1999 - 2000 Strategic Plan

 

Adopted by Section Leadership ? March 9, 1999

Please Note:  This Strategic Plan reflects a process of discussion, development, and review by members of the Environment Section.  The Plan was adopted by Section Leadership on March 9, 1999.  The Plan reflects the Environment Sectionís Objectives as stated in Section By-Laws.  In addition, we will ensure that this plan dovetails with the new APHA-wide Strategic Plan currently being circulated within the APHA membership.  If you have any questions about the Plan, or would like to be involved in implementation, please contact Polly Hoppin, Section Past Chair (hoppin_thomas@email.msn.com) or Chair Susan West, (west@neetf.org).

Section Policy Priorities:
After soliciting input from Section members, Section Leadership agreed to work on four priority policy issues in 1999-2000.  The issue areas were chosen for their timeliness and significance in current national and international discussions.  Details of implementation can be found in Goal #2.

1. healthy schools; 
2. public health protections for drinking water and pesticides;
3. persistent organic pollutants and the precautionary principle; and 
4. reduce childrenís exposure to mercury.

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I.  Vision and Mission

The Environment Section at APHA serves as a multi-disciplinary "home" for professionals, leaders and students involved in environmental health. 

The Section's mission is to:

Influence policy and other changes that create and sustain healthy environments and enhance research, public awareness, prevention and treatment of disease caused or exacerbated by environmental factors; 

Develop alliances and professional support with others who work in a variety of public and private settings;

Keep up to date with relevant science and policy.

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II.  Principles

1. We recognize and support different interests, viewpoints and backgrounds of Section Members. However, we will not be paralyzed by our diversity; we will adopt Section positions even if there is dissenting minority opinion.

1. Members should have access to information about Section activities, and have the opportunity to participate.

1. Our advocacy should be proactive and well-planned.  While we will decline some last minute requests in order to preserve time to pursue the goals below, we will have a mechanism for and remain open to reacting quickly in certain situations.

1. We will seek opportunities to work closely with other APHA Sections, and maintain formal liaisons with other environment and health activities at APHA (e.g., the National Environmental Health Coalition, the Environmental Health Partnership and the Environment and Health Task Force).

1. We will be mindful that we are a volunteer organization.  The objectives and workplans we agree on for any given year should not be overly ambitious, but should reflect time commitments by members.  Out of respect for ourselves individually and collectively, we should expect that the work we undertake--though less ambitious than if it were our day job--will be timely and of high quality.

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III.  Goals

GOAL 1 Improve environment and health practice such that public health and environmental protection are integrated into practice level decision-making.

GOAL 2 Strengthen APHA's role as a respected national and international force to improve   environmental, health and other policies so the policies recognize environmental     components of disease and promote prevention.

GOAL 3 Mobilize Section members to collaborate with APHA staff and leaders in work on environmental health policy and practice.  Serve as the primary source for APHA staff and leadership of expertise and guidance on environmental health issues.

GOAL 4 Build and sustain a strong and active membership base through strategic recruitment, opportunities for participation, effective communication and member recognition.

GOAL 5 Ensure that the APHA Annual Meeting is a dynamic and current forum for environmental health issues, thereby meeting the needs and interest of Section members, building the awareness of all APHA members about environmental health, and increasing the Section's membership.

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IV.  Strategies and 1999-2000 Actions

GOAL 1 -- Improve environment and health practice such that public health and environmental protection are integrated into practice level decision-making.

Strategy 1.  Develop guidelines for the core competencies needed to practice environmental health at the local level by involving key stakeholders and building upon the expertise and guidance of local professionals.

Action 1.1.  Identify section members willing to serve on an action group to initiate developing the guidelines. (Quarter 1 (Q1))
Action 1.2  Identify stakeholders, provide information on issues and plan a meeting date. (Q2)
Action 1.3.  Conduct two day meeting to develop draft guidelines. (Q3)
Action 1.4.  Submit to stakeholders for review and comment and complete final draft. (Q4)
Action 1.5.  Obtain APHA endorsement and make available to the public health community. (Q4)

Strategy 2.  Link Environment Section with two national efforts that are addressing specific ways to improve state and local environmental health practice.

