What’s Next?

2021 will be a year of strategic alignment. ATSDR is focusing on three priority areas developed with the communities and the nation we serve in mind:

• Strengthening our response to environmental health hazards and toxic exposures
• Expanding our scope and reach
• Sustaining the "One ATSDR" culture through operational excellence

ATSDR continues its commitment to environmental justice and health equity, working with economically and socially marginalized communities to evaluate and address environmental exposures.

ATSDR has a long history of working with environmental justice communities to address environmental concerns. ATSDR's staff in headquarters and regional offices have worked with communities that have been economically and socially marginalized since the agency's creation in 1980. These communities — which include low-income communities, communities of color, and Indigenous and Native American communities ­— are at a higher risk of living in communities affected by environmental exposures. In addition to conducting public health evaluations, ATSDR provides resources and tools for communities to take action to protect their health and makes actionable recommendations to state and local health partners to address environmental justice concerns.

ATSDR collaborates with federal, state, and local partners, including the U.S. Environmental Protection Agency, to assist communities in revitalizing land impacted by contamination. ATSDR's efforts support the safe reuse of environmentally contaminated land to improve community health and reduce health and social inequities. ATSDR also tracks unique public health indicators associated with land reuse and redevelopment to maximize health outcomes through focused community revitalization projects.

In collaboration with CDC, ATSDR continues to use and update tools such as the CDC/ATSDR Social Vulnerability Index — developed by ATSDR's Geospatial Research, Analysis, and Services Program (GRASP) — to help identify groups disproportionately affected by environmental contamination.

ATSDR's ongoing partnership with the Community Outreach Network (Network), formed in 2015 by federal agencies and Navajo Nation tribal government, works with Navajo communities to educate residents about the legacy of uranium contamination on Navajo Nation tribal lands. This collaboration ensures information sharing to increase general understanding of uranium exposure, potential health issues related to exposure, how communities can be engaged in the ATSDR public health assessment process, and agency partner clean-up projects at abandoned uranium mines and former uranium mills.

ATSDR also is involved in several partnerships aimed at reducing health disparities to promote children's environmental health and safety:

• ATSDR's Pediatric Environmental Health Specialty Units (PEHSU) network provides instructional content and guidance to educate health professionals and families on safer disinfectant use and COVID-19 risk reduction practices. These activities include engaging families and healthcare providers in under-resourced areas.
• ATSDR's Choose Safe Places for Early Care and Education (CSPECE) Program prevents childcare facilities from opening in locations where environmental hazards might be present due to previous uses of the space, building, or nearby properties. Such properties are often located in economically under-developed or former industrial/commercial zones. CSPECE provides education to stakeholders nationwide to promote new policies and processes at the state and local level, sustains program through effective evaluation, and coordinates technical assistance from across ATSDR to ensure chemical hazards are identified, evaluated, and addressed to best protect children's health.

Moving forward, as a core function of our work, ATSDR is committed to environmental justice and will continue a comprehensive approach to defining environmental justice communities and assessing gaps in services to these communities through public health activities, products, and decision-making processes. This will lay the foundation for identifying actions to address environmental justice and health inequities in ATSDR engagements and inform future approaches.

ATSDR's Community Engagement Playbook guides professionals to engage communities in meaningful, impactful ways throughout an environmental public health response.

The Community Engagement Playbook (Playbook) outlines a new framework for guiding the four phases of community engagement (CE) that unfold during an environmental public health response. Public health professionals will find questions and context in the Playbook to help them identify critical local considerations and a list of CE activities that can be tailored to the community's specific needs.

The Playbook also includes tools to support professionals conducting community and tribal engagement: a tip sheet, a CE planning tool, and links to additional tools and resources from ATSDR, other government agencies, and both academic and non-governmental organizations. The glossary and resource sections introduce advanced practice topics.

The Playbook reconfirms ATSDR's commitment to improving how we build relationships and effectively engage with communities, including tribal nations, during environmental public health responses.

ATSDR's Community Stress Resource Center helps public health professionals address stress as part of public health responses to environmental contamination.

Life in a community experiencing long-term environmental contamination can be stressful for many reasons, including uncertainty, health and financial concerns, and feelings of powerlessness. Environmental contamination can cause chronically elevated psychological and social stress in some people and across families and communities. While it is normal for community members to feel stress in these situations, chronic or sustained stress can pose health risks on top of those related to environmental exposures. In addition, lower income and communities of color often face disproportionate effects from multiple social and environmental stressors.

ATSDR has been working to better understand and develop resources to address the psychological and social effects associated with living in a community affected by long-term environmental contamination. In 2020, ATSDR developed and tested a new Community Stress Resource Center, released in 2021.

The Resource Center helps public health professionals reduce community stress and build resilience through work with community members, community-based organizations, and clinicians facing environmental contamination. It contains a new 3 Keys Framework — Recognize, Prepare, and Partner — and over 40 diverse resources for achieving the framework's objectives.

Public health professionals can use the Resource Center to

• Learn the science about the connection between environmental contamination and stress-related health risks
• Take action by recognizing, preparing, and partnering to reduce community stress and build resilience as part of public health responses to environmental contamination
• Find resources to help achieve the objectives of the 3 Keys framework

A self-guided introductory training for public health professionals on chronic stress and environmental contamination is also available on the Resource Center.

ATSDR fosters collaboration between multiple agencies to protect the Navajo Nation from the effects of uranium contamination.

ATSDR collaborated with the Navajo Nation and federal agencies in 2020 to continue to address the effect of uranium contamination on the Navajo Nation. The Ten-Year Plan, released in January 2021, builds on two previous Five-Year Plans (2008–2013, 2014–2019) to address legacy contamination of uranium mining and milling operations on the Navajo Nation.

During the years spanning the new ten-year plan, ATSDR will

• Work with the Indian Health Service to provide training to clinicians and other healthcare providers about the health effects of non-occupational exposure to uranium
• Work with the Navajo Nation Department of Health to develop outreach and health education materials and to provide training to community health representatives
• Participate in the Community Outreach Network

The COVID-19 pandemic made it necessary for ATSDR to pause in-person community engagement, including the Community Outreach Network's Uranium 101 community health education events at Chapter Houses. ATSDR remains committed to working with Navajo Nation tribal communities.

ATSDR and CDC's National Center for Environmental Health (NCEH) work to define human health risks regarding exposure to and toxicity from microplastics.

Microplastics (MPs) are plastic particles measuring less than 5 mm. MPs and nanoplastics (NPs), which measure less than .001 mm, have been intentionally placed in cleaning products, coatings, cosmetics, and medical applications. They are also created when items such as bottles, clothing, tires, and packaging break down in the environment. MPs and NPs can be transported into streams and seas, carried into the air, and fall with the rain. MPs also attract pollutants that may already exist in the environment at trace levels, accumulating toxins and delivering them to the wildlife that eats them, leading to bioaccumulation through the food chain. MPs and NPs are being found in fish, crab meat, and even table salt. MPs and NPs have been repeatedly found in human waste and some human organs, which has led to concern regarding the effect these pollutants may have on human health.

Because MPs and NPs are emerging pollutants, it was necessary to examine the scope of MP and NP contamination, as well as their potential short- and long-term effects on public health. ATSDR formed the microplastic workgroup in partnership with NCEH in 2020. Together, the workgroup members have undertaken a massive literature review to define human health risks from MPs and NPs. Early results on human exposures and health effects have been published here. When the full results are published, ATSDR will hold a symposium with scientists and academic institutions to share the findings and to encourage scientists to focus on the necessary data gaps.