United States
Environmental Protection
Agency
Waste, Pesticides &
Toxics Division
(D-8J)
EPA 905-R-00-003
June 1,2000
Proceedings
Workshop On Actions To Take
For Children's Health
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U.S. Environmental Protection Agency
Region 5, Library (PL-12J}
77 West Jackson Boulevard. 12th Floor
Chicago. IL 60604-3590
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Ms. Linda Ruskowski from the Marion County
Asthma Community Development Group (ACDG)
and Mr. Ron Burke of the American Lung
Association of Metropolitan Chicago provided
advice about asthma management in schools. Dr.
Steven Potsic from the U.S. Department of Health
and Human Services spoke about asthma
initiatives and asthma statistics for residents of
Chicago.
Asthma Management in Schools
J
Ms. Linda Ruskowski presented information on the
ACDG Program she has been involved within
Marion County, Ohio. The group consists of
people from hospitals in Marion County and
employees of the local health department and lung
association. The goals of the group are to identify
asthma problems in the community and to try to
prevent them. The ACDG offers four different
asthma education workshops, including those
targeting school staff and those targeting school
children.
Ms. Ruskowski focused on the workshop for school
staff. The group gives folders to teachers
containing material on how to manage students
with asthma. The information is presented in a
mandatory teachers' meeting held at the beginning
of the school year and is free of charge.
Information presented during the workshop
includes common asthma triggers in the school
setting. Which may include:
<» Perfume, lotions, and deodorants
* Pet animals, including furry pets and birds
* Clapping chalkboard erasers
* Dusty carpets
<» Construction
<» Opening windows during lawri maintenance
To reduce asthma triggers, Ms. Ruskowski
suggests using wipes instead of chalkboard
erasers to prevent chalk dust and cleaning the
rooms regularly to thoroughly eliminate dust.
Ms. Ruskowski stressed the importance of
community education. Members of the community
can stating the teachers and parents, can be more
informed about asthma triggers and be better
prepared to help prevent asthma attacks.
Chicago Asthma Initiative - A Chicago
Area Intervention Project
J
Dr. Steven Potsic of the U.S. Department of Health
and Human Services presented information on the
mission and general model of public health
initiatives, asthma initiatives for the U.S.
Department of Health and Human Services, and
goals for the Chicago Asthma Initiative.
Dr. Potsic spoke about the general responsibilities
to public health as being assessment, assurance,
and policy development. He stated that evolving
public health priorities include maintaining a global
approach and eliminating social disparities. Dr.
Potsic spoke about a model that should be used in
general public health studies. The Chicago
Asthma Initiative project followed this model, which
consists of the following:
1. Define the problem
2. Measure and assess the problem
3. Determine risk factors
4. Develop and implement intervention strategies
5. Evaluate the effectiveness of the strategies
Dr. Potsic also spoke about the current initiatives of
secretary of the U.S. Department of Health and
Human Services to help prevent and manage
asthma. These initiatives include determining the
causes of asthma, reducing the burden of asthma
for people with the disease, improving the means
for managing asthma, and tracking and assessing
the effectiveness of asthma programs. The
department has targeted goals to (1) reduce the
asthma death rate to no more than 14 per million in
the United States and (2) reduce asthma
hospitalizations to 10 out of every 10,000 people in
the general population. Between 1993 and 1995,
the number of deaths due to asthma was 18 per
million population. In 1980, the self-reported
percentage of the U.S. population that had asthma
was 3.1 percent. That percentage rose to 5.4
percent between 1983 and 1994.
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In response to EPA Administrator Carol Browner's
National Agenda to Protect Children's Health from
Environmental Threats (1996), President Clinton's
Executive Order 13045, Protection of Children from
Environmental Health Risks and Safety Risks
(1997), and the establishment of the U.S.
Environmental Protection Agency (EPA) Region 5
Children's Health Team (the "REACH Team,"
Regional Environmental Actions for Children's
Health") (1997), the Region hosted a children's
environmental health workshop. The workshop,
entitled, "Environmental WATCH" (Workshop on
Actions to Take For Children's Health) was
sponsored by EPA Region 5, U.S. Department of
Health and Human Services (HHS), and the
Agency for Toxic Substances and Disease Registry
(ATSDR). The Environmental WATCH workshop
was held July 20-21, 1999 at the Metcalfe Federal
Building in Chicago, Illinois.
EPA Region 5 has a goal to effectively integrate
pollution prevention -concepts into the children's
environmental health initiative. Under the Pollution
Prevention Act of 1990, Congress established a
national policy that pollution should be prevented
or reduced at the source whenever feasible.
Pollution prevention is defined as any practice that
reduces the amount of any hazardous substance,
pollutant, or contaminant entering any waste
stream or otherwise released into the environment
prior to recycling, treatment, or disposal; and
reduces the hazards to public health and the
environment associated with the release of such
substances, pollutants, or contaminants. Pollution
prevention tools and resources were emphasized
at the Environmental WATCH.
Workshop participants listened to various speakers
during two plenary and 22 breakout sessions
during the two-day workshop. Participants also
developed recommendations on how to strengthen
community efforts to protect children's
environmental health through pollution prevention.
The recommendations will form the basis for a
regional action plan to protect children's
environmental health through prevention,
intervention, education, and collaboration. The
action plan is in development. EPA Region 5 will
ensure that this action plan is used as the
foundation for its planning and funding decisions to
support local activities to protect children's
environmental health. Other regions may use this
model to integrate pollution prevention into
community-based efforts to protect children's
environmental health. EPA is committed to
ensuring that action plans are implemented, and
prevention of pollution at the source becomes the
fundamental way that our children's environmental
health is protected.
This document contains a summary of discussions
and presentations during each of the plenary and
breakout sessions. More information about EPA
Region 5 efforts to protect children's health, can be
found on the world wide web at
http://www.epa.qov/r5ptb/reach/watch.
CONTACT:
Maryann Suero
U.S. Environmental Protection Agency
Region 5
77 W. Jackson Boulevard (T-13J)
Chicago, IL 60604
(312) 886-9077
E-mail: suero.maryann@epa.gov
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Plenary Sessions
The two-day workshop kicked off with two plenary
sessions. During the sessions, speakers
representing academia, various state and federal
agencies, and a nonprofit organization, spoke
about issues pertaining to:
* preventing children's health problems,
* the importance of education and collaboration
in addressing children's health issues,
»:• tools for success in protecting children's health,
and
* comprehensive approaches to addressing
multiple children's health issues
Opening Remarks
j
Ms. Phyllis Reed, Chair of the EPA Region 5
Children's Health Team, and Ms. Hannah
Rosenthal, Regional Director of the U.S.
Department of Health and Human Services (HHS),
welcomed participants and provided opening
remarks. Ms. Reed discussed EPA's intent to
provide support after the workshop and to help
participants carry out the action plan that would
result from discussions during the plenary and
breakout sessions. She explained that EPA had
set aside some funds to help communities begin
implementing the action plan; EPA requested that
community groups provide a written summary of
their plans for using the money by July 23, 1999.
Ms. Reed pointed out that interagency cooperation
and partnerships have been a benefit of the
Children's health initiative. Ms. Rosenthal
explained that HHS had been working in
partnership with EPA on many issues, including
those pertaining to children's health.
Prevention, Intervention,
Education, and Collaboration
Dr. Barbara Sattler, Assistant Professor and
Director of the Environmental Health and Education
Center, University of Maryland, began her
presentation by explaining that children's
environmental and health issues surfaced as a
focal point in the mid-1980's. This, she explained,
was a shift from the earlier focus on natural
habitats and adults. Dr. Sattler's presentation
included a discussion of:
<» lead poisoning
<• the need to better educate families about
pesticides commonly found in and around
homes and their effects on children
«:» indoor air quality issues
* water quality issues
* opportunities for community activism
Lead Poisoning
Dr. Sattler pointed out that although most people
think their homes are "safe havens," over 50
percent of homes have lead-based paint. This
problem is particularly common in homes of poor
families in substandard living conditions. Dr.
Sattler explained that lead can cause a variety of
health problems for children, including:
<» kidney damage
* cardiovascular problems
<» anemia
* learning disabilities
* higher incidents of aggressive behavior in
adolescence
In addition, she pointed out that many cases of
lead poisoning in kids are not diagnosed. These
children surfer twice because the undiagnosed lead
poisoning often causes learning problems. When
parents and teachers do not know about the lead
poisoning, they tend to alter their expectations for
the child's learning. This can lead to children being
placed in learning disability classes, for instance,
when, in fact, their problem is not limited learning
capacity but lead poisoning.
Dr. Sattler pointed to a pilot study in Rhode Island
as an example of ways to address the problem of
lead poisoning in children. As part of the pilot
study, if a child is found to have lead poisoning,
health professionals can "do the equivalent of
writing a prescription to have children's homes
evaluated for lead contamination." The evaluations
are paid for with health department dollars. Dr.
Sattler noted, however, that the Rhode Island
program begins with a lead-poisoned child and
focuses, therefore, on responding to the problem
versus preventing it.
Pesticides
Dr. Sattler explained that pesticides are poisons;
most, however, have never been tested to see
how they affect fetal or children's nervous systems.
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She discussed how stuffed animals, pillows, and
rugs become "wicks" for pesticides when people
use roach "bombs" and other similar items in their
homes. This is an area where greater community
education is needed.
Major issues of concern regarding pesticides and
their effects on children include:
* the risk of leukemia for children increases 3.8
times when pesticides are used in the home
* the risk of leukemia for children increases by
6.5 times when pesticides are used on lawns
* children in families living in suburban areas are
particularly at risk because of the number of
lawns on which chemicals are used
* current standards for pesticide exposure are
based on adult white males. To compare
fetuses and children to adult males is like
"comparing apples to oranges."
Air Quality
Dr. Sattler stated that traffic is the number one
cause of air pollution. She stressed that we need
to adjust our ways of thinking to consider the
impacts of our actions on children's health. Vice
President Al Gore is currently leading an effort to
rethink how to plan for growth in a way that is less
harmful on human health.
Schools present another set of potential problems
with respect to children's health. Some of these
problems include:
* poorly ventilated schools with synthetic
products that give off chemicals that pose
health problems.
•!• school carpets contribute to poor indoor air
quality and asthma
* some schools are adjacent to Superfund sites
Dr. Sattler explained that risks to the female
reproductive system are posed by a variety of
environmental factors, such as:
* smoke stacks caused by waste incineration
(which is a particular problem caused by U.S.
hospitals)
* the creation of the by-product dioxin, generated
from the burning of plastics (dioxin is a
carcinogen that looks to the body like estrogen;
therefore, it has the potential to disrupt
endocrine systems)
Water Quality
During her presentation, Dr. Sattler pointed out that
under the Safe Drinking Water Act, every public
drinking water supplier will be required to produce
a consumer confidence report. This requirement
becomes effective in October 1999. The reports
will have to identify contaminants in water, their
levels, and probable sources. This information will
be included in water bills.
Community Activism
Dr. Sattler concluded her presentation by noting
that many opportunities exist through community
activism to protect children's health. She said
"although we are in a crisis situation, it is exciting
that we are thinking about opportunities to make
the world safer. The work of devising solutions for
our children and our children's children is Very
noble' work".
