A Conceptual Framework for a Community Health Observing System for the Gulf of Mexico Region
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A Conceptual Framework for a Community Health Observing System for the Gulf of Mexico Region

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    The Gulf of Mexico (GoM) region has been a frequent location for major environmental disasters, including but not limited to hurricanes, floods, and oil spills, and it is likely to continue to experience significant natural and technological disasters. Environmental disasters, singly and in combination, take a huge toll on the health and well-being of people in the GoM region, and many of the health effects are serious and long-lasting. A significant baseline of health information is necessary to identify the health changes caused by a given disaster. Unfortunately, the GoM and all other regions of the U.S. lack a sufficient baseline to identify, attribute, mitigate, and prevent the major health effects of future disasters. Recognizing that developing capacity to assess the human health consequences of future disasters - oil spills, hurricanes, floods, industrial accidents, wildfires, economic, or other – requires the establishment of a sustained community heath observing or surveillance system for the GoM as well as a platform and technical capacity for its implementation, the Research Board of the Gulf of Mexico Research Initiative (GoMRI) commissioned a project to develop a framework for a comprehensive GoM Community Health Observing System (GoM CHOS). To the best of our knowledge, this is the first such system designed for any disaster-prone area in the world. In addition, the COVID-19 pandemic revealed an urgent need for comprehensive national health surveillance. A nation-wide system modeled on the GoM CHOS described here could be a major step toward meeting this need.A proposed framework for the GoM CHOS consists of six levels of data domains, beginning with existing, large-scale surveys and studies and proceeding to longitudinal cohort studies focused specifically on the GoM and probable future disasters there. These data domains are: (1) the National Health and Nutrition Examination Survey (NHANES), Behavioral Risk Factor Surveillance Survey (BRFSS), and National Health Interview Survey (NHIS) cross-sectional surveys; (2) a proposed new Augmented BRFSS survey for the GoM states; (3) the new National Institutes of Health (NIH) All of Us national longitudinal study; and proposed new (4) Large, (5), Small, and (6) Disaster-​Specific Gulf of Mexico longitudinal cohort studies. The last three are presented as nested data domains, with the intent that each of the new cohort studies will build upon the other. They are the unique and most important parts of the observing system. Another significant strength of the GoM CHOS is its ability to adapt rapidly as needs arise and new biomedical and other technologies are developed. The GoM CHOS is designed to continue indefinitely to ensure that essential pre-, during, and post-disaster health data are collected and maintained. The geographic focus of the proposed GoM CHOS will be the disaster-prone coastal counties of the five GoM States. These are counties that either directly face the GoM (have a GoM shoreline) or are near the coast and include areas identified by the Federal Emergency Management Agency (FEMA) as having high risk for tidal and/or storm surge flooding. A statistically representative sample of volunteers from the population in these counties is proposed. It will also include stratification to ensure proportionate inclusion of both urban and rural populations and with additional, targeted recruitment as necessary to enroll adequate numbers of people deemed particularly vulnerable or typically under-​represented. Initially, volunteer participants are expected to be recruited using a mail-address sampling frame, followed by use of electronic communication means to the greatest extent possible. As necessary, targeted recruitment may focus on Federally Qualified Health Centers and community organizations. It may employ locally-based Community Health Workers, engagement activities, and other means to identify and contact potential participants from vulnerable and under-served groups. New data collection will include participant-​provided information via detailed questionnaires, clinical measures of mental and physical health, acquisition of biological specimens from which biomarkers and other health indicators will be derived, sharing of electronic health records, syndromic surveillance information from State Health Departments and the U.S. Centers for Disease Control and Prevention (CDC), and use of wearable health devices. These will be augmented with data from secondary sources such as national community surveys, environmental exposure databases, social media, remote sensing, and others. Biomarker data will be used for calculations of Allostatic Load, a construct of chronic stress and its impacts on physical and mental health, and in other analyses of health status.Primary audiences for use of the GoM CHOS are public health personnel (State and County Health Departments, health systems, community health centers, mental health professionals, physicians, nurses, paramedics, and other health and human services providers), emergency managers and responders, and clinical and academic researchers/pra​ctitioners. Secondary users will include community leaders, planners, and organizations; natural resource managers; chambers of commerce, business associations, and private businesses; charitable and other non-​governmental organizations; and community members including tribes and indigenous people.Data and information products from the proposed GoM CHOS are expected to be used to: (1) assist in the identification and prevention of disaster-​related health effects; (2) improve disaster planning and response; (3) enhance protection of emergency responders, disaster workers, and residents; (4) aid in identifying and directing health services to those in need; (5) increase individual and community resilience; (6) help determine the duration for health response and recovery activities; (7) assist in identifying needed skill sets and development of training programs for health care disaster responders; (8) facilitate planning to minimize disaster health impacts related to loss or damage to housing, employment, and threats to or loss of cherished ways of life; and (9) support new clinical, biomedical, and public health research and practice. It is anticipated that a consortium will be formed in the GoM region to implement the CHOS. Examples of potential organizational and governance models are provided. The governing entity will be expected to solicit as necessary and provide the required start-up and operational funding; be responsible for final design and implementation; provide financial, technical, and management oversight; establish or secure services of a qualified Institutional Review Board (IRB); create or acquire secure data management services; manage participants; and provide access to system data and information as appropriate.
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