Summit County Environmental Health Preliminary ... - Healthy Summit

Summit County Environmental Health Preliminary ... - Healthy Summit

Summit County



Preliminary Assessment

Local public health agencies are focused on improving the health status of their communities. Factors that negatively impact health and that lend

themselves to intervention strategies include social causes such as low educational attainment, poverty and discrimination factors. Personal behavior

modifications such as smoking cessation, increased physical activity, access to primary health and healthy foods also significantly impact

an individual’s health. Equally influential to one’s health and addressed in this report are

environmental determinants; air, water and soil quality; housing, waste disposal, etc.

The public health standing of a community or neighborhood is directly tied to the condition of the local environment. Childhood asthma, elevated

blood lead levels, or the risk for gastrointestinal illness from water contamination can all be traced to measureable environmental factors.

Environmental assessments can be used to measure baseline status and trends in the community, track

progress on remediation goals and objectives, and build core surveillance capacity.

Balance is crucial to this effort. Developing the environmental health assessment and surveillance tools provides community partners the flexibility

to adopt specific intervention measures on the basis of local needs and priorities. Such a data driven approach will

focus on prevention of environmentally related diseases and engage communities to take on environmental health and safety issues

as a priority equal to other health promotional activities.

Summit County Public Health is working to increase public awareness of and support for a broader definition of health in identifying prevention

strategies. We recognize that achieving this goal requires an approach that recognizes community institutions and

residents as collaborators rather than clients.

The process of developing assessment measures and collecting the information began in the fall of 2010. Summit County Public Health is pleased

to release Phase I: Planning Environmental Health Assessment of the agency’s multi-phased assessment of local environmental issues. Each

generation has a particular stewardship responsibility to maintain a healthful environment and to thoughtfully manage sanitation needs, assure

safe drinking water, protect our air and soil and prevent lead poisoning among young children. Please join us in advancing those values.

Thank You,

Gene Nixon

Health Commissioner


Why Is Environmental Health Important?

Environmental health addresses all the physical, chemical, and biological factors external to a person, and all the related factors impacting behaviors.

It encompasses the assessment and control of those environmental factors that can potentially affect health. It is targeted towards preventing

disease and creating health-supportive environments. (American Planning Association Policy Guide on Smart Growth, April 2002. Available

from URL:

Environmental hazards are responsible for as much as a quarter of the total burden of disease world-wide, and more than one-third of the burden

among children. Heading that list are diarrhea, lower respiratory infections, various forms of unintentional injuries and malaria. The disease burden

is much higher in the developing world, although in the case of certain non-communicable diseases, such as cardiovascular diseases and cancers,

the per capita disease burden is larger in developed countries. Health impacts of environmental hazards run across more than 80 diseases

and types of injury. (World Health Association Public Health and Environment, 2011. Available from URL:

Well-targeted interventions can prevent much of this environmental risk. Worldwide, as many as 13 million deaths could be prevented every year

by making our environments healthier. Maintaining a healthy environment is central to increasing quality of life and years of healthy life. Environmental

factors are diverse and far reaching. They include:

Exposure to hazardous substances in the air, water, soil, and food

Natural and technological disasters

Physical hazards

Nutritional deficiencies

The built environment

Related Topic Areas:


Heart Disease and Stroke

Occupational Safety and Health

Physical Activity

Respiratory Diseases

Poor environmental quality has its greatest impact on people whose health status is already at risk. Therefore, environmental health must address

the societal and environmental factors that increase the likelihood of exposure and disease. (Healthy People 2020, Environmental Health, May

2011. Available at URL:


Understanding Environmental Health

Environmental health is the branch of public health that is concerned with all aspects of the natural and built environment that may affect

human health. Other terms that concern or refer to the discipline of environmental health include environmental public health and environmental health and

protection. Environmental health is defined by the World Health Organization as: those aspects of the human health and

disease that are determined by factors in the environment. It also refers to the theory and practice of assessing and controlling factors in the environment

that can potentially affect health.

