water contamination from historical disposal of wastes containing perfluorochemicals (PFCs) in communities located east of Minneapolis-St. Paul (the “East Metro”). Measures to reduce exposures to PFCs in drinking water were implemented in 2006, including installation of carbon filtration systems in public and private water supplies and provision of alternative water sources for households using private wells.
As a result of community and policymakers’ concerns, MDH conducted a biomonitoring project in 2008 to measure PFCs in the blood of 196 East Metro residents exposed to contaminated drinking water. Findings showed that residents’ blood levels were higher than the national average. Biomonitoring data helped to inform citizens and policy-makers about PFC exposures in the East Metro.
Were actions in the East Metro to reduce drinking water exposure to PFCs successful?
MDH conducted a follow-up biomonitoring project in 2010-2011. PFC blood levels were measured in 164 participants from the earlier project. Results showed that blood levels of the three most commonly detected PFCs declined substantially (from 13-26% on average) since 2008. The findings showed that the public health actions were working.
MDH held public meetings with concerned citizens and helped to connect people in the study with a health care provider for consultation. Biomonitoring data helped to provide important reassurances to the community. State funding provided for sample collection and analysis, and federal (CDC) funding supported communication and outreach and development of PFC data on MDH’s data portal.
Helping communities understand cancer risks
Each year in Minnesota citizens and communities raise questions about cancer and the environment through the media, environmental review processes, and other channels. People want to know:
- Are cancer rates higher in my community compared to other areas?
- Could environmental contamination be causing excess cancer?
- What can our community do to prevent cancer?
City and county officials also need data to help answer their community's questions.
In 2012, the Minnesota Tracking Program, in partnership with the MN Cancer Surveillance System (MCSS), launched a series of new interactive maps, charts, and queries for state and county-level data on the Data Access portal.
Around that time, residents of Anoka County became concerned about cancer excesses and environmental contamination (Superfund sites; volatile organic chemicals in groundwater), and many turned to the portal’s cancer data. Tracking data showed that the total number of cancers in Anoka County was about 4% higher than the state average, and lung cancer accounted for most of the cancer excess. Further analysis showed that smoking rates in Anoka County were much higher than in surrounding communities.
The MN Tracking Program and MCSS worked with local elected officials and health officials to inform the local community about cancer data, and the risks of smoking and radon – the leading causes of lung cancer – and distributed a fact sheet addressing local concerns (Community Concerns about Cancer in Fridley and Anoka County: PDF). The Fridley community group used these data in a definitive report that answered local questions about the role that industrial contamination may have played in cancer in the area.
With this experience, the Tracking Program is developing more tools that communities can use to get answers to their questions or cancer concerns. With cancer data on the County Profiles application, people can quickly see how their county’s cancer rates compare to statewide rates. And, in 2014,Tracking Program staff interviewed local public health officials about their experience responding to cancer concerns, to develop a better template for fact sheets. With these tools in hand, MDH is poised to quickly and effectively respond to cancer concerns in local communities.
- National Public Health Accreditation
Using tracking data to inform assessment and planning
The costs of treating and managing chronic diseases and conditions, such as cancer, asthma, and heart disease, are high. Nationwide, 75% of the $2.6 trillion spent for health care goes for chronic disease treatment. Minnesota’s costs are estimated to be about $5 billion per year.
Local health departments in Minnesota conduct periodic community health assessments to help guide programs and initiatives to reduce the prevalence and impact of chronic diseases and conditions, such as asthma, cancer, and obesity, and promote healthy behaviors at the community level. Local health and environment data are often difficult to access, despite the fact that they are important to track and measure progress with assessments over time.
To improve access to local health and environment data, the Tracking Program developed data on over 17 health and environment topics. Local health departments across the state are using these data to identify priorities and measure effectiveness of programs and initiatives. The data include interactive maps and charts and custom queries for county and state data for many chronic diseases and their risk factors.
Local health departments in Minnesota also are using these data to meet national standards for public health accreditation (see Public Health Accreditation Board (PHAB)). Accreditation through PHAB is voluntary, however, many local health departments and MDH see it as an important step to improve public health services, and will likely be a factor considered in grants and federal funding proposals. For more information, see Minnesota Public Health Data Access and Minnesota Local Health Assessment and Planning.
