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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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- Radon in Minnesota
- The public awareness campaign and media coverage in July accounted for at least 400 additional tests kits ordered.
- The MN Data Access portal saw a six-fold (600%) increase in overall website traffic to radon information July 2016.
- The campaign expanded the reach of the department's Facebook page, increasing its 'friends' by nine percent. The radon posts were among the MDH Facebook posts with overall highest engagement rates (Likes, shares) in 2016.
- Oral health data helps secure funds for dental clinics for low-income families in SE Minnesota
- Building capacity in Minnesota for the disaster epidemiology
Part 1: Novel data analysis identifies higher radon risks statewide and informs county officials
Health risks and data limitations of radon
Radon—a colorless, odorless gas— is the number one cause of lung cancer in non-smokers and the second leading cause of lung cancer (after tobacco use) in smokers in the United States today. Previously, Minnesota radon levels were projected based on the Environmental Protection Agency (EPA) radon estimates, which identified "zones" of potential risk based on geology and computer modeling. Actual levels in Minnesota were unknown and made targeting at-risk counties difficult. County health officials and the public needed better understanding of Minnesota's radon levels to stimulate action.
Collaborations and new data analyses MN Tracking partnered with the MDH Indoor Air Quality Unit to analyze radon test results (237,252 records) from eight private radon labs in Minnesota and develop key radon data measures to highlight differences in radon testing and radon levels across Minnesota counties. Radon tests were geocoded to identify a latitude and longitude and assigned to the intersecting county. This provided a more accurate picture of the radon levels for each county and was a novel approach to radon data analysis. The number of radon tests conducted in each county was then adjusted for population size in order to compare testing rates by county.
Analyses indicated that the radon levels are higher than EPA radon risk potential predicted. Seventy-eight percent of counties have average radon levels that exceed ≥4 pCi/L and 2 in 5 Minnesota buildings tested statewide have radon levels that pose a significant health risk.
Minnesota specific radon data
The MN Data Access portal launched new radon content in 2015 and now displays information using interactive maps and charts that show: 1) seven radon measures per county, 2) Minnesota radon levels compared to national levels, 3) annual number of tests conducted, 4) number of counties within the EPA radon level categories, and 5) radon level seasonal variation.
The MDH Indoor Air Quality Unit, other state programs, policy makers, public health organizations, local public health, and researchers are using these data to inform their planning, outreach, research and evaluation.
Part 2: Radon communications campaign expands home test kit orders and public awareness
Many county public health departments have active radon programs, but there was previously little public awareness of the need for home testing statewide. MN Tracking led the development of a public awareness campaign to encourage every property owner to conduct radon testing for their own safety, and to educate the public about the health effects from radon exposure. The campaign included traditional media outreach, social media and email to reach as many Minnesotans as possible.
More than 20 partner organizations (including nonprofits and real estate professionals) were enlisted to assist with the outreach effort. A web page created for the partners contained content and infographics to use to help spread the word about the radon health risk in Minnesota. Email was sent to 150 local health departments, medical centers and other organizations and 5,600 individual GovDelivery subscribers to encourage their use of these resources and to help spread the word.
Impact of communications campaign
To purchase your own radon kit go to the MDH Radon webpage.
Community Dental Care, a nonprofit dental clinic in Minnesota, received a $1 million grant from Delta Dental of Minnesota Foundation (DDMF) to build an 18 chair dental clinic scheduled for completion in September 2017. Identifying a significant, unmet need for dental health care among low-income families in Southeastern Minnesota, Community Dental Care applied for funding to build the new clinic in Rochester to supplement Community Dental Care’s Rochester clinic—where patients currently wait two months for a dentist appointment and seven months for a dental hygienist. “This new clinic will make a substantial impact for thousands of Minnesotans who otherwise would not have access to quality care,” said Joe Lally, executive director for DDMF. “We know oral health is key to overall health, and we believe every single person deserves a healthy smile.”
