Community Environmental Health Assessment and PACEEH in Cowlitz County

1
Community 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

2
Agenda

• 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

3
Objectives

• 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

4
What is Public Health?

• The profession?
• The methods?
• Governmental services?
• Ultimate outcomes?
• Broad social enterprise?

5
What 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

6
What 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

7
Mission of Public Health

• fulfilling societys interest in assuring
  conditions in which people can be healthy
• The Future of Public Health, Institute of
  Medicine, 1988

8
Core Functions of Public Health

• Assessment
• Think diagnosis
• Assurance
• Think treatment
• Policy development
• Think treatment plan

9
10 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.

10
10 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.

11
10 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.

12
10 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.

13
10 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.

14
10 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.

15
10 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.

16
10 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.

17
10 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.

18
10 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.

19
What 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

20
Public Health as a System. . .

• Interdisciplinary approach and methods
• Emphasis on preventive strategies
• Links with government and political decision
  making
• Dynamic adaptation to new problems

21
What else?

• Collective effort of people and organizations
• Composite of efforts and activities

22
Foundation in Science

• Public Health is grounded in science and
  evidence-based practice.
• Sciences
• Epidemiology
• Biostatistics
• Environmental science
• Management science
• Behavioral science
• Economics

23
Public 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

24
Community Environmental Health Assessment

• A process to
• improve community health
• AND
• involve community members in making decisions
  about the environment and health.

25
How 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)

26
MAPP Assessments
27
MAPP Assessments
28
MAPP Assessments
29
MAPP Assessments
30
Community 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

31
Quality 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.

32
Local 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

33
Local 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

34
Forces 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

35
Scenario 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

36
Previous 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.

37
Previous 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?

38
Favorite Quote

• Pace is a salsa brand,
• not a process!
• Explain!!

39
What 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.

40
History 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?

41
History 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

42
Development 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

43
The 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
44
PACE-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

45
PACE-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

46
PACE-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

47
PACE-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

48
13 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

49
13 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

50
13 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

51
13 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

52
13 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

53
13 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

54
13 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

55
13 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

56
13 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

57
Task One

• Determine community capacity
• Specify resources, skills, capacities needed
• Specify available resources, skills, capacities
• Review possibilities for collaboration
• Determine ability to carry out assessment

58
Task 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

59
Task Two

• Define and characterize the community
• Define the community
• Describe the communitys characteristics,
  composition, organization and leadership
• Refine the definition of community as needed

60
Task 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

61
Task 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

62
Task 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)

64
Task Four describing scope
Continuum of Possible Issues
Health of the environment (ecology)
Human health
Environmental Health
65
Environment 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.

66
Task 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

67
Task Five existing efforts

• Quality of Life survey
• Community Report Card
• Head Start Assessment
• Indicate a need for more in-depth EH assessment
  work

68
Task 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

69
Task 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

70
Task 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

71
Indicators. . .

• 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.

72
Task 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

73
Task 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

74
Task 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

75
Task Ten

• Rank issues
• Determine the purpose of ranking
• Decide on ranking criteria
• Select a method for ranking
• Rank the issues

76
Task 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?

77
Task Eleven

• Set priorities for action
• Determine local priority-setting criteria
• Select a method for prioritizing
• Determine priorities

78
Task Eleven - priority setting
79
Task Eleven existing efforts

• Call to Action from Community Report Card may
  emerge as priority?

80
Task 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.

81
Task 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

82
Task 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?

83
Task 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

84
Arlington County, Virginia
85
Delaware, Ohio
86
Scott County, Iowa
87
10 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.

88
10 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.

89
Benefits 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.

90
Outcomes 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

91
Challenges 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

92
Objectives

• 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

93
Your questions
94
Next 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

95
Thank you for your attention!!

• Any questions?
• Feel free to contact me
• Heather Morrow-Almeida
• Ph 501-1218
• Email morrowh_at_co.cowlitz.wa.us