Demographic Discussion Assessment
This is a graded discussion: 50 points possible
due Jan 14
Week 2: Demographic and Epidemiological Assessment
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For this discussion, you will collect assessment data about your city or county. This post will include information about demographics (general characteristics) and epidemiological data (disease or health behavior rates) of your community.Demographic and Epidemiological Assessment Essay
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Demographic data: Go online to the U.S. Census Bureau at https://www.census.gov/quickfacts/ (Links to an external site.)Links to an external site.. Obtain a range information about the demographic characteristics of the population for your city or county of residence. You may have to look at county data if your city is not listed. Discuss demographic data about age, ethnicity, poverty levels, housing, and education.
Epidemiological data: Go to your city or county health department website (search the Internet) or County Health Rankings (http://www.countyhealthrankings.org/ (Links to an external site.)Links to an external site.) and report epidemiological data about your area.
Identify several priority health concerns for your area.
The Instructions on Finding Demographic Data on the U.S. Census Website (Links to an external site.)Links to an external site. will assist you in using this website as a resource.Demographic and Epidemiological Assessment Essay
Nies, M. A., & McEwen, M. (2015). Community/Public health nursing: Promoting the health of populations (6th ed.). St. Louis, MO: Saunders/Elsevier.
My city Is Upper Marlboro, Maryland and my County is Prince George’s County, Maryland
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Environmental health risk assessment contributes increasingly to policy development, public
health decision-making, the establishment of environmental regulations and research planning. It
also often plays an important role in cost-benefit analysis and risk communication. Its credibility
depends, to a large extent, on the strength of the scientific evidence on which it is based.Demographic and Epidemiological Assessment Essay
Epidemiology, toxicology, clinical medicine, and environmental exposure assessment all
contribute information for risk assessment.
However, epidemiological studies play a unique role in the assessment of the health risk of
environmental factors. Unlike laboratory experiments, epidemiology provides evidence based on
studies of human populations under real-world conditions. It largely avoids the extrapolations
across species and levels of exposure that are required for the use of data from animal
experiments, and which contribute large uncertainties. In addition, epidemiology has often
contributed to the recognition of new hazards, thereby stimulating new research and identifying
new areas for public health action. Epidemiology’s contribution to health risk assessment has
been widely discussed (see e.g. NRC 1983, Gordis 1988, Federal Focus Inc. 1996, HertzPicciotto 1995, Samet & Burke 1998). However, epidemiological studies that report associations
between measures of the health of populations and the presence of hazardous factors in the
environment are frequently difficult to interpret (Neutra & Trichopoulos 1993, Taubes 1995).
Therefore, a careful evaluation of all existing epidemiological evidence is necessary as part of
the risk assessment process.
In order to provide authoritative assessments of environmental epidemiology research, public
health and regulatory agencies may rely on expert review groups to evaluate the evidence, draw
conclusions on the existence of hazard to health, and estimate the magnitude of associated health
risks. These expert reviews may then be used to support actions that are difficult and expensive.
It is, therefore, imperative that the processes and methods used to evaluate the evidence and
estimate health risks are clear and explicit, and based on valid epidemiological theory and
To improve the methodology used by the expert groups reviewing the evidence, the WHO
European Centre for Environment and Health, Bilthoven Division, in collaboration with the
International Programme on Chemical Safety, initiated the project “Accepting epidemiological
evidence for health impact assessment”. The results of this project are summarized in this report.
This project has been supported by a special grant from the Swiss Agency for the Environment,
Forests and Landscape, which is gratefully acknowledged.
2. Scope and purpose
The purpose of this project is to develop guidelines, which identify a set of processes and general
approaches to assess available epidemiological information in a clear, consistent and explicit
manner. The guidelines should also help in the evaluation of epidemiological studies with
respect to their ability to support risk assessment and, consequently, risk management.
EVALUATION AND USE OF EPIDEMIOLOGICAL EVIDENCE FOR ENVIRONMENTAL HEALTH RISK ASSESSMENT
Conducting expert reviews according to such explicit guidelines would make health risk
assessment, and subsequent risk management and risk communication processes, more readily
understood and likely to be accepted by policy-makers and the public. From WHO’s standpoint,
it would also make the conclusions reached by reviews more readily acceptable as a basis for
future WHO guidelines and other recommendations, and would provide a more rational basis for
setting priorities for future research.
