U.S. EPA's Community Action for a Renewed Environment program and collaboration with CDC/ATSDR.

Editor's note: As part of our effort to highlight innovative approaches to improving the environment and the health of communities, the Journal will feature a bimonthly column from the U.S. Environmental Protection Agency's (U.S. EPA's) new Community Action for a Renewed Environment (CARE) program. Since the CARE program is designed to work with and support community-based efforts to understand and address local environmental health concerns, we think this column will be of interest to a broad range of environmental health professionals. The CARE program will report here on the activities and lessons learned from CARE communities across the nation and describe the broad range of U.S. EPA resources and programs available to support local environmental health initiatives. The column will also report on progress in building a partnership that spans federal, state, and local environmental and environmental health agencies to improve support for communities. We believe that this column is an indication of U.S. EPA's commitment to joining with environmental health professionals to better meet the needs of communities, and we are pleased to make it available to our readers.

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This is the first in a series of articles about the U.S. Environmental Protection Agency's (U.S. EPA's) Community Action for a Renewed Environment (CARE) program and an exciting new collaboration with the Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry (CDC/ATSDR) to combine forces in support of communities.

Established in 2005, CARE helps communities build and sustain broad-based partnerships organized to create healthier environments. CARE is premised on the belief that when residents, businesses, organizations, schools, and governments join together to leverage tools and resources, they will find the best solutions to solve local problems. Because communities see environmental problems holistically, rather than through the regulator's lens of air, land, and water regulations, U.S. EPA's CARE approach makes common sense.

At the same time, CDC's National Center for Environmental Health is also a champion of voluntary partnerships and helps build the capacity of local health practitioners to lead community-based initiatives. The two agencies have complementary resources and skills to reduce environmental health risk. U.S. EPA has expertise in identifying and managing environmental exposures; CDC/ATSDR has expertise in developing health assessments, monitoring exposure, and health education.

On July 18, 2007, U.S. EPA Administrator Stephen Johnson and CDC/ATSDR Director Julie Gerberding announced the next phase in the agencies' history of collaboration to support communities--the signing of a memorandum of understanding (MOU) and the selection of four pilot communities in which to model collaboration. The MOU calls for the agencies to jointly support the pilot communities, develop community-friendly tools and resources, identify key community data needs and ways of addressing them, and explore the feasibility of a U.S. EPA/CDC Community Environmental Health Leadership Academy, including a "one-stop" U.S. EPA/CDC Web site for communities. The pilot projects, located in Cerro Gordo, Iowa; Boston, Massachusetts; Cherokee Nation, Oklahoma; and Savannah, Georgia, will be showcases modeling interagency collaboration in the field. Lessons learned will be shared with the larger community, and the collaboration will be expanded to bring in other agencies and partners.

Other CARE projects provide more opportunities for collaboration with CDC/ATSDR. CARE is a community-based and community-driven program created to build partnerships aimed at understanding and reducing environmental health risk from all sources. It offers two types of cooperative agreements to work through the four steps illustrated in Figure 1. Under a Level I agreement (about $90,000), communities organize a collaborative partnership to assess and prioritize local environmental risks and solutions. Level II agreements (about $275,000) are used by communities to take action to address local priorities and to develop the capacity to monitor and improve the local environment over the long term.

CARE provides a forum for bringing together the best information and tools from all levels of government, as well as academia, business, and the nonprofit community. The CARE four-step process (Figure 1) allows communities to harness their collective creativity, knowledge, and power to use the information and tools to address their most pressing environmental health problems appropriately Unlike in traditional grant programs, U.S. EPA also provides CARE communities with focused and comprehensive technical assistance and leadership support throughout the two-year period and participates as a full partner in the project.

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In the first three years of the program, 29 CARE communities have engaged over 600 partners and leveraged more than $1.2 million in local and other U.S. EPA support. For 2007, 22 new projects were selected to submit final applications to the CARE program, and $4 million--twice the amount awarded in 2005--will be distributed in the fall. The next request for proposals will be available early in 2008.

Of the 29 recipients of CARE grants (Figure 2), five are local public health departments. Some of the Level I grantees in this group, such as the Oneida County Health Department in Utica, New York, are implementing the Protocol for Assessing Community Excellence in Environmental Health (PACE-EH) tool. CDC supported the development of PACE-EH by the National Association of County and City Health Officials. Other partnerships, such as the Muskegon County Environment Coordinating Council in Michigan, had already completed PACE-EH and are using CARE Level II funding to take action to address their priorities.

CARE communities address many environmental issues, but health concerns such as indoor air quality, truck and vehicle emissions, lead in homes, and exposures from local business operations often top their priorities. U.S. EPA developed the Community Guide to EPA Voluntary Programs (U.S. EPA, 2006) as a "menu" for communities to select from among nearly 40 programs designed to reduce exposure to toxics from a wide range of sources such as diesel engines, use of toxic chemicals, and small business operations. The guide and other U.S. EPA resources for communities can be found at www.epa.gov/CARE.

Look to this bimonthly column for in-depth coverage of how CARE's community-based projects find innovative ways to conduct environmental health assessments and use pollution prevention, voluntary programs, and other means to reduce environmental health risk. In addition to updates on the CARE projects, this column will also provide updates on the U.S. EPA/CDC/ATS-DR collaboration and on other U.S. EPA programs designed to help communities address their environmental concerns.

Corresponding Author: Henry (Hank) Topper, Co-Chair, Community Action for a Renewed Environment Program, Office of Pollution Prevention and Toxic Substances, U.S. Environmental Protection Agency, 1200 Pennsylvania Avenue, NW, Washington, DC 20460. E-mail: [e-mail] Web site: www.epa.gov/care.

Reference

U.S. EPA. (2006). CARE's community guide to EPA voluntary programs. Retrieved June 22, 2006, from http://www.epa.gov/care/library/guide_vol_progs_2006.pdf.

Henry (Hank) Topper, Ph.D.