Community-Based Environmental Health Assessment (CEHA)

The communities profiled in relation to this map took on CEHA activities using PACE EH under the auspices of NACCHO and the National Center for Environmental Health (NCEH). Many of the facilitators of these projects remain connected to NACCHO through ongoing PACE EHwork and as CEHA advisors within NACCHO’s Peer Network.

San Juan Basin Health Department, Durango, Colorado

Completing PACE EH in less than 12 months
The facilitators from the San Juan Basin Health Department, drawing on extensive experience working with community members on a number of environmental health advisory committees, organized PACE EH (Protocol for Assessing Community Excellence in Environmental Health) work around existing community environmental health interest networks. 

This greatly reduced the time and expertise normally required for facilitators to work through the first four tasks of the PACE EH methodology. One of the primary facilitators of the San Juan PACE EH process was well-versed in community based participatory research methods, filling a need that many other PACE EH sites have to either find or develop.

The relatively short time frame ensured that volunteers always "saw the light at the end of the tunnel." Their commitment increased because the project requirements were well established and alternates were chosen
for each crucial team member. Strict meeting times and schedules were established and adhered to, as were clear and concise channels of communication between facilitators and volunteers. 

For more information, visit San Juan Basin Health Department, Durango, CO.

Linn County Public Health Department, Cedar Rapids, Iowa

Background/Project Description

Linn County is a center of commerce in eastern Iowa with approximately 170,000 residents, making it the second most populous county in Iowa. The PACE EH(Protocol for Assessing Community Excellence in Environmental Health) process began when Linn County formed a core steering committee of a group of stakeholders who were already familiar with environmental health issues. The steering committee invited other groups to participate as members of the full assessment team. Together, the health department, the steering committee, and the other assessment team members revisited issue lists and then divided the assessment team into six subcategories: air
quality, water quality, land use, waste management and hazardous materials, food safety, and general environmental issues.

For more information about Linn County Public Health PACE EH project and other pilot site results, see “PACE EH in Practice,” a compendium of the pilot site results. This document is available for download on NACCHO's Bookstore.

Scott County Health Department, Davenport, Iowa

Background/Project Description

Scott County (IA) Health Department (SCHD) serves a population of 150,979. SCHD saw PACE EH as a fundamental tool in evaluating the environmental health needs of the county within a framework that would allow the agency to generate environmental health priorities from the community’s perspective rather than the agency’s. SCHD used the PACE EH process in two ways:

  • An internal learning tool for the department’s environmental health staff.
  • A focus point on the priority of cardiovascular health.

Adapting the PACE EH methodology and using the indicators framework helped the environmental health staff broaden their scope and understand environmental health issues both from a community perspective and a public health systems approach.

For more information about the Scott County (IA) Health Department’s PACE EHproject and other pilot site results, see “PACE EH in Practice,” a compendium of the pilot site results. This document is available for download on NACCHO's Bookstore.

McHenry County Public Health Department, Illinois

Background/Project Description

McHenry County is located in Northeast Illinois and is home to 250,000 residents living in both urban and rural areas. McHenry County Health Department's interest in serving as a PACE EH (Protocolfor Assessing Community Excellence in Environmental Health) pilot site was the result of 10 years of experience in community health assessment, familiarity with the Assessment Protocol for Excellence in Public Health (APEX PH), development of a local needs assessment, and a community health plan that addressed environmental health issues.

McHenry County Health Department’s PACE EH effort resulted in a 19-member CEHA team representing many diverse community institutions. The CEHA team survey and analysis resulted in a list of 12 environmental health areas of concern from which indicator development could begin. The 12 areas ranged from specific (e.g., indoor air quality) to more general social issues (e.g., tobacco use, teen pregnancy, and domestic violence). Action plans were developed on the basis of survey results and assessment team interaction.

For more information about the McHenry County Health Department’s PACE EH project and other pilot site results, see “PACE EH in Practice,” a compendium of the pilot site results. This document is available for download on NACCHO's Bookstore.

Northern Kentucky Independent District Health Department

Background/Project Description

The Northern Kentucky Independent District Health Department (NKIHD) serves a population of approximately 348,000, providing support to communities ranging from large urban centers to suburbs to rural areas.

NKIHD applied to pilot test PACE EH (Protocol for Assessing Community Excellence in Environmental Health) after it developed expertise in both public health assessment activities and community outreach. The PACE EH subcommittee of the community health committee served as Northern Kentucky's community-based environmental
health assessment (CEHA) team. The team grew to 26 individuals representing regional public health agencies, local businesses, environmental interest groups, and other community members. After conducting a community survey, the PACE EH subcommittee selected the top two issues for inclusion in the Community Health Plan 1999.