Environmental health services are defined by the World Health Organization as: those services which implement environmental health policies through

monitoring and control activities. They also carry out that role by promoting the improvement of environmental parameters and by encouraging the use of

environmentally friendly and healthy technologies and behaviors. They also have a leading role in developing and suggesting new policy areas.

Environmental health practitioners may be known as sanitarians, public health inspectors, environmental health specialists or environmental health officers.

In many European countries physicians and veterinarians are involved in environmental health. Many states in the United States require that individuals

have professional licenses in order to practice environmental health.

The Ohio Revised Code 4736.01 provides the following state board of sanitarian registration definitions.

Environmental health science” means the aspect of public health science that includes, but is not limited to, the following bodies of knowledge: air

quality, food quality and protection, hazardous and toxic substances, consumer product safety, housing, institutional health and safety, community noise

control, radiation protection, recreational facilities, solid and liquid waste management, vector control, drinking water quality, milk sanitation, and rabies


“Sanitarian” means a person who performs for compensation educational, investigational, technical, or administrative duties requiring specialized

knowledge and skills in the field of environmental health science.

“Registered sanitarian” means a person who is registered as a sanitarian in accordance with this chapter.

“Sanitarian-in-training” means a person who is registered as a sanitarian-in-training in accordance with this chapter.

“Practice of environmental health” means consultation, instruction, investigation, inspection, or evaluation by an employee of a city health district, a general

health district, the environmental protection agency, the department of health, or the department of agriculture requiring specialized knowledge, training,

and experience in the field of environmental health science, with the primary purpose of improving or conducting administration or enforcement under

any of the following:

The state board of sanitarian registration may further define environmental health science in relation to specific functions in the practice of environmental

health through rules adopted by the board under Chapter 119. of the Revised Code.




The primary goal is to improve the well-being of the community by assuring a healthy and safe environment, free from exposure to physical, chemical,

biological or psychosocial threats, contaminants, and safety hazards.

Overview of Survey and Methodology

Summit County Public Health conducted an Environmental Health Survey regarding environmental health issues that affect Summit County residents.

The survey was modeled off of PACE EH. PACE EH is designed to help communities systematically conduct and act on an assessment of

environmental health status in their localities. PACE EH takes the user through a community-based process for:

Characterizing and evaluating local environmental health conditions and concerns;

Identifying populations at risk of exposure to environmental hazards;

Identifying and collecting meaningful environmental health data; and

Setting priorities for local action to address environmental health problems.

The survey methodology consisted of two phases. In the first phase it asked the surveyors to review a list of environmental risk factors. Identify the

three most common or significant risks which impact, or have the potential to impact the public’s health. In phase two the surveyors are asked to

then rate those three chosen risk factors by intensity of impact (magnitude) and scope of impact. The following is a list of the environmental health

issues and their rank.


Environmental Scan




Air Pollution 1 42.9%

Safe Drinking Water 1 42.9%

Combined Sewer Overflow 2 23.8%

Landfill Concerns 2 23.8%

Food Safety 2 23.8%

Pesticide Use/exposure 3 19.0%

Chemical In Water 3 19.0%

Infectious Diseases 3 19.0%

Other (please specify) 3 19.0%

Radon 4 14.3%

Global Climate Change 4 14.3%

Mold 5 9.5%

Ecology and Health 5 9.5%

Indoor Air Quality 6 4.8%

Septic Tanks 6 4.8%

Waterborne Disease Outbreaks 6 4.8%

Occupational Health 6 4.8%

Risk Prevention and Monitoring 6 4.8%

Non-point source pollution 6 4.8%

medicines in water supply 6 4.8%

UV over exposure 6 4.8%

Recycling 6 4.8%

Lead Poisoning Not applicable 0.0%

Toxicology Analysis Not applicable 0.0%

Soil Quality Not applicable 0.0%

Vector Not applicable 0.0%



I. Air Pollution

Poor air quality is linked to premature death, cancer, and long-term damage to respiratory and cardiovascular

systems. Progress has been made to reduce unhealthy air emissions, but in 2008, approximately 127 million

people lived in U.S. counties that exceeded national air quality standards. Air quality is affected by transportation

activities, such as driving cars and trucks. It is also affected by burning fossil fuels, such as coal and oil, for

heat or electricity. Air quality forecasts are provided by state and local agencies, using EPA’s Air Quality Index

