Good Government Programs: Pediatric Environmental Health Specialty Units

Given how many complaints we've been hearing lately about wasteful government spending, I thought this might be a good time to highlight some lesser-known, worthwhile government-funded programs that promote public health. (Core agency functions, like EPA's Clean Air Act enforcement, are also crucial for public health, but I trust this audience is already fairly familiar with them.)

One example - which comes immediately to mind because we have one affiliated with our department here at the George Washington University School of Public Health & Health Services - is pediatric environmental health specialty units, or PEHSUs. PEHSUs are needed because pediatricians' education doesn't include enough environmental-health content and children (who take in more air and water per pound of body weight and spend lots of time on the ground) are disproportionately exposed and vulnerable to environmental health hazards. PEHSU staffers consult with individual families as well as the larger community about environmental health issues, and they also train health professionals to detect and treat environmentally related illnesses.

A parent who's concerned about a child with potential lead poisoning can contact a PEHSU for advice. A clinician needing advice about long-term, low-dose pesticide exposure can ask a PEHSU doctor about evaluation and likely outcomes. (Acute poisonings should be referred to a Poison Center - 1-800-222-1222 - which I hope will survive budget cuts). PEHSUs will also identify environmental-health issues that affect a whole community, like mold following a flood, and conduct outreach and education efforts to help families protect their health.

PEHSU funding comes from the Agency for Toxic Substances and Disease Registry, which is part of CDC, and from the EPA. Over the past five years, EPA and ATSDR spent $8.37 million for all US sites - an average of $1.7 million per year divided between 11 PEHSUs. PEHSUs must be formal collaborations with a clinic that's a member of the Association of Occupational and Environmental Clinics and with an academic department of pediatrics. There are 11 PEHSUs in the US, with one in each of the 10 EPA regions (plus an additional one in Region 9). Each PEHSU includes an occupational and environmental medicine physician and a pediatrician, as well as a coordinator, who is often a nurse. Other healthcare professionals - like toxicologists, pediatric allergists, and industrial hygienists - can also be involved.

Here are a few of the many environmental-health issues PEHSUs have tackled in recent years (they're all described in more detail in this article):

• The Northwest PEHSU collaborated with the Pacific Northwest Center for Agricultural Safety and Health to conduct a needs assessment on pesticide information in Washington State, home to many orchards that use organophosphate pesticides, and discovered that only 22% of health professionals had received child-specific information on pesticide safety, and most weren't comfortable responding to patient questions about pesticides. So, the PEHSU and the Center developed and ran a two-day interactive workshop for community health workers working in agricultural regions and created an online curriculum for health professionals, Organophosphates and Child Health: A Primer for Health Care Providers.
• The Mount Sinai PEHSU assisted the New Jersey Department of Health and Senior Services in their response to a report of mercury exposure at a childcare center located in a building where mercury thermometers had been manufactured. The PEHSU assisted with plans for exposure assessment, medical screening, and communication. A PEHSU pediatrician led a community meeting for parents, and PEHSU staff developed fact sheets summarizing health impacts and fielded inquiries from concerned parents.
• The Southwest Center for Pediatric Environmental Health (which serves Arkansas, Louisiana, New Mexico, Oklahoma, and Texas) responded to concerns about housing air quality for Gulf Coast residents affected by 2005's Hurricanes Katrina and Rita. In collaboration with the national PEHSU Network and the American Academy of Pediatrics, the SWCPEH developed recommendations for children returning to previously flooded areas. For parents, staff designed tip sheets on mold and sludge; for healthcare providers, they provided a flood-focused environmental history form. After concerns emerged about air quality in trailers housing displaced families, SWCPEH responded to inquiries and developed fact sheets on the issue.

There is one PEHSU in Canada and one in Mexico, not funded by ATSDR and EPA. If you're in the US and need help with a pediatric environmental health issue, you can contact the PEHSU that serves your EPA region:

• Region 1: ME, NH, VT, MA, RI, CT: New England Pediatric Environmental Health Specialty Unit
• Region 2: NY, NJ, Puerto Rico, Virgin Islands: Mount Sinai Pediatric Environmental Health Specialty Unit
• Region 3: PA, WV, DE, DC, MD, VA: Mid-Atlantic Center for Children's Health and the Environment
• Region 4: KY, TN, MS, AL, GA. FL, NC, SC: Southeast Pediatric Environmental Health Specialty Unit
• Region 5: MN, WI, IL, IN, OH, MI: Great Lakes Center for Children's Environmental Health
• Region 6: NM, TX, OK, AR, LA: Southwest Center for Pediatric Environmental Health
• Region 7: NE, KS, MO, IA: Mid-America Pediatric Environmental Health Specialty Unit
• Region 8: CO, UT, MT, WY, ND, SD: Rocky Mountain Regional Pediatric Environmental Health
• Region 9: CA, AZ, NV, HI: University California Pediatric Environmental Health Specialty Unit (San Francisco and Irvine locations)
• Region 10: OR, AK, WA, ID: Northwest Pediatric Environmental Health Specialty Unit

I'd love to hear from commenters about some of your favorite lesser-known, worthwhile government-funded programs that promote public health.