For more information about the Northern Kentucky Independent District Health Department's PACE EH project and other pilot site results, see "PACE EH in Practice," a compendium of the pilot site results. This document is available for download on NACCHO's Bookstore.

Barren River District Health Department

Background/Project Description

The Barren River District Health Department (BRHD) serves an eight-county area in south-central Kentucky. Although primarily rural, this district is one of the fastest growing areas in the state. BRHD serves its eight member counties through health centers located in each county, and a district office in Bowling Green. At the time BRHD
undertook the PACE EHprocess, it had completed the APEX PH(Assessment Protocol for Excellence in Public Health), an assessment methodology designed to enhance the organizational and leadership capability of local health agencies. As APEX PHwas being conducted separately in four member counties, the decision was made to conduct the PACE EH environmental assessment for the district as a whole.

The PACE EH community-based environmental health assessment (CEHA) team members represented each local county government, two cities, five planning commissions, several local environmental agencies, and Western Kentucky University.

Based on survey results, the team designated the following issues as high priority:

  • Public water supplies;
  • Straight pipe sewage disposal;
  • Food supply and safety;
  • Solid-waste disposal; and
  • Illegal dumping

The work group developed action plans, which brought forth new partnerships to address these issues.

For more information about Barren River District Health Department's PACE EH project and other pilot site results, see "PACE EH in Practice," a compendium of the pilot site results. This document is available for download on NACCHO's Bookstore.

The Muskegon County Health Department, Muskegon, Michigan

Building and Using a Successful PACE EH Team
Developing an inventory of environmental interest groups in the community is extremely important before beginning PACE EH (Protocol for Assessing Community Excellence in Environmental Health). Identifying these organizations takes time and research, but is well worth the initial investment. In Muskegon County, MI, groups that were not directly involved in "environmental endeavors" did not immediately see the connection between their organizations and the health of the environment.

To ensure that community participants in the PACE EH project are getting as much as possible from the work of the team it is important to:

  • Treat all opinions with respect;
  • Ask questions to understand team members' points of view;
  • Keep conversations simple, avoiding the use of jargon; and
  • Use creativity to complete tasks, keeping the team interested and participating.


Jill Montgomery
Public Health Quality Improvement Specialist

Mahoning County District Board of Health, Youngstown, Ohio

Partnering with Regional Environmental Protection Agency Representatives

The Mahoning County (OH) PACE EH facilitators enjoyed the commitment, resources, and expertise of regional Environmental Protection Agency officials who served as members of their CEHA team. The U.S. EPA Region 5 Cleveland Office uses a Community-Based Environmental Protection (CBEP) approach to serve the Northeast Ohio
region. The CBEP approach helps EPA get the best environmental results by collaborating with other federal agencies, state and local governments, tribes, businesses, organizations, and individuals to solve environmental problems.

The Ohio Environmental Protection Agency (EPA) introduced the Mahoning PACE EH project to the Cleveland Office and suggested joining the steering committee. U.S. EPA staff became involved in the project by participating in commission and steering committee meetings and by serving as a resource for the Indoor Air Work Group.

The Cleveland Clean Air Century Campaign (CCACC) began as an EPA pilot project in 2001 and shared its background, membership, activities, goals, and lessons learned with the Mahoning PACE EH Commission.

Both U.S. EPA and Ohio EPA were key resources for technical literature relating to the three public health issues selected by the commission for action plans: protection of water supplies, urban sprawl, and indoor air pollution. Ohio EPA provided a copy of the completed Source Water Protection Plan (SWAP) for each of the community water
supplies in the region and provided presentations on the topics of SWAPs and the possible use of pre-existing Water Quality Management Plans (WQMPs) as a tool to address both the protection of water supplies and urban sprawl issues. U.S. EPA provided access to numerous fact sheets related to indoor air pollution.

Health Valley PACE EH Project Report (December 2004)


Jane Warga

Delaware General Health District, Delaware, Ohio

Background/Project Description

Delaware County, in central Ohio, is the fastest growing county in Ohio and one of the fastest growing counties in the United States. Upon implementation of the PACE EH process, the Delaware City/County Health Department (DC/CHD) had approximately 50 staff members primarily focused on food safety, plumbing, inspections, waste management, and emergency response.

With support from the board of health, which promoted a proactive, community-driven approach to public health, this effort resulted in the formation of a CEHA team made up of 26 community volunteers, ranging from city officials to local business people.