(AQI), a uniform index that provides general information to the public about air quality and associated health

effects. The AQI is an index for reporting daily air quality. It tells you how clean or polluted air is, and what

associated health effects may be a concern for the public. U.S. EPA has established national air quality

standards to protect public health for several pollutants.

Decreasing air pollution is an important step in

creating a healthy environment.


Indicator 1: Air Quality Index – Reduce the number of days the (AQI) exceeds 100

National Target: 10 days or fewer with AQI above 100

Summit County Target: Reduce the number of days with AQI above 100


Days that Air Quality Index Exceeded 100 ‐ 2008









Summit County

National Average

According to this data, Summit County has fewer days in which

the AQI exceeds 100 than the national average.

Data source: Air Quality System (formerly the Aerometric Information Retrieval System), EPA, Akron Regional Air Quality Management District



Indicator 2: Alternate Modes of Transportation – Increase the use of alternative modes of transportation for work

National Targets:

Bicycle: 0.6%

Walking: 3.1%

Mass Transit: 5.5%

Summit County Targets:

Bicycle: None identified

Walking: None identified

Mass Transit: None identified


Alternate Modes of Transportation,

2005‐2009 Average



National Baseline

Summit County











Bicycle Walking Mass transit

According to this data, Summit County appears to be a very auto-dominated county with fewer

residents using alternative modes of transportation than the national average.

Data source: U.S. Bureau of the Census, American Community Survey (ACS)


Indicator 3: Indoor Air Quality – Reduce the levels of radon in homes.

The U.S.EPA and the Surgeon General’s Office have estimated that as many as 20,000 lung cancer deaths are caused each year by

radon. Radon is a cancer-causing radioactive gas. It occurs naturally in the earth; however homes draw concentrated radon gas from

the ground. Because radon is nine times heavier than air, elevated radon levels build up in basements and lower levels. At the EPA

action level of 4.0 pCi/L, radon carries approximately 1,000 times the risk of death as any other EPA carcinogen. There are no

“safe” levels of radon gas. Testing is the only way to know a home’s radon level. If necessary, a radon reduction system may be installed.

They are inexpensive and can work to reduce radon levels in a home by up to 99%.

National Target: None identified

Summit County Target: None identified



Percent of Indoor Radon Readings Above 4.0 pCi/L

(picocurie per litre)










Summit County

National Average

According to this data, the percent of indoor radon readings that

exceed 4.0pCi/L far exceeds the national average.

Data source: Ohio Department of Natural Resources,


Indicator 4: Toxic Air Emissions – Reduce toxic air emissions to decrease the risk of adverse health effects caused by airborne


National Targets:

Mobile sources: 1.0 billion tons

Area sources: 1.7 billion tons

Major sources: 0.7 billion tons

Summit County Targets:

Mobile sources: None identified

Area sources: None identified

Major sources: None identified


National Toxic Air Emissions (in billions of tons)


Summit County Toxic Air Emissions (in millions of




Mobile sources, 2008

Area sources, 2005

Major sources, 2005






Mobile sources,














National Baseline

Summit County

No data was available regarding area sources of toxic emissions in Summit County. Available data shows that

Summit County emits over 4 million tons of toxic air via mobile and major sources.


Data source: National Emissions Inventory (NEI), U.S. Environmental Protection Agency (EPA).


