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:
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. *
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In undertaking the PACE EH process, communities will explore these questions:
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)
PACE EH is a voluntary process for community self-assessment leading to a practical plan of action. Use of the methodology should result in:
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.”
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.”
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:
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.
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.