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If you have comments or suggestions, contact Sharon R. Coleman by sending an Email to SRC3@cdc.gov
In accordance with the Government Performance and Results Act of 1993, ATSDR has developed a FY 1999 Strategic Performance Plan. This plan integrates the agency's strategic directions with the Fiscal Year (FY) 1999 budget submission. Key to this plan is the inclusion of performance objectives and measures used to assess and communicate results achieved in critical program areas implemented by ATSDR.
This plan will drive the activities and guide decisions of ATSDR for FY 1999. During FY 1998 (Oct 1, 1997- Sept 30 1998), ATSDR will continue to modify this plan on the basis of feedback from customers and stakeholders, the refinement of performance data, and the establishment of ATSDR's budget for FY 1999. The strategic planning process at ATSDR is an ongoing, continuous learning process that defines the purpose and direction of the agency and how it will achieve performance results by addressing four fundamental questions:
Where are we going (Mission and Vision)?
How do we get there (Strategic Directions, Strategic Issues, and External Factors)?
What is our plan for action (Performance Plan)?
How do we know we are on track (Evaluation and Performance Measurement)?
Using the performance information generated by this plan, ATSDR will aim for continued progress in effective program outcomes, build and refine data systems to match performance management needs, and use performance information to alter programs to best meet customer and stakeholder needs.
We invite your input on this document. You may E-mail your comments to:
Sharon R. Coleman at SRC3@cdc.gov
or, if you prefer to send your comments by mail, please contact:
Sharon R. Coleman
Agency for Toxic Substances and Disease Registry
Office of Program Operations and Management
Mail Stop E60
1600 Clifton Road
Atlanta, GA 30333
About ATSDR
The Agency for Toxic Substances and Disease Registry (ATSDR) was created as a federal agency by the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA), more commonly known as Superfund legislation. ATSDR was created to implement the health-related sections of CERCLA and other laws that protect the public from hazardous wastes and environmental spills of hazardous substances. In 1983, the Secretary of the Department of Health and Human Services (DHHS) established ATSDR as an agency of the Public Health Service. In 1984, amendments to Resource Conservation and Recovery Act (RCRA) legislation authorized ATSDR to conduct public health assessments at these sites, when requested by the Environmental Protection Agency (EPA), states, or individuals, and to assist EPA in determining which substances should be regulated and the levels at which substances may pose a threat to human health.After the 1986 reauthorization of Superfund under the Superfund Amendments and Reauthorization Act (SARA), the agency received major new mandates. ATSDR's responsibilities currently include public health assessments of communities exposed to hazardous substances, establishment and maintenance of toxicologic databases, national registry of persons exposed to select hazardous substances, emergency response to chemical releases, applied research in toxicology and epidemiology, surveillance, information dissemination, and medical education. New program areas within ATSDR were created to implement these mandates, and the agency was reorganized in August 1989 to facilitate the implementation of its expanded responsibilities.
The following list comprises ATSDR statutory authorities:
On the basis of these authorities, ATSDR has developed a statement of values, vision and mission statements, seven program areas, and three overarching goals.
Statement of Values
ATSDR's highest priority is protection of public health. In meeting that priority, the agency and its employees commit to the following values.We will act at all times in the best interest of the public's health.
We will treat the public respectfully and courteously and will respond promptly to requests with accurate, up-to-date information.
We will treat each other courteously and respectfully.
We will meet high performance standards, produce quality work, and seek innovative means of accomplishing our work.
We will base hiring and promotions on job-related qualifications; the agency is committed to equal employment opportunity.
We will promote employees' career development through education, training, and quality work experiences.
We will follow the Department of Health and Human Services Standards of Conduct for all employees.
Vision
The ATSDR vision, "Healthy People in a Healthy Environment," conveys the desired results of the agency's commitment to achieve environmental public health goals by controlling or eliminating the public's exposures to hazardous substances contaminating the environment and by promoting healthy behaviors that reduce the risk for adverse health effects of those exposed to the contaminants.
Mission
To prevent exposure and adverse human health effects and diminished quality of life associated with exposure to hazardous substances from waste sites, unplanned releases, and other sources of pollution present in the environment.