This project focuses only on approaches to the evaluation and use of epidemiological evidence
for health risk assessment. However, this should not be interpreted as implying that only
epidemiological studies are important. The Working Group, and WHO, appreciate that data from
toxicological, clinical, and other areas of research often play vital roles in both the
characterization of health hazards and the estimation of risks to health, and may, in the absence
of suitable epidemiological data, provide the sole basis for such activities.
Public health action (e.g. the reduction of population exposure to a suspected hazard or even its
elimination from the human environment) must often proceed even when the scientific evidence
is insufficient. Most of the Working Group members agree that the Precautionary Principle Demographic and Epidemiological Assessment Essay
should play a role in guiding public health action where there is uncertainty.
The project considers two distinct activities of health risk assessment: Health Hazard
Characterization and Health Impact Assessment. They correspond to components of risk
assessment defined by both the US National Research Council (NRC) and WHO (NRC 1983,
· Health Hazard Characterization involves the identification of environmental hazards via
the collection, evaluation, and interpretation of available evidence from epidemiology and
other scientific disciplines concerning the association between an environmental factor and
· Health Impact Assessment involves the quantification of the expected health burden due
to an environmental exposure in a specific population.
Health Hazard Characterization comprises the hazard identification, and elements of the doseresponse assessment stages of the NRC Risk Assessment paradigm, at least as they apply to
epidemiological studies. Health Impact Assessment combines the exposure assessment, doseresponse assessment, and risk characterization stages of the NRC and WHO risk assessment
paradigm. Thus the two stages overlap and interlock.
This project focuses on the evaluation and use of epidemiological evidence on associations
between environmental factors and health. This evidence is used to support the assessment of
health impact of certain exposures. The Health Impact Assessment discussed in this report is,
therefore, not synonymous with the broader concept of assessment of health impacts of
“specified action on the health of a defined population”. The latter is an emerging tool in the
evidence-based public health policy making. It can be applied to a wide range of actions, policies
or projects on various determinants of health, such as behavioral factors, socioeconomic issues or
health care system reforms. Environmental Health Risk Assessment, with its well established
methodology, is a significant contribution to the wider concept of Health Impact Assessment
(Scott-Samuel 1998).Demographic and Epidemiological Assessment Essay
The scope and purpose of the project with respect to the audience and the issues that it would
address have been further refined as follows:
· The target audiences for these guidelines are expert review groups that WHO (or other
organizations) might convene in the future to evaluate epidemiological evidence on the
health effects of environmental factors.
· The Working Group, convened to develop this project, saw its role as providing future
review groups with general recommendations and principles for conducting such
evaluations, rather than providing formulae, or lists of “approved methods”.
· The Working Group focused on the evaluation of evidence in the context of large-scale
public health issues, as opposed to “local emergencies.” The Working Group
acknowledged that epidemiological studies of local environmental exposures (e.g. clusters
of childhood leukaemia in the vicinity of nuclear power plants) might provide evidence
about large-scale public health concerns, but felt that the evaluation of such “outbreaks”
presents a unique set of problems, which warrant attention in their own right.
· The Working Group agreed that health impact assessments are conducted for a range of
purposes and under a variety of conditions, and, therefore, the purpose of the health impact
assessment will, and should, determine its scope, form and content.
· The principles described apply, in the first place, to chemical pollutants. In reviews
concerning some other exposures, adjustments may be proposed. Should such deviations
from the principles be applied, a clear justification must be given.
The WHO Working Group of experts in epidemiology, public health, and environmental policy
was assembled at the end of 1998 (see Annex 1). The experts were selected on the basis of their:
· experience in the scientific review of epidemiological evidence for the governmental
bodies, WHO or other public and private sector organizations;
· involvement in risk assessment of environmental factors;
· involvement in communication related to health risk with general public or decision makers;
· representation of wide range of countries within the European Region of the WHO and the
The experts were asked to prepare working papers presenting their views and proposals
concerning the process of review of epidemiological evidence, as well as criteria for its
acceptance and use in assessment of health risk of environmental factors. The papers were
distributed to all Working Group members and provided a basis for the discussion at the meeting
of the Working Group, convened in Il Ciocco, Italy, from 31 May to 2 June 1999. Dr Robert
Maynard chaired the meeting, and Dr Aaron Cohen acted as its Rapporteur. The working papers
are not included in this report, although the individual authors may choose to publish them
EVALUATION AND USE OF EPIDEMIOLOGICAL EVIDENCE FOR ENVIRONMENTAL HEALTH RISK ASSESSMENT
After a half-day plenary discussion to establish the exact scope of the meeting and the methods
of working, two sub-Working Groups were formed: one to consider Health Hazard Demographic and Epidemiological Assessment Essay
Characterization, and another to consider Health Impact Assessment. A third group met initially
to discuss issues related to the broader social and public policy contexts in which environmental
health risk assessment is used. Their views were ultimately incorporated into the chapters of the
two main sub-Working Groups.