Tools for Success in Protecting
Children's Environmental Health
J
Ms. Angela Spittal, Chief of Staff, Indiana
Department of Environmental Management
(IDEM), presented information on an IDEM
initiative focused on children's health issues. The
initiative, "Bright Beginnings for Indiana's Children,"
is being carried out in collaboration with many
partners.
Ms. Spittal explained that in 1996, Indiana
Governor Frank O'Bannon established a multi
agency work group focusing on children's health
issues. The initiative began in fall 1997 with the
following goals:
»t» reduce children's exposure to toxic chemicals
* educate families
* involve children
* achieve a tangible outcome
Reducing Children's Exposure to Toxics
Ms. Spittal explained that this aspect of I OEM's
efforts to reduce children's exposure to toxics
consisted of a multi pronged approach focusing on
lead, toxic chemicals, mercury, and ozone and
particulate matter. Means to achieve the overall
goal of reducing children's exposure included:
Lead
* establish lead education grants for priority
neighborhoods
«> enhance protection from lead in drinking water
* train 100 people as lead risk assessors
Toxic Chemicals
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*• expand toxics monitoring network
«> announce Governor's toxic reduction challenge
(which was a challenge to business and
industry to voluntarily reduce their toxic air
emissions)
Mercury
* reduce the use of mercury by ventilation
contractors
* offer a "mercury collection day" in every county
Ozone and Paniculate Matter
•* establishment of seven regional ozone steering
committees
Educate Families
To meet the initiative's goal of educating families
as a step toward reducing children's exposure to
contaminants, IDEM developed a "simple steps for
families" effort, which included launching an
outreach campaign, complete with place mats,
billboards, posters, and public service
announcements.
In addition, Ms. Spittal explained that other efforts
were launched, such as:
»:» a self-assessment program for child care
centers, including the development of a "how-
to" manual
<• a 5-star environmental recognition program for
child care centers
* efforts to reduce the number of combined
sewer overflows (CSO) in Indiana and
educating parents on ways to keep children
away from CSOs
•> an outreach program and 1-800-number for
children's health issues
»:• development and distribution of "simple steps
to get the lead out" material
Involve Children
Efforts to involve children have included getting
15,000 students involved in providing IDEM with
environmental information, and educating the
students on the difference they can make in
creating a safer environment.
Achieve a Tangible Outcome
Ms. Spittal mentioned a variety of specific
accomplishments that have been achieved through
IDEM.'s initiative, including:
»:• $620,000 distributed for lead education and
mercury education
<• 2,100 pounds of mercury recycled
* Distribution of more than 20,000 educational
brochures, place mats, magnets and other
items
* Increased partnerships
*> Changed behaviors
«:« Reduction of toxics
* Prevention of lead poisoning
«> Improvement of children's lives
Ms. Spittal closed her talk by encouraging
participants to be persistent in their children's
health efforts, and she shared the following lessons
learned by IDE:M:
* set achievable goals
* expand existing partnerships
* involve partners in goal setting
* recognize factors beyond your control
* make children's health a priority
<• realize that you can't do everything, but you
should do something
More information about I OEM's children's health
initiative can be obtained on their web site
www state.in.us/idem/kids. Or, by calling Angela
Spittal at 317/233-3043.
Comprehensive Approaches to
Addressing Multiple Children's
Health Issues
Dr. Robert Amler, Chief Medical Officer, ATSDR,
presented information based on the foundation that
"Children are Not Small Adults." In his
presentation, Dr. Amler explained that the fact that
children are not small adults is a basic tenet to
pediatrics; however, the concept of treating
children as different from adults from an
environmental perspective is a relatively new
concept.
Pointing out specific differences between children
and adults, Dr. Amler stated that:
* Pound for pound of body weight, children drink
more water, eat more food, and breath more air
than adults
* Children are more likely to come in contact with
a variety of media
* Children are less empowered than adults
* Children are completely dependent on adults
for risk management, access to child care, and
other decisions
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Dr. Amler urged participants to see the differences
as an opportunity, not a problem, and spoke of the
following major issues, summarized below that
affect children's health.
* Saturation of mercury vapors into toys and
blankets
* Thousands of children being rushed to
emergency rooms for health problems caused
by use of roach spray in their homes (and most
are misdiagnosed)
* Fish contaminated by mercury and other
contaminants from industry operations (a
particular issue for tribal and other communities
who rely on fishing as a means for sustenance)
«:» Nearly 1 million American children have
excessive lead levels in their blood
* Early exposure to trichloroethylene and RGBs
result in less mature neonatal reflexes and
diminished IQS
* 50 percent of lifetime pesticide ingestion occurs
in the first 5 years of life
* Asthma death rates have doubled in American
children since 1980 (asthma is the most
common admission diagnosis in most
Children's hospitals)
ATSDR's Children's Health Initiative
Dr. Amler explained that ATSDR began its
children's health initiative about two years ago.
ATSDR has worked closely with the EPA Office of
Children's Health Protection. Basic tenets of the
ATSDR program include (1) emphasis on children's
health in ATSDR's own programs, (2) educating
ATSDR staff, (3) formation of an Office of
Children's Health, with a message that "Children
are not small adults!"
Major activities of ATSDR's Office of Children's
Health:
* pediatric referral units
* expert workgroups on pediatric assessment
* children's environmental health and safety task
force
»3> a web site
»:« partnerships with non-government entities
(medical associations, national Parent
Teacher's Association (PTA), children's health
environmental coalition, National Association of
Children's Health Organizations (NACHO)
Discussing one partnership as an example of
training children to be risk communicators, Dr.
Amler described an ATSDR partnership with the
Girl Scouts of America. Girl scouts can earn a "No
Lead" badge by investigating the history of mining,
health education, or historical problems caused by
lead in their communities.
thought of. Greater awareness ii'aeeded* Most
physicians specMiangiQ enviioflffieatal medicine
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«:• Neurological and developmental problems
prevail (lead, mercury, and endocrine
disrupters)
»:» Disconnect exists between environmental
programs and children's health. Questions
should be asked such as: Are programs
continuing to achieve health goals? Do
programs reflect new science regarding health
goals? What health goals are we trying to
accomplish?
Mr. Neltner expressed concern about the amount
of time it takes to build new scientific developments
into regulatory standards. He made the following
points:
»:» Disconnection is most significant at the
regional and state level: the focus is on
implementation, not assessment
«t» Piecemeal delegation leads to
departmentalization
* Environmental agency separated from the
public health agency is an example of weak
institutional links
* Bureaucratic obstacles and lack of regulatory
momentum exist because of a" we've always
done it that way" mentality
* Cautious programs with minimum standards
(Example: ozone standards were done
cautiously and defensibly, however, agencies
are slow to identify and respond to new issues)
* Federal programs focus on "regulatable
sources" that are able to be commanded and
controlled
»> Paternalistic system prevails in government
agencies ("we know best!" mind set, while
forgetting that standards are only minimum)
* Poorly understood but potentially significant
hazards exist: toxics, and endocrine disrupters
(We need to get information out on what we do
know about these hazards)
Mr. Neltner pointed out that information gaps do
exist in many areas regarding health risks in
general and children's health risks in particular. He
suggested, however, that agencies and
organizations "embrace right-to-know" to fill in the
gaps. He offered several models of success in this
area, including:
Toxics Release Inventory data
Worker right-to-know/hazard communication
Risk management planning
Fish consumption advisory data
Mr. Neltner suggested that organizations who
generate children's health threats should
communicate those threats directly to those
threatened. Government agencies establish
requirements and ensure quality, but they should
not necessarily relay all information. He pointed
out that a key issue is trust ~ and, in particular,
whether those with the information believe that they
can trust parents and guardians with the
information. Agencies and organizations often
believe that parents and guardians will "over react"
to information about health threats. Instead of
allowing mistrust to prevail, Mr. Nelter said that key
information should be disseminated, and (partial or
complete) answers to the following questions
should be provided:
What is known about the hazards?
What precautions should be taken?
What critical information gaps exist?
Mr. Neltner explained that proactive notice and
information dissemination should be a focal point of
organizations and agencies, to put the control in
the parents' hands. He also pointed out that
threats to sensitive populations need to be taken
into account (those who are not representative of
the population, chemically-sensitive individuals,
and sick children).
CONTACT:
Tom Neltner
Improving Kids' Environment
5244 Carrollton Ave.
Indianapolis, IN 46220
Phone: (317) 442-3973
Fax:(317)283-6111
e-mail: neltner@in.net
Consumer Product Labeling
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Participants in the Chicago Asthma Initiative
include employees at the U.S. Department of
Health and Human Services, researchers at the
University of Illinois, Circle Campus, and members
of the Chicago Asthma Association. The goals of
the initiative are as follows:
* Facilitate outreach and education about
asthma in communities
<» Assist in asthma prevention
<• Provide education and preventive services to
families suffering from asthma
* Offer services to communities that have a
greater risk of asthma
<• Train and employ members of the community
to help spread asthma education and
prevention
Asthma Train-the-Trainer
Mr. Ron Burke from the American Lung Association
of Metropolitan Chicago discussed some of the
association's programs for schools and students
that focus on education about and prevention of
asthma. Some of the programs include Open
Airways for Schools (OAS) and the Sesame Street
A is for Asthma Childhood Asthma Awareness
Program.
The OAS program is directed at children with
asthma aged 8 to 11. It is based on the idea that
children learn by doing. The OAS program
includes six curriculum lessons, flipcharts, an
instructor's guide, and numerous handouts about
asthma triggers and prevention tips. OAS has
documented that children have fewer and less
severe asthma attacks after completing the
program. In addition, parents have taken more
steps to help control their children's asthma. OAS
has been implemented in 40 schools in the
Chicago area.
The Sesame Street A is for Asthma Childhood
Asthma Awareness project is geared toward
children ages 3 to 6. A kit developed for the project
includes a videotape in English and Spanish,
posters, and a caregiver's guide. The goal of the
project is to increase awareness about asthma.
The program has been implemented in 30 sites in
Cook County, Illinois, and over 2,000 children have
been given the program. In addition, over 250 kits
have been distributed in the Chicago metropolitan
area.
Mr. Burke also discussed several barriers
encountered during the implementation of these
programs, including getting parents involved,
having program volunteers report results, getting
into schools, and obtaining financial support.
Facilitated Discussion
J
Mr. Randy Cano of the U.S. Environmental
Protection Agency (EPA) Region 5 facilitated a
discussion on asthma prevention. The following
key issues were raised during the discussion:
1. Need for overall public awareness about
asthma
2. Need for parental behavioral changes
3. Education of physicians and clinics about
asthma
4. Generation of community activism with regard
to air quality
5. Exploration of holistic options and alternatives
to asthma management
6. Awareness of policy makers and government
to asthma problems
CONTACTS:
Steven R. Potsic. M.D.. M.P.H.. FACPM
U.S. Department of Health & Human Services
105 West Adams Street, 17th floor
Chicago, Illinois 60603-6201
Phone:(312)353-1385
Fax:(312)353-0718
Ron Burke
American Lung Association of Metropolitan
Chicago
1440 West Washington Blvd.,
Chicago, Illinois 60607-1878
Phone:(312)243-2000
Fax:(312)243-3954
Linda Ruskowski. R.R.T.