Strategic Directions
ATSDR is the lead public health agency within the federal government charged with developing and assuring the public health agenda of CERCLA. On the basis of its authorities, ATSDR conducts comprehensive site evaluations, public health assessments, health investigations and health studies, applied research, and health education and promotion activities at NPL sites and sites petitioned of the agency to accomplish three goals:
Identify people at health risk because of their exposure to hazardous substances in the environment.
Evaluate relationships between hazardous substances in the environment and adverse human health outcomes.
Intervene to eliminate exposures of health concern and prevent or mitigate adverse human health outcomes related to hazardous substances in the environment.
Our goals reflect our public commitment to provide quality environmental public health advice, conduct responsible applied research, and establish effective working relationships with community members and leaders, which will enable the public to address environmental health issues. These goals selected by the agency clearly identify ATSDR's public health priorities. The goals focus our efforts on public service, and are in concert with the goals and priorities of the EPA, the Centers for Disease Control and Prevention (CDC), and DHHS. ATSDR has shared these goals, along with its vision and mission statements, with its partners in state, local, and tribal governments; its staff; EPA; and CDC.
ATSDR goals are achieved through the implementation of seven key program areas:
Public Health Assessments and Consultations evaluate data and information on the release of hazardous substances into the environment to (1) assess any current or future impact on public health, (2) develop health advisories or other health recommendations, and (3) identify studies or actions needed to mitigate or prevent human health effects. ATSDR conducts public health assessments and related activities for all sites proposed for the NPL and in response to petitions from the public.
Public health assessments are enhanced by exposure investigations and exposure dose reconstruction activities that gather and analyze biomedical samples, exposure point samples, or approximate exposures through spatial analysis techniques. ATSDR's public health assessment determines whether actions should be taken to reduce human exposure to hazardous substances from a site and whether additional information on human exposure and associated health effects is needed and should be acquired by conducting epidemiologic studies or establishing registries, medical surveillance, medical monitoring programs, or other methods.
Health Studies increase understanding of the relationship between exposure to hazardous substances and adverse health effects through epidemiologic, surveillance, and other studies of toxic substances and their effects.
The National Exposure Registry program established and maintains a registry of persons exposed to dioxin, trichloroethylene, trichloroethane, and benzene contamination in the environment.
Toxicological Profiles summarize and make available to the public data on the health effects of hazardous substances, identify significant gaps in knowledge, and initiate research in toxicology and health effects where needed.
Applied Research is designed to increase scientific knowledge about the effects on human health of hazardous substances in the environment.
Emergency Response activities provide health-related support to states, local agencies, and health care providers in public health emergencies involving exposure to hazardous substances, including health consultations on request and training for first responders.
Health Education and Promotion programs integrate environmental medicine, health education, risk communication, and capacity building to involve communities in reducing the impact of exposure to hazardous substances.
To document progress in achieving these goals, ATSDR has created a database, HazDat, that contains information on all aspects of the agency's work. Results of the agency's activities are assessed each year to determine the best course of action for meeting the public's evolving environmental health needs. The identified course of action then becomes the agency's Annual Plan of Work, from which the agency develops program plans and priorities. Information from HazDat is also used to determine how best to work with agency partners and stakeholders to assure that mutual goals are met.
Strategic Issues
ATSDR supports the federal government's management reform initiatives including the National Performance Review (NPR), the Government Performance and Results Act (GPRA), and the Chief Financial Officer's (CFO) Act. In response to the concept of developing a performance-based government, ATSDR has undergone an annual strategic planning process to revisit the agency's vision, mission, goals, and performance objectives. The result of the process was the validation of ATSDR's current vision, mission, and goals, as well as the identification of four strategic issues to guide the agency's performance management reform effort. The following strategic issues are critical for the agency. Effectively focusing its programs on these issues will enable the agency to understand stakeholders' needs, address the agency's mandates, and evaluate its programs so that agency operations, management, products, and services can be improved.
How should ATSDR evaluate the public health needs of its stakeholders and involve those stakeholders in the agency's program planning, implementation, and evaluation?
How should ATSDR's roles in assessment, science, health promotion, and service be implemented to meet the needs of ATSDR's stakeholders and to achieve ATSDR's mission?
How does ATSDR ensure that it has the authorities and resources necessary to address the public health needs of its stakeholders?
How should ATSDR evaluate the public health impact of its products and services?