Action 2.1.  In cooperation with NEHA, HUD and CDC, update reference material on housing (this includes the CDC Basic Housing Inspection Manual and the APHA/CDC Model Housing Code).
2.1.a.  Prepare a scope of work for the activity (Q1)
2.1.b.  Identify an expert panel to review progress. (Q2)
2.1.c.  Establish contract for preparation of the documents (pending availability of funds) (Q3)
2.1.d.  Complete the document preparation and prepare for publication and placement on the Internet. (Q3, 2000)

Action 2.2.  Convene a group of stakeholders to review and reach consensus on the National Center for Environmental Health (NCEH) initiative to create a National Environmental Health Service Corps (NEHSC). This initiative is directed at supporting environmental health activities at the state and local levels through improved communication, education, training, and consultation. It also will work to address public health in environmental science and protection decisions.
2.2.a.  Identify section members to work on the issue (Q1)
2.2.b.  Identify stakeholders, plan and conduct meeting to reach consensus on the NEHSC proposal. (Q3)
2.2.c.  Seek APHA support/endorsement of the initiative. (Q4)

Please Note:  The Section proposes to address two initial strategies to address this goal. In the development process of this goal, Section members have also recommended other strategies and activities. These recommendations may warrant further discussion by the Section to determine if there are other activities that Section members want to pursue at this time. Please see Attachment A for the additional recommendations for how the Section might want to proceed on addressing this Goal in future years.
 

GOAL 2 -- Strengthen APHA's role as a respected national and international force to improve environmental, health and other policies so the policies recognize environmental     components of disease and promote prevention.

Strategy 1.    Convene highly visible debates, meetings or workshops and otherwise pursue policy activities related to the Sectionís four priority issue areas in 1999.

Please Note:  The four issue areas chosen for emphasis in 1999 are: (1) healthy schools; (2) public health protections for drinking water and pesticides; and (3) persistent organic pollutants and the precautionary principle, and (1) reduce childrenís exposure to mercury.  Each priority area will be headed up by a point person in the Section.  Activities will vary between issue areas. 
 

Action 1.1.  Promotion of Healthy Schools (For more information contact Claire Barnett, healthyschools@aol.com)

1.1.a.  Decide on issueís priority by Section vote. (Q1)
1.1.b.  Identify Section champion/contact person for the issue (Q1)
1.1.c.  Broaden constituency for action within APHA, for instance, by scheduling a panel session on healthy schools at the national meeting. (Q1-4)
1.1.d.  Draft an APHA resolution on healthy schools, better defining and refining issue, and submit it as a late breaker, tying the issue to new school construction identified by President Clinton in his State of the Union address. (Q1-2) 
1.1.e.  Work with EPA staff to put healthy schools on the agenda of NEHC meeting; identify other groups to work with as allies, including PTA, Learning Disabilities Association etc. (Q2)
1.1.f.  Identify section members willing to put similar resolutions before state professional societies; monitor success of existing resolution in California. (Q2-4)
1.1.g.  Sponsor a brownbag lunch with policy makers from HUD, HHS and other relevant agencies, along with APHA senior staff.(Q3-4)
1.1.h.  Work with APHA staff to identify a healthy schools champion on  Capitol Hill, and work to craft legislation that addresses APHA concerns including the precautionary principle. (Q1-3)

Action 1.2 Realizing public health protections for drinking water and pesticides. (For more information, contact Sharon Newsome, snewsome@psr.org , on drinking water, and David Wallinga, M.D., dwallinga@nrdc.org on pesticides)

[Background -- Within the last two years, significant public health protections were written into two laws, the Safe Drinking Water Act (SDWA) and the Food Quality Protection Act(FQPA).  APHA and its Environment Section can, and should, play a major role in making sure that the promise of public health protection in these laws is realized through their proper implementation.]

1.2.a.  Decide on issueís priority for the Section. (Q1)
1.2.b.  Identify a Section champion/lead person for this issue. (Q1)
1.2.c.  Educate the public and the health profession about health hazards of contaminated drinking water and/or food quality issues, beginning with Section sponsorship of sessions on these topics at the national meeting. (Q1-4)
1.2.d.  Work with NEHC to have periodic updates on implementation of public health provisions of the drinking water and pesticides laws through the National Environmental Health Coalition. (Q1-2)
1.2.e.  Work with APHA and Section leadership and members in signing letters to Congress, to EPA or the White House on implementation of these public health laws.(Q2-4)
1.2.f.  Identify Hill champion and consider APHA sponsorship of Congressional briefings or hearings on these issues, making use of Section members as expert witnesses.(Q2-4) 

Action 1.3.  Persistent Organic Pollutants and the Precautionary Principle. 

