TABLE 1.

CDC, EU and Quebec environmental health tracking systems: strengths and weaknesses

Initiative	Strengths	Weaknesses	Indicators
CDC Centers for Disease Prevention and Control (CDC 2006b)	Partnership with federal, state and local government agencies, academic and community groups, healthcare organizations Strong stakeholder input Pilot projects well coordinated	Varying levels of state readiness Early in development: First national report, 2008 Network launch, 2008	Topics Air, ambient (outdoor) Air, indoor Disasters Lead (Pb) Noise Pesticides Sentinel events Sun and ultraviolet Toxics and waste Water, ambient Water, drinking Indicator Types Hazard Exposure Health effect Intervention
EU European Union (WHO Europe 2004)	Includes upstream driving forces Includes home, work and ambient exposures Includes population exposure and health impact assessment (air quality, noise) Linked to health-based policy action programs (NEHAPs) Developing a children's environment and health indicator set	Diverse data systems across EU Gaps in survey and biomonitoring data Still to define outputs (printed reports and Web-based data)	160 indicators proposed in: Air quality Housing Noise Traffic accidents Water and sanitation Food safety Chemical emergencies Radiation Workplace
Quebec (Institut national de santé publique du Québec 2006)	Common surveillance re: occupational and infectious diseases within Ministry of Health and Social Services Annual reporting Research in environmental health surveillance since 1997 with Geomatics for Informed Decisions National Centre of Excellence (GEOIDE NCE) Strong public health surveillance mandate in 2001 Public Health Law Stable funding Strong Quebec Public Health Institute [Institut national de santé publique du Québec (INSPQ)]	Not all indicators completed Gaps in data for some proposed indicators	Twenty-six of 41 indicators reported. Environmental Indicators: Recreational water quality (beaches) Drinking water quality Boil-water advisories Waste water treatment Air pollution Environmental tobacco smoke exposure Health-Based Indicators: Carbon monoxide and other poisonings notification rates Allergic rhinitis prevalence Cancers of interest for environmental health Hospitalization/mortality rates for diagnoses linked to environmental hazards Proposed Indicators: Noise Indoor air Pesticides Climate change (mortality for heat waves, morbidity and mortality linked to extreme weather events)