By addressing these strategic issues, ATSDR will establish a strong foundation from which the agency can progress towards its stated goals. In doing so, the agency will be assured that its long-term and annual performance objectives and indicators will be aligned with, and support the achievement of its mission and goals.
External Factors
Several key external factors beyond ATSDR's control could significantly affect the achievement of the agency's goals. The agency was created by Superfund legislation, which directs the agency's mission and funds its programs. Debate over the future direction of Superfund programs has delayed the reauthorization of CERCLA. The Congressional debate will greatly affect future directions for agency resources, responsibilities, and research needs.
ATSDR relies heavily on strong working relationships with tribal, state, and local organizations; private, nonprofit, and community-based organizations; and other federal agencies to implement critical environmental health programs. As part of the public health assessment process, ATSDR recommends to EPA, state and local governments, private citizens, and others actions that can be taken to reduce or mitigate the risks of adverse health effects from exposures to toxic substances. Before FY 1997, approximately 53% of ATSDR's recommendations were implemented by the informed organization or person. ATSDR tracks the recommendation follow-up process to understand reasons for compliance and noncompliance to improve the quality and effectiveness of ATSDR's recommendations and improve interactions with EPA, states, and others to whom ATSDR provides recommendations.
Toxicologic research and environmental technology influence the ability of ATSDR to address many of the public's concerns regarding potential exposure and adverse health effects resulting from toxicants released in the environment. ATSDR pursues research in these areas through partnerships with the EPA, the National Institutes of Health, and other agencies, the private sector, and academically based research programs. These collaborative programs allow ATSDR to fill priority data gaps in environmental health related to the chemical toxicity and environmentally related disease, and to develop biological monitoring methods to identify levels of key contaminants in human populations. The lack of sufficient information about the health effects of various levels of exposure to specific substances limits the agency's ability to assess the public health implications of such exposures at sites.
ATSDR Performance Plan
ATSDR is committed to support EPA efforts to improve waste management and restore abandoned waste sites by providing needed data on exposure and health effects. As knowledge about the role of environmental toxicants in human disease increases, ATSDR's programs must evolve to ensure that this information is meaningfully applied to the agency's assessment/investigation, education, intervention, and research activities. ATSDR assesses progress toward achieving its goals by measuring the outcomes of intermediate steps outlined in this strategic performance plan. Although this performance plan does not address all of ATSDR activities and services, the performance objectives listed in this plan begin to focus the agency's priorities for the next 5 years.
Goal I: Identify people at health risk because of their exposures to hazardous substances in the environment.
ATSDR has documented that approximately 12.5 million people reside within 1 mile of the nation's 1,300 most hazardous Superfund sites. Among these are children who are at increased risk for adverse health outcomes and a significantly higher percentage of minority populations than in other parts of the affected counties. The effects on people who live around sites contaminated with toxic chemicals are adverse health outcomes including severe and debilitating disorders such as birth defects, respiratory dysfunction, and some cancers. The occurrence and impacts of other health effects, such as psychological stress, are not fully understood.
To identify persons at risk of adverse health effects, ATSDR implements a comprehensive series of site activities that identify levels and location of contamination, potential and completed exposure pathways, receptor populations, and include the involvement of community members and local, state, federal, and tribal health and environmental agencies in managing and implementing public health recommendations. ATSDR strives to provide accurate, complete information to the public, EPA, and other stakeholders in a timely manner and, where there are urgent or significant health concerns, ensures that effective controls or interventions are implemented to prevent or mitigate adverse health outcomes. ATSDR has refined its definition of affected population through its partnering and community involvement activities. The redefinition requires the collection of additional data during the health assessment process. ATSDR's comprehensive public health assessment activities are the nucleus of the agency's operations. In FY 1999, the results of approximately 500 assessment activities will determine what public health actions are warranted and which sites need health follow-up activities. In support of EPA's goal to move 900 sites to the construction completion phase by the year 2000, ATSDR will review and update previous health decisions on sites to ensure that the health of the community will not be adversely affected by the site or the remedial actions taken.
