Adequacy of State Capacity to Address Noncommunicable Disease Clusters in the Era of Environmental Public Health Tracking

We sought to assess the capacity of state public health agencies to address noncommunicable disease clusters (NCCs) and to develop recommendations to enhance agencies' NCC response capacity. We conducted an inventory of state public health agency Web sites and administered a Web-based survey of state health agency personnel to examine NCC capacity with respect to responsibility and authority, scope, protocols, trends in NCC investigations, and desired assistance. Twenty-six of the state agency Web sites listed an NCC contact, and 12 mentioned a cluster response team. Thirty-seven states completed the Web-based survey, all addressed cancer clusters, and 30 also responded to other NCCs, such as multiple sclerosis, amyotrophic lateral sclerosis, and autism. NCCs are of key concern to communities, and all of the survey respondents indicated that citizen reports were an impetus for investigations; yet, state-level capacity to address NCCs was inconsistent and disjointed. State agency personnel were committed to responding to NCC inquiries but were hampered by lack of personnel, resources, and prescribed protocols, as well as inadequate interagency communication. We offer recommendations to address these challenges.