After an iterative process of subgroup discussion and plenary meetings, the sub-Working Groups
summarized their discussions and drafted recommendations on their respective topics, which
were further refined following the plenary meeting of the Working Group. These discussions are
summarized in two papers prepared by the two working groups and are presented in Annex 3.
Based on these materials the rapporteur of the meeting, assisted by the chairmen and rapporteurs
of the subgroups, and the secretariat, prepared a draft of the meeting report. Prior to its finalization,
that draft was presented to all members of the Working Group to ensure that it correctly reflected
the Working Group’s consensus on the recommendations and the rationale for them.
The draft report was discussed at a special WHO Symposium, organized at the joint conference
of the International Society for Environmental Epidemiology and the International Society of
Exposure Analysis in Athens, in September 1999 and made available, through the World Wide
Web, for review. The comments that were received (see the list of their authors in Annex 2) were
used in the preparation of the final draft of this Guideline Document in November 1999.
Revisions based on these comments have focused on improving the depth and clarity of
presentation of the Recommendations and Conclusions, rather than on additional detailed
discussion of methodological issues of risk assessment presented in Annex 3. The draft was
reviewed by the chairmen and rapporteurs of the Working Group (and subgroups) and accepted,
with small editorial changes, as the Guideline Document in January 2000.
4. Conclusions and recommendations
This chapter lists the major recommendations made by the Working Group for the evaluation
and use of environmental epidemiology studies for health risk assessment. They constitute the
core of the Evaluation and use of epidemiological evidence for environmental health risk Demographic and Epidemiological Assessment Essay
assessment. This Guideline Document comprises a set of general recommendations, followed by
specific recommendations for evaluations of epidemiological research for Health Hazard
Characterization, and use of epidemiological data for Health Impact Assessment.
4.1 General recommendations
1. Expert review groups should adopt a systematic and explicit approach to the assessment
of epidemiological evidence for health risk assessment. The Working Group acknowledged
that various expert review groups had, in the past, used a variety of methods and standards
to assess epidemiological evidence, and that these were often inadequately described.
2. Expert review groups, and the agencies that sponsor them, should strive for better
communication with stakeholders (e.g. citizens, private interests, and government
agencies) regarding the process of evaluating, and drawing conclusions from, epidemiological
evidence. The need for an evaluation of the epidemiological evidence often reflects the
existence of divergent views among stakeholders about the true extent of the risk. When
expert review groups make explicit, and explain in clear terms, the methods they use to
conduct their evaluations and reach their conclusions, they reduce the potential for those
conclusions to be misunderstood and mistrusted by stakeholders.
3. To improve the applicability of epidemiological research to Health Risk Assessment,
future epidemiological studies should seek where possible to provide results in a way that
enhances the Health Risk Assessment at the interface of epidemiology, other fields of
research, and policy-making. In particular, the study reports should describe as precisely as
possible the exposure characteristics, shape of the exposure-response function, as well as a
distinguish between the acute and chronic effects of exposure.
4. The WHO secretariat of the future reviews should assess the feasibility of
implementation of these recommendations and the increased time and effort that will be
needed and modify the Guideline Document as necessary. WHO should also attempt to
assess whether their use leads to increased acceptance by stakeholders of the evaluations of
environmental epidemiology research produced by expert review groups.
5. It has also been noted that the proposed more rigorous and thorough approach to the
review of the evidence and its use in health impact assessment may require increased effort
and resources. The transparency of the methods should, however, lead to a wider
acceptance and applicability of the reviews, and may reduce the need for duplication of
effort and facilitate updating.
6. The Working Group did not propose a “scale” or “rating” of the evidence, with respect to a
“level of proof” required to support risk management decisions. Although Health Hazard
Characterization precedes, and is often viewed as a prerequisite for, Health Impact
Assessments, (because it provides the scientific justification for them, and provides data Demographic and Epidemiological Assessment Essay
for the calculation of risk estimates), the existence of a specific level of scientific evidence
required to justify either a Health Impact Assessment, or subsequent action, is
controversial. For example, expert judgement that the available evidence is consistent with
a causal relationship between exposure and health effect is considered a necessary
condition for action by some, but not all (see Rothman 1988). Discussion of the level of
evidence on hazard needed to conduct Health Impact Assessment is summarized at the end
section A3.1. Demographic Discussion Assessment