Community Hospital South
1402 E. Co. Line Rd. S.
Indianapolis, Indiana 46227
Phone:(317)887-7402
Fax:(317)887-4770
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Mr. Phil Nixon of the University of Illinois, Mr. Todd
Okamoto of the U.S. Environmental Protection
Agency (EPA) Region 5, Ms. Amy Brown of the
University of Maryland, and Mr. Steven Brachman
of the University of Wisconsin presented several
approaches to reducing pesticides exposure of
children in the United States.
Preventing Pesticide Exposures at
Home
J
Mr. Phil Nixon, an entomologist from the University
of Illinois Extension Service, discussed how to
prevent pesticides exposure in residential lawns and
in the home.
Mr. Nixon described the "golf course standard" that
many homeowners strive toward when maintaining
their lawns. In most cases, he said, homeowners
apply too much pesticides to achieve a "perfect"
lawn completely free of weeds. He posed the
question of whether a beautiful lawn has to be
weedless or pestless. He showed a photograph of
a tree at a golf course that was infested by leaf
hoppers to demonstrate that even golf courses are
not perfect. He reported that many so-called plant
pests are actually not very harmful. Another
photograph showed that a tree infested by the
Japanese beetle still served as a good shade tree.
Mr. Nixon then turned his attention to insects in the
home. He asserted that many nuisance pests such
as winged ants and spiders are not harmful and
therefore do not have to be eradicated with
pesticides. He recommended simply vacuuming up
the nuisance pests and disposing of them outside,
which eliminates the problem and does not leave
harmful chemical residues in the home.
Mr. Nixon reported that as median income rises, so
does intolerance to pests. More affluent
neighborhoods generally have better-manicured
lawns and homes free of nuisance pests. These
conditions are maintained primarily by the use of
many pesticides. He stressed the need to change
the general attitude toward weeds and pests. He
stated that not all weeds or pests have to be
eradicated with harmful chemicals.
Mr. Nixon introduced the concept of integrated pest
management (IPM), which he defined as the
combination of environmentally compatible and
economically feasible management methods. He
referred to subsequent presentations for more
details on IPM. He stated that when pesticides
must be used, applicators should keep the tips
below in mind.
* Read the label on pesticides products carefully.
* Wear protective clothing such as gloves when
using pesticides.
* Store pesticides where children cannot reach
them.
«> Triple rinse empty pesticides containers before
disposing of them.
Insecticidal Chalk in Chicago
Mr. Todd Okamoto of EPA's Office of Pesticide
Programs described an illegal chalk product from
China that has resulted in the hospitalization of one
Chicago child who ate it. He stressed the need to
bring awareness of this toxic chalk to the Asian
community. When asked what active ingredients
comprise the chalk, Okamoto stated that permethrin
was probably one of them, but he was unsure
because it is an unregistered product. The chalk is
currently not illegal in China, and it is being imported
into the United States.
A town meeting on insecticidal chalk was held in
Chicago to discuss ways to educate businesses and
residents about health risks associated with using
the illegal product. The meeting brought together
the following groups:
<« Chicago Asian community groups
»> Chicago African-American community groups
* Chicago Hispanic community groups
* Minority advocacy groups
* Community business groups
* Poison control specialists
* Import brokers
* U.S. customs agents
»»» University of Illinois Extension Service
»:• Federal and state pesticide regulators
•> Concerned parents
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Educating Parents, School Staff, and
Nurses about Prenotification
Application
newsletter, and provides links to pesticides-related
references and resources.
Ms. Amy Brown, entomologist from the University of
Maryland, described a new law in Maryland that
mandates school IPM programs and requires the
posting of signs in school areas where pesticides
are being used. She reported that pesticides are
widely used in schools because of the perceived
need that insect pests need to be controlled in that
environment. School IPM programs are currently
also required in Louisiana, Michigan, Texas, and
West Virginia.
Ms. Brown and her colleagues at the University of
Maryland conducted a survey of pesticides control
strategies in schools. Survey respondents included
staff members and parents of children at Anne
Arundel Public Schools. The schools have initiated
a voluntary prenotification program that involves
informing school staff and parents of anticipated
pesticides application activities at the beginning of
the school year, followed by another notification
immediately prior to the application.
Preliminary results of the University of Maryland's
1999 survey showed that about 50 percent of the
parents and 30 percent of the staff surveyed did not
remember receiving prenotification within the past
year. In terms of actions taken in the response to
notification, 44 percent of parents and 16 percent of
staff members watched for possible symptoms in
the children. About 86 percent of parents and
90 percent of staff did not notice symptoms
associated with the application, but 3 percent of
parents and 4 percent of staff thought they did. Of
the 3 percent of parents who noticed symptoms in
their children, 30 percent brought their children to
the doctor; 56 percent of the parents did not have
their children diagnosed. Most respondents
preferred prenotification at the beginning of the
school year, as well as another notification
immediately prior to the application. Half of the
parents and 64 percent of the staff surveyed stated
that the school provided enough information about
the pesticides application.
Ms. Brown reported that the University of Maryland
and the Maryland Department of Agriculture have
jointly developed resource guides and conducted
training for pesticide applicators. For more
information on the University of Maryland's pesticide
education and assessment program, Brown
directed the audience to the following web site:
http:\\www.pest.umd.edu. The web site currently
features information on the impacts of pesticides on
migrant and seasonal laborers, includes a pesticide
Neighborhood Spray Notification,
Education, and Prevention Program
Mr. Steven Brachnnan, a waste education and
management specialist at the University of
Wisconsin Extension Service, presented a
discussion of Wisconsin's landscape registry and
how it can improve children's health. Brachman
stated that the registry contains names and
addresses of homeowners who hire commercial
pesticides applicators to treat their lawns and the
contact information for their neighbors. Under the
program, pesticides applicators are required to
notify others in the neighborhood prior to spraying.
The program was established in 1993 in response
to concerns about over spraying of herbicides and
potential children's health risks. It ensures that
residents are notified about pesticides applications
in their neighborhoods so that they can take the
necessary steps to protect themselves and their
children. Brachman reported that the registry has
grown from 500 households in 1993 to over 1,000
households today. Dane and Milwaukee Counties,
the two most populous counties in Wisconsin,
comprise over half of the state registry. The
program is currently promoted primarily by word of
mouth
Mr. Brachman stated that the registry has a strong
potential to increase educational awareness about
the risks posed by pesticides application and ways
to reduce exposure. He stressed the need for
stronger partnerships with educational organizations
and increased outreach efforts on the matter. He
suggested that targeted pilot studies may generate
more information about pesticides use.
Facilitated Discussion
J
Ms. Sue Brauer and Mr. Peter Murchie of EPA
Region 5 facilitated a discussion on pesticides
prevention around the home, school, and
neighborhood. The following key issues were
raised during the discussion:
* Expand the scope of pesticides education
awareness programs to include pesticides use
from all sources, not just landscape
improvement
* Identify funding opportunities on the regional
and federal levels to promote awareness of
pesticides
-------
* Change the public perception of the need for
the "perfect lawn"
* Consider alternative ways to control pests
* Compile a children's environmental health
clearinghouse or compendium of information
(for example, on the EPA homepage) that links
to efforts on the state and local levels
* Educate parents, school nurses, primary care
physicians, and politicians, among others, about
risks associated with pesticides and how to
reduce the exposure of children
«> Continue to work with county extension
agencies and collaborate with local efforts on
reducing pesticide use (an EPA role)
* Explore other avenues and programs to
increase awareness about pesticides risk and
use
* Increase attention on this issue, especially
among private applicators, by increasing the
focus on cost, in addition to health, issues
This list of discussion topics was narrowed down to
the following three to be considered for the action
plan:
* Need for clearinghouse of information
* Incorporation of pesticides awareness into
educational programs for public and pesticides
users
* Broaden view of pesticides awareness to
include more than landscape management
CONTACTS:
Phil Nixon
University of Illinois at Urbana-Champaign
1103 W. DornerDr.
Urbana,IL61801
Phone(217)333-6650
Fax (217) 244-1507
Dr. Amy Brown
Associate Professor, Department of
Entomology
Coordinator, Maryland Pesticide Education &
Information Programs
University of Maryland,
College Park, Maryland 20742
Phone:(301)405-3913
Fax:(301)314-9290
Steven D. Brachman
University of Wisconsin-Extension, Solid &
Hazardous Waste Education Center
161 W. Wisconsin Ave., Suite 6000
Milwaukee, WI 53206-2602
Phone(414)227-3160
Fax (414) 227-3165
e-mail: brachman@uwm.edu
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&" #?
Ms. Jane Storey and Ms. E.J. Schumaker, from the
Lincoln-Lancaster County Health Department,
provided advice for training day care and health
care workers in environmental health issues and
discussed their own efforts. Dr. Daniel Hryhorczuk,
an environmental health physician, spoke about the
role of doctors in environmental health and the
barriers to training physicians in this environmental
health specialty. Issues discussed are summarized
below.
Starting an Environmental Health
Program for Health Care and Day
Care Providers
Ms. Storey offered the following advice for people
seeking grants to set up environmental health
training programs with health care and day care
centers.
* Make a list of all health care and day care
centers and providers in your area.
* Ascertain which centers and providers already
have environmental health or related programs
and which ones you can contribute to.
* Find out which laws apply to health care and
day care providers in your state.
* Work with the general public through activities
such as sending mailings to parents of children
at day care centers.
* When applying for grants from the U.S.
Environmental Protection Agency (EPA), get a
mentor from the agency who will help you
through the grant application process.
Ms. Schumaker works with a program called Kids in
Touch Environmentally (KITE). She discussed her
experience with establishing a food safety outreach
program for children at day care centers. She uses
games, pictures and other activities to show day
care providers how to relate food safety to children.
The goal of the food safety program is to encourage
children to be proactive and think about cleanliness.
The KITE program includes five other topics,
including a program on lead.
The Role of Physicians in
Environmental Health
Dr. Hryhorczuk spoke about the following roles of
physicians in environmental health:
* To provide care and advice for individuals;
«> To be advocates for individuals by
communicating with employees, the public,
environmental health authorities and landlords;
* To be involved with the community and to
advise and educate citizens; and
* To participate in environmental health policy
making.
Dr. Hryhorczuk also pointed out that there are
several barriers faced by doctors wanting to
become involved in the environmental health field,
including a lack of training in the field, little
reimbursement and time for practicing
environmental health, and addressing legal and
administrative burdens. There are several "core
clinical competencies" in the environmental health
field with which doctors should be familiar; these
include understanding the influence of the
environment on human health, being able to elicit
an environmental history from a patient, and
understanding the legal and ethical issues involved
in seeing patients with environmental health
problems.
Environmental health resources in the Great Lakes
area are listed below.
* National Institute of Occupational Safety and
Health (NIOSH) Education and Research
Center, which offers health hazards evaluations
for communities.
* National Institute of Health (NIH) Fogarty
Center.
* World Health Organization (WHO)
Collaborating Center.
•> Toxicon, which offers 24-hour access to a
toxicologist, at the University of Illinois.