Successful storytelling with data
Community Dental Care helped their funder understand Southeastern Minnesota’s growing need for low-income families’ access to dental care by including oral health data from the MN Public Health Data Access portal. They were able to show that of the people eligible for public programs in Olmsted County (and six bordering counties), almost 70 percent went without care in 2014. Additionally, only 43 percent of the more than 10,000 Medicaid-eligible children in that area visited a dentist. Community Dental Care also compared 2014 portal data with their own 2014 statistics, and found that their current Rochester clinic provided close to 25 percent of the dental encounters for MHCP patients in Olmsted County and almost 19% of all MHCP patient encounters in the six bordering counties.
Oral health data published online represents an ongoing collaborative project between MDH’s Environmental Public Health Tracking and Oral Health programs to provide timely, understandable and actionable state and county oral health data. These data, which include health disparities and trends in disease and service use, help identify unmet needs and target resources more efficiently.
Learn more about the diseases linked to oral health problems and how to prevent them.
Health impacts of disasters
Disasters can have a long-lasting impact on the health of responders and the affected community. Long-term health outcomes may include: cancer, respiratory disease, disabling injury and mental health impacts. Chronic disease epidemiologists are not usually a part of the team in emergency situations and are new to disaster preparedness planning and response. To strengthen Minnesota’s emergency response and surveillance capacity of chronic health outcomes, a plan was needed to ensure the timely collection of data on exposed members of the community to enable future follow-up of the long-term health effects from disasters.
MN Tracking Program built capacity, conducted training
MN Tracking Program developed a plan to collect data on affected community members for surveillance of chronic health outcomes related to an emergency event. To practice using the plan, we used a train derailment scenario. This helped us practice how to work within the MDH response and identified resource needs. We also met with partners to identify areas of collaboration and information sharing to support an effective response to a hazardous chemical with long-term health implications. Partners included Minnesota Poison Control System, University of Minnesota, local health departments, American Red Cross, and the Minnesota Pollution Control Agency.
Improved emergency planning and data collection
As a result of MN Tracking’s efforts, Minnesota is better prepared to answer critical public health questions about the long-term health effects originating from disasters. MDH staff and local partners are more aware of the LTS annex and better prepared to respond to disasters with long-term health implications. The exercises made clear how the plan functions at the state level, and how to coordinate with local and regional partners. By effectively integrating long-term surveillance into emergency planning at the state level, early planning for long-term surveillance data needs were addressed.
More Success Stories:
Click on a topic below to read a success story.
- Tracking data informs Minneapolis Climate Change Vulnerability Assessment
- MN Tracking Enables Better Communication: Biomonitoring PFCs of residents in the East Twin Cities metro
- provided outreach and information to Minnesota residents concerned about PFCs (2008-2015).
- developed and maintained new data online showing the most current national biomonitoring reference values for PFCs and other chemicals, and linked these pages to the biomonitoring project results.
- developed press releases, factsheets, infographics and reports for the Minnesota Legislature.
- Data helps doctors explain mercury, lead and cadmium in women and their babies
Increasing summer heat is an important environmental effect of climate change that the City of Minneapolis must plan for and adapt to. Increasing frequency and intensity of heat events will have health consequences for people in Minneapolis that can exacerbate existing health conditions and increase risk of illness or death.
In anticipation of this public health risk, the City of Minneapolis selected social and heat vulnerability indicators to determine overall place vulnerability. This identified places in Minneapolis vulnerable to climate change when both heat and social factors were considered. These places are considered priority places for climate change adaptation or resilience measures.
To look at existing spatial patterns of health vulnerability, the MN Tracking program provided heat-related illness, heart attacks, and asthma hospitalizations for Minneapolis at the zip code level. The City of Minneapolis plans to address these areas through reductions in landscape vulnerability to heat, as well as efforts to reduce social vulnerability to climate change.
This work by MN Tracking and the City of Minneapolis provides information for decision-makers to prioritize actions. The assessment was presented to the City of Minneapolis staff, the Minneapolis Community Environmental Advisory Commission (CEAC), and the Public Health Advisory Committee.
