Chapter Eight - Role of the State Department of Health
Summary
Center for Community Health
Bureau of Child and Adolescent Health: oversight of Childhood Lead Poisoning Prevention Program which contracts with local health units, community-based organizations and regional Lead Poisoning Prevention Resource Centers and Interim Housing Units; conducts informational campaigns; collects and analyzes data. [(518) 402-5706]
Wadsworth Center
The Division of Environmental Disease Prevention: analysis of lead content in blood, urine and other clinical specimens, technical assistance to laboratories, proficiency testing; research on analytical methods. (518) 474-5475; environmental samples (518) 474-4323.
Center for Environmental Health
Bureau of Community Sanitation and Food Protection: development of protocols for environmental assessment of lead hazards, training of local public health environmental staff and State Department of Health district offices. [(518) 402-7600]
Bureau of Occupational Health: Heavy Metals Registry, laboratory reporting of all childhood blood lead tests and occupational health clinics. [(518) 402-7900]
Bureau of Environmental and Occupational Epidemiology: investigation of health effects of toxic exposures. [(518) 402-7950]
Issues related to childhood lead poisoning are addressed by many units within the State Department of Health.
Role of the State Department of Health
Center for Community Health
The Childhood Lead Poisoning Prevention Program is located in the Bureau of Child and Adolescent Health.
Activities of this program include:
- development of statewide informational campaigns to inform the public and professionals about childhood lead poisoning; the Department's Public Affairs Group assists in these activities;
- collection and analysis of statewide data on the extent and severity of childhood lead poisoning, including initiation of the statewide Childhood Lead Poisoning Registry in 1994;
- development of the Regional Lead Poisoning Prevention Resource Centers which assist pediatric care providers in the management of children with elevated blood lead levels;
- coordination with other Department of Health programs, such as the Supplemental Nutrition Program for Women, Infants and Children (WIC), the Early Intervention Program and the Medicaid Managed Care Program; and
- establishment of nine projects to provide interim lead-safe housing for families with lead poisoned children while their dwellings are being remediated.
Wadsworth Center
The Division of Environmental Disease Prevention's Lead Poisoning Laboratory analyzes blood, urine and environmental specimens for lead, provides guidance and technical assistance to other laboratories, assures the quality of lead laboratory services statewide through the proficiency testing program and conducts research on bone lead measurement, capillary blood collection techniques and analytical methods for blood lead screening.
Center for Environmental Health
The Bureau of Occupational Health maintains the department's Heavy Metals Registry which receives confidential reports from laboratories of all blood lead tests drawn in New York State. These results are transmitted to local health departments for their follow-up.* The bureau also undertakes surveillance of adult blood lead poisoning, occupational lung disease and pesticide poisoning and conducts industrial hygiene assessments and consultations to help reduce continuing exposures. Another major activity is coordination of a statewide network of occupational health clinics which focus on the prevention, diagnosis and treatment of occupationally related diseases. Occupational lead poisoning prevention is an important area of clinic activity.
The Bureau of Community Sanitation and Food Protection develops environmental management protocols, provides training oversight and on-site technical guidance to environmental health staff of local health units and state district offices implementing lead poisoning prevention programs. Staff review and comment on proposed legislation and regulations and also serve as consultants to the statewide Lead Advisory Council's Environment Committee.
Childhood Lead Registry
For the most effective allocation worker training and safety/maintenance standards for rental housing, maintenance worker education/title X notification requirements, prevention resources, data on the extent of lead poisoning problems and the location of the worst lead hazards must be available for study. By combining data on blood lead levels, environmental sources of lead and community demographics, public health agencies can identify and quantify the risk of lead poisoning in the community. An important element to data collation is complete information about the child when a blood lead test is ordered. This task is accomplished by the primary care physician or the laboratory that obtains blood lead specimens for testing. Required information to be reported includes patient name, date of birth, race, gender, address, county of residence, physician ordering the test, laboratory identifiers, date the sample was collected, date of analysis, blood lead levels and type of test (fingerstick or venous).
With universal screening of all one-and two-year old children and reporting of all blood lead test results by laboratories to the State Department of Health, a population-based registry has been created as mandated by the 1992 Lead Poisoning Prevention Act. All individual information is confidential. The information on blood lead levels will be supplemented with reports from local health departments on follow-up activities including lead hazard identification and abatement.
This registry enables the department to construct a demographic and geographic profile of affected children and lead hazards throughout the state.
Case-specific information is collected by the registry from the local health unit. Local health units report the results of their follow-up activities for children with elevated blood lead levels. State and local environmental programs will report the results of environmental investigations and management efforts for children with elevated blood lead levels.
Information in the registry allows the development of screening penetration rates and prevalence rates. This permits informed decisions about promotion of screening or continuation of universal screening activities in specific localities, targeting of resources, etc. Epidemiological analysis of the data will enable better targeting of primary and secondary prevention efforts to high-risk populations and geographic areas. Prioritizing, targeting and focusing efforts and resources are extremely important because of the scope of the lead poisoning prevention task and limited resources.
* The Bureau of Environmental Epidemiology investigates the health effects of exposure to toxic substances in the environment and at the worksite. In addition to community health assessments relative to known environmental exposures, the bureau conducts epidemiologic research to identify risk factors and potential interventions.
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