[Recognizing the site of the next national meeting on the Great Lakes, the Section could fashion work designed to highlight the public health steps which ought to be taken on substances known to bioaccumulate and to be in persons at levels approaching those which cause health effects, and yet for which the full range of health effects are not completely known nor is the dose level at which those effects occur.]

1.3.a  Decide on issueís priority for the Section. (Q1)
1.3.b.  Specify Section member as champion or lead.
1.3.c.  Craft a resolution or statement that reflects APHAís viewpoint on regulation of POPs, incorporating the precautionary principle. 
1.3.d.  Decide and carry out the best means of turning this viewpoint into action, either by sending a member to participate in the international POPs conferences, designing educational materials around POPs, letters to Carol Browner supporting lower reporting levels for POPs etc. 
1.3.e.  Focus Environment Section panels at national meetings around a POPs theme. 

Action 1.4.    Reduce Childrenís Exposure to Mercury  (For more information, contact Felice Stadler, fstadler@nrdc.org) 

1.4.a.  Section to vote on issueís priority (Q1)
1.4.b  Broaden constituency for action within APHA, by scheduling a panel session on mercury reduction at national meeting. (Q1-4)
1.4.c  Discuss with APHA staff (Don Hoppert) putting the mercury resolution on the agenda of NEHC meetings, seeking to identify allies within the larger environment and public health communities, perhaps linking with the Health Care Without Harm campaign. (Q1-2)
1.5.d   Submit mercury resolution for consideration at national meeting in Chicago (this resolution was handed out for review by the section at the D.C. meeting). (Q1-4)
1.6.e.    Identify section members willing to put similar resolutions before state professional societies, helping to build a groundswell of activity on mercury reduction at local level. (Q1-4)
1.7.f   Work with APHA staff to identify a champion on  Capitol Hill, seeking to introduce legislation reflective of concerns in resolution.(Q1-4)

GOAL 3 -- Mobilize Section members to collaborate with APHA staff and leaders in work on environmental health policy and practice.  Serve as the primary source for APHA staff and leadership of expertise and guidance on environmental health issues.

Strategy 1.  Meet regularly with and involve APHA staff and leadership in Section decision-making while at the same time involving Section leadership in APHA decision-making on environmental health issues and activities.
 

Action 1.1  Section Leadership will meet with members of the APHA staff and members in leadership positions on APHAís environmental health projects to (1) discuss the Sectionís Strategic and Action Plan, (2) identify the linkages between Section activities and APHA staff-driven activities, and (3) formalize the process for seeking Section involvement in both environmental health policy and practice activities coordinated by APHA staff. (Q1)

Action 1.2.  Meet with APHA staff and leadership once/quarter for review and discussion of joint activities, and to plan brown bag lunches, establish Section database, and discuss possible policy resolutions. (every Q)

Strategy 2.  Convene occasional brown bag lunches for APHA staff and leadership on contentious current environmental health issues.
 

Action 2.1.  Set yearly schedule for brown bag lunches to be held at the APHA offices in downtown DC (once/quarter) and coordinate with appropriate APHA staff member. (Q1)

Action 2.2.  Informally survey all members as to their topics of interest.  Another option is to choose the areas of focus in environmental health policy for the Section (i.e. healthy schools, childrenís exposure to mercury, and drinking water/pesticides - see proposed areas of focus in Goal #2).  Identify "brown bag planner" who can arrange the session and invite the speakers.  APHA staff will be asked to send invitations.(Q1)

Action 2.3.  Invite APHA staff and leadership as well as all Section members, and members of APHAís National Environmental Health Coalition and Environment and Health Task Force.

Strategy 3.  Build the Sectionís capacity to respond to requests for expert testimony, peer review of documents, collection of public comments, and other activities coordinated by APHA staff and leadership.
 

