Working with community organizations to evaluate potential disease clusters

A Critique of Soil Contamination and Remediation: The Dimensions of the Problem and the Implications for Sustainable Development

Contaminated land is a global concern and can be considered a major barrier to sustainable development. The purpose of this article is to examine how the technological, economic, environmental, social, legal, and political framework of contaminated sites and the current remediation strategies hinder progress toward sustainability. Conflicts between various dimensions of sustainability reveal that the only long-term solution to this problem is prevention. This article will place particular emphasis on the technological dimension of remediation practices and how a reliance on technological solutions may well propagate the problem by diverting the focus from preventive measures.

Things to know and do about cancer clusters

Perceived cancer clusters present difficulties and opportunities for clinicians and public health officials alike. Public health officials receive reports of perceived cancer clusters, evaluate the validity of these reports, and/or launch investigations to identify potential causes. Clinicians interact directly with the affected patients, families, or community representatives who question the occurrence of cancer and the underlying causes. Clinicians may identify cancer clusters when they question the unusual occurrence of a rare form of cancer within their practice or community. In addition, clinicians may be asked to discuss cancer clusters and inform local debates. In this paper, we describe the public health practice experience with cancer clusters and identify cancer prevention and control opportunities for clinicians and public health officials. Scientific investigations of cancer clusters rarely uncover new knowledge about the causes of cancer. However, a set of common characteristics, unique to etiologic cluster investigations have uncovered new information about the causes of cancer or demonstrated a preventable link to a known carcinogen. These characteristics may provide useful clues for sorting out the small number of clusters worthy of further scientific investigation. Public awareness of cancer clusters may promote an opportunity to inform and motivate people about the preventable causes of cancer and effective cancer screening methods.

Environmental epidemiology forward

Environmental epidemiology is the specialized aspect of public health science that studies human health risk from environmental hazards. It is rises largely upon a foundation of public health surveillance, and relies heavily upon analyses of data for small areas and sparse population groups. To a degree, environmental epidemiology is assigned the role of discerning very subtle human health impacts, or discerning early evidence of a tragic sequence. In that context, environmental epidemiology has a substantial public education and risk communication role. Environmental epidemiology will be greatly advanced as effective biological markers of exposure and precursor health effects are developed. At this point in time, statistical methods are in place to monitor population-level disease rates in high-risk populations for early risk identification and sentinel event recognition. Advances in geographic methods have provided a boon to the discipline by advantaging spatial studies. These advances in the discipline still need further refinement and pilot experiences. The inclusion of environmental epidemiological considerations with instances of proposed industrial expansion, hazardous waste management, and contamination remediation is heartily recommended.

Cluster management and the role of concerned communities and the media

Public health services often have to deal with reported clusters of adverse health events. An important characteristic of disease clusters is that the involved community often is concerned about environmental factors influencing health. To facilitate cluster investigations, a stepwise protocol was developed in the Netherlands, based on international literature. Essential is the two-way approach, consisting of a disease-track and an environment-track. Attention to potential environmental exposures is as important as attention to the reported diseases, not only because environmental pollution often is the reason of public concern and thus relevant for risk communication, but also for deciding about the boundaries of the population at risk. Moreover, environmental information is necessary for judgement of the plausibility of a causal relation and for advising measures to prevent exposure. Within this two-way approach, three stages are distinguished: orientation stage, verification stage and quantification stage. Only if an increased risk as well as an elevated exposure is verified, under certain conditions a case-control study may be useful to study causality between exposure and adverse health events. During all stages of the investigation, good risk communication strategies have to be taken into account. However, even then it might be difficult to prevent conflicts, because of the differing interests between experts and the community involved. One of the most important aspects that determine judgements about risks by threatened people, is controllability; that is why community participation is essential. Therefore it can be concluded that cluster management is a mutual endeavour for experts, public and media, where experts are judged on three characteristics: expertise, credibility and empathy.

Research responses to outbreaks of concern about local environments

Traditional epidemiological approaches based on biomedical models may be limited with respect to their response to "outbreaks of concern" among work-force or community populations. Three published Canadian "outbreaks" were reviewed in this study. In all three instances, research was initiated because lay persons were concerned about either nonspecific symptoms or hazardous exposures, and individuals publicly called for a response. Epidemiologic analyses were inconclusive as to the reasons for the outbreaks, and they contributed little toward the resolution of concerns. There is a need for a fuller recognition of the role of social context and of the action-oriented nature of such research. The elucidation of multifactorial and culturally mediated causation, as well as the development of remedial actions, require a rethinking of research methods. We specifically call for (a) an expansion of the disciplinary base of research teams to include social scientists, and (b) the adoption of combined qualitative and quantitative research approaches.

Public health research and lay knowledge

Social science research into the social patterning of health and illness is extensive. One important aspect of this has been work on lay knowledge about health and illness. In this paper we develop three main arguments. First, we suggest that recent developments in social science understanding of the nature and significance of lay knowledge should be more widely recognized within the social sciences themselves. Second, we argue that if public health research, whatever the disciplinary perspective, is to provide an understanding of contemporary health problems that is simultaneously more robust and more holistic, it must incorporate and develop the theoretical and conceptual insights offered by this recent work on lay knowledge and with lay people. Finally, we argue that in order to accomplish this it will be necessary to construct research questions in such a way that the conventional distinctions between science and non-science, and the methodological wrangles associated with this distinction, become marginal to the research process. This will inevitably involve conflicts between members of different professional groups. These conflicts provide the opportunity for open debate on the science and politics of public health research and represent a challenge for the many disciplines involved in this field.

Rapid reporting of cancer incidence in a population-based study of breast cancer: one constructive use of a central cancer registry

To support a study of genetic risk factors for breast cancer, the North Carolina Central Cancer Registry has implemented a rapid reporting procedure for hospitals in the study area. This system permits the identification of newly diagnosed breast cancer cases within a very short time period (less than one month). The procedures are straightforward, cost-effective, and greatly benefit the objectives of tissue collection and interviews with the cases. This article describes the rapid reporting procedures and their potential impact for population-based research. For the objective of making generalizable risk statements, the necessity of population-based research is stressed; participation with central cancer registries is endorsed for this and other molecular epidemiologic applications.