»> Center of Environmental Health (CEH).
Dr. Hryhorczuk informed the audience that the CEH
works with parents, and the other centers are for
health care professionals.
-------
The attendees broke out into groups and then
identified the following three action items:
1. To provide stable funding for an accurate
center, with a repository of resources, for health
care and day care providers. This repository
should include both web-based and hard
copies, include both EPA and non-EPA
resources, and include case studies and list
uses for each of the resources.
2. To train the trainer in an ethically and culturally
specific manner.
3. As a prevention strategy, to use environmental
issues to seek economic justice.
CONTACTS:
A. Jane Storey
Environmental Health Specialist
Environmental Health Division
Lincoln-Lancaster County Health Department
3140 "N" Street
Lincoln, NE 68510
Phone: (402)441-8025
E.J. Schumaker
Grant Coordinator
Environmental Health Department
Lincoln-Lancaster County Health Department
3140 "N" Street
Lincoln, NE 68510
Phone.: (402)441-8638
Daniel Hryhorczuk
Cook County Hospital, Division of
Occupational Medicine
1900 West Polk Street, Suite 500
Chicago, IL 60612
Phone(312) 633-5310
Fax (312) 633-6442
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During this workshop, Ms. Marge Altergott,
Mr. Victor Ceballos, and Ms. less Aldrich spoke
about environmental education relating to children's
health issues. Ms. Altergott is from Health
Organizing through Popular Education (HOPE),
which deals with community wellness issues.
Mr. Ceballos works with the Little Village
Environmental Justice Organization on a project
called the Bucket Brigade that deals with air quality
issues and with schools built on contaminated land.
Ms. Aldrich works at the Alivio Medical Center in
Chicago with the Child to Child health program.
Child to Child is an international health promotion
program founded on the belief that children have
the power to effect change in their lives. Founded
in 1979, the program has spread to 80 nations
worldwide.
Popular Education
J
Ms. Altergott provided an overview of the concepts
behind popular education. A simple definition of
popular education is education "of the people, by
the people, for the people." Popular education
depends on the six key principles summarized
below.
Education is not neutral: People who teach have
their own political agenda. Education can either
maintain the status quo by teaching people the
values or culture of the majority, or liberate people
by helping them become creative and free.
Content comes from the participants: One
cannot know what the issues are and keep them
relevant to the people if the members of the
community are not involved. People will act on
issues they feel strongly about; therefore, educators
should start by identifying issues that local people
feel strongly about.
Dialogue: By participating, people shape the
content of a program through working together
cooperatively. Each person has something unique
to bring to a discussion. Everyone needs to be a
learner and a teacher. Education is a mutual
learning process.
Problem-posing education: A facilitator can help
participants learn by asking questions rather than
lecturing. In this way, people can learn to develop
skills in critical analysis.
Reflection and Action: The information people
share is reflected by a body of knowledge called
"popular knowledge," which develops from group
work. This leads to discussion of planning, which
eventually leads to action. This process of reflection
and action is ongoing and given time, will lead to
transformation.
Transformation: Ultimately, popular education is
aimed at transformation. Education should work to
transform the quality of each person's life, the
environment, community, and entire society.
Popular education is an ongoing creative process
that may take years to flower in a community.
Popular Education and the Child to
Child Health Program
Ms. Aldrich provided a brief overview of how the
Child to Child health program uses popular
education to promote public health through children.
Child to Child came to the United States in 1983
and was started in Chicago at the Pilsen Little
Village neighborhood. The Child to Child health
program process is summarized below.
* Children name the health issues that they feel
affects them the most or are their biggest
concerns through an interactive activity.
•> After learning about that topic, children plan an
action to help educate other people in their
communities, schools, and families about the
topic. Activities range from making up skits,
posting flyers in public places, to writing letters
to community leaders.
<» All the activities are planned and implemented
by the children themselves. In this way, the
children become the "owners" of the program.
The children are referred to as "health
promoters." This gives them a sense of
responsibility and pride.
* Each program is unique because the children
pick the issues that they want to learn about.
-------
Popular Education and the Little
Village Environmental Organization
Mr. Victor Ceballos provided a real-life example of
how popular education is working for the Little
Village Environmental Organization. The Little
Village Environmental Organization was established
in 1997 as a response to proposals to build new
elementary schools on or near Brownfields, drum
recyclers, and other unsafe areas.
In 1997, Mr. Ceballos worked with high school
students, grammar school students, and two
second-year medical students to prepare a short
skit aimed at educating community members about
the dangers of a nearby Brownfields site. The
children went door to door for 2 weeks speaking to
their neighbors about the site and inviting them to a
community meeting. Members of the community
met in one of the high school student's back yard.
The meeting started with a skit about how
contamination from the Brownfields site can enter
the homes of community members. A 2-hour
community discussion followed the skit in which
members discussed the health hazards associated
with the Brownfields site and educated each other
about related issues.
The Little Village Environmental Organization
example shows how popular education can help
people of all ages identify health issues that affect
them and educate other members of the community
about these issues.
CONTACTS:
HOPE
Ms, Joyce Bowen
Phone: (773)942-2451
Marjorie Altergott PhD.
Health Organizing Through Popular Education
(HOPE)
4022 N. St. Louis
Chicago, IL 60618
Phone: (773) 583-6876
Fax: (773) 509-9725
Victor Ceballos
General Wood Boys and Girls Club
2950 W. 25th Street
Chicago, Illinois 60623
Phone: (773) 247-0700
Tess Aldrich
Alivio Medical Center
5417N. Glenwood
Chicago, IL 60640
tessa 12(g),hotmail.com
Mary Nelson
Bethel New Life, Inc.
367 N. Karlov
Chicago, IL 60624
Phone: (773) 826-5540
Fax: (773) 826-5728
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Mr. Matt Schullick of the Chicago Health Corps,
Dr. Vicky Persky of the University of Illinois Chicago,
and Mr. Terry Allen of the Cuyahoga Board of Health
spoke about respiratory ailments and approaches to
educating the community about these ailments.
Clean Air for Schools Campaign
J
Mr. Matt Schullick from the Chicago Health Corps
discussed the Clean Air for Good Health in Schools
project that focused on increasing community
knowledge about indoor air quality (IAQ) in five
Chicago area schools.
The goals of the project were: (1) to raise awareness
about IAQ and its relationship to health outcomes, (2)
educate school communities, and (3) perform
environmental assessments.
Mr. Schullick described the importance of IAQ
because people in the United States spend 90
percent of their time indoors. IAQ problems can lead
to spread of infectious diseases and increased long-
term and short-term health problems, including
respiratory conditions and tissue irritation. With
respect to schools, IAQ problems can lead to an
unfavorable learning environment, reduced student
productivity, and accelerated school deterioration.
A clean air checklist was developed to determine the
main pollutants in the classroom. This one-page
checklist, to be filled out by teachers, asks questions
regarding classroom cleanliness, presence of
animals, excess moisture, thermal comfort,
ventilation, renovation, and chemicals used for
maintenance and cleaning. Project volunteers
informed the school staff about what they could do to
improve IAQ. Teachers were told they should
communicate classroom IAQ issues to engineering or
maintenance staff, report spills and smells, remove
chemicals from the classroom, and report
temperature differences.
The project team conducted a chemical inventory in
each classroom of each of the five schools
participating in the study. The team did an analysis
and summary of findings to determine safe
alternatives for hazardous chemicals and to develop
a proper storage plan. Results were shared with
school staff. In addition, the school airways and vent
shafts were cleaned of foreign material.
Finally, Mr. Schullick discussed lessons learned
during the project. Establishing good relationships
with the schools was very important, and technical
expertise was only secondary. Mr. Schullick
suggested that schools encourage parents to get
involved and establish interactive clubs that would
educate students about respiratory ailments.
Asthma Education
Dr. Vicky Persky of the University of Illinois Chicago
discussed educating communities about asthma and
asthma prevention.
Dr. Persky reported that the prevalence of asthma is
increasing yearly. Risk factors include low birth
weight, smoking, and a young maternal age.
Hospitalization for asthma is higher in younger age
groups and higher after increased ozone levels and
high pollen counts. Asthma is more widespread in
poverty-stricken neighborhoods.
Persky focused on asthma in schools and discussed
several ways schools can help prevent asthma.
Schools should provide a medication policy, training
about asthma for nurses, a protocol for teachers,
presentations for parents and school staff, and take-
home brochures for parents.
Dr. Persky discussed the Community Asthma
Prevention Program (CAAP) Asthma Association.
The goal of CAAP is to increase asthma knowledge
in communities to help prevent the disease. CAAP
has educational programs based on the Head Start
program, Catholic and public schools, and
community-based health centers. CAAP volunteers
developed culturally sensitive materials to distribute
within communities as well. The program trained peer
educators to work with parents. The peer educators
and asthma experts made presentations in
communities and schools to spread asthma
education. These presentations were well received by
families. The CAAP program has helped reduce
hospitalizations related to asthma by 50 to 75 percent
in communities.
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Infant Mold Disease: Community
Education and Intervention
Mr. Terry Allen from the Cuyahoga County Ohio
Board of Health described infant mold disease and
discussed options for prevention of and education
about the disease.
Infant mold disease is also described as "bleeding
lung disease" and is associated with pulmonary
deterioration and hemorrhage. The Board of Health,
in conjunction with the Centers for Disease Control,
the Ohio Department of Health, and the Cleveland
Department of Public Health, studied 43 cases of
infant mold disease. Thirty of the cases occurred in
males, and fifteen of the cases resulted in death. The
cases occurred in the poorest parts of the county.
Mr. Allen reported that infant mold disease occurs
because of mold and water problems in buildings.
Mold can form on dry wall, and water can be a
problem from leaking roofs and condensation. He
discussed ways to control moisture and mold to help
prevent infant mold disease.
Mr. Allen stated that the keys to the success of the
study were the full cooperation of medical, public
health, and housing agencies, and the building of
personal relationships and sharing successes
between the agencies.
Facilitated Discussion
J
Mr. Randy Cano of EPA Region 5 facilitated a
discussion on respiratory ailments. The following key
issues were raised during the discussion:
1. Link housing and public health agencies with
medical groups.
2. Create community coalitions to address
respiratory issues.
3. Involve the community, parents, and schools to
address asthma issues.
CONTACTS:
Dr. Victoria Persky
University of Illinois - School of Public Health
2121 W.Taylor Street
Chicago, IL 60612-7260
Phone:(312)996-4783
Fax:(312)996-0064
Matthew Shullick
Environmental Health Coordinator
Project Director, Clean Air for Good Health in
Schools Project
Chicago Health Corps,
845 South Damen Avenue, 11th Fl.
Chicago, Illinois 60612-8945
Phone:(312)413-7892
Terry Allan
Cuyahoga County Board of Health
One Playhouse Square
1375 Euclid Ave, 5th Floor
Cleveland, Ohio 44115-1882
Phone:(216)698-2380
Fax:(216)443-5655
e-mail: tallan@netincom.com
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Mr. Lame identified the three questions below which
be addressed when implementing an IPM program.