Long-Term Performance Objective 1.1
By FY 2002, ATSDR will identify the impacted populations (those in potential or completed exposure pathways) at all sites having public health assessment activities.
| Baseline: | Sites having public health assessment and related activities scheduled for the fiscal year. |
| Source of Data: | HazDat |
| Budget Activity: | Public Health Assessments, Health Consultations, and Site-Specific Public Health Activities |
| Link to EPA Goal: | Better waste management and restoration of abandoned waste sites. |
| Link to DHHS Goal: | To promote health and confront the major threats to health and productive lives for all Americans. |
Long-Term Performance Measure 1.1
The number of sites receiving public health assessment activities where the population within the potential and completed exposure pathways has been identified.
FY 1999 Annual Performance Objective 1.1
ATSDR will identify the impacted populations at 50% of the sites having public health activities.
FY 1999 Annual Performance Measure 1.1
The proportion of sites receiving public health assessment activities where the population within the potential and completed exposure pathways has been identified.
Goal II: Evaluate relationships between hazardous substances in the environment and adverse human health outcomes.
ATSDR is working to determine the relationships between identified adverse human health outcomes and hazardous substances through an applied research program. The program provides public health officials with sound scientific data on the effects of chemical exposures on the human body. A major objective of the program is to establish linkages between levels of contaminants in the environment and levels in human tissue and organs associated with adverse health effects. Once such links have been established, strategies to mitigate potentially harmful exposures can be developed. Through the development of a priority list of hazardous substances, ATSDR ensures that toxicologic research is focused on those chemicals believed to be most hazardous to human health. ATSDR's applied research is directed to fill key data gaps for priority hazardous substances, then interpret and communicate those findings through the publications such at the toxicological profiles. Health professionals regard ATSDR toxicological profiles as an authoritative source of up-to-date information on the health effects of hazardous waste components and as a credible source of health guidance values for estimating potential human health risk that may result from exposure to toxic substances.
Through the science of epidemiology, associations between disease occurrence and exposures to toxic substances are investigated. To evaluate illnesses among people living near hazardous waste sites, ATSDR evaluates priority health conditions in populations living or working near hazardous waste sites; maintains a national exposure registry to assess the long-term health consequences of low-level, long-term exposure to hazardous substances; and conducts surveillance programs to evaluate adverse health effects that can occur at low rates over a period of time. ATSDR's recent research efforts provide evidence of the following outcomes: (1) increased risk of birth defects such as neural tube or heart defects in children born to women living near an NPL site; (2) statistically significant increases among some age groups for stroke, anemia and other blood disorders, urinary tract disorders, skin rashes, and cancers; and (3) estimates of the oral intake of methylene chloride in drinking water that would produce adverse effects on the central nervous system, and liver--in both adults and children.
In FY 1999, ATSDR will continue ongoing epidemiologic/health studies, surveillance, and registries, as well as initiate 13 new epidemiologic/health studies and three new surveillance projects. These new studies are critical to address site-specific disease and exposure concerns.
Applied research in toxicology is critical to determine levels of significant human exposure to priority hazardous substances. EPA and ATSDR use the levels to set standards and assess health risks to people exposed to specific chemicals. In FY 1999, ATSDR will continue work on 25 profiles and initiate 12 new profiles. In addition, ATSDR will fund research to address 21 priority data needs through the Association of Minority Health Professions Schools and the Great Lakes Research Program.
Long-Term Performance Objective 2.1
On an ongoing and needed basis, complete human health studies to assess the relationship of hazardous waste at Superfund sites to adverse health effects focusing on the seven priority health conditions.
| Baseline: | Baseline will be determined in FY 1999 after the development of a new HazDat module supporting the priority health conditions (birth defects and reproductive disorders, cancer (at selected anatomic sites), immune function disorders, kidney dysfunction, liver dysfunction, lung and respiratory diseases, neurotoxic disorders). |
| Source of Data: | HazDat |
| Budget Activity: | Surveillance, Epi/Health Studies, and Registries |
| Link to EPA Goal: | Better waste management and restoration of abandoned waste sites. |
| Link to DHHS Goal: | To strengthen the science base for health and human services. |
Long-Term Performance Measure 2.1
Association or lack of association between exposures to chemicals and the manifestation of adverse health effects in populations affected by hazardous substances in their environment.
FY 1999 Annual Performance Objective 2.1
Complete five health studies focusing on exposures to hazardous substances and their associations with adverse health effects.
FY 1999 Annual Performance Measure 2.1
Reporting of association or lack of association between exposure to hazardous substances and the manifestation of adverse health effects among studied populations.