The information has been integrated into the City of Minneapolis Comprehensive Plan update and an interdepartmental strategy developed for moving adaptation and resilience work forward. The selection of 2 to 3 communities in Minneapolis is now in progress, to engage and empower residents to identify local climate change impacts and to prioritize the solutions.
In 2008 Minnesota began a biomonitoring program to measure perfluorochemicals (PFCs) in the blood of residents living in the East metro of Minneapolis and St. Paul. They were exposed to contaminated drinking water over many years from past waste disposal. Biomonitoring showed that residents’ blood levels were higher than the national average in 2008.
Repeat biomonitoring in 2010 and 2014 tracked declining PFC levels in these residents over time and checked the effectiveness of new water filtration systems installed in 2006. The most recent results were released to the general public in December of 2015. However, communicating the results of biomonitoring is challenging, and more resources for outreach in the community were needed. Interpretation of the findings was hindered by limited public access to national reference data.
MN Tracking staff:
These communications efforts provided important reassurance to the community that the public health interventions are effective. MN Tracking program's efforts enabled the public’s right to know about chemicals in people.
Legislators, local health officials and community members have expressed their gratitude for the effort made to keep them well informed on the progress of the investigation while providing important context with the national data.
The Minnesota Family Environmental Exposure Tracking (MN FEET) study at MDH is measuring mercury, lead and cadmium in women and their babies. These chemicals can be harmful to a baby’s health. When participants with elevated results are contacted by the study physician, Dr. Mary Winnett, they are encouraged to share the results with their own physician. However, many physicians are not prepared to give patients advice regarding environmental chemical exposures and how to protect themselves and their families. “Patients are used to the idea that the doctor knows what to do with results,” Dr. Winnett commented. As a family doctor used to talking with patients about their results, she has a sense of what numbers are considered high or unusual for conditions, such as cholesterol or blood pressure. With biomonitoring, however, she needed more information. The MN Tracking Program’s Public Health Data Access portal provides detailed information from national biomonitoring data about mercury, lead, and cadmium levels for women of childbearing age and children. MN Tracking used the portal data and created an “Information for Medical Providers” webpage, linked to the main MN FEET study page, so participants’ primary care doctors can easily find the information they need. MN Tracking also published an article in Minnesota Physician bringing attention to the importance of early life chemical exposure prevention and the role of physicians. By reviewing the data and information, Dr. Winnett knew the degree to which she should be concerned. Biomonitoring depends on successful communication with study participants, and having this data readily available helps that communication. “Regarding biomonitoring, or chemicals in people, population levels are great, but population levels with extra information is even better. That’s what the MN Public Health Data Access portal provided me,” stated Dr. Winnett.
Impact on health:
In our report, Economic Burden of the Environment on Children’s Health: The Cost of Prenatal Mercury Exposure, MN Tracking estimated that nearly 6,000 children born each year in Minnesota are potentially impacted by elevated mercury exposure, and that the average IQ point loss for these babies is 0.34 points. Physicians who are well informed can provide early intervention.
In Nobles County, Minnesota school nurses reported that students were coming to school with cockroaches in lunchboxes and bedbugs in their clothing. The lack of healthy and clean housing was affecting students' health, and poor student health was affecting educational outcomes.
To address this public health issue, Nobles County applied for and obtained a $25,000 grant to develop and implement interventions to improve local housing conditions. Using the Minnesota Environmental Public Health Tracking’s one-click County Profiles Tool, local officials showed that rates of childhood poverty in Nobles County were nearly 1.5 times the statewide average, and 7 in 100 children did not have health insurance.
Minnesota Tracking data made a strong case for the Healthy Nobles County Project to:
- (1) improve access to health care, including education about health resources and preventive care; and
- (2) address health equity, by focusing on vulnerable populations and eliminating health disparities.