Action 3.1.  Assess current system of involving Section members in APHA responses and requests and determine short-term ways to fine tune the system. (Q1)

Action 3.2.  Choose the main activities that should involve Section participation.  Such activities might include:  expert testimony in Congressional hearings and panels; appointment representing APHA on federal advisory committees, scientific boards and committees (i.e. US EPA, National Academy of Sciences); peer review/public comments on federal documents, reports, and recommended changes in standards; synthesis of Section comments on public documents; interviews with the media on environmental health issues or APHA press events and briefings; review of Action Alerts or letters to Congressional members and/or Executive Branch. (Q1)

Action 3.3.  In coordination with APHA staff, develop a mechanism for requesting Section membersí involvement in the above mentioned activities.  Develop mechanisms for both the anticipated activities (public comments, committee appointments) and unforseen and reactive activities. (Q2)

Action 3.4. Develop a data base of members and other public health professionals and leaders with expertise on particular issues:
3.4.a.  Set up database system in coordination with APHA staff that is "housed" at APHA and staffed by APHA staff. (Q2)

3.4.b.  Survey all interested Section members with a brief questionnaire asking for Contact Information (name, title, organization, address, phone, fax, email), Short Professional Biosketch (work history, credentials, publications, current appointments, other experiences testifying (if applicable)), Issue Areas (include description of their perspective the given issue), Type of Involvement (testimony, peer review, committee appointment), Conflict of Interest Disclosure (including funding sources), Response Time (can respond quickly or prefers advance lead time), Ability to Travel (to DC or other locations). (Q2)

3.4.c.  Store all information in a database capable of sorting by all fields (including issue areas, type of involvement, response time, and geography) (Q3)

3.4.d.  Utilize the database system in the latter part of 1999 to determine its effectiveness and discuss the findings at the Section Business Meeting in November 1999 in Chicago. (Q4)

Strategy 4. Streamline and systematize the Sectionís review and development of environment-related resolutions.
 

Action 4.1. Improve/Enhance Content of Resolutions ? scheduled for 2000

4.1.a.  Identify current environmental-health related policy resolutions held by APHA. 

4.1.b.  Identify gaps in the resolutions, with specific attention to current and expected policies and practice issues in environmental health. 

4.1.c.  Informally survey Section members and APHA staff as to upcoming important issues for which APHA does not have a policy resolution to guide APHA decision-making (this may also dovetail with the areas of focus that the Section may adopt). 

4.1.d.  Proactively ask Section member(s) to draft 2-3 new resolutions for the 1999 or 2000 resolution review process in response to the identified gaps or prospective policy issues. 

Action 4.2. Develop a system to ensure earlier review and input by Section members on upcoming policy resolutions and position papers.

4.2.a.  Section Chair reviews proposed 1999 Resolutions with relevance to Environment Section. (Q1)

4.2.b.  Section leadership receives copies of all environmental health-related resolutions for their review and comment in time for May 1999 Joint Policy Committee (JPC) Meeting (week of March 22)

4.2.c.  Section designee will collect Section Leadership comments and prepare draft Section memo for JPC for approval by Section Leadership in time for May 4-5 JPC Meeting.  (Q2)

4.2.c.  Schedule time for resolution authors to brief Section Members at Monday morning Section Business Meeting at APHA Annual Meeting. (Q4)

GOAL 4 -- Build and sustain a strong and active membership base through strategic recruitment, opportunities for participation, effective communication and member recognition.

Strategy 1:  Establish a balanced membership committee
 

Action 1.1  Recruit two to three additional members, including one student, to serve on the membership committee and hold a kick-off meeting. (Q1)

Strategy 2:  Develop and implement a strategic and successful recruiting drive; welcome and orient new members to the Section;
 

Action 2.1.  Obtain lists of persons who would be potential candidates for membership, and work with APHA staffers to distribute the flyer and recruitment letter to persons on these lists. (Q3)

Action 2.2.  Obtain from APHA staff a complete list of all Environment section members and create a database that can be used for outreach. (Q3)

Action 2.3.  Prepare a flyer and letter to help recruit prospective members. The letter and flyer should be suitable for distribution via facsimile, e-mail and regular mail. (Q2&3)

Action 2.4.  Organize a session at each Annual Meeting specifically for new and prospective members (see Goal 5).  This session could discuss careers in environmental health and provide networking opportunities. (Q3)

Action 2.5.  Establish links to schools of public health and environmental health programs to encourage students to become involved in the environment section. 
 

