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What is PACE EH?


What is the protocol for assessing community excellence in environmental health (PACE EH)?

Carl Osaki, R.S., M.S.P.H, is Vice-Chair of the Washington State Board of Health and has worked in the field of public health for more than 30 years. 

He empathically feels that “the purpose of PACE EH is to ensure that community values, beliefs, expectations, and perceptions are fully explored and incorporated into the actions determined by policy makers.”

He stresses that “the value to the community through the PACE EH process is the active and meaningful involvement in the development of environmental public health policies or priorities.”

The Protocol for Assessing Community Excellence in Environmental Health (PACE EH) guidebook is designed to help communities systematically conduct and act on an assessment of environmental health status in their localities. The methodology takes the user through a community-based process for:

  • Characterizing and evaluating local environmental health conditions and concerns;
  • Identifying populations at risk of exposure to environmental hazards;
  • Identifying and collecting meaningful environmental health data; and
  • Setting priorities for local action to address environmental health problems.

The PACE EH guidebook provides tools and direction for those charged with organizing and leading this action-oriented, locally based process. The process is intended to strengthen a collective understanding of and appreciation for the critical role that environmental health plays in the overall health of a community. It guides users through a comprehensive environmental health assessment that will provide an accurate and verifiable profile of the community’s environmental health status. Community health officials and advocates can then use this profile for proactive, locally appropriate decision making.

Listen as Jonathan Schwartz, Senior Analyst at NACCHO, provides background information regarding key objectives, benefits, and an overview of the 13 tasks. *

* You may need to download and install the free software RealPlayer to use these files. (click on basic realplayer, free download)

Target issues

In undertaking the PACE EH process, communities will explore these questions:

  • What are the connections between the environment—where people live, work, learn, and play—and human health and well-being?
  • Are certain groups in the community currently experiencing, or likely to experience, an increased risk or disproportionate share of adverse health effects from environmental hazards?
  • What can be done to protect human health and the environment?
  • How appropriate and effective are current environmental health protection measures in the community?
  • What are some of the key environmental resources in communities that should be preserved or protected?  

PACE EH provides a method to help local public health professionals and communities work collaboratively to assess and improve local environmental health status. PACE EH adheres to tenets of the core functions of public health, the 10 essential services, and community collaboration principles, by identifying local issues, setting priorities for action, and targeting populations most at risk, and through collaboration, strategically addressing the identified issues.

Leadership Role for Local Health Officials in Environmental Health

If the mission of public health is “…assuring conditions in which people can be healthy” (Institute of Medicine, 1988), the importance of a strong environmental health system is apparent. The PACE EH guidebook has been designed to help local health officials and agency staff demonstrate leadership in working collaboratively to provide for a healthy environment and healthy citizens. This leadership responsibility may require taking on new roles in the community, such as catalyst, convener, and collaborative partner. It may also require expanding the boundaries of “environmental health” beyond the traditional responsibilities of public health agencies (e.g., sanitation, food safety, water quality) and examining the relationships among environment, human health, and quality of life.

 -from “The Future of Public Health” (Institute of Medicine, 1988)

Objectives

PACE EH is a voluntary process for community self-assessment leading to a practical plan of action. Use of the methodology should result in:

(bulleted list)

  • A thorough and well-documented decision-making and planning process;
  • Effective participation of a well-represented public throughout the process;
  • An enhanced understanding of the community’s environmental health needs;
  • Strengthened community support for the identification and prevention of environmental risks;
  • An enhanced appreciation for the critical connections between health and the environment;
  • An appropriate and equitable distribution of environmental health programs and services, directed to priority environmental health issues; and
  • A plan for action that capitalizes on the strengths of the community and the local health agency to improve the community’s health.

Although the methodology is not designed for use in responding to an acute environmental health crisis, successful completion of the PACE EH process will nonetheless be extremely valuable if and when crises do occur. The process will help establish a foundation of trust and broad-based support among community partners so that decision makers can act quickly and decisively in a climate of urgency.

Carl Osaki would like to reinforce that “the value to the health jurisdiction is the development and sustainability of support and trust by the community it serves. And the value to the policy maker is the confidence that decision making is guided with appropriate and fully explored technical data and community values and interests. The resulting outcome can be an array of relevant and appropriate environmental health activities to achieve maximum public benefit.” 

Value

As a result of engaging in a community-based environmental health assessment process, information about a range of environmental health issues facing the community is assembled, along with a listing of informational resources available to the community. Because environmental health assessment is expected to be an ongoing activity at the local level, and not a one-time event, this information should be current and updated every three to five years (or as frequently as deemed appropriate by the assessment team).