The Delaware CEHA team began Phase II of the PACE EH process using a community outreach process to develop a ranking of 20 priority environmental health issues identified in Phase I. The issues included traditional environmental health categories such as water quality and water pollution, housing safety and sanitation, noise control, and pesticide and toxic substances control. Nontraditional issues included environmental education, zoning, and quality of life issues. Thirteen of the 20 identified issues were assigned to four community-action committees.

For more information about Delaware County General Health District's PACE EH project and other pilot site results, see "PACE EH in Practice," a compendium of the pilot site results. This document is available for download on NACCHO's Bookstore.

For more information, visit:


Susan Sutherland

Assessment Coordinator, Environmental Health

Multnomah County Health Department, Portland, Oregon 

Trusting the Community to Lead

The Multnomah County PACE EH (Protocol for Assessing Community Excellence in Environmental Health) Community Coalition is a union of agencies, government, nonprofit groups, and community organizations intent on
revitalizing the participation of communities in the Portland metro area (population 600,000) around environmental issues that affect their health.

The coalition organized community partners, generated excitement and possibilities for collaborative work, fought diligently for resources, and organized a steering committee and a community assessment team. The coalition has largely rewritten a long history of "uncooperative government" coupled with "apathetic community"

The coalition used the PACE EH methodology to:

  • Establish data identifying five environmental justice communities across the county;
  • Hire community connectors to facilitate, connect, and organize both community and coalition partners, and
  • Complete an ambitious community health assessment for an initial pilot project.

Ongoing efforts build upon focus groups, door-to-door surveys, and informal gatherings around key environmental health issues in multifamily housing units. The Coalition created a community newsletter, a Web-based "events and alert" list, and a local PACE EH Web site.

Coalition recommendations and findings from the assessment team will be presented at future community meetings where the team will seek approval on current and future community action plans.

The Multnomah County Health Department, lead partner of the local PACE EH work, relinquished control in the process and assessment in favor of a coalition effort focused on the voice and concerns of the affected citizens. 

Allentown Health Bureau, Pennsylvania

Background/Project Description

Allentown, PA, with a population of 105,000, was one of the first to implement PACE EH as a pilot site. The Allentown Health Bureau (AHB) housed a distinct Environmental Health Services Section (EHSS) that was responsible for environmental protection and injury-prevention programs. The EHSS had fairly extensive experience working directly with community members and partnered with state and federal agencies as diverse as the Allentown
Chamber of Commerce, Pennsylvania Department of Environmental Protection, Allentown fire and police departments, and local housing services. From the outset, AHB prepared for its community-based environmental health assessment (CEHA) project, adhering to a strict timeline and producing realistic action plans. The assessment component of the AHB project took 12 months.

For more information about Allentown Health Bureau's PACE EH project and other pilot site results, see "PACE EH in Practice," a compendium of the pilot site results. 

Blount County Health Department Maryville, Tennessee 

Extensive Survey Implementation and Analysis

The Blount County (TN) Environmental Health Action Team (EHAT) developed and administered a PACE EH survey with the goal of identifying environmental health issues that concerned residents of Blount County. The survey was adapted from a previous tool used by the Northern Kentucky District Health Department, an earlier PACE EH site.

The survey was distributed to 2,000 random households in the county. A mailing list was purchased to assure weighted distribution among all county ZIP codes, according to population size. A graduate student analyzed the returned surveys using EpiInfo 2000 software.

The initial survey results presentation displayed the value of such an extensive (and relatively expensive) survey distribution and analysis. EHAT members embraced and "owned" the results and committed to work on the top six issues identified by their fellow residents: outdoor air quality, safe drinking water, surface water quality, loss of rural land, ground water quality, and urban development.

The team formed three subgroups:

  1. Air quality;
  2. Land use (to address loss of rural land and urban development); and
  3. Water quality (to address safe drinking water; surface and ground water).

These subgroups, inspired by results from the community survey process, are the springboard for the vast majority of PACE EH work, including action planning and implementation.

San Antonio (TX) Metropolitan Health District

Background/Project Description

The San Antonio Metropolitan Health District (SAMHD) is the single public agency charged by state law, city code, and county resolution with responsibility for public health programs in San Antonio and unincorporated areas of Bexar County. By engaging in the PACE EH initiative, the mission of SAMHD was to characterize the environmental
health status of the City of San Antonio and Bexar County. The new community-based environmental health assessment (CEHA) team included key players and neighborhood groups. A community survey was developed and
five main areas of concern were identified.