Strategy 3:  Enhance communication within the Section, including alerting members about opportunities to participate in specific Section projects (e.g., list serve discussion group, regular e-mails to all members, new member packet);
 

Action 3.1.  Work with APHA staff to establish an outreach program for new section members to engage them in section activities and encourage them to attend the Annual Meeting. (Q3&4)

Action 3.2.  Work with the editor of the environment section newsletter to send copies of the newsletter to potential members. (Q2)

Strategy 4:  Strengthen the role of Section Committees and ensure that leaders can commit the time to involve interested members and achieve yearly objectives.

SEE Actions 2.4. and 8.1

Strategy 5.  Develop a Section Manual to orient new Section leaders and inform all Section members about how the Section operates. The Manual would include the strategic plan, role of Section leadership positions and committees, policy resolution process, Annual Meeting planning, relationship of the Section with APHA, and other activities.
 

Action 5.1.  Identify several Section members in 1999 who are willing to begin the process of developing a Section Manual.

Strategy 6.  Publish a regular Section newsletter that updates members on Section activities, opportunities to participate, activities in the environmental health field, and other relevant information.
 

SEE Action 2.3. and Action 3.2.

Strategy 7.  Organize and hold an Awards Ceremony at the Annual Meeting that recognizes members through the Distinguished Service Award and national leaders through the Homer Calver Award (see Goal 5).
 

Action 7.1.  Working with the Section Chair, Awards Committee will choose candidates for the Distinguished Service Award and the Homer Calver Award.

Action 7.2.  Coordinate with Section Chair and Annual Meeting Program Planners to plan Awards session.

Strategy 8.  Build a strong continuing education program for Environment Section members.
 

Action 8.1.  Work with the environment section program planners (see Goal 5) and the APHA staff to (1) identify the continuing education needs of our membership and (2) obtain continuing education certification for our program at the Annual Meeting. (Q1,2,3)

GOAL 5 -- Ensure that the APHA Annual Meeting is a dynamic and current forum for environmental health issues, thereby meeting the needs and interest of Section members, building the awareness of all APHA members about environmental health, and increasing the Section's membership.

Strategy 1  Create High Quality and High Interest Scientific Sessions
 

Action 1.1.  Attract high quality abstracts for individual and group presentation and actively solicit coherent and provocative full-sessions (Q1&2)

Action 1.2.  Seek out other Sections with which to jointly plan sessions and/or for joint sponsorship:

1.2.a.  Pursue joint sponsorship with the maternal and child health section on our children's environmental health sessions (likely to be 5 total) 
1.2.b.  Pursue joint sponsorship with the occupational safety and health section and the medical care section on environmental impacts of medical practice
1.2.c.  Identify at least one session for joint sponsorship with the international health section

Action 1.3.  Collaborate with APHA staff and leadership on APHA-sponsored sessions relevant to environmental health (Q1)

1.3.a.  Work with Polly Hoppin, Section Chair, to influence the selection of environment-related topics for the APHA-sponsored sessions.  Potential ideas generated by program planners APHA-wide include: food safety and globalization of food supply; food irradiation; environmental health aspects of disastersóElizabeth Dole; sanitation throughout the century and the world; settlement housingóOprah; A day in the life of public health: turn of the century, now, 2100.
1.3.b.  Select at least one of the above topics that is rejected as an APHA-sponsored sessions to highlight in the environment section program 

Action 1.4.  Respond to key areas of focus identified through the strategic planning process (see Goal 2) by holding two panel discussion slots for these topics (Q2)

1.4.a.  Work with section leadership to identify key issues not addressed in program 
1.4.b.  Solicit additional sessions 
1.4.c.  Finalize sessions for inclusion in the final program 

Action 1.5.  Increase attendance by identifying one or two key environmental health issues in the Midwest and develop sessions on these topics (Q1&2)

1.5.a.  Solicit panels on topics of Midwest concernóoptions: healthy schools, great lakes water quality; economic development/brownfields
1.5.b.  Highlight these sessions in any preliminary program, marketing and recruitment materials

Strategy 2:  Increase/enhance Networking Opportunities
 

Action 2.1  Convene a host-city committee to help organize local events (Q1)

Action 2.2.  Host a vibrant social event (Q4) 

Action 2.3.  Consider arranging a tour linked with environmental health issues (e.g. environmental justice or sustainability (brownfields) tour and meeting/summit for APHA members) (Q1)