II. Water Quality

Surface and ground water quality applies to both drinking water and recreational waters. Contamination by

infectious agents or chemicals can cause a wide range of illnesses, from mild to severe. Approximately 90%

of people in the United States get their water from a community water system. These public water systems are

required to provide drinking water that meets standards established under the Safe Drinking Water Act. The

rest use household wells, cisterns and springs.

Protecting water sources and minimizing exposure to

contaminated water sources is a critical part of maintaining a

healthy environment.


Indicator 1: Drinking Water Quality – Increase the proportion of persons served by community water systems who receive a supply

of drinking water that meets the regulations of the Safe Drinking Water Act.

National Targets: 91%

Summit County Targets: None identified

Percent of drinking water meeting

Safe Drinking Water Act standards ‐ 2005













Summit County


National Average

According to this data, all residents in Summit County who are served by community water systems

receive a supply of drinking water that meets the regulations of the Safe Drinking Water Act. This study only looked at

public water systems. No data was found regarding the quality of private water systems including wells, cisterns and springs.

Data source: Potable Water Surveillance Systems (PWSS), Safe Drinking Water Information System (SDWIS).


Indicator 2: Water Use – Reduce per capita domestic water withdrawals with respect to use and conservation.

National Targets: 89.1 gallons per capita per day

Summit County Targets: None identified

Gallons of water used

per person per day ‐ 2010












Summit County

National Average

According to this data, Summit County residents use more

gallons of water per day than the national average.

Data source: "Estimated Use of Water in the United States," U.S. Department of the Interior (DOI), U.S. Geological Survey (USGS).



III. Food Safety

Food safety refers to the handling, preparation, and storage of food in a manner that prevents food-borne illness.

Each year, 1 in 6 people in the US become ill due to contaminated food. The majority of those illnesses are

microbial food-borne illness, commonly called food poisoning.

Adequate food safety practices are critical to

maintaining a healthy environment.


Indicator 1: Number of Foodborne Illnesses – Reduce the occurrence of food-borne outbreaks.

National Targets: None identified

Summit County Targets: None identified


Foodborne Outbreaks Per 100,000 People ‐ 2008







Summit County

National Average

According to this data, Summit County appears to have fewer

food-borne outbreaks than the national average.

Data source: US Centers for Disease Control and Prevention, Ohio Department of Health.



IV. Infectious Diseases

An infectious disease is a disease caused by bacterial, viral, fungal, or protozoan infection. Though some

infectious diseases are not contagious, others may be transmitted from animal to person or from person to person.

Infectious diseases kill more people worldwide than any other single cause.

Infectious disease prevention is critical to maintaining a

healthy environment.


Indicator 1: Reportable Communicable Diseases (non-sexually-transmitted) – Reduce the incidence of communicable disease.

State of Ohio Targets: None identified

Summit County Targets: None identified


Reportable Disease Cases Per 100,000 People ‐2009





Summit County

State of Ohio

According to this data, the number of reportable disease cases per 100,000 in

Summit County is slightly less than the average for the state of Ohio.

Data source: Ohio Department of Health.



V. Hazardous Waste

The health effects of toxic substances and hazardous wastes are not yet fully understood. Research to better

understand how these exposures may impact health is ongoing. Meanwhile, efforts to reduce exposures continue.

Reducing exposure to toxic substances and hazardous wastes

is fundamental to environmental health.


Indicator 1: Hazardous Waste Sites – Minimize the risks to human health and the environment posed by hazardous sites.

National Targets: 1,151 total sites

Summit County Targets: None identified


Number of Hazardous Waste Sites Per 100,000

People ‐ 2009







Summit County


National Average

According to this data, the number of hazardous waste sites per 100,000

in Summit County far exceeds the national average.

Data source: Comprehensive Environmental Response and Cleanup Liability Information System (CERCLIS), EPA.


Indicator 2: Toxic Releases into the Environment – Reduce the amounts of toxic pollutants released into the environment.

