Public Health

Hawaii Lacking Key Specialist to Spot Trends in Health Data

The Hawaii Department of Health’s Hazard Evaluation and Emergency Response will be looking into lead, mercury, arsenic and pesticide poisoning.

by Sophie Cocke, The Honolulu Star-Advertiser / January 3, 2017

(TNS) - Every year, thousands of lab reports on possible lead, mercury, arsenic and pesticide poisoning pour into the Hawaii Department of Health’s Hazard Evaluation and Emergency Response Office. The blood and urine tests contain information that could help state officials identify trends and even link clusters of diseases, such as cancer, or birth defects to environmental causes, but the department has lacked the needed expertise to fully evaluate the data.

In the coming year, the department is adopting a new software system that is expected to revolutionize its ability to track cases of lead poisoning in particular, but the department still lacks a skilled epidemiologist who can analyze the information for potential trends and identify potential clusters of health conditions.

The HEER office recently requested funding for a full-time epidemiologist, according to budget documents made public on the governor’s website — a request that has been made several times in recent years. But the item was one of many requests throughout the departments that didn’t make it into Gov. David Ige’s budget for the upcoming two fiscal years.

“This one, unfortunately, was not selected because there were other priorities, not just in environment, but the entire department,” said Keith Kawaoka, the Health Department’s deputy director of environmental health.

For instance, the Health Department is still working to restore its vector control division in light of ongoing concerns about another dengue outbreak and the threat of the Zika virus, which can cause devastating birth defects. The division was gutted following the 2008 financial crisis. The Health Department has either hired or is actively recruiting for 20 positions it was given this past year and is hoping to gain approval for 12 more positions, which would restore the division to pre-recession levels.

Ige’s budget will be debated in the Legislature, which reconvenes Jan. 18, and will likely be heavily amended, though the governor ultimately controls the release of funding.

A mountain of data

The HEER office receives the results of about 20,000 lab tests for heavy metals and pesticides annually, according to Barbara Brooks, the state toxicologist. About three-fourths of those are for potential lead poisoning, which is routinely screened for in infants and children and can cause developmental delays. The lab tests, which are ordered by physicians for their patients, include both negative and positive results.

“Basically, we receive data daily and an epidemiologist could be evaluating the trends, how many people are coming in with heavy metal poisoning, how many people have pesticide poisoning,” Brooks said. “So it is data analysis, evaluation and statistics, and report writing — that would be one job of the epidemiologist.”

An epidemiologist could also be used to investigate whether there are links between higher rates of health conditions in certain communities or neighborhoods and potential sources of chemical exposure. Communities on Kauai have been particularly concerned about pesticide spraying on agricultural fields, while some on Hawaii island have wanted more information on potential links between cardiac and respiratory conditions and vog and geothermal emissions.

“I think the big drive for adding to our technical and scientific staff, by having a full-fledged environmental epidemiologist, is so that we can go out and be proactively looking for issues,” said Fenix Grange, manager of the HEER office. “The MAVEN software, where we can do active surveillance at the time the results come in, is one example of that, but there are many questions that come up from the community when they might be concerned about vog, they might be concerned about living near a landfill or some other industrial operation that is in their neighborhood. And an epidemiologist can provide the kind of research that is needed to see what kind of data would be needed to be collected to see if there is a connection between that environmental event that is happening and some kind of human effect.”

The HEER office has been operating without an environmental epidemiologist for four or five years. The division had a couple lower-level specialists in epidemiology, but those jobs were eliminated.

Still, the department has been moving ahead in manually reviewing five years of lab tests on lead and is expected to release the results of their review in the coming weeks. But just scrubbing the data to get it into a usable form has been a painstaking process.

Other past data likely has limited use. The data on pesticides, for example, likely has limited value because there is no baseline for individual patients to compare the results to.

The new MAVEN software system is expected to be up in March, and results on lead will be automatically inputted. Brooks said she hopes that the system can be expanded in the future to include results for other heavy metals and pesticides and that they will eventually have an epidemiologist to oversee the system.

Brooks noted that a well-funded state such as California has many epidemiologists. “But certainly there is a need for one (here), especially with the public concern about chemicals, not only pesticides, but air pollution and emissions from industrial processes and landfills,” she said. “There is a need in the state.”


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