Lab Matters Summer 2018 - Page 10

feature have some health concerns. White Mesa was one of the places our [study] group went. They were concerned about heavy metals, particularly uranium.” That kind of outreach and public health laboratory support is not unique. And it is becoming ever more common as health departments and their collaborators intensify efforts to empower underserved communities and reduce health disparities. Proactive vs. Reactive Public Health P ublic health laboratories, said Atkinson-Dunn, have “been addressing health disparities as long as public health laboratories have existed.” She said, “When you look at our infectious disease group, the bread and butter of what they do is STD and TB testing. And the majority of communities we serve [with those programs] are those who are seeking care at free clinics.” Indeed, the average state public health laboratory performs HIV diagnostic testing In Utah, a liaison with the health agency’s Office of American Indian/Alaska Native Health Affairs helped the laboratory navigate the complex relationship between the state government and the Ute Mountain Ute Tribal government. on about 21,000 specimens per year, according to APHL data. Three quarters of state public health laboratories provide first-line TB drug susceptibility testing. And 82% of state public health laboratories test children’s blood for lead. All of these activities mainly target low-income individuals, though they indirectly benefit the larger society as well. Yet in the public health laboratory, as in public health writ large, there is a growing effort to “more consciously” address health disparities, said Jennifer Rakeman, PhD, director of the New York City Public Health Laboratory. Thus, instead of waiting for residents to ask for services, more public health laboratories are proactively sending staff out into the community to learn how the laboratory can help. In Utah, a liaison with the health agency’s Office of American Indian/Alaska Native Health Affairs, Melissa Zito, MS, RN, helped the laboratory navigate the complex relationship between the state government and the Ute Mountain Ute Tribal government. Zito said “tribes don’t always want to work with us, because of historical mistrust” and explained that there is a formal consultation process agreed to by all American Indian tribes in Utah to assure “we’re working on a government-to-government basis that recognizes their Tribal sovereignty.” Gaining buy-in from all vested parties was key to project success. Ultimately, the health department collected urine specimens and well water samples from 19 communities throughout the state, including Utah’s White Mesa Reservation. Altogether, 7.4% of the urine specimens exceeded 0.029 µg uranium/g— the 95 th percentile value from the National Health and Nutrition Examination Survey (NHANES), a CDC study that examines a nationally representative sample of about 5,000 people/year. (The NHANES value is used because there is no official reference standard for safe human uranium exposure.) And 2.5% of all the well water samples exceeded the US Environmental Protection Agency maximum contaminant level of 30 µg uranium/g. Since the Utah Department of Health is still analyzing test data, Atkinson-Dunn said findings will first be shared with the state’s environmental epidemiologist and Ute Mountain Ute Tribal public health authorities upon completion. In addition, every participant will receive their own test results, along with information to put results “into perspective” and to facilitate follow-up. “This is a research study with [institutional review board oversight],” said Atkinson-Dunn. “So we have to be very clear that the results are in no way diagnostic. And that’s why we direct [participants] to other resources if they have questions about what this data means for their personal health.” In the meantime, the Ute Mountain Ute Tri