Working to build healthy communities: community environmental health assessments using PACE EH.

Editor's note: NEHA strives to provide up-to-date and relevant information on environmental health and to build partnerships in the profession. In pursuit of these goals, we will feature a column from the Environmental Health Services Branch (EHSB) of the Centers for Disease Control and Prevention (CDC) in every issue of the Journal.

EHSB's objective is to strengthen the role of state, local, and national environmental health programs and professionals to anticipate, identify, and respond to adverse environmental exposures and the consequences of these exposures for human health. The services being developed through EHSB include access to topical, relevant, and scientific information; consultation; and assistance to environmental health specialists, sanitarians, and environmental health professionals and practitioners.

EHSB appreciates NEHA's invitation to provide monthly columns for the Journal. In the coming months, EHSB staff will be highlighting a variety of concerns, opportunities, challenges, and successes that we all share in environmental public health.

What is a healthy community? What role do environmental health practitioners play in ensuring that healthy communities are constructed, protected, and maintained? Healthy communities can be described in many ways depending on local values. The commonly accepted public health definition of a healthy community is one that is "continuously creating and improving those physical and social environments and expanding those community resources that enable people to support each other in performing all the functions of life and in developing to their maximum potential." Healthy communities promote physical activity, which has been shown to reduce the risk for developing high blood pressure, cardiovascular disease, diabetes, and colon cancer. Well-designed, healthy communities decrease vehicular traffic, which reduces accident-related injuries and respiratory problems associated with air pollution. Healthy communities protect green spaces so that outdoor areas are available for recreational activities. However healthy communities are defined, they depend on the services provided by environmental health practitioners. These services include protecting the safety of food and water, controlling vectors that spread diseases, and preventing exposure to environmental contaminants.

Traditional environmental public health practice has sought to protect against environmental factors that adversely affect human health. This goal has not changed, but new tools and methods are needed to identify and resolve today's environmental public health issues. Environmental public health specialists must work closely with the communities they serve to ensure that people of all ages can remain healthy and develop to their fullest potential. Increasingly, environmental health practitioners are required to mobilize community residents, engage the residents in discussions about what environmental health means for the community, and assess community values and priorities as they relate to environmental health and quality of life. One tool for doing so is the Protocol for Assessing Community Excellence in Environmental Health (PACE EH), which was developed by the National Association of County and City Health Officials (NACCHO) and the National Center for Environmental Health (NCEH) to assist environmental health practitioners to meet the needs of communities.

The PACE EH guidebook describes a process for conducting a community-based environmental health assessment (http://pace. naccho.org/DownloadPage.asp). The assessment process consists of 13 tasks (see sidebar on page 33) that guide communities and environmental public health officials in identifying local environmental health concerns, implementing action plans, and evaluating progress in reducing environmental problems and improving quality of life. PACE EH engages communities in environmental health planning activities that go beyond conventional regulatory practices. A fundamental value of the PACE EH process is community collaboration, which leads to the development of lasting partnerships and community involvement in addressing priorities to define community health.

Organizations that conduct a PACE EH process may gain from a thoughtfully implemented assessment. PACE EH adheres to the core functions of public health--assessment, policy development, and assurance--and ensures that the 10 essential environmental public health services are provided. Conducting a PACE EH activity can yield many benefits for the implementing organization and its partners:

* improved relationships and understandings among community members and the environmental public health practitioners,

* enhanced understanding of the local issues affecting certain sectors of the population that historically have been underrepresented, and

* equitable distribution of environmental public health services based on community priorities and available resources.

PACE EH also provides collaborating partners a forum in which to share strategies and synergies to resolve problems. This collaboration ultimately benefits everyone involved.

Since May 2000, the PACE EH guidebook has been distributed to more than 1,000 agencies. In 2002, NCEH and NACCHO supported PACE EH demonstration sites in eight local environmental public health organizations across the United States. PACE EH has been initiated at the state level in Florida, with 21 counties involved in local efforts that address environmental problems related to rapid growth, urbanization, urban sprawl, and urban planning (www.doh.state.fl.us/environment/programs/PACE-EH/PACE-EH.htm). In addition, PACE EH is being implemented in eight communities in the state of Alabama (www.se-rac.uab.edu/pace_content.asp?ID=7) and has been used at the state level in Montana to support environmental public health tracking activities. Many innovative PACE EH applications and outcomes were presented at the National PACE EH Summit held in Louisville, Kentucky, March 28-29, 2006. Additional information from the proceedings can be found at www.naccho.org/topics/environmental/CEHA.cfm.

Because of the widespread and growing use of the guidebook, NCEH initiated a process evaluation of the methodology in August 2004. The purpose was to answer five questions:

* How have potential users been made aware of PACE EH?

* What factors contributed to the decision to implement PACE EH?

* How is PACE EH being implemented in the communities that have elected to use the methodology?

* What are the intermediate impacts of PACE EH on agencies and communities?

* What recommendations do local and national stakeholders have for improving the method and the guidance provided?

In February 2007, the results of this evaluation, which are expected to be disseminated on the CDC/NCEH/EHSB Web site (www.cdc.gov/nceh/ehs/default.htm), will include recommendations for reducing barriers to the adoption and implementation of the PACE EH methodology The evaluation is expected to provide information that will guide future investment by NCEH and NACCHO in resources so that new challenges in maintaining healthy communities can continue to be met. Information on the community environmental health assessment work-in-progress at NCEH/EHSB may be found at www.cdc.gov/nceh/ehs/PIB/PACE.htm.

Corresponding Author: Brian Hubbard, Environmental Health Scientist, Environmental Health Services Branch, Division of Emergency and Environmental Health Services, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA. E-mail: [e-mail].

Brian Hubbard, M.P.H.

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RELATED ARTICLE: Tasks Recommended by the PACE EH Guidebook

Task 1: Determine community capacity to undertake the assessment.

Task 2: Define and characterize the community.

Task 3: Assemble community environmental health assessment team.

Task 4: Define goals of the assessment.

Task 5: Generate the environmental health issues list.

Task 6: Analyze issues with a systems framework.

Task 7: Develop appropriate community environmental health indicators.

Task 8: Select standards.

Task 9: Create environmental health issue profiles.

Task 10: Rank environmental health issues.

Task 11: Set priorities for action.

Task 12: Develop an action plan.

Task 13: Evaluate progress and plan for the future.