Melanoma is the most dangerous form of skin cancer and one of the most rapidly increasing cancers among Minnesotans. The incidence of melanoma in Minnesota has doubled since 1988 for both males and females, with a notable increase among young women (20-49 years of age) over the last 15 years.
These increases are likely the result of exposure to ultraviolet (UV) light, both natural (sunlight) and artificial (tanning beds), and better medical detection. The Centers for Disease Control and Prevention (CDC) estimate that exposure to UV light causes 65-90% of all melanoma. Use of tanning beds continues to be common in Minnesota.
These circumstances provided a unique opportunity to use tracking data to inform outreach and policy to prevent melanoma and stop this alarming trend. The Tracking Program published interactive maps and charts showing trends and geographic patterns of melanoma (see: Minnesota Public Health Data Access, Melanoma: Basic Facts and Figures).
The Tracking Program collaborated with state programs and other partners, including the American Cancer Society in Minnesota and the MN Cancer Alliance, to use tracking data to support program and policy initiatives to prevent melanoma. These partners identified reducing the use of artificial UV light for tanning as a key objective in Cancer Plan Minnesota: 2011-2016. Tracking data are helping to raise awareness about this important public health issue and to evaluate the effectiveness of program and policy initiatives over time.
The Tracking Program also worked with partners to integrate state and county-level melanoma data into the MN County Health Tables, a combined set of indicator profiles used by state and county health professionals. Incorporating melanoma data into these tables enables state and local health professionals to use melanoma data to inform their planning and assessment activities.
Lastly, the Tracking Program worked with our partners to issue a press release, entitled Melanoma rates on the rise in Minnesota, which led to statewide coverage on radio and television networks in the state. This press release highlighted the importance of reducing exposure both to natural UV light and tanning beds and included a link to the melanoma data and maps available at MN Public Health Data Access. The press release was a joint effort of three federally funded programs (the Tracking Program, American Cancer Society of MN, and MN Cancer Alliance), providing a good example of how state programs can leverage funding and work together to address an important public health issue.
The Tracking Program continues to work with partners to identify opportunities for using data to support outreach and education initiatives on melanoma. We also are working with the MN Cancer Surveillance System to develop and evaluate additional tracking data and measures that inform cancer prevention initiatives (such as data on colon cancer, radon, and smoking).
- Communities, Health, and the Environment
Working with Hiawatha CARE to identify neighborhood health issues
Some Minnesota communities are faced with multiple health and environmental inequities like high rates of asthma, lack of health care access, poverty, high density traffic and air pollution, and aging or deteriorating housing. However, it’s often difficult for citizens and local officials to evaluate priorities and the progress of public health initiatives over time, since neighborhood-level public health data is hard to get. This information is often not easily accessible to the public, or unavailable for geographies smaller than the county level such as zip code or census tract.
Recently, the Tracking Program collaborated with the Minnehaha-Hiawatha Corridor Environmental Collaboration in Minneapolis (Hiawatha CARE project) which aims to identify priorities for public health, safety, and environmental issues affecting the Minnehaha-Hiawatha corridor in south Minneapolis. This project was done with funding from the US Environmental Protection Agency, in conjunction with Hennepin County.
The Tracking Program was able to provide community-level data for asthma hospitalizations and childhood lead poisoning, allowing the Hiawatha CARE project to see how these environmental public health issues affected their community. Viewing this information by census block group level and zip code level revealed that asthma hospitalization rates in two of the zip codes were higher than the rate for Hennepin County and the statewide average. It also showed that almost all children in the Hiawatha CARE project area born between 2006 and 2008 had their blood lead levels tested before 3 years of age, and about 1% of children tested had an elevated blood lead level. The Tracking Program staff developed a fact sheet (PDF - 618KB) to inform the community of its childhood lead poisoning status, including maps at the census block group level for two key blood lead measures: the percent of children tested and the percent of children with elevated levels).
Using this type of information, the Hiawatha CARE project staff worked with community residents to select five areas that posed the greatest risk and concern to the community: air pollution and vehicle emissions, asthma, economic instability, nutrition and obesity, and water quality. With these priority areas, the group will develop a plan to use existing resources and propose new projects to improve these five areas.
For more information, contact the Tracking Program.
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Tracking Success Across The Country
For more, see the National Tracking Network's Success Stories, or view the videos below: