Title: Community Environmental Health Assessment and PACEEH in Cowlitz County
1Community Environmental Health Assessment and
PACE-EH in Cowlitz County
- Heather R. Morrow-Almeida
- CDC Public Health Prevention Fellow
- Cowlitz County Health Department
- 12 June 2008
2Agenda
- What is Public Health?
- Foundation for Community Environmental Health
Assessment in Cowlitz County - Describe PACE-EH in detail
- Benefits of the work
- Expected/intended outcomes
- Examples from other communities
- Next steps bringing together the workgroup,
practicalities
3Objectives
- Explain the foundational work that supports doing
a Community Environmental Health Assessment
(CEHA) - Recognize how CEHA relates to core functions and
essential services of Public Health - Differentiate between CEHA and PACE-EH
- Describe tasks to conduct a PACE-EH
- Declare intention to join workgroup
4What is Public Health?
- The profession?
- The methods?
- Governmental services?
- Ultimate outcomes?
- Broad social enterprise?
5What is Public Health?
- . . .the science and art of preventing disease,
prolonging life and promoting health and
efficiency through organized community effort for
the sanitation of the environment, the control of
communicable infections, the education of the
individual in personal hygiene, the organization
of medical and nursing services for the early
diagnosis and preventive treatment of disease,
and for the development of the social machinery
to insure everyone a standard of living adequate
for the maintenance of health, so organizing
these benefits as to enable every citizen to
realize his birthright of health and longevity. - CEA Winslow, 1920
6What is Public Health?
- The landmarks of political, economic and social
history are the moments when some condition
passed from the category of the given into the
category of the intolerable. I believe that the
history of public health might well be written as
a record of successive re-definings of the
unacceptable. - Sir Geoffrey Vickers
- Social Policy Specialist, UK
7Mission of Public Health
- fulfilling societys interest in assuring
conditions in which people can be healthy - The Future of Public Health, Institute of
Medicine, 1988
8Core Functions of Public Health
- Assessment
- Think diagnosis
- Assurance
- Think treatment
- Policy development
- Think treatment plan
910 Essential Services of PH
- Monitor health status to identify and solve
community health problems. - Diagnose and investigate health problems and
health hazards in the community. - Inform, educate, and empower people about health
issues. - Mobilize community partnerships and action to
identify and solve health problems. - Develop policies and plans that support
individual and community health efforts.
1010 Essential Services of PH
- Monitor health status to identify and solve
community health problems. - Diagnose and investigate health problems and
health hazards in the community. - Inform, educate, and empower people about health
issues. - Mobilize community partnerships and action to
identify and solve health problems. - Develop policies and plans that support
individual and community health efforts.
1110 Essential Services of PH
- Monitor health status to identify and solve
community health problems. - Diagnose and investigate health problems and
health hazards in the community. - Inform, educate, and empower people about health
issues. - Mobilize community partnerships and action to
identify and solve health problems. - Develop policies and plans that support
individual and community health efforts.
1210 Essential Services of PH
- Monitor health status to identify and solve
community health problems. - Diagnose and investigate health problems and
health hazards in the community. - Inform, educate, and empower people about health
issues. - Mobilize community partnerships and action to
identify and solve health problems. - Develop policies and plans that support
individual and community health efforts.
1310 Essential Services of PH
- Monitor health status to identify and solve
community health problems. - Diagnose and investigate health problems and
health hazards in the community. - Inform, educate, and empower people about health
issues. - Mobilize community partnerships and action to
identify and solve health problems. - Develop policies and plans that support
individual and community health efforts.
1410 Essential Services of PH
- Enforce laws and regulations that protect health
and ensure safety. - Link people to needed personal health services
and assure the provision of health care when
otherwise unavailable. - Assure competent public and personal health care
workforce. - Evaluate effectiveness, accessibility, and
quality of personal and population-based health
services. - Research for new insights and innovative
solutions to health problems.
1510 Essential Services of PH
- Enforce laws and regulations that protect health
and ensure safety. - Link people to needed personal health services
and assure the provision of health care when
otherwise unavailable. - Assure competent public and personal health care
workforce. - Evaluate effectiveness, accessibility, and
quality of personal and population-based health
services. - Research for new insights and innovative
solutions to health problems.