National Targets: 1,123,085 pounds per 100,000 people

Summit County Targets: None identified



Pounds of Toxic Waste Released into the

Environment Per 100,000 People ‐ 2008








Summit County

National Average

According to this data, the amount of toxic waste released into the environment

in Summit County is far less than the national average.

Data source: U.S. National Toxics Release Inventory (TRI), EPA.



VI. Landfill Usage

Making effective use of landfill space is critical because of the limited capacity of landfills around the nation to

accept waste at traditional generation rates.

Reducing generation of solid waste and recycling of those

wastes which exist are two powerful strategies to improve the



Indicator 1: Solid Waste Generation – Reduce the generation of municipal solid waste.

National Targets: No targets identified

Summit County Targets: No targets identified


Pounds of Solid Waste Generated

Per Person Per Day ‐ 2008








Summit County

National Average

According to this data, Summit County generates fewer pounds of

solid waste than the national average.

Data source: Characterization of Municipal Solid Waste, EPA, OSW, Summit Akron Solid Waste Management Authority (SASWMA).


Indicator 2: Recycling Solid Waste – Increase recycling of municipal solid waste.

National Targets: 36.5% of solid waste recycled

Summit County Targets: 25.0% of solid waste recycled


Percent of Solid Waste Recycled ‐2008











Summit County

National Average

According to this data, Summit County residents recycle less

solid waste than the national average.

Data source: Characterization of Municipal Solid Waste, EPA, OSW, Summit Akron Solid Waste Management Authority (SASWMA).


**Data is currently unavailable for the following three public health risks**


VII. Combined Sewer Overflow – No indicators identified

A combined sewer is a type of sewer system that collects sanitary sewage and storm water runoff in a single pipe

system. Combined sewers can cause serious water pollution problems due to combined sewer overflows, which

are caused by large variations in flow between dry and wet weather. This type of sewer design is no longer used

in building new communities, but many older cities continue to operate combined sewers.


Combined Sewer System. During dry weather (and small storms), all flows are handled by the publicly owned

treatment works (POTW). During large storms, the relief structure allows some of the combined storm water and

sewage to be discharged untreated to an adjacent water body. Combined sewer overflows are a major water pollution

concern because they contain not only storm water but also untreated human and industrial waste, toxic

materials, and debris. These materials are released into public waterways. Protecting water sources is a critical

part of maintaining a healthy environment.

The Akron Water Pollution Control Station treats sewage from Akron, Cuyahoga Falls, Fairlawn, Tallmadge,

Lakemore, Silver Lake, Munroe Falls, Mogadore, portions of Stow, and some unincorporated areas of Summit

County including Springfield, Bath, Copley, and Coventry Townships. Approximately 21% of Akron’s sewers

are combined before they reach the Akron Water Pollution Control Station. As of 2011, the City of Akron has 34

sewers that overflow into the Cuyahoga and Little Cuyahoga rivers and the Ohio & Erie Canal after heavy rains

and snow melts.

Data Sources: U.S. Environmental Protection Agency, Washington, D.C. "Report to Congress: Impacts and Control of CSOs and SSOs." Document No.

EPA 833-R-04-001; City of Akron; Akron Beacon Journal (, February 20, 2011)



VIII. Pesticide Use / Exposure – No indicators identified

Although pesticides can be useful in killing disease-causing organisms, they can also cause harm to humans,

animals, or the environment because they are designed to kill or otherwise adversely affect living organisms.

The challenge is in finding the balance between the risks and the benefits of pesticide use.

Summit County Public Health utilizes pesticides and rodenticides to aid in the reduction of the spread of disease.

However, Summit County Public Health uses the approach of Integrated Pest Management (IPM) which entails

more than simply applying pesticide. For the mosquito program, the IPM consists of four components. The idea

of education and source reduction consists of cultural practices such as applying repellants and reducing

mosquito breeding sites. Surveillance entails trapping of mosquitoes to determine if the encephalitis virus is

present. Larviciding is the daytime treatment of standing water areas that breed mosquitoes. Adulticiding is

the evening spraying of residential streets to reduce the number of adult mosquitoes.

