ADVANCEMENT OF THE PRACTICE
Results Figure 1 shows the correlation coecients for all the indicators used in this study. Of note are the strong relationships within the two major groups. For example, in the health group, there are strong negative relation- ships between the percentage of people who indicated high health status and cardiovas- cular disease and COPD. Thus, people who report the highest health status have lower incidence of these two conditions. Another example within the environmental public health group is the relationship between air pollution and several funding indicators. States with higher per capita public health funding, higher levels of non-healthcare funding, and higher levels of funding from CDC have lower levels of air pollution. To address the purpose of this exploratory study, Table 2 summarizes relationships between indicators in the environmental public health group and the health group. This table reveals some interesting results, including the potential for spending on sewer infrastructure to serve as an indicator of envi- ronmental health workforce eectiveness. Per capita expenditures on construction, mainte- nance, and operation of sanitary and storm sewer systems and sewage disposal plants are moderately associated with lower levels of premature death and physical distress and higher levels of health status. Thus, the states that spent the most per capita on sewer sys- tems also had the lowest levels of premature death and frequent physical distress. In addi- tion, the states that spent more money per capita on sewer infrastructure have a greater percentage of adults who report their health as very good or excellent. Also notable in the financial category of the environmental public health group is that per capita health spending on non-healthcare-related services, including environmental health, is positively related to the percentage of people who report very good or excellent health status. On the other hand, the indicator related to the percentage of housing stock with ele- vated lead levels is probably not a good proxy for the eectiveness of the environmental health workforce eectiveness. In this analy- sis, higher levels of lead are associated with higher health status—a finding that seems contradictory. States with higher levels of lead have lower levels of premature death and physical distress; however, lead levels show
TABLE 2
Summary of Statistically Significant ( p ≤ .05) Relationships Between Indicators of Environmental Public Health (EPH) and Health Outcomes
EPH Indicator
Health Indicator PreDeath PhysDis HiHlth Asthma Cancer
CVD
COPD
PHFund
M-
HlthPC
M+
NatPC RecPC SWPC SewerPC CDCPC21
M- M-
M-
M+
M+
S+
S+
FoodIns
VS+
VS+
VS- M+
S+
S+
Lead
M- M-
M-
M+
Severe AirPoll DWater
S-
M-
M-
M+
M- M-
M+
M+
Note. Empty cells indicate no statistically significant relationship. M = moderate relationship (coefficient = 0.30–0.39); S = strong relationship (coefficient = 0.40–0.69); VS = very strong relationship (coefficient = ≥0.70). The plus (+) and minus (-) signs indicate the direction of the association, so M- is a moderate negative association and VS+ is a very strong positive association. For the health indicators: PreDeath = premature death; PhysDis = % physical distress; HiHlth = % high health status; Asthma = % asthma; Cancer = % cancer; CVD = % cardiovascular disease; COPD = % chronic obstructive pulmonary disease. For the EPH indicators: PHFund = public health funding; HlthPC = per capita non-healthcare spending; NatPC = per capita national resources spending; RecPC = per capita recreation spending; SWPC = per capita solid waste spending; SewerPC = per capita sewer spending; CDCPC21 = per capita funding from the Centers for Disease Control and Prevention; FoodIns = % food insecure; Lead = % housing with high lead; Severe = % housing with severe problems; AirPoll = exposure to particulate matter; DWater = % with drinking water violations. See Table 1 for complete definitions of the health and EPH indicators.
air pollution and drinking water quality are negatively related to high health status; thus, states with higher levels of air pollu- tion and more drinking water violations also have lower numbers of people reporting high health status. The only significant correlation between environmental quality and environ- mental health-related health indicators is a positive one between drinking water and car- diovascular disease. Overall, this study shows that the stron- gest relationships are between food insecu- rity and several health outcomes. This find- ing includes the relationships among food insecurity and premature death, physical distress, and high health status. Addition- ally, food insecurity is strongly related to car- diovascular disease and COPD. This impact of food insecurity is aected by many social determinants of health that influence it, espe- cially poverty—which raises questions about environmental health inequities.
a moderate positive association with asthma. The unexpected relationship between lead and health could be because the lead indica- tor is based on the age of the housing stock. The states with the highest lead risk include Massachusetts, New York, Pennsylvania, and Rhode Island. These states have older hous- ing stock than the states with the lowest risk, which include Alaska, Arizona, Florida, and Nevada. Another reason is that lead exposure is mainly associated with children’s health risk and the state health indicators used in this study represent adults. The two environmental quality indica- tors—air pollution and drinking water qual- ity—show some interesting correlations. Air pollution levels and drinking water violations are moderately related to several health indi- cators. States with higher levels of air pollu- tion have high levels of physical distress and states with higher drinking water violations have higher levels of premature death. Both
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Volume 86 • Number 7
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