1610 Essential Services of PH
- Enforce laws and regulations that protect health
and ensure safety. - Link people to needed personal health services
and assure the provision of health care when
otherwise unavailable. - Assure competent public and personal health care
workforce. - Evaluate effectiveness, accessibility, and
quality of personal and population-based health
services. - Research for new insights and innovative
solutions to health problems.
1710 Essential Services of PH
- Enforce laws and regulations that protect health
and ensure safety. - Link people to needed personal health services
and assure the provision of health care when
otherwise unavailable. - Assure competent public and personal health care
workforce. - Evaluate effectiveness, accessibility, and
quality of personal and population-based health
services. - Research for new insights and innovative
solutions to health problems.
1810 Essential Services of PH
- Enforce laws and regulations that protect health
and ensure safety. - Link people to needed personal health services
and assure the provision of health care when
otherwise unavailable. - Assure competent public and personal health care
workforce. - Evaluate effectiveness, accessibility, and
quality of personal and population-based health
services. - Research for new insights and innovative
solutions to health problems.
19What is Public Health?
- Broad social enterprise
- Seeks to extend benefits of current knowledge
- Maximum impact on health status of population
- Identifying problems that call for collective
action to protect, promote, and improve health - Primarily through preventive strategies
20Public Health as a System. . .
- Interdisciplinary approach and methods
- Emphasis on preventive strategies
- Links with government and political decision
making - Dynamic adaptation to new problems
21What else?
- Collective effort of people and organizations
- Composite of efforts and activities
22Foundation in Science
- Public Health is grounded in science and
evidence-based practice. - Sciences
- Epidemiology
- Biostatistics
- Environmental science
- Management science
- Behavioral science
- Economics
23Public Health is Very Important!
- 91 - prevention of spread of infectious diseases
(TB, measles, flu, AIDS) - 88 - research into causes and prevention of
disease - 86 - ensuring people are not exposed to unsafe
water, air pollution or toxic waste - 85 - work to reduce death and injuries from
violence - 68 - encourage people to live healthier
lifestyles, eat well, not smoke
24Community Environmental Health Assessment
- A process to
- improve community health
- AND
- involve community members in making decisions
about the environment and health.
25How did we get here?
- CCHD partnered with Pathways 2020 to initiate
Mobilizing for Action through Planning and
Partnerships (MAPP) system. - MAPP
- Organize for success
- Visioning
- Assessments
- Strategic issues
- Goals / strategies
- Action cycle (planning, implementation,
evaluation)
26MAPP Assessments
27MAPP Assessments
28MAPP Assessments
29MAPP Assessments
30Community Themes and Strengths
- "What is important to our community?"
- "How is quality of life perceived in our
community?" - "What assets do we have that can be used to
improve community health?" - Quality of Life survey data- Pathways 2020
- Focus groups Pathways 2020
- Community Assessment workgroup
31Quality of Life Survey
- Collaboration between Pathways 2020 and CCHD
- 1004 respondents were queried about raising
children, growing old and other factors of life
in Cowlitz County. - Low crime, good schools and good jobs were the
most frequently reported factors that are
important for having a healthy community.
32Local Public Health System Assessment
- "What are the components, activities,
competencies, and capacities of our local public
health system?" - "How are the Essential Services being provided to
our community?" - LPHSA survey Cowlitz County Health Department
33Local Public Health System Assessment
- Sent out 600 surveys received 155 completed
surveys from local agencies that serve Cowlitz
County - Core questions were about individual agencys
work - Also asked about each agencys participation in
the ten essential services of public health
34Forces of Change Assessment
- "What is occurring or might occur that affects
the health of our community or the local public
health system?" - "What specific threats or opportunities are
generated by these occurrences?" - Scenario planning data- Pathways 2020
35Scenario Planning Outcomes
- Streamline all processes for new business
- Support improvements in local transportation
- Provide more social and recreational activities
for youth and adults - Promote life-long learning
- Develop or expand opportunities to train and
attract community leaders
36Previous Assessments and CEHA
- Builds on the assessment products from Pathways
2020 and CCHD collaborations. - Not duplicative
- offers chance to delve deeper on some of the
identified issues from Quality of Life and other
assessments. - May allow shortening or skipping of some tasks
due to previous assessment work.