Through an effective assessment process, a better understanding of community values and priorities is achieved. In addition, agency responsibilities and other locally available resources to address each issue are identified. A repository of supportive data and information and community resources/expertise is developed and made available to facilitate priority setting, policy development, and future program development. Thus, not only are current community issues addressed, but the local health official who capitalizes on this activity as an opportunity for developing and fostering positive working relationships with his or her community members, including partner agencies and organizations, will realize long-term, wide-ranging benefits.

Listen as Jonathan Schwartz, Senior Analyst at NACCHO explains the value PACE EH and health equity.

A community-based environmental health assessment is not an easy task. It is work-intensive, time-consuming, and complex. However, PACE EH pilot site coordinators believe the work was well worth it. Indeed, in most pilot communities, the assessment process will be an ongoing community activity.

Pilot site coordinators also find PACE EH invaluable for the many beneficial coalitions it helps communities forge. Through the PACE EH process, local health officials form collaborative relationships with a range of community residents and leaders. In many cases, these partnerships have involved the local health agency in community-based projects in which they otherwise would not have been included.

One coordinator identified the changed attitude fostered among his staff and peers as the most valuable outcome of engaging in PACE EH. Community-based environmental health assessment is seen not simply as an added “sideline” task, but rather as an integral component of effectively performing the work of the local public health agency.

“Not only did PACE EH bring to the table community players usually absent from health agency activities,” said one coordinator, “but it also provided local health agency staff members with seats at the ‘tables’ of a variety of other community-based initiatives.”

Challenges

Environmental health assessments are constrained by limited understanding of the complex relationships between the environment and health and incomplete availability of local data. PACE EH is designed to address these constraints to the extent possible and build on relevant local, state, and national models, including:

  • Healthy People 2000 (and its latest revision, Healthy People 2010), prepared by the U.S. Department of Health and Human Services, and Healthy Communities 2000:Model Standards, produced by the American Public Health Association, which provide a national context for local environmental health issues.
  • Profiles of local environmental health conditions, such as those prepared by Washington state and Allegheny County, Pennsylvania.
  • The U.S. Environmental Protection Agency’s Comparative Risk projects, which provide guidance for ranking and prioritizing environmental issues within a collaborative framework.
  • Healthy Communities 2000: Model Standards, Guidelines for Community Attainment of the Year 2000 National Health Objectives (American Public Health Association, 1991).
  • Healthy People 2000: National Health Promotion and Disease Prevention Objectives (U.S. Department of Health and Human Services, 1990).
  • A Community Environmental Health Assessment for Allegheny County, PA (University of Pittsburgh, April 1996).
  • Washington State Community Environmental Health Data Assessment for APEX/PH (Washington State Department of Health, 1995)
  • A Guidebook to Comparing Risks and Setting Environmental Priorities (U.S. Environmental Protection Agency, 1993).

Gaps in Scientific Understanding

Current understanding of the complex relationships between environmental exposures and health effects is limited. Many toxic substances and their interactions have not been tested and verified. Little is known about the synergistic interaction of various pollutants or the effects of multiple exposures. Even with good data, the cause-and-effect relationships between environmental exposures and health consequences are uncertain. Nonetheless, communities cannot always wait for or rely on conclusive scientific evidence when decisions are needed immediately. 

The 13 tasks of PACE EH

Tasks are laid out sequentially, but the process does not usually work that way; it often takes two steps forward, one back. 

  • Task 1: Determine Community Capacity
  • Task 2: Define/Characterize the Community
  • Task 3: Assemble a CEHA Team
  • Task 4: Define the Goals, Objectives and Scope
  • Task 5: Generate List of EH Issues
  • Task 6: Analyze Issues w/ Systems Framework
  • Task 7: Develop Indicators
  • Task 8: Select Standards
  • Task 9: Create Issue Profiles
  • Task 10: Rank Issues
  • Task 11: Set Priorities for Action
  • Task 12: Develop Action Plan(s)
  • Task 13: Evaluate Progress and Plan for the Future

Timeline

The first time through PACE EH takes approximately 18–24 months.

Tasks 1–3 is stage 1 of the process, averages about 3 months.

Tasks 4–6 is stage 2, averages about 6–12 months.

Tasks 7–9 is stage 3, another 3 months.

Tasks 10–13 is stage 4, takes about 3–6 months.

 


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NACCHO Annual Conference July 7-9, 2015