Long-Term Performance Objective 2.2
Assess health consequences of low-level, long-term exposures to hazardous chemicals identified at hazardous waste sites and short-term acute exposure among specified populations.
| Baseline: | Registry Baseline Data:
Surveillance Baseline Data: | |||||||||||||||
| Source of Data: | Registry Update and/or Surveillance Reports in HazDat | |||||||||||||||
| Budget Activity: | Surveillance, Epi/Health Studies, and Registries | |||||||||||||||
| Link to EPA Goal: | Better waste management and restoration of abandoned waste sites. | |||||||||||||||
| Link to DHHS Goal: | To strengthen the science base for health and human services. |
Long-Term Performance Measure 2.2a
Association or lack of association of adverse health effects in populations enrolled in ATSDR's National Exposure Registry Program subregistries and their exposures to trichloroethylene (TCE), trichloroethane (TCA), benzene, and dioxin.
FY 1999 Annual Performance Objective 2.2a
Conduct a biennial follow-up for registrants on the subregistries.
FY 1999 Annual Performance Measure 2.2a
Report number of registrants completing follow-up and any adverse health effects described.
Long-Term Performance Measure 2.2b
Association or lack of association between exposures to hazardous substances emergency events and acute health effects among studied populations.
FY 1999 Annual Performance Objective 2.2b1
Administer and analyze an annual questionnaire to the hazardous waste worker registrants.
FY 1999 Annual Performance Measure 2.2b1
Report the adverse health effects found in the hazardous waste worker registrants.
FY 1999 Annual Performance Objective 2.2b2
Collect and analyze standard event information from 14 participating states.
FY 1999 Annual Performance Measure 2.2b2
Report the standard event information from the 14 participating states, including morbidity/mortality rates in hazardous substance emergency events.
Long-Term Performance Objective 2.3
By 2002, data deficiencies on exposure potential and toxicity of 65 hazardous substances (50 ongoing plus 15 new substances) will have been identified. Efforts to fulfill at least 50% of the priority research needs for 65 total substances will be identified, under way, or completed, assuring that ethnic, racial, and low-income populations are targeted.
| Baseline: | FY 1998 data |
| Source of Data: | HazDat |
| Budget Activity: | Scientific Assessment, Research and Information Dissemination |
| Link to EPA Goal: | Better waste management and restoration of abandoned wastes sites. |
| Link to DHHS Goal: | To strengthen the science base for health and human services. |
Long-Term Performance Measure 2.3
Research in toxicology is conducted to assess linkages between levels of contaminants in the environment and levels in human tissue and organs associated with adverse human health effects, and the results are communicated to appropriate audiences, including appropriate demographic identifiers.
FY 1999 Annual Performance Objective 2.3a
Develop or update 12 toxicological profiles on priority hazardous substances and determine key research needs required to assess accurately the substance's risk to human health.
FY 1999 Annual Performance Measure 2.3a
The completion of 12 toxicological profiles and identification of key data gaps for each profile chemical.
FY 1999 Annual Performance Objective 2.3b
Develop priority data needs documents [that identify priority research needs] for 15 new substances.
FY 1999 Annual Performance Measure 2.3b
In 1999, a total of 194 priority data needs will be identified for the original 50 substances.
Goal III: Intervene to eliminate exposures of health concern and prevent or mitigate adverse human health outcomes related to hazardous substances.
Results from public health assessments and applied research programs supply ATSDR and EPA with critical information to protect our communities and assure conditions in which people can be healthy. ATSDR is committed to using information and other resources effectively to eliminate exposures and prevent adverse health outcomes in communities. In this effort, particular attention is paid to the needs and concerns of the affected communities--especially to high-risk and disadvantaged populations. ATSDR has learned that engaging and empowering communities to become involved in the public health process provides substantially more effective results. When community members fully understand the relationship of health and environment, their participation and acceptance of their role increases. ATSDR's environmental health education and promotion program will provide a comprehensive approach to health education, environmental disease prevention and health promotion, and public health practice by (1) providing leadership to ATSDR's partners and constituents in applying the expertise, competencies, state-of-the-art methods, technical assistance, and other capacities required to conduct effective health education and promotion; (2) making the science of public health assessments, health studies, and toxicological research accessible, understandable, and relevant to the public's health concerns and needs; and (3) promoting collaboration with and among individuals, communities, and medical and public health entities to implement public health education, promotion, and communication strategies based on scientific inquiry and findings.