37Previous Assessments and CEHA some differences
- New opportunity for community members to get
involved! - Opportunity to foster new community leaders
- End goal of CEHA is action
- New health indicators for community report card
- Opportunities for success
- Evaluation and planning for whats next?
38Favorite Quote
- Pace is a salsa brand,
- not a process!
- Explain!!
39What is PACE-EH?
- Protocol for Assessing Community Excellence in
Environmental Health - A tool to help local health officials work with
the public to assess and improve the
environmental health status of their communities.
40History of PACE-EH
- How do we. . .
- Accurately identify environmental health problems
at the community level? - Identify populations at disproportionate risk of
environmental exposure and adverse health
outcomes? - Strategically allocate resources to address
pressing community environmental health concerns?
41History of PACE-EH
- NACCHO and CDC collaboration
- Developed by workgroup of local health officials,
under guidance of multidisciplinary steering
committee - Funding from NACCHO, National Centers for
Environmental Health, CDC
42Development of PACE-EH Tool
- Workgroup provided 10 Local Health Departments
(LHD) with early draft - LHDs implemented methodology and provided
feedback over 2 years - Results and feedback were integrated into final
handbook
43The Work of PACE-EH
Comprehensive environmental health assessment
Accurate and verifiable profile of communitys
EH status
Community health officials and advocates can use
for proactive, locally appropriate decision making
44PACE-EH 13 Tasks
- 1 determine community capacity
- 2 define and characterize the community
- 3 assemble a community-based EH assessment team
(workgroup) - 4 define the goals, objectives and scope of the
assessment
45PACE-EH 13 Tasks
- 1 determine community capacity
- 2 define and characterize the community
- 3 assemble a community-based EH assessment team
(workgroup) - 4 define the goals, objectives and scope of the
assessment
46PACE-EH 13 Tasks
- 1 determine community capacity
- 2 define and characterize the community
- 3 assemble a community-based EH assessment team
(workgroup) - 4 define the goals, objectives and scope of the
assessment
47PACE-EH 13 Tasks
- 1 determine community capacity
- 2 define and characterize the community
- 3 assemble a community-based EH assessment team
(workgroup) - 4 define the goals, objectives and scope of the
assessment
4813 Tasks
- 5 generate a list of community specific EH
issues - 6 analyze the issues with a systems framework
- 7 develop locally appropriate indicators
- 8 select standards against which local status
can be compared
4913 Tasks
- 5 generate a list of community specific EH
issues - 6 analyze the issues with a systems framework
- 7 develop locally appropriate indicators
- 8 select standards against which local status
can be compared
5013 Tasks
- 5 generate a list of community specific EH
issues - 6 analyze the issues with a systems framework
- 7 develop locally appropriate indicators
- 8 select standards against which local status
can be compared
5113 Tasks
- 5 generate a list of community specific EH
issues - 6 analyze the issues with a systems framework
- 7 develop locally appropriate indicators
- 8 select standards against which local status
can be compared
5213 Tasks
- 9 create issue profiles
- 10 rank the issues
- 11 set priorities for action
- 12 develop an action plan
- 13 evaluate progress and plan for the future
5313 Tasks
- 9 create issue profiles
- 10 rank the issues
- 11 set priorities for action
- 12 develop an action plan
- 13 evaluate progress and plan for the future
5413 Tasks
- 9 create issue profiles
- 10 rank the issues
- 11 set priorities for action
- 12 develop an action plan
- 13 evaluate progress and plan for the future
5513 Tasks
- 9 create issue profiles
- 10 rank the issues
- 11 set priorities for action
- 12 develop an action plan
- 13 evaluate progress and plan for the future
5613 Tasks
- 9 create issue profiles
- 10 rank the issues
- 11 set priorities for action
- 12 develop an action plan
- 13 evaluate progress and plan for the future
57Task One
- Determine community capacity
- Specify resources, skills, capacities needed
- Specify available resources, skills, capacities
- Review possibilities for collaboration
- Determine ability to carry out assessment
58Task One - resources
- Human capacity
- Workgroup team 10-25 people would be ideal
- Project coordinator
- Logistics, facilitate mtgs, support, follow-up
activities - Financial
- Low budgetary requirements
- Skills
- Coalition building, data collection, project
management, others - Time
- One to two years to complete (usually 18-24