Mr. Marc Lame of the Indiana University-Bloomington,
Ms. Karen Delahault of the University of Wisconsin
Madison, and Mr. David Rountry of the Washington
State Department of Ecology discussed integrated
pest management (IPM) programs in schools. Issues
discussed are summarized below.
Pollution Prevention and IPM in
Schools
J
Mr. Marc Lame, an entomologist and faculty member
at the School of Public Environmental Affairs at
Indiana University-Bloomington, discussed IPM at
child-sensitive facilities, including day care centers
and elementary, middle, and high schools. He
described a study that he and his colleagues
conducted that introduced IPM to schools in the
Monroe County Community School Corporation. He
touted IPM as a "win-win" situation.
Mr. Lame reported that IPM is mandatory in several
states, including Louisiana, Michigan, Texas, and
West Virginia, and added that Illinois and Montana
are also experimenting with voluntary IPM programs.
He stated he prefers the voluntary approach because
legislative mandates of IPM in schools can give
special interest groups the opportunity to subvert IPM,
and IPM laws have generally resulted in unfunded
mandates.
Mr. Lame stated that there has been a recent shift in
the pesticides management paradigm. Specifically,
the focus has moved from the traditional approach of
hiring commercial pesticides applicators to the new
approach of educating support staff (including
custodians, maintenance workers, kitchen staff,
administrators, and teachers) and students about the
risks associated with the use of pesticides. Similarly,
there has been a movement towards IPM, from
cultural, chemical, and mechanical controls to
monitoring, prevention, and treatment.
*
What action needs to be taken?
:» Who should take those actions?
> Are resources available to implement
actions?
the
He described the implementation of IPM in schools as
a five-step process involving the following:
1. Awareness - Disseminate information about
pesticides use through mass media and
interpersonal communication.
2. Persuasion - Communicate evidence that
IPM will meet the community's needs.
3. Decision - Demonstrate that IPM will meet
the community's needs by using results from
model and pilot programs.
4. Implementation - Communicate the process
of matching the positive attributes of IPM with
mitigating the negative attributes of pests.
5. Confirmation - Communicate the fact that the
decision to adopt the program worked.
Mr. Lame reported that the approach used in his study
on schools in the Monroe County Community School
Corporation resulted in the reduction of pesticides use
by 92 percent in participating schools over a 3-year
period. He listed the following recommendations
when implementing IPM in schools:
* Coordinate and communicate about policies and
the implementation plan among agencies
involved in the management of child-sensitive
facilities
•> Increase outreach to school district decision-
makers.
* Continue analyzing the costs and benefits
associated with IPM in schools.
*> Adopt pesticides application prenotification
policies.
* Explore means to fund IPM programs (currently
no funding sources).
* Coordinate existing IPM resources for national
use (do not "reinvent the wheel").
* Feature IPM programs at annual meetings and
workshops.
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Reducing Pesticides Use in Turf
J
Ms. Karen Delahaut, an IPM outreach specialist at the
University of Wisconsin Madison, discussed ways to
reduce pesticides use on school athletic fields. She
acknowledged that pesticides use reduces the risk of
children tripping and falling. Pesticides usage on
school fields may be a source of pesticide exposure
to children.
Ms. Delahaut stated that a study of school grounds
personnel has shown that many do not have
appropriate training in pesticide application. She
reported that although lawn care companies and farm
cooperatives are required to be certified, school
custodians whose primary responsibility is not to apply
pesticides do not undergo pesticides application
training.
Ms. Delahaut along with others at the University of
Wisconsin created an IPM manual for schools
and initiated a pilot, hands-on IPM program this year
that included a range of communities and scenarios
(eg., urban and rural communities). By the year 2000,
she aims to expand the IPM program to include 25
schools. A trainer's manual is currently being
developed for distribution to other agencies.
Ms. Delahaut stated that the IPM manual for schools
and the trainer's manual that is being developed will
be on the Internet at: http:\\ipcm.wisc.edu.
Community Partnerships for Safer
Pest Control at Schools
Mr. David Rountry from the Washington State
Department of Ecology began his presentation by
distributing a blue book entitled "Calculating the True
Costs of Pest Control," which was recently released
by the Hazardous Waste and Toxics Reduction
Program of his agency the previous week (Publication
99-433). He described the resource as a compilation
of IPM success stories. He reported that
demonstration sites are showing the success of IPM
and new practices. He redefined IPM as "intelligent"
pest management.
Mr. Rountry described Washington State's 5-year-old
IPM program. He added that the U.S. Environmental
Protection Agency (EPA) Region 10 is involved in his
state's program. He described Washington's Master
Gardeners Program as an example of an effective
IPM program. The program promotes
environmentally prudent horticultural practices and
attempts to identify alternatives to conventional pest
eradication methods.
Mr. Rountry also described a workgroup on statewide
IPM programs in schools. He stated that EPA Region
10 provided funds and a representative to facilitate
the workgroup's discussions. He emphasized that
IPM goes beyond pest control — it measures the
ability of members in a community to cooperate. He
reported that by working with various stakeholders at
workgroup meetings, clear objectives are identified
from the start. The workgroups focus on outcomes,
not just actions.
Facilitated Discussion
J
The session ended with a discussion about IPM
facilitated by Ms. Sue Brauer and Mr. Peter Murchie
of EPA Region 5. Brauer and Murchie reviewed
issues raised and asked for suggestions of issues to
consider for the action plan. The following key issues
were raised during the discussion:
* Consolidate resources into a national database.
* List resource people and have them talk with
stakeholders on the local level.
* Funnel more funds to states for IPM program
implementation.
* Consider a child-specific environmental budget
line item.
»> Explore methods of information delivery to
department heads of buildings and maintenance
at schools.
CONTACTS:
Marc L. Lame
Indiana University, School of Public &
Environmental Affairs
Bloomington, Indiana 47405-2100
Phone:(812)855-7874
Fax: (812) 855-7802
e-mail: mlame(a),indiana.edu
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Karen Delahaut
University of Wisconsin-Madison
Department of Entomology
1630 Linden Drive
Madison, WI 53706
Phone: (608) 262-6429
Fax: (608) 262-3322
email: kadelaha@facstaff.wisc.edu
David D. Rountrv
Washington State Department of Ecology
P.O. Box 47600
Olympia, Washington 98504-7600
Phone: (306) 407-6749
Fax (360) 407-6715
e-mail: drou461 @.ECY.WA.GOV
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Duringthisworkshop.Ms.TamiJohnsonfrom
thelndianaDepartmentofEnvironmental
Management(IDEM),Ms.KadiRowfromthe
NationalHome*A*SystProgram,andMs.Sally
PatrickfromtheMinnesotaPollutionControl
Agency(MPCA)spokeaboutresources
availabletocommunitymemberstohelpreduce
theamountoftoxicchemicalschildrenare
exposedto.lssuesdiscussedaresummarized
below.
Self Assessments for Child Care
Facilities to Prevent Health Risks
Ms. Johnson of IDEM introduced the Indiana
Five-Star Environmental Recognition Program
for child care facilities. This program focuses on
preventing environmental threats to health and
safety and includes tools such as a user-friendly
self assessment to identify risks and take
specific actions to reduce those risks. This plan
focuses on the three core issues summarized
below.
Environmental Threats: Preventing exposure
to hazardous substances such as asbestos,
radon, mercury, pesticides, mold, tobacco
smoke, and lead.
Health and Safety: Providing training on
building safety, fire and emergency planning,
chemical safety, and bloodborne pathogens.
Environmental Stewardship Opportunities:
Providing education to families on topics such as
recycling and energy efficiency.
The Five-Star program has the following
characteristics:
* Completely voluntary: It will have no
licensing bearing on the child care facility.
<» Not a new set of regulations: Some activities
outlined in the program are already required
by law. The program aims at providing easy-
to-understand, inexpensive steps to
decrease health and safety environmental
risks.
* An educational tool: This program should
promote awareness of which environmental
toxins can exist at various child care facilities
and what can be done to educate the child
care staff about toxins used at work.
The five components of the Five-Star program
are summarized below.
1. Environmental Pledge: A commitment health
care providers must make to protect children
from environmental threats.
2. Self Assessment: Steps outlined in an easy-
to-understand publicly available booklet that
allows health care centers to give
themselves a high or low risk rating.
3. Five-Star Recognition: An award bestowed
upon child care facilities to recognize their
accomplishments. Facilities can receive 1, 3,
or 5 stars depending on their condition. The
star rating needs to be renewed every 2
years.
4. Confidential On-Site Telephone Assistance:
A toll-free assistance number for facilities
that have questions regarding the application
process, technical terms, or any other
program-related questions.
5. Guidance Manual: Detailed information for
child care facility managers. The manual
includes easy-to-understand explanations
and demonstrations of environmental health
regulations.
Over 50 child care facilities in Indiana currently
participate in the Five-Star program.
National Home Assessment Program
Ms. Kadi Row of the Nat'l Home *A* Syst
Program spoke about using the National Home
Assessment Program (Home*A*Syst).
Home*A*Syst is a national educational program
based at the University of Wisconsin at Madison.
It targets parents, renters, and homeowners and
challenges them to look at environmental risks in
the home. The program was designed to help
an individual conduct a whole home
environmental and health audit.
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The program is driven by a comprehensive guide
book that each state can adapt to fit individual
state needs.
Health issues described in the manual include
drinking water, pesticides and other hazardous
products, indoor air quality, lead, and food
safety. Each chapter starts with background
information on each issue and an explanation of
why the issue is of concern. An assessment
checklist follows that individuals can use to rate
risks in their homes as low, medium, or high.
The manual also guides the user to create an
action plan to decrease health risks in "high"
rated areas.
Roots of Hazard: Household
Hazardous Waste School Educational
Tool
Ms. Sally Patrick of the MPCA spoke about an
interactive, computer-based school educational
tool she helped develop to inform children about
household hazards. Roots of Hazard is a free
CD-ROM software developed for use in
Minnesota schools. It is a game that helps
children explore the proper use, storage, and
disposal of household hazardous products.
Roots of Hazard was developed through a grant
and intended for license-free use on individual
computers and computer laboratories.
The game was tested on 5th and 6th grade
students. After the first session, students were
able to recall at least one of the main learning
objectives.
Roots of Hazard is also easy to install. A single
copy of the CD-ROM can be used to install the
software onto an unlimited number of
computers. Through the use of puzzles,
problem-solving activities, and matching games
students can accomplish the following:
* Learn to identify different types of
hazardous household products.
* Understand the importance of label
reading and signal words.
* Develop and improve their computer
skills by using interactive courseware.
Over 5,000 CD-ROM disks of the Roots of
Hazard were printed. Of these disks, two copies
were sent to each school district in Minnesota,
500 were sent to Hamline University, 250 were
sent to science museums, and 500 stayed at the
MPCA.
The project has been effective. When tested, 38
percent of students recognized signal words
(caution, warning, danger, and poison), 24
percent understood hazard levels, and 30
percent could recognize hazard symbols.