The assessment team was then divided into focus groups to address the five areas of air, water, physical environment, hazardous waste, and miscellaneous. The teams were community members, SAMHD staff, academics,
social service providers, and members of the regulated community who met regularly to develop indicators for the five issues.

For more information about the San Antonio Metropolitan Health District PACE EH project and other pilot site results, see "PACE EH in Practice," a compendium of the pilot site results. 


Nicole Rogers

Alexandria Environmental Health Department, Virginia

Using the PACE EH Peer Assistance Network

Before taking on PACE EH, the Alexandria (VA) Health Department consulted the adjacent Arlington County Health Department, an established PACE EH site. This consultation provided the Alexandria Health Department a with third-party viewpoint when it solicited support from the health director and city council.

Arlington County PACE EH representatives played a key role in the initial community assessment team meetings, especially during the planning stages. Alexandria's survey was a compilation of several examples.

As the Alexandria CEHA team learned the fundamentals of ranking and prioritizing the issues, an Arlington representative was present to answer questions and to keep the team on track.


Bob Custard

Environmental Health Manager

Arlington Department of Human Services, Virginia

Environmental Health Bureau

Arlington (VA) Department of Human Services (ADHS) Environmental Health Bureau was one of the 10 sites that piloted the PACE EH tool. Arlington, an urban area, boasts a widely diverse community.

To begin the PACE EH process, a community-based environmental health assessment (CEHA) steering committee was formed to solicit the participation of citizens and key agencies. A full CEHA team was established representing ADHS, The George Washington and Georgetown Universities, League of Women Voters, United Way, Department of Public Works, Arlington Health Foundation, National Environmental Health Association, Phoenix House, Department of Environmental Quality (Northern Virginia Regional Office), Virginia Environmental Health Association, and Department of Environmental Services (county).

A broad range of environmental health issues was identified, including noise, outdoor air pollution, food safety, dangerous chemicals in homes, and indoor air pollution. Four priority areas were chosen and action plans were put in place to address those issues.

For more information about the Arlington County Department of Human Services Environmental Health Bureau's PACE EH project and other pilot site results, see "PACE EH in Practice," a compendium of the pilot site results. This document is available for download on NACCHO's Bookstore.

Rock County Health Department Janesville, Wisconsin

Adapting the Methodology to fit Local Needs (Tasks 6–9)

The Rock County (WI) PACE EH project followed the guidelines established in the PACE EH document; however, it altered the sequence to fit the needs of the local project and the committee members. Tasks 1–5 were conducted
sequentially, but Tasks 6–9 were completed for each of the approximately 30 priority environmental health issues on an issue by issue basis. The committee chose to focus on an identified priority issue, develop appropriate indicators, identify relevant standards, and complete an issue profile, all before beginning the process on the next priority issue. Typically, it was able to address Tasks 6–9 for any given issue in a single PACE EH meeting. 

The Rock County PACE EH committee members found that the change in sequence expedited their overall PACE EH work and simultaneously invigorated the committee by organizing project work around the introduction and development of a new environmental health topic at each meeting. This alteration allowed the facilitators to take strategic advantage of key project volunteers. Committee members with expertise in specific environmental health issue areas were able to commit to a much smaller window of time.

The Rock County PACE EH facilitators also found that conducting Tasks 6–9 in this manner allowed them to develop a more complete picture of broad environmental health issues before marking any for elimination.

Benefits related to conducting Tasks 6–9 on an issue-by-issue basis:

  • Maintains team focus on one environmental health issue at a time;
  • Narrows focus time for guest speakers to contribute;
  • Works well for committee members unable to commit to every meeting;
  • Makes meetings more manageable;
  • Reduces the overall length of a PACE EH project;
  • Focuses on a single issue from data formulation to profile creation; and  
  • Lends itself to formulating potential action steps for each issue 

A specific obstacle the Rock County PACE EHteam identified related to their adaptation of Tasks 6–9 is the recognition that more environmental health issues will be possible priorities for a longer period of time. For the Rock County team, this recognition resulted in a decision to establish a review of upcoming Tasks 10–12 for each issue carried through the PACE EH methodology.

The adaptations of the Rock County PACE EH team are a reminder that the PACE EH methodology offers a great deal of flexibility. Grouping Tasks 6–9 on an issue-by-issue basis better served variable time commitments of team
members, limited availability of local environmental health experts, and meeting facilitation, and also laid the foundation for reliable ranking and prioritizing exercises.

Timothy Banwell

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