Through this Project, local partners distributed outreach materials to communities about actions they can take to promote healthy homes. For example, a local hardware store developed an educational display that identified common housing problems and solutions - focusing on mold, pests and vermin, smoke, and carbon monoxide. A school nurse's office received a high-heat dryer to help kill bed bugs that students carry to school in their clothing.
This project continues to develop additional toolkits and to provide vouchers to help address inequities related to health and housing. By offering easy, understandable, one-click access to data for counties and the state, the Profiles Tool has empowered a local community in Minnesota to implement a comprehensive Healthy Homes Project. Minnesota Tracking Network’s data helped to illustrate the important connection between housing, health and educational outcomes.
State agencies have a wealth of health and environment data that inform public health action. But data are sometimes difficult to access or use by policy makers, public health professionals, and the public. State agency data are commonly provided to the public through individual, custom data requests. These can be time consuming and expensive.
The Minnesota Tracking Program (MN Tracking) developed Minnesota Public Health Data Access website to make data publicly available. TMyriad health and environment topics are available in one centralized, 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 mobile-friendly design and County Health Profiles for all 87 Minnesota counties. The portal receives more than 9,500 page views each month (March 2016).
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.
- 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
- 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 Disorder:
Raising awareness of an underestimated public health issue
The 5th leading cause of death in Minnesota, chronic obstructive pulmonary disease (COPD) affects around 164,000 men and women in Minnesota---and surprisingly, as many as half remain undiagnosed. Historically, few hospitals in Minnesota as well as nationwide tracked the number of hospital stays for COPD. This information gap hindered decision-makers from making informed policy decisions to reduce COPD. The Upper Midwest Chapter of the American Lung Association (ALA) reported to MDH that ongoing surveillance of COPD by the states is needed for informing and evaluating their efforts in disease prevention. Older adults with COPD are particularly vulnerable to the impacts of air pollution.
To address this data gap, the Minnesota Tracking Program staff analyzed hospitalizations and death certificate data in Minnesota to determine the number of COPD cases, rates of hospital stays, and death rates by race and ethnicity. Data are now available on the data portal by state and county, and part of the Minnesota County Profiles. MN Tracking’s analysis of COPD death rates by race and ethnicity identified striking disparities for American Indians compared to the white, black, Asian or Hispanic populations of Minnesota. MN Tracking shared these data with Minnesota tribal communities, ALA staff and health professionals.
MN Tracking has also developed COPD hospitalizations by ZIP code for the Twin Cities metropolitan area, currently displayed in an interactive map. Access to finer geographic resolution data can aid in informing local communities and targeting resources where they are most needed.
Because of MN Tracking’s efforts, Minnesota became one of the first states to measure and report COPD burden statewide. Minnesota communities now benefit from enhanced outreach and awareness about COPD. COPD data are available for decision-makers, health care and public health professionals, environmental professionals and community organizations to evaluate trends and spatial patterns over time, address disparities, monitor the impacts of interventions, and reduce COPD in Minnesota.
In 2014, the American Lung Association in Minnesota and MN Tracking using the COPD data to inform and evaluate actions to prevent and treat COPD in Minnesota. This partnership and use of data resulted in a joint report, The Scope of COPD in Minnesota (PDF) and a video; products that were shared widely with partners. ALA used COPD data in trainings with American Indian communities to address indoor air quality, part of a COPD in Elders study.
In 2015, the Minnesota Pollution Control Agency published a joint report, Life and Breath (PDF), using ZIP code level data on COPD in the Twin Cities, as part of a new state initiative to inform communities and legislators about air pollution, the Air Quality Index, and respiratory health. .
- 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 real estate agents, 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
Tracking data helps protect nearly 1,000,000 Minnesota residents from environmental tobacco smokeSecondhand 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.
- MN Public Health Data Access: Cancer
- MN Public Health Data Access: County Profiles
- National Public Health Accreditation
Using tracking data to inform assessment and planning
- Communities, Health, and the Environment
Working with Hiawatha CARE to identify neighborhood health issues
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 Local Public Health Assessment & 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).
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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