A framework for the development and evaluation of environmental public health indicators (EPHI): A tool for environmental health practitioners

Environmental public health indicators (EPHIs) are summary measures that describe baseline environmental health information by characterizing spatial and temporal trends of hazards, exposures and health effects over person, place, and time. The complexity of environmental health surveillance calls for a systematic framework and concrete set of criteria to guide development, selection and evaluation of indicators and measures. Previous indicator initiatives have explored the theoretical foundations and methods for indicator development; however, these concepts have not been evaluated specifically for the development and evaluation of EPHI in the United States. Consequently, environmental health practitioners at local, state and federal agencies are lacking important resources and tools to develop indicators. A case-synthesis review of previous indicator models from both environmental monitoring and public health was employed to develop an integrated evaluation framework. The framework is organized around three assessment phases: scientific basis and relevance, analytic soundness and feasibility, and interpretation and utility. Key elements within the framework include: assessing the environmental health importance, public health importance, and public concern that indicators are addressing; understanding the technical capacity and feasibility required to produce EPHI measures; evaluating the analytic soundness of the measures; demonstrating the potential for using the indicator measures to develop targeted intervention and prevention strategies; and addressing the ultimate utility of the indicators for policy development. The framework fills a critical gap for environmental health practitioners by outlining important constructs and criteria to consider during the indicator development process and establishes quantitative methods to objectively evaluate the quality of proposed measures.