PACE EH Online Course Module 2

This phase is devoted to developing goals and objectives for the process and identifying and analyzing the local issues. Once the CEHA team is assembled, members should work together to create a shared vision, goals, and objectives for the project. During Phase 4, the team may seek to develop a shared or expanded definition of environmental health for the community. Once this is done, the group may identify expected outcomes of the assessment.

Note: During this phase it may be helpful to review Task 1 to consider what barriers must be overcome, what resources are available, and what related efforts may affect the problem.  

During Task 5, the team, through a combination of formal or informal data collection methods, will begin to compile local environmental health concerns. Once the data has been collected, the group will move to Task 6 to analyze the issues. During Task 6, the group will begin to reexamine the issues and take into account how the issues are manifested in the community. Examples of questions to consider here are:

  • Who is affected? 
  • How are people exposed? 
  • Is it an issue of perception vs. scientific evidence?

In the past, this stage has tended to be very facilitator-driven. Coordinators need to be very aware of the balance between advising and controlling. Also, this task can be affected by single-issue advocates. Note: One issue of consideration in this phase of the process is the fact that the process has “gone public.” You must now contend with heightened community expectations. You cannot ask them what they care about and then ignore the answers. But this does not mean that the project facilitators have to promise to “fix” every issue they uncover, just that community concerns will not be ignored.

The assessment team should clearly delineate the goals, objectives, and scope of the process. Involvement of the community (as represented on the assessment team) in this task will help strengthen support for the assessment and ensure ownership of the process.

At the completion of this task, the assessment team should have:

  • Delineated the goals and expected outcomes of the assessment 
  • Described the vision that will guide the process 
  • Described the scope of issues to be addressed by the assessment 
  • Agreed-on definitions for terms likely to be used during the course of the assessment   
  • Establish goals and objectives for the assessment

Assemble Available Information Pertaining to the Relationships between Health and Environmental Factors

The more thorough the work done to this point, the easier it will be to define goals and objectives. Review Task 1 and consider how agency and community strengths can be used, what barriers must be overcome, what resources are available, and what related efforts may affect the problem. Because each member of the assessment team will bring his or her own priorities and values to the process, establishing consensus among team members about the goals and objectives of the assessment will make later decisions easier.

Describe the Vision That Will Guide the Process

Development of a shared vision for the process will provide focus, purpose and direction throughout the assessment and help people set goals. A vision expresses a statement about the desired future that is held mutually by assessment team members. It provides a concrete picture of the end results of the assessment by illustrating what the community will look like if the process is successful. Additionally, a vision can serve as a means to communicate the goals of the process to others. Further, a compelling vision can serve as a source of inspiration and motivation for completing the process.

Describe the Scope of Issues to Be Addressed by the Assessment

It is important to ground the process in a shared understanding of the scope of environmental health. It is essential to spend time early in the process clarifying the boundaries of the assessment and the kind of issues that will and will not be considered part of “environmental health.” This will help keep the effort focused and reduce frustration and confusion throughout the process.

Scope of the Assessment

Does environmental health just include human health effects from environmental sources Does it include the health of the environment (ecology) Does it include health and well-being of the community including quality of life, economic viability/prosperity, and social health Team members will enter the process with completely different assumptions and opinions.

Define Key Terms

Define terms like health, health status, and environmental health. There is the potential for disagreement among assessment team members about the definition of even basic concepts, such as environment. For instance, “environment” may refer strictly to one’s physical surroundings, or it may include social conditions as well.

Note: Problems such as homicide, intentional injury, and depression or suicide are examples of health outcomes that may be strongly influenced by one’s social environment. In these cases, living in a high-crime neighborhood represents a major risk factor and may be considered as significant a part of one’s environment as the more traditional considerations of clean water and air.

Questions to Consider

Why is it important to develop a vision and goals for the assessment process?  What role should  the PACE EH coordinator play in developing the goals?  Why is it important that the team agree upon a shared definition of environmental health?

In this task, the team will collect descriptive information about perceived community concerns. The intent is to identify concerns that are most relevant to community members and to determine how prevalent or widespread these concerns are in the community. Statistical information about the community’s environmental health status is combined with this descriptive information to generate issue profiles in Task 9. A comprehensive list of environmental health issues should be generated, as these will be used to develop community-specific standards and indicators, draft issue profiles, rank concerns, and set priorities for action.

At the completion of this task, the assessment team should have:

  • Data on community knowledge, attitudes, behaviors, and perceptions related to environmental health 
  • A manageable list of community-identified environmental health concerns

Evaluate and Select Data-Gathering Methods

Community assessments are simultaneously research projects and efforts to engage the community around environmental health issues. Therefore, it is important to consider the process of gathering information on the community’s concerns needs to do more than build on the existing base of knowledge and gather additional community-specific information in order to foster the community’s understanding of the project and provide opportunities for community engagement.