months) - Workgroup members 1-2 mtgs/month
59Task Two
- Define and characterize the community
- Define the community
- Describe the communitys characteristics,
composition, organization and leadership - Refine the definition of community as needed
60Task Two existing efforts
- Community Report Card
- Community Resource Directory
- Head Start Assessment work
- MAPP assessments
- More work to do with vulnerable, invisible and/or
disenfranchised populations
61Task Three
- Assemble a community-based environmental health
assessment team - Clarify expectations of team members
- Identify and invite individuals to help design
and carry out the assessment - Determine a governing structure, decision making
structure, and ground rules
62Task Four
- Define the goals, objectives, and scope of the
assessment - Establish goals and objectives for the assessment
- Describe the vision that will guide the process
- Describe the scope of issues to be addressed by
the assessment - Define key terms
63- Health is created and lived by people within the
settings of their everyday life where they
learn, work, play and love. - The Ottawa Charter (1986)
64Task Four describing scope
Continuum of Possible Issues
Health of the environment (ecology)
Human health
Environmental Health
65Environment Health
- The environment is everything around us - the air
we breathe, the water we drink and use, and the
food we consume. It's also the chemicals,
radiation, microbes, and physical forces with
which we come into contact. - Environmental health strives to prevent illness,
disability, and death from interactions between
people and the environment.
66Task Five
- Generate a list of environmental health issues
- Evaluate and select data-gathering method(s)
- Collect data on community concerns
- Collect data on community knowledge, attitudes,
behaviors, and perceptions - Create a manageable list of issues
67Task Five existing efforts
- Quality of Life survey
- Community Report Card
- Head Start Assessment
- Indicate a need for more in-depth EH assessment
work
68Task Six
- Analyze the issues with a systems framework
- Understand the framework
- Identify the connections among health status,
affected populations, exposure factors,
environmental agents/conditions, contributing
factors and behaviors, and public health
protection factors for selected EH issues
69Task Six - example LEAD
- Environmental Health Status -
- elevated LEAD, reduced IQ
- Route of exposure ingestion, inhalation
- Affected population children under 6 years,
home renovators - Exposure factors home, recreational environment
- Contributing factors lead paint, lead in gas,
home renovation - Protection factors protective gear, treatment,
regulate emissions, education
70Task Seven
- Develop locally appropriate indicators
- Develop list of potential indicators
- Identify key indicators based on selected
criteria - Simple - measures ONE item
- Understandable makes sense to users, public,
policy makers - Acceptable - to community, reflects concerns
- Measurable - comparable, quantifiable
- Defensible - supports relationship between
environment and health
71Indicators. . .
- An environmental health indicator is a measure of
health, environmental quality, or
socio-demographics which is important for
monitoring the overall health of the population. - Total annual pounds of carcinogenic pesticides
applied agriculturally during prior 12 months. - Rate of asthma hospitalizations of children 0-14
years old during prior 12 months.
72Task Eight
- Select standards against which local status can
be compared - Identify external standards
- Healthy People 2010
- Environmental Goals for America, EPA, 2005
- WA Environmental Health Tracking Network
- Other state models?
- Agree upon locally appropriate standards
73Task Nine
- Create issue profiles
- Adopt a standardized format for organizing
information - Scope
- Background
- Standards
- Community specific indicators
- Data
- Evaluation
- Gather information
- Collect data for locally developed indicators
- Develop a summary statement
74Task Nine - data collection
- Non-governmental
- Non-profit or advocacy organizations
- Local
- Municipal departments
- Planning department/commissions
- Institutions
- State
- Environmental quality / protection agency
- Natural resources agency
- Federal
- Environmental Protection Agency
- Centers for Disease Control and Prevention
- National Forest Service
- National Institutes of Health
75Task Ten
- Rank issues
- Determine the purpose of ranking
- Decide on ranking criteria
- Select a method for ranking
- Rank the issues
76Task Ten - ranking
- Does this issue affect our community more than
others? - How many people does it affect?