CONTACTS:
Tami Johnson
Indiana Dept. of Environmental
Management
P.O. Box 6015
Indianapolis, Indiana 46206
Phone:(317)233-5628
Fax:(317)233-5627
e-mail: tsjohnson@,dem.state.in.us
Kadi Row
Home*A*Syst Program
University of Wisconsin-Madison, B142
Steenbock Library
Madison, Wisconsin 53706
Phone: (608) 265-2774
Fax: (608) 265-2775
e-mail: krow(o>facstaff. wisc.edu
Sally Patrick
Minnesota Pollution Control Agency
520 Lafayette Rd.
St. Paul, Minnesota 55155-4194
Phone:(651)297-8326
Fax:(651)297-8676
e-mail: sally.patrick(5),pca.state.mn.us
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^T^t
S^oS^S^
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Ms. Jura Scharf of the Chicago Asthma
Consortium, Ms. Maggie Butterfield of the Health
Education Center of Wisconsin, Ms. Jackie Reed
of the Westside Health Authority, and Ms. Mary
Nelson of Bethel New Life discussed their
experiences in coalition building.
Discussion Forum on Coalition
Building: Learning by Example
J
Ms. Scharf of the Chicago Asthma Consortium,
reviewed the findings of a study conducted by
the Health Resources and Services
Administration (HRSA) in 1998. The study
determined that coalitions were effective in
changing health status and health systems if
they followed certain rules, such as having a
clear goal and monitoring progress towards it.
Ms. Scarf listed the seven steps below to
coalition success.
1. Have a clear vision and mission.
2. Create community ownership.
3. Solidify the coalition structure.
4. Recruit and retain active, diverse members.
5. Develop leadership.
6. Focus on action and advocacy.
7. Market the coalition.
Ms. Butterfield of the Health Education Center of
Wisconsin discussed one of the projects she
works on: Awesome Asthma Days. The goals of
the asthma coalition are as follows:
* To identify kids with asthma,
* To assess the impact of asthma on home
care,
* To increase understanding and self-care of
asthma, and
* To increase control of asthma symptoms.
The Awesome Asthma School Days project
takes fourth-graders on field trips to teach them
about asthma and provide them with ways to be
proactive about their own care.
Ms. Reed of the Westside Health Authority,
spoke about how she founded the Westside
Health Authority in Chicago. Her goal in
founding the center was to listen to people and
provide programs based on their needs. For
example, the community with which she worked
needed jobs, so the Westside Health Authority
set up a program to train people for careers as
health care providers. Ms. Reed found that it
was important to create specific goals and build
a vision. She also pointed out that the bottom
line in coalitions involves relationships, and she
offered the four pieces of advice below to
coalition-builders.
1. Listen to people.
2. You need to need, but not overwhelm,
people.
3. Give people credit.
4. Avoid hidden agendas-get issues on the
table and be clear.
Ms. Nelson of Bethel New Life talked about
creating a community development corps (CDC),
which works with communities to provide livable
wages, housing, education, and healthy families.
She noted that a sustainable community needs
the following:
1. Economic security;
2. Environmental quality;
3. High quality of life; and
4. Public participation and accountability in
decision-making.
Her CDC initiatives include Brownfields
development, community outreach, small
business development, and local worker training.
Bethel New Life also spearheads a coalition of
CDCs called Accelerating Community
Transformation (ACT). Ms. Reed's advice to
people founding CDCs or coalitions is to invite all
groups to join from the beginning, to make data
user-friendly, and to have someone keeping the
communication lines open.
The attendees broke out into action groups and
answered the following question: Based on the
presentations and your knowledge, what should
others remember about coalition building when
they develop action plans?
The groups identified the following three topics:
-------
1. Goals and missions of the coalition;
2. Relationships; and
3. The process of coalition-building.
CONTACTS:
Jura S. Scharf
Chicago Asthma Consortium
1440 W. Washington Blvd.
Chicago, Illinois 60607
Phone:(312)243-1560
Fax:(312)243-3954
Maggie Butterfield
Health Education Center - Children's Health
System
1533 No. Rivercenter Dr.
Milwaukee, WI 53212
Phone: (414) 765-9355
Fax: (414) 765-0996
Jacqueline Reed
Westside Health Authority
5437 W. Division
Chicago, IL 60651
Phone: (773) 378-0233
Fax: (773) 378-5035
email: MRSREED@WORLDNET.AH.NET
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Mr. Joe Schirmer of the Wisconsin Department
of Public Health and Family Services, Mr. Mark
Ramion of the Milwaukee Health Department,
Ms. Placida Venegas of the Minnesota Pollution
Control Agency, Mr. Myron Falcon of the
Minnesota Department of Health, and Ms.
Susan Gust of Phillips, Minnesota, spoke about
lead poisoning, focusing in particular on
education, reduction, and prevention of lead
poisoning. Topics discussed are summarized
below.
Lead Poisoning Prevention
J
Mr. Joe Schirmer from the Wisconsin
Department of Public Health and Family
Services stated that limitations to lead poisoning
prevention include using an old definition of
lead poisoning, lack of resources to screen
children for lead, weak enforcement
mechanisms for remediating lead, and an
unresponsive bureaucracy. To be successful at
lead poisoning prevention, "infected" children
must be identified. Ways to identify children
that may have high lead levels involves
cooperation of medical groups, parents, and
state legislatures. Assessment would be easier
if there was a universal reporting requirement
for lead levels in children's blood streams.
Educational materials about lead poisoning
should be distributed to housing areas with high
lead levels; these materials should be
informative and easy to read.
Mr. Schirmer stated that lead poisoning
prevention is a phased approach involving an
action phase and a hazard control phase. The
action phase includes inspecting and locating
lead hazards inside and on the exteriors of
houses. During the hazard control phase, the
goal is to abate lead hazards. For example, in
Wisconsin, the U.S. Environmental Protection
Agency and the U.S. Department of Housing
and Urban Development provided funding for
high efficiency particulate arresting (HEPA)
vacuums to clean lead dust and chips. The
funding was also used to treat damaged exterior
paint containing lead and replacing windows
with lead paint trims. After only 1 year, lead
dust levels decreased significantly. Cleaning is
only a temporary measure; however, the study
in Wisconsin shows that if lead dust levels are
controlled using HEPA vacuums, lead blood
levels in children will decline significantly.
Lead Hazard Education and
Reduction Strategies
Mr. Mark Ramion from the Milwaukee Health
Department discussed the effectiveness of
education and lead hazard reduction strategies
to reduce lead levels in Milwaukee.
Between 1994 and 1998 in Milwaukee, blood
lead level trends were examined. The percent
of lead in children's blood decreased from 35 to
17 percent as a result of lead hazard reduction
strategies and education. Based on studies
where only lead poisoning education materials
were used, blood lead levels declined 18
percent. Based on studies where educational
materials about lead were used in combination
with lead hazard reduction strategies, blood
lead levels declined 24 percent.
Treatments for lead hazards include scraping
and repainting walls and window sills to
eliminate lead hazards, and enclosing window
wells and floors to isolate lead hazards. In the
Milwaukee study, several intervention strategies
were used, including cleaning, scraping, and
painting, window replacement, and window well
wrapping.
A primary prevention project was conducted by
the Lisbon Neighborhood Development. The
goals of the project were to educate and
mobilize community members about lead
poisoning and reduce lead hazards. Of the
houses inspected, 88 percent had lead hazards.
The average cost of hazard reduction was 12
percent of the average assessed value of the
house. Target areas for the project were rental
units and pre-1950s housing. Lessons learned
as a result of the project are summarized below.
-------
* Community-based strategies must be
flexible.
«:* Risk-reduction training for renters in low-
income housing is necessary.
* Multiple strategies for lead poisoning
prevention need to be implemented,
evaluated, and revised.
Lead Waste Disposal in Minnesota
Ms. Placida Venegas of the Minnesota Pollution
Control Agency explained the properties of lead
and its uses. Lead is a naturally-occurring, toxic
metal that gives luster to and makes paint
durable and long lasting. It is soft and can be
easily bent. It is used in paint, gasoline, solder,
and batteries, as well as a component of
weights and sinkers, medical devices, and
ammunition. Lead has hazardous effects on
both children and adults. In children under 6
years of age, common health effects may
include shortened attention span, hyperactivity,
aggressive behavior, reading disabilities, mental
retardation, convulsions, and even death. In
adults, exposure to lead can affect the nervous
system, kidneys, bones, heart, and reproductive
system.
Minnesota's residential lead hazard reduction
program is a cooperative effort between the
following:
«> U.S. Department of Housing and Urban
Development (funding),
* Minnesota Department of Health (licensing,
certification, and enforcement),
* Minnesota Legislature (lead laws),
<• Minnesota Pollution Control Agency (proper
lead waste disposal),
•*• Minnesota Housing Finance Agency
(information clearinghouse), and
<» Cities of Duluth, Minneapolis, and St. Paul
(implementation of lead program).
Minnesota has several state laws designed to
control lead hazards and enforce proper lead
waste disposal: the Childhood Lead Poisoning
Act, Lead Poisoning Prevention Rules,
Residential Lead Paint Waste Disposal,
Abrasive Blasting of Lead Paint from
Residential and Steel Structures, and
Hazardous Waste Disposal Rules. Under these
laws, any person whose activities produce lead
waste is responsible for proper disposal of the
waste. Management responsibility is not
transferable to the occupant of a structure with
lead-based hazards. Waste produced by
activities of the occupant must be managed as
provided by household hazardous waste laws.
Categories of waste generated from lead paint
removal projects include paint chips, paint dust,
demolition debris, solvents, rinse water, rags,
mops, scrapers, and materials used for testing
and cleanup. Ways to contain lead waste
include sealing the waste in a heavy-duty plastic
bag and wrapping doors, windows, frames, and
trim in polyethylene sheeting. All waste should
be stored in a secured area.
Ms. Venegas also describes methods for
handling and transporting waste. At the end of
each working day, contractors and workers
should conduct the following activities:
1. Categorize and separate waste into lead
paint chips, solid debris, and demolition
debris;
2. Store lead paint chips in a durable, tightly-
covered container;
3. Store solid debris in a durable, tightly-
covered container;
4. Store demolition debris in a covered drum;
and
5. Filter wash water on site to separate any
debris or paint chips present.
All lead waste should be transported in a
covered vehicle to prevent blowing and loss of
material. If loss does occur, the material must
be picked up immediately and returned to the
vehicle or container, and the area must be
properly cleaned. For shipments within
Minnesota, a Residential Lead Abatement
Notification and Shipping form is required. For
shipments out of state, a manifest may be
required by the state(s) through which the waste
will be transported.
Ms. Venegas discussed the authorized
management methods allowed by Minnesota. A
homeowner or occupant of a residence must
bring lead paint chips to a household hazardous
waste collection site. A contractor may take the
lead paint chips to a local smelter to be
reclaimed or recycled. Wastewater containing
lead should be filtered with a 5-micron filter
sack to remove lead debris prior to discharge to
a sewer system. Options for placement of solid
lead waste include the following:
-------
* A lined landfill with liner and leachate
collection system,
<» A hazardous waste facility,
* A permitted demolition debris facility for
woodwork, walls, and windows, or
* A solid waste incinerator ash landfill.
Ms. Venegas also discussed methods of lead
waste management that are prohibited by
Minnesota statutes. Lead waste must not be
incinerated at a mixed municipal solid waste
landfill, disposed of at an unlined landfill, left at
a residence, or placed in a municipal solid
waste compost or refuse-derived fuel facility.
