ATSDR Public Health Assessment Guidance Manual describes the health assessment process as defined by ATSDR and clarifies the methodologies and guidelines that are used by ATSDR staff and agents in conducting health assessments. This guide covers the individual steps for performing a health assessment and discusses how the health assessment report should be written, in addition to the format in which it should be presented. The guide will be a standard reference for anyone doing health assessments, all federal agencies, ground water and hazardous waste engineers and scientists, public health professionals, and libraries.
PREFACE. LIST OF FIGURES. LIST OF TABLES. LIST OF ACRONYMS AND ABBREVIATIONS. INTRODUCTION. HEALTH ASSESSMENT OVERVIEW. Definition and Purpose. Uses of Health Assessments. Health Assessments and Risk Assessments. Follow-Up Actions and Evaluations. Health Assessment Process. Health Assessment Report. EVALUATING SITE INFORMATION. Background Information. Community Health Concerns. Demographic Information. Land Use and Natural Resource Use Information. Environmental Contamination Information. Environmental Pathways Information. Health Outcome Data. RESPONDING TO COMMUNITY HEALTH CONCERNS. Before the Site Visit. During the Site Visit. After the Site Visit. Public Comment Period. Adding Community Health Concerns to the Health Assessment. DETERMINING CONTAMINANTS OF CONCERN. Identifying Contaminants. Reviewing Concentration Levels. Evaluating Sampling Data and Techniques. Making Data Comparisons. Using Background Concentrations. Comparing Environmental Concentrations to EMEGs. Community Health Concerns. Toxic Chemical Release Inventory. IDENTIFYING AND EVALUATING EXPOSURE PATHWAYS. Identifying Element 1-Source of Contamination. Identifying Element 2-Environmental Media and Transport. Identifying Element 3-Point of Exposure. Identifying Element 4-Route of Exposure. Identifying Element 5-Receptor Populations. Categorizing Completed and Potential Exposure Pathways. Eliminating an Exposure Pathway. Defining Exposure. Presenting the Pathways Analyses Section. DETERMINING PUBLIC HEALTH IMPLICATIONS. Toxicologic Evaluation. Evaluating Health Outcome Data. Evaluating Community Health Concerns. DETERMINING CONCLUSIONS AND RECOMMENDATIONS. Determining Conclusions. Determining Recommendations. HEALTH ASSESSMENT FORMAT. Summary. Background. Community Health Concerns. Environmental Contamination and Other Hazards. Pathways Analysis. Public Health Implications. Conclusions. Recommendations. Preparers of Report. References. APPENDICES. Appendix A: Environmental Media Evaluation Guides. Appendix B: Standards and Health Guideline Values. Appendix C: Data Evaluation Criteria. Appendix D: Estimation of Exposure Dose. Appendix E: Food Consumption Values. Appendix F: State and Local Sources of Health Outcome Data. Appendix G: National Sources of Health Outcome Data. Appendix H: Health Outcome Data Checklist. Appendix I: Sources of Health Outcome Data. Appendix J: Census Information. Appendix K: Units and Conversion Factors. Appendix L: Site Summary Form. Appendix M: Glossary.