These considerations will affect the choice of a data-gathering method. If the project is to involve the community, build new relationships, establish a presence for the project sponsors, and educate members of the community, then the team needs to consider the degree to which a research method will contribute to or impede these goals.

Some questions to consider are:

  • Does the method provide an opportunity to engage citizens in learning about the project, the community, or environmental health? 
  • Does the method provide an opportunity to introduce the project’s sponsors to key constituents? 
  • Does the method provide an opportunity to enhance the visibility of the project and the sponsors?

An assessment of community concerns can be done formally or informally. A formal assessment collects data that are representative and valid. Data can be collected by one of two methods: population survey or sample survey. In a population survey, all possible respondents are identified and approached to provide information. In a sample survey, a segment of the population is carefully selected and approached to provide information. You can learn more by using this sample survey tool.

An informal assessment collects data that may be useful but may not stand up to scientific scrutiny. The main advantage is the ability to collect basic information quickly. Informal methods recognize the possibility of bias and can actually use it to their advantage, i.e., to collect specific data from a targeted audience. The more closely the assessment team approximates conditions of scientific accuracy and validity, the more valid and reliable the data procured will be. At the very least, when using informal assessment methodologies, the assessment team needs to be aware of the possible biases involved, and interpret the results accordingly.

Collect Data on Community Concerns

Solicit opinions from the community at large via the selected method(s). Be sure to tap into knowledge contained within the team by having each member list any information he or she has about issues of importance to the community. As this list will be influenced by assumptions that may or may not be valid, consider designing a data-collection method capable of generating information to support or clarify these assertions.

Create a Manageable List of Issues

The list of issues generated at this point will be the focus of the rest of the assessment process. The process will be most effective and useful if the list of issues is manageable. Evaluate the proposed list of issues according to these criteria:

  • Does the issue fall within the intended scope of the assessment? 
  • Does the issue represent a relationship between the environment and human health? 
  • Is it a local concern? 
  • Was this an issue identified by a significant majority of the public? 
  • Can other information from the community support the inclusion of this issue?

Questions to Consider

When gathering local data, what issues, and concepts must you take into account?  What are some of the benefits and limitations of formal and informal data collection methods?  Once issues are identified, how do you begin to create a manageable list of issues?

At the completion of this task, the assessment team should have mapped the connections among:

  • Health status 
  • Affected populations 
  • Exposure factors 
  • Environmental agents/conditions 
  • Contributing factors and behaviors 
  • Public health protection factors for selected environmental health issues

Understand the Framework

You can access a PDF illustration of the systems framework here.

Environmental health in a community results from many interconnected factors. The complex nature of a community environmental health issue will be better understood after a systematic “mapping” process.

Mapping clarifies the connections between the health of the community and the health of the environment. It shows the relationships between environmental conditions, the public policies or personal behaviors that influence the conditions, the characteristics of populations most affected by exposure and the dynamics of their exposure, and the health and quality-of-life outcomes that result from exposure.  

In the framework, environmental health status is described by linking contributing factors – public policy decisions and personal behaviors – with exposure factors that describe how and where affected populations are exposed to environmental agents and the public health protection factors that are implemented by individuals or communities and reflect the collective capacity to address environmental health issues.

The framework allows users to begin with community-identified environmental health concerns, map out the components of the issue, and ultimately generate a list of indicators to move the process from theory to action (in Task 7).

The value of the framework lies in the analysis that occurs in considering the many dimensions of each environmental health issue. Working with the framework will help the assessment team identify and describe why people care about an issue, the linkages between issues of concern, relevant contributors, and opportunities for intervention.

To use the framework, select one issue of concern to the community. Then, map out the reasons why the community cares about that issue. Some potential questions to consider are:

  • Why is this important? 
  • Why do citizens care about this issue? 
  • Are they concerned about health impacts and particular populations or environmental endpoints?

After Thinking through These Considerations, Plug Them into the Framework

Environmental health should be considered broadly in this process. Some communities may identify issues based on concerns about ecological or quality-of-life outcomes rather than concerns about human health. For some issues, such as Lyme disease, the framework might reveal important connections between environmental conditions and health effects. For others, quality-of-life or ecological status may be the community’s primary focus. The mapping exercise might be challenging for these types of issues, but the process will still be valuable in identifying connections among components.

Having mapped the system related to the identified environmental health issues, the assessment team is now ready to develop a set of potential indicators – quantitative measures – that describe the status of an issue.

Question to Consider

What are the key interconnected factors you should consider when applying the systems framework?

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