Interagency Efforts to Reduce Lead
Poisoning - Present and Future
Mr. Myron Falcon of the Minnesota Department
of Health and Ms. Susan Gust, a citizen of the
city of Phillips, Minnesota, discussed
interagency efforts to reduce lead poisoning in
Minnesota.
Mr. Falcon discussed how the Minnesota
Department of Health works with the
Department of Human Services, Medicaid
agencies, medical providers, and local agencies
to identify areas that are at risk for high blood
lead levels. High risk areas were mapped using
Geographic Information Systems (GIS)
software. GIS was also used to identify sites
that may have high lead levels but were not
targeted. Data was shared among agencies
through development of environmental and
medical case management software. A
prevalence study for high lead levels was
performed in three counties.
Ms. Gust discussed how changes in lead
prevention and education in her community
have influenced lead prevention efforts in
Minnesota. Ms. Gust stated that Phillips,
Minnesota, is a very ethnic community. People
in the community got together and dropped their
own agendas to focus on the health issues of
the children in Phillips. They lobbied for money
from the University of Minnesota to study lead
poisoning and lead hazard prevention in the
city.
The goal of the study was to determine how
many children in the community are poisoned
by lead. The community volunteers for the
project started at the local medical center to
identify children that had elevated blood lead
levels. However, the data on the blood lead
levels was not organized and much of the data
had to be collected again.
The city worked with Americorps and
community volunteers to identify the children in
the community who were at risk. Using their
resources from the University of Minnesota, the
core project members trained peer teachers
about lead hazards. These peer teachers
approached people in the community with
culturally-specific materials to educate the
community about lead hazards. Children at risk
were identified and tested.
The project also researched the effect that lead
has on the brains of infants and toddlers. It was
determined that children become more
aggressive when exposed to lead. The
volunteers took the project a step further by
providing guidance to parents on how to deal
with children that have lead poisoning and brain
damage as a result of exposure to lead.
Ms. Gust stated that the project was a learning
experience and a success. By putting the
community in charge of the project, the city of
Phillips reaped the results of the research.
Many relationships were built as a result of the
project and people in the community actively
worked together to learn about lead hazards
and lead prevention and in turn educate their
peers about the subject.
Facilitated Discussion
J
Ms. Patty Krause of EPA Region 5 facilitated a
discussion on lead poisoning prevention and
education of lead hazards . The following key
issues were raised during the discussion:
* Instigate more collaboration among
communities and the government for
developing action agendas.
* Improve information dissemination.
* Mandate lead blood level screening in all
children.
* Recognize local leadership in addressing
lead issues.
<• Shift from a medical model (screening blood
lead levels) to a housing model (prevention
and cleanup of lead hazards).
* Increase awareness of safe work practices.
-------
Promote a national annual program for
increasing awareness of lead poisoning.
Provide for sustainability of lead prevention
activities and funding grants from the U.S.
Department of Housing and Urban
Development.
CONTACTS:
Joseph Schirmer
Wisconsin Division of Public Health
1414 E. Washington Ave., Room 96,
Madison, Wisconsin 55703
Phone: (608) 266-5885
Fax: (608) 267-0402
Mark A. Ramion
City of Milwaukee Health Department
3141 South 34th Street,
Milwaukee, Wisconsin 53215
Phone:(414)286-5171
Fax:(414)286-0715
Placida L. Venegas, J.D.
Major Facilities Section, Policy & Planning
Division
Minnesota Pollution Control Agency,
520 Lafayette Rd. N.,
St.Paul,MN 55155-4194
Phone: (651)297-8370
Fax:(651)297-8676,
E-Mail: placida.venegas@,pca.state.mn.us
Mvron Falken MS, MPH. PhD
Minnesota Department of Health
121 E. Seventh Place, Suite 220, P.O. Box
64975, St. Paul, MN 55164-0975
Phone(651)215-0877, Fax(651) 215-0975
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Ms. Louise Fabinski of the Agency for Toxic
Substances and Disease Registry (ATSDR), Mr.
Al Stenstrup of the Wisconsin Department of
Natural Resources (WDNR), Mr. Steve
Skavroneck of the Pollution Prevention
Partnership, Mr. Ken Runkle of the Illinois
Department of Public Health (IDPH), and Dr.
Ying Feng of the Ohio Department of Public
Health (ODH) described examples of education
and outreach programs on the impacts of
mercury. Issues discussed are summarized
below.
Educational Materials for Prevention
of Mercury Exposure
J
Ms. Louise Fabinski of ATSDR reported that in
1997, ATSDR and the U.S. Environmental
Protection Agency (EPA) issued a combined
alert about mercury, increasing awareness that
the mercury issue goes beyond mercury in fish
tissue. She reasserted the point made by Dr.
Robert Amler during the Plenary Session that
children are not small adults. She also
suggested that parents and guardians may also
be bringing mercury into the home.
Mercury Exposure Prevention
Curriculum
J
Mr. Al Stenstrup of the WDNR began his
presentation with a Jeopardy game, where he
involved audience members in revealing
information on mercury. He stated that the
Jeopardy game was part of the training on
mercury that he and his colleagues conducted
for educators and high school students.
Mr. Steve Skavroneck of the Pollution
Prevention Partnership reported that of the 5,000
pounds of mercury collected last year, 3,000
pounds came from schools. As Mr. Stenstrup
distributed a training manual jointly developed by
WDNR and the Pollution Prevention Partnership
entitled "Mercury: In Your Community and the
Environment" (1998), Mr. Skavroneck described
the following activities that comprise the mercury
curriculum):
* Case study of mercury contamination in a
community.
* A local survey about mercury.
<• School mercury audit.
«!» Home mercury audit.
* Trade-offs exercise.
* Mercury in fish.
•:• Community action projects.
The training promotes awareness of the risks
associated with mercury which includes lesson
plans and hands-on exercises.
Health Hazard Evaluation of the Ritual
Use of Mercury in Chicago, Illinois
Mr. Ken Runkle of IDPH described the ritual use
of mercury in Hispanic communities in Chicago.
Specifically, items that contain mercury have
been found in stores called botanicas, which sell
health and religious ritual items such as statues
and icons, natural herbs, folk remedies, annulets,
and rosaries. The Chicago Department of Public
Health conducted a study in which 16 botanicas
visited sold mercury in one of the following
different forms:
»:» Caplets containing 0.5 milliliter (mL) (about
6.5 grams [g]) of mercury
•> Caplets containing 1 mL (about 13 g) of
mercury
»> An unmeasured amount in amulets of various
shapes and sizes
Mr. Runkle stated that mercury is used ritually to
obtain good luck, acquire money, acquire love, to
control others, or for heating.
The ritual use of mercury includes the following:
* Sprinkled around the home and in beds
* Burned in candles
* Used in cleaning water
«:» Rubbed onto skin
<» Ingested
«> Carried on person
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Multiple health hazards are associated with
mercury. The primary route of mercury
exposure is inhalation. Mr. Runkle
acknowledged that because mercury vapor is
dense and is present closer to the floor, children
are more susceptible to mercury poisoning. He
listed the following symptoms of mercury
exposure:
* Headaches
* Trembling
* Blurred vision
* Personality changes
»:» Memory loss
* Neuromuscular problems
»J» Acrodynia
IDPH is conducting an exposure study to
evaluate the health significance of ritual mercury
use. The study involves the following aspects:
* Approximately 100 participants from 20
homes.
«:» Air screening with a Jerome mercury vapor
analyzer.
* Air sampling with sampling tubes and pumps.
* Urine sampling of residents in the morning
and afternoon.
* Monitoring of carbon dioxide levels to gauge
air exchange rate.
<« Distribution of educational materials.
Ms. Runkle reported the problems below
associated with recruitment for the IDPH study:
Potential participants do not want others to
know.
Identity and immigration issues arise.
Participants mistrust the government.
Religious reasons encourage mercury use.
There is no financial incentive to cooperate.
Mercury Exposure Prevention
Outreach
Dr. Ying Feng of ODH described mercury
outreach efforts being conducted by ODH. She
reported that one of the largest mercury spills
occurred in Springfield, Ohio in 1997, which
prompted the establishment of a mercury spill
prevention program. Dr. Feng recounted the
story of a group of teenagers breaking into
Tower Metal Alloy Recycling Station, an
abandoned metal recycling facility, in October,
1997. The teenagers found a 5-gallon drum of
metallic mercury. They poured mercury into
plastic soda bottles, which they removed from
the premises and brought home, spilling the
contents along the way. The mercury was
subsequently spilled in their homes and yards,
on their clothes, and brought to school the
following day.
The incident resulted in the following:
* Sixteen homes were contaminated and
required cleanup procedures,
»:» Sixty-nine residents had to leave their homes
for 3 to as long as 25 days,
* 162 urine specimens were collected from
area residents, and
«:» Five students had mercury levels above 20
micrograms per liter, the ATSDR benchmark
for children.
The emergency removal action involved EPA,
the Ohio Environmental Protection Agency, the
Clark County Combined Health District, the
Springfield Fire Division, the City of Springfield,
the Springfield Emergency Management Agency,
the local Red Cross, and ODH. Dr. Feng stated
that 200 pounds of mercury were retrieved from
contaminated residences in 28 days, resulting in
a $500,000 cleanup effort. Displaced families
were allowed to return to their homes by late
November, 1997. The incident prompted the
realization that a mercury spill prevention
program was needed to (1) reduce mercury
sources, (2) change the public's behavior toward
mercury, and (3) develop guidance to respond
to mercury spills.
Dr. Feng described a mercury recycling program
that her department jointly developed with the
Ohio Dental Association. There is no charge for
mercury collection, and fourteen collection
stations have been established around the state.
She reported that 838 pounds of mercury have
been collected so far.
Dr. Feng also described a mercury training
program that ODH is developing with the Ohio
Environmental Health Association. Regional
seminars are being held in four locations around
the state. In addition, the ODH Site Assessment
Section has developed educational materials
including a fact sheet titled "Mercury Spill Fact
Sheet for Schools."
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Facilitated Discussion
Mr. William Massie of EPA Region 5 facilitated a
discussion on mercury use and exposure. The
following key issues were raised during the
discussion:
* Consider replacing all mercury thermometers.
* Overcome perception of scientific accuracy of
mercury in thermometers; perceive it more as
a human health risk.
* Develop standard response to cleanup and
spills.
* Educate the public on the cumulative effects
of mercury.
* Conduct outreach efforts to policy makers.
<* Encourage medical facilities to reduce use of
mercury.
<* Consider alternative outreach, (e.g., culturally
appropriate educational materials for fish
consumption advisories).
* Eliminate abandoned mercury stockpiles.
This list was narrowed down to the following
three topics for inclusion in the action plan:
* Educate society about the effects and
consequences of mercury exposure using
culturally appropriate methods and tools.
* Encourage and mandate mercury use
reduction.
* Discourage unregulated recycling of collected
mercury to eliminate abandoned stockpiles.