In FY 1999, ATSDR will implement over 500 site-specific public health activities, including health education and health promotion, that engage community members, leaders, and groups to participate in the public health process.
Long-Term Performance Objective 3.1
Working with communities on an ongoing and needed basis, screen and refer people at significant risk of adverse health effects resulting from exposures to hazardous substances in the environment.
| Baseline: | Number of persons potentially at risk at all "Urgent" and "Current Public Health Hazard" sites in HazDat |
| Source of Data: | HazDat |
| Budget Activity: | Health Education |
| Link to EPA Goal: | Better waste management and restoration of abandoned waste sites. |
| Link to DHHS Goal: | To promote health and confront the major threats to healthy and productive lives for all Americans. |
Long-Term Performance Measure 3.1
The number of persons screened and referred for medical treatment in the prevention and mitigation of adverse health outcomes or disease from exposures to hazardous substances.
FY 1999 Annual Performance Objective 3.1
Evaluate the appropriateness and feasibility of medical monitoring at sites posing an urgent or public health hazard; and implement medical monitoring at two sites.
FY 1999 Annual Performance Measure 3.1
Assessment of the outcomes from medical monitoring aimed at preventing and mitigating adverse health outcomes or disease in high-risk populations exposed to hazardous substances at two sites.
Long-Term Performance Objective 3.2
Through an optimal combination of health education and communication strategies, increase public awareness and knowledge and promote behavioral change to eliminate exposures and mitigate adverse human health outcomes related to hazardous substances in the environment.
| Baseline: | The baseline is constructed annually and is listed in the Annual Plan of Work. Baseline for this objective are the sites planned for health education activities in the FY 1999 Annual Plan of Work. |
| Source of Data: | HazDat |
| Budget Activity: | Health Education |
| Link to EPA Goal: | Better waste management and restoration of abandoned waste sites. |
| Link to DHHS Goals: | To improve the quality of health care, prevention, and human services. To promote health and confront the major threats to healthy and productive lives for all Americans. |
Long-Term Performance Measure 3.2a
Increased awareness, knowledge, and behavioral change in communities affected by hazardous waste sites or unplanned releases.
FY 1999 Annual Performance Objective 3.2a
Implement community health education activities at sites on the Annual Plan of Work where such activities are indicated, on the basis of a formal needs assessment.
FY 1999 Annual Performance Measure 3.2a
Increased awareness, knowledge, or behavioral change promoting the interdiction of exposure or mitigation of adverse health effects at 40% of sites on the Annual Plan of Work where a needs assessment determined such needs.
Long-Term Performance Measure 3.2b
Increased awareness, knowledge, and behavioral change among health care providers located in communities affected by hazardous waste sites or unplanned releases.
FY 1999 Annual Performance Objective 3.2b
Implement health care provider health education activities at sites listed on the Annual Plan of Work where such activities are indicated on the basis of a formal needs assessment.
FY 1999 Annual Performance Measure 3.2b
Integration of environmental medicine-related diagnosis, treatment, and referral, in the practice of health care providers at sites where communities are, or have been, exposed to hazardous substances at levels of public health concern.
Long-Term Performance Objective 3.3
By 2002, ATSDR's community involvement program, which fosters community and stakeholder participation at Superfund sites, will be revised on the basis of pilot studies with representative communities.
| Baseline: | All sites having public health activities scheduled for the fiscal year |
| Source of Data: | HazDat |
| Budget Activity: | Health Education |
| Link to EPA Goal: | Better waste management and restoration of abandoned waste sites. |
| Link to DHHS Goal: | To improve the quality of health care, prevention, and human services. To promote health and confront the major threats to healthy and productive lives for all Americans. |
Long-Term Performance Measure 3.3
Components are defined for a plan that effectively fosters community involvement in a meaningful way.
FY 1999 Annual Performance Objective 3.3
Define core standards for effective community involvement activities and pilot the plan at specified sites.
FY 1999 Annual Performance Measure 3.3
Core requirements are defined and agreed upon by stakeholders; pilots have been selected and initiated, and customer satisfaction evaluated.
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