- What areas of the community are affected?
- Who in this community is affected?
- What is the reason for concern?
- Is the condition or risk changing?
- Is it high/medium/low concern?
77Task Eleven
- Set priorities for action
- Determine local priority-setting criteria
- Select a method for prioritizing
- Determine priorities
78Task Eleven - priority setting
79Task Eleven existing efforts
- Call to Action from Community Report Card may
emerge as priority?
80Task Eleven setting priorities
- Issues must be evaluated within the context of
public perception of risk - AND the constraints/opportunities presented by
the communitys unique scientific, legal,
economic, - social and political systems.
81Task Twelve
- Develop an action plan
- Develop goals and objectives
- Identify contributing factors
- Identify possible interventions and prevention
activities - Identify community assets
- Identify potential barriers
- Select an intervention(s)/activity(ies)
- Determine resource needs
- Identify potential partners
- Provide training
- Develop timeframe
- Determine measures of success
82Task Twelve - PEARL
- Proper and politically feasible Is the
intervention suitable? Is any special authority
or permission required? - Economic Does it make economic sense? Are there
economic consequences if the intervention is NOT
carried out? - Acceptable Will the community accept this
intervention? Is it consistent with local norms
and values? - Resources Are there local resources or
expertise? Can they be obtained? Is financial
support available or potentially available? - Legal Do current laws allow this intervention?
83Task Thirteen
- Evaluate progress and plan for the future
- Agree on the questions to be answered by the
evaluation - Evaluate the success of the assessment process
- Begin preparations for ongoing community-based
environmental health assessment activities
84Arlington County, Virginia
85Delaware, Ohio
86Scott County, Iowa
8710 Essential Services of PH
- Monitor health status to identify and solve
community health problems. - Diagnose and investigate health problems and
health hazards in the community. - Inform, educate, and empower people about health
issues. - Mobilize community partnerships and action to
identify and solve health problems. - Develop policies and plans that support
individual and community health efforts.
8810 Essential Services of PH
- Enforce laws and regulations that protect health
and ensure safety. - Link people to needed personal health services
and assure the provision of health care when
otherwise unavailable. - Assure competent public and personal health care
workforce. - Evaluate effectiveness, accessibility, and
quality of personal and population-based health
services. - Research for new insights and innovative
solutions to health problems.
89Benefits of Conducting PACE-EH
- Community members will have a constructive forum
to talk about environmental health. - Environmental health issues of concern will be
identified. - Specific issues will be fleshed out that is,
well better understand the issue as it relates
to Cowlitz County. - Data and indicators will be identified for
particular issues. - Action plans will be developed on specific
environmental health issues. - A community coalition/workgroup for environmental
health will be formed.
90Outcomes from PACE-EH
- Thorough and well-documented decision making and
planning process - Effective participation of well-represented
public - Enhanced understanding of communitys EH needs
- Strengthened support for identification and
prevention of environmental risks - Enhanced appreciation for connection between
health and environment - EH programs and services directed equitably to
priority EH issues - Plan for action that capitalizes on strengths
91Challenges to PACE-EH
- Gaps in scientific understanding
- Disparity between scientific understanding and
public perception - Data limitations
- Lack of standard indicators
- Fragmentation of authority and responsibility for
EH
92Objectives
- Explain the foundational work that supports doing
a Community Environmental Health Assessment
(CEHA) - Recognize how CEHA relates to core functions and
essential services of Public Health - Differentiate between CEHA and PACE-EH
- Describe tasks to conduct a PACE-EH
- Declare intention to join workgroup
93Your questions
94Next Steps. . .
- Commit to the workgroup!!
- Designate regular meeting times
- T3 - Agree on roles, responsibilities and rights
- T3 - Do we represent the community?
- T3 Decide governing structure, ground rules,
etc. - T4 - Goal-setting, objectives, vision, scope
95Thank you for your attention!!
- Any questions?
- Feel free to contact me
- Heather Morrow-Almeida
- Ph 501-1218
- Email morrowh_at_co.cowlitz.wa.us