Strategy 3: Expand Continuing Education Credits
 

Action 3.1.  Work with Paul Locke, (see Goal 4) membership coordinator, to increase continuing education credits (Q2&3)

Strategy 4:  Use the Annual Meeting to Enhance Membership Development
Note: these actions are intended to complement the activities in strategic goal #4 to increase membership
 

Action 4.1.  Identify environment section membership, APHA affiliates and schools of public health/environmental policy and management in the Midwest and send special promotional materials (Q2&3)

4.1.a.  Investigate the possibility of including the final program in a summer newsletter 
4.1.b.  Send other promotional materials as possible 

Action 4.2.  Recruit individuals who may be interested in learning more about and joining the Environment Section at sessions (Q3&4)

4.2.a.  Develop sign up recruitment sheets (in collaboration with Paul Locke, membership coordinator) 
4.2.b.  Send recruitment sheets to session presiders and ask for their assistance in distributing the sheets prior to the 1999 meeting.

Action 4.3.  Host a special session for students and others interested in pursuing professional careers in environmental health (Q4)

Action 4.4.  Send a special mailing which focuses on the Annual Meeting to potential new members (Q3)

4.4.a.  Work with membership committee (Paul Locke) to coordinate mailing information about the meeting. 
4.4.b.  Share final program with Paul Locke
4.4.c.  Develop and distribute marketing materials through section newsletter, posters on-site, and fliers at business meetings and primary environment section hotel.

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Attachment A: 

Additional Recommended Activities for Environmental Health Practice (Goal 1)

Environmental protection and environmental health issues converge at the local level. It is precisely at the local level where the front-line war is waged to prevent disease. While the resources for environmental protection issues have expanded, the resources for more traditional state and local environmental health activities have not or have been reduces. This loss of support for environmental public health may have contributed to many of the recent outbreaks of disease. Included is the cryptosporidium outbreak in  Milwaukee, the E. coli O157:H7 outbreak associated with beef and the hantavirus outbreak in the southwest in 1993. There is an imbalance of funding and support between environmental protection and environmental health at the local level. The ability of local health departments to adequately address environmental health and protection issues has been severely hampered. The environmental health professionals at the local level are our front-line troops in preventing disease. The importance of this role in preventing disease needs to be recognized and addressed within the public health community.

Other activities affecting state and local environmental health programs and which address some of the important issues of public health and environmental protection follow. These activities also address the issue of preparation of professionals entering the field.

Possible additional Environment Section activities for future years include:
 

1. Advocate the need for local environmental health and protection programs to adopt the IOM recommendations of assessment, policy development and assurance in establishing their priorities.
2. Strengthen the ability of local environmental health programs to implement the Food Safety Initiative(FSI). Very little, if any, federal funding reaches programs at the local level. Consequently, many of these program are not prepared to implement the initiative.
3. Along with other associations (NEHA, NALBOH, NACCHO) and affiliates, advocate for a minimum credential to practice the field of environmental health and protection at the local level. The Registered Sanitarian/Registered Environmental Health Specialist are required in only 18 states.
4. Work with other associations and federal, state and local agencies to develop national guidelines on the minimum competencies necessary to practice in the field of environmental health and protection. These guidelines would be used to elevate the practice of environmental health and protection at the local level to the highest possible level.
5. Support of the APHA/NEHA/CDC effort to revise the Basic Housing Inspection manual.
6. Support and advocate the use of the National Association of County and City Health Officials (NACCHO) the Protocol for Assessing Community Excellence in Environmental Health (PACE:EH). This document is to be completed next fall and is an excellent tool for helping health departments to learn and address the needs of the community in environmental health.
7. Support the work of the CDCís Public Health Practice and Policy Office (PHPPO) and others to develop public health performance standards that include environmental health.
8. Work with other associations to develop a common policy on the issue of environment and public health.
9. Work to expand the base of accredited schools of environmental health that can provide well prepared environmental health professionals. (The USPHS will now only appoint graduates from these programs into the Commissioned Corps). Work with ASPH and accredited programs in environmental health to develop leaders in environmental health who have a strong background in public health.
10. Work with EPA and the Environmental Council of States to promote public health in decision-making.
11. Advocate (especially with other sections) the importance on addressing health when environmental protection decisions are made.
12. Work with other sections to address the importance of strong environmental health and protection programs at the local level in an overall public health program.