Use of the Driving Forces, Pressures, State, Exposures, Effects and Actions Indicator Model to Develop Climate Change Environmental Public Health Indicators for Pollen and Asthma Emergency Department Visits

BACKGROUND: The Council of State and Territorial Epidemiologists (CSTE)/State Environmental Health Indicators Collaborative (SEHIC) Asthma Work Group recently completed an original indicators manuscript on specific methods to develop or adapt new Environmental Public Health Indicators (EPHIs).  One proposed improvement to the development of climate change EPHIs was to use the World Health Organization (WHO) Driving Forces, Pressures, State, Exposures, Effects and Actions (DPSEEA) indicator model.  The DPSEEA indicator model forces the indicator developer to consider how other vectors can modify the way pollen influences asthma Emergency Department (ED) visits, and to also enumerate interventions. This poster will demonstrate how pollen and asthma ED visits EPHIs, previously developed by the CSTE/SEHIC Asthma Work Group, can be displayed as a DPSEEA climate change indicator.   

METHODS: The five DPSEEA vectors are represented as segments on a circle’s circumference.  Vector-derived Actions are symbolically placed in the circle’s center.  The upper-left of the circle’s circumference includes pollen (Exposures) followed by asthma ED visits (Effects).  Additionally, the upper-right includes Driving Forces (e.g., barriers to health care, unable to purchase asthma medication) and Pressures (e.g., increases in temperature, more carbon dioxide).  State, the cumulative end point, is in the bottom-half of the circle's periphery.  State health department pollen and asthma ED data are used to develop this pollen-asthma DPSEEA climate change indicator.

RESULTS:  The DPSEEA indicator framework enables the indicator developer to represent the negative contribution of pollen on asthma ED visits within the larger context of environmental public health.  By identifying what Actions have to be taken to decrease pollen effects on asthma ED visits, either directly or through changes in the Driving Forces and/or Pressures, the DPSEEA indicator model supports the creation of appropriate intervention activities.  Possible environmental public health interventions could include decreasing pollen exposure, increasing health care access, and/or teaching asthmatics how to avoid asthma attacks that result in ED visits.  Long-term climate change actions consist of minimizing anticipated future increases in ambient temperature and carbon dioxide, and their combined effects on pollen spore density and allergenicity. 

CONCLUSIONS: Use of the DPSEEA indicator framework should contribute to a better understanding of how climate change influences pollen and asthma ED visits within a larger ecological and social context, and facilitate the identification of more effective intervention activities that will decrease the negative impact of pollen on asthma ED visits.