For the rodent control program, IPM consists of educating residents, teaching them to recognize the difference

between mice and rats, providing pamphlets explaining ways to reduce opportunities for rodent infestation,

working with other city and county officials to ensure properties are kept clean and orderly, as well as applying

rodenticide when necessary.



IX. Chemicals in Water – No indicators identified

Protecting water sources and minimizing exposure to contaminated water sources is a critical part of maintaining a

healthy environment.

In 2008, the U.S. Geological Survey sampled Tinker’s Creek watershed, located in Summit, Portage, Geauga and

Cuyahoga counties. A wide variety of medicines, household chemical and other organic wastewater compounds

were detected at very low concentrations in the watershed. Chemicals found in diesel fuel, asphalt and asphalt

sealers, explosives, fragrances, tobacco, caffeine, insect-repellants, and medicines are among the compounds

detected. This study did not examine the potential aquatic or human health effects of exposure of chemicals in

trace amounts. However, other studies have shown that some fish and amphibians that have been exposed to

waters contaminated by medications show signs of developmental and reproductive problems.

Summit County Public Health has created a program called Dispose of Unused Medications Properly (D.U.M.P.)

to attempt to reduce the amount of medicines and pharmaceuticals that are thrown into landfills or are flushed

down toilets, eventually ending up in public water sources.



Environmental health is a dynamic and evolving field. While not all complex environmental issues can be predicted, some known emerging issues in the

field include:

Climate change is projected to impact sea level, patterns of infectious disease, air quality, and the severity of natural disasters such as floods, droughts,

and storms. (US Environmental Protection Agency (EPA), Office of Air Quality Planning and Standards. Our Nation's air: Status and trends through 2008.

Washington: EPA; 2010.) (Patz J, Campbell-Lendrum D, Holloway T, et al. Impact of regional climate change on human health. Nature. 2005 Nov 17;438


Disaster Preparedness for the environmental impact of natural disasters as well as disasters of human origin includes planning for human health needs

and the impact on public infrastructure, such as water and roadways. 5Noji E, Lee CY. Disaster preparedness. In: Frumpkin H. Environmental health, from

global to local, 1st edition. San Francisco: Jossey-Bass; 2005.

The potential impact of nanotechnology is significant and offers possible improvements to: disease prevention, detection, and treatment, electronics,

clean energy, manufacturing and environmental risk assessment. However, nanotechnology may also present unintended health risks or changes to the environment.

During Phase Two, the health district will be asking key stakeholders in Summit County to come together and assist in developing an action plan. The outcome

of the ranking and prioritizing processes will guide the development of strategies to address the community’s most pressing environmental health

concerns. The collection of strategies for all priority issues constitutes a community action plan for environmental health. This will be completed identifying

possible intervention and prevention activities, identifying community assets, selecting intervention activities, determining resource needs and possible

partners, and developing a timeframe and measure of success.

Out of all of the priority indicators, three of the priority indicators: chemicals in water, combined sewer overflow, and pesticide use and exposure had no

local measurements within their field. During Phase Two of this process, Summit County Public Health will also be looking to develop indicator measurements

for these three priority indicators.

While Phase Two is being implemented, Phase Three will begin which will address the evaluation of the priority issues. Evaluation measures and documents

will be developed to measure the degree to which activities and outcomes are being achieved, within the designated timeframe.

Phase Four will be designed to offer a process for ongoing assessment and evaluation and not as a one-time project. Much of the value lies in tracking key

environmental health indicators over time, in continuing the relationships developed through the process, and in evaluating the success of the community in

addressing selected priorities. The process can be reinvigorated as changes in the community suggest the need for more information, additional community


involvement, or a shift in concerns and priorities.

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