CONTACTS:
Louise Fabinski
Agency for Toxic Substances and Disease
Registry
77 W. Jackson Boulevard
Chicago, IL 60604
Phone:(312)886-0840
email: fabinski.louise@,epa.gov
Al Stenstrup
Wisconsin Department of Natural Resources
P.O. Box 7921, 101 S. Webster
Madison, Wisconsin 53707
Phone: (608) 264-6282
Fax: (608) 264 - 6293
email: stensa@dnr.state.wi.us
Ken Runkle
Illinois Department of Public Health
525 W. Jefferson St.
Springfield, IL 62761
Phone: (217) 782-5830
Fax:(217)785-0253
email: krunkle@idph.state.il.us
Dr. Ying Feng
Ohio Department of Health
246 North High Street
Columbus, OH 43215
Phone:(614)644-6447
Email: YFENG@gw.odh.state.oh.us
Steve Skavroneck
Environmental Consultant
346 E. Wilson St.
Milwaukee, Wisconsin 53207
Phone:(414)486-1613
e-mail: cranehousesp@msn.com
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Outreach and Education
Ms.EllynMcKenzieoftheSixteenthStreet
CommunityHealthCenterandMs.Sarah
SchubertoftheMilwaukeeHealthDepartment
spokeabouttheirexperiencesworkingwith
agenciesandcommunitiesinsuccessful
partnerships.Ms.JulieMoriartyEPA'sOfficeof
PublicAffairsEnvironmentalEducationGrant
Program)gaveadviceonhowtoapplyfor
grants.
Successful Partnerships
J
Ms. McKenzie of the Sixteenth Street
Community Health Center discussed the
Center's work with the Brownfield Environmental
Assessment Program (BEAP). The Center
worked with the Wisconsin Department of
Natural Resources and community members to
clean up and develop an old factory site. Ms.
McKenzie noted that the features that led to
success of the project included the following:
* The agency gained the trust of the
community,
* There was a common point of contact
for multiple parties, and
* The agency had site-specific processes
with long-term goals.
Ms. McKenzie also mentioned the following
other programs:
«:» Child Health Champion National
Initiative by EPA which provides grants
for community programs in eleven cities.
* Milwaukee Community Health Center
(CHC) project involves communities,
parents, and children in an effort to help
kids cope with asthma.
Ms. Schubert of the Milwaukee Health Dept.
offered insights from her experience in dealing
with community groups. She is a specialist in
the lead poisoning program at the Milwaukee
Health Department. A telephone survey
conducted by the lead poisoning program found
that there is a general awareness of the risks
associated with lead in housing, especially in
high-risk areas, and that an important step in
reducing lead poisoning was increasing
knowledge of risk reduction behaviors through
outreach and education programs. Based on the
findings of the survey, and a focus group, the
lead poisoning program center has developed a
community plan to provide people with the ability
to reduce their risk of lead poisoning. When
working with a community, Ms. Schubert noted
that the following factors are important:
* Be flexible
* Be involved
* Listen to people
* Be honest
* Be available
Grant Applications
Ms. Moriarty, of the U.S. EPA, provided hints on
how to prepare a grant application for EPA. The
most important part of grant-writing is creating a
plan for the organization. Ms. Moriarty
suggested considering the following objectives
when preparing a grant application.
* Define what your organization is and what its
goals and strengths are.
* Identify funding agencies.
* Focus on a specific problem your
organization will address.
* Be realistic in you goals.
•> Show what partnerships your organization
will form.
* Demonstrate sustainability.
One of the participants stated that some
partnerships are created only because they are
required in order to be eligible for a grant and are
not necessarily for useful purposes. Although
this is sometimes true, the speakers pointed out
that partnerships should benefit all parties.
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CONTACTS:
Ellvn McKenzie
Sixteenth Street Community Health Center
1337 S. Cesar E. Chavez Dr.
Milwaukee, WI 53204
Phone:(414)672-1315
Fax:(414)672-9190
Email: Ellyn.McKenzie@SSCHC.ORG
Sarah Schubert
Milwaukee Health Department
1230 West Grant Street
Milwaukee, WI 53215
email: sschub@ci.mil.wi.us
Julie Moriarty
U.S. EPA Region 5
77 W. Jackson Boulevard (P-19J)
Chicago, IL 60604
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At this workshop, Ms. Diana Fleming, a
children's advocate and activist, and Ms. Clare
Hintz, from Safer Pest Control Project spoke
about integrated pest management (IPM.) IPM
is a method of preventing and controlling pests
in a way that is the least hazardous to human
health and the environment.
IPM uses information about the pest's biology
and habitat to get to the root of the pest problem.
Pesticides are used sparingly, if at all. Topics
discussed are summarized below.
Perceptions and Misconceptions of
Environmental Activism and IPM: A
Case Study
Ms. Fleming described how she became an
activist. She helped pass one law requiring
schools to notify parents and staff prior to
pesticides applications on school grounds and is
currently working on getting a law passed that
would require schools to adopt IPM programs.
She spoke about her personal journey to
becoming an activist and gave advice to the
audience about becoming a tactical activist. Her
top ten rules of tactical activism are summarized
below.
* Avoid fighting a battle on your opponent's
terms.
* Pursue a proactive agenda rather than a
defensive response to your opponent's
plans.
* Define the problem and learn the issues.
* Establish a goal.
* Recognize a strategy.
* Define tactics to support the strategy
* Assess a campaign's success.
* Be a tactical activist-listen, be tenacious,
creative, and willing to make mistakes.
* Remember that tactical activists never fail—
they only make mistakes and learn from
them.
* Be cautious of the media.
The common perception that governments are
too burdensome for environmental change
campaigns to succeed is a misconception.
Becoming a tactical activist to promote positive
change is a viable solution. Ms. Fleming also
spoke about the importance of using IPM from a
firsthand experience. She stressed the huge
impact of the use of hazardous chemicals on
children at school and stated that adults need to
do a better job of protecting children from these
dangers.
Roach Control Using IPM
J
Ms. Clare Hintz of Safer Pest Control Project,
spoke about her research with regard to roach
control. It is important to have a cockroach-free
home because they can release allergens into
the home that can make many people sick.
These allergens can also trigger asthma attacks.
Ms. Hintz described simple techniques to reduce
roach populations in the home without
pesticides. These techniques are summarized
below.
* Seal all entrywavs into the home.
Cockroaches can get into a home through
cracks around baseboards and holes in the
walls where plumbing or heating ducts come
through. Cockroaches hide in cardboard
boxes that people carry inside.
* Keep food away from cockroaches.
Cockroaches need food to stay alive.
Keeping crumbs out of the kitchen and food
in sealed containers will cut off the roaches'
food supplies.
* Wash dirty dishes promptly, and vacuum
regularly.
* Have leaks repaired: Cockroaches also
need water to live. Leaks provide all the
water roaches need to stay alive.
* Reduce clutter: Clutter is hard to clean
around and offers lots of hiding places for
roaches.
* Use hot, soapy water to scrub away roach
droppings. Roach droppings attract other
roaches and can cause allergies.
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Ms. Hintz stressed that IPM is a technique that
anyone can implement to reduce cockroach
problems without using pesticides.
CONTACTS:
Clare Hintz
Safer Pest Control Project
17 E. Monroe St. - Suite 212
Chicago, IL 60603
Phone:(312)641-5575
Fax:(312)641-5454
Email: spcp(o),iname.com
Diana Fleming
Phone: 630-323-2821
Fax 630-323-5908
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Ms.lngaBackofthelnter-TribalCouncilof
Michigan,Ms.LisaSchneideroftheChicago
HousingAuthority(CHA),andDr.HelenBinnsof
Children'sMemorialHospitalandtheChicago
AreaHealthProfessionalsLeadConsortium,
spokeaboutleadeducationandprevention.
Tribal Lead Education
Ms. Inga Back from the Inter-Tribal Council (ITC)
of Michigan talked about lead education and
prevention for Tribes in Michigan. The purpose
of the ITC lead education program was to
develop Tribal-specific material about lead
hazards and conduct educational and outreach
activities to inform the Tribes about lead.
Ms. Back described five basic areas of lead
education:
1. Sources (hobbies and occupational hazards);
2. Risk groups (children under 6 years and
pregnant women);
3. Health effects (affects the central nervous
system);
4. In-home hazards (paint dust and chips,
remodeling debris); and
5. Protecting children (testing for lead and
reducing exposure through thorough
cleaning).
To educate Tribes about lead, Ms. Back used
tribal-specific brochures, materials from the
Center for Disease Control, and materials from
EPA. Several groups were targeted for
education: health care professionals, housing
authorities, parents, environmental groups, and
day-care and school staff. Ms. Back said it is
important for health care professionals to
educate the public about lead screening policies.
Clinics can develop a targeted screening policy
based on at risk areas. The Tribal housing
facilities need to be educated about U.S.
Department of Housing and Urban Development
requirements regarding lead in older housing
units. Monetary incentives should be provided to
encourage parents to get involved, and health
and housing fairs should be held. Teachers and
school staff should be informed about activities
they can offer to children to help them learn
about lead hazards. Also, Head Start centers
should be brought on board to establish early
blood lead screening policies.
ITC visited 10 out of 11 Tribes in Michigan.
Presentations about lead hazards and lead
poisoning prevention were given at eight health
clinics, eight Head Start centers, and one health
fair. Four new blood lead screening programs
were established and an existing screening
program was strengthened.
Ms. Back stated that future activities included
expanding presentations about lead hazards to
junior high schools and procuring funding for
testing blood lead levels.
Lead Prevention Activities in Chicago
Ms. Lisa Schneider of the CHA spoke about the
CHA's lead prevention efforts in Chicago public
housing units.
The CHA has approximately 39,000 units
throughout the City of Chicago. About 66,000
individuals live in public housing. In 1995, no
lead prevention activities existed at the housing
units. Lead hazards are present in many of the
family housing developments. CHA assembled
a lead poisoning prevention taskforce to create a
lead poisoning prevention campaign.
Participants and partners in the campaign
included resident environmental community
groups, the University of Illinois at Chicago, the
Chicago Department of Health, and the Chicago
Legal Clinic.
The goals of the campaign were to educate
residents prevention techniques such as good
nutrition and daily cleaning. The CHA began a
lead hazard notification program. The CHA
tested soil, water, paint, and dust at the housing
developments and sent mailings to all residents
where lead was to be found. Within each
mailing, residents received a $5.00 rent credit for
verifying they received and read the materials.
All residents were invited to a party to be held at
the housing development.
CHA then held a "Lead Awareness Party" to
educate about lead hazards and lead poisoning
prevention. Participation was encouraged by
providing free t-shirts, lunch, and free blood lead
screening. Adults at the party were schooled on
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cleaning and nutrition while the children learned
about lead hazards through videos and games.
Ameri-Corps and the Chicago Department of
Health helped to support the Lead Awareness
Parties.
Ms. Schneider reported that the CHA
established an additional program for resident
education about lead. Occupants living in the
housing developments were paid to go door-to-
door to educate their neighbors about lead
hazards. The program's goals were to increase
the number of blood lead level screenings,
increase parental knowledge about lead
hazards, and decrease the number of children
with elevated blood lead levels. The peer
educators were paid livable wages and
underwent a 3-week intensive training course to
learn about safety, nutrition, lead hazards, and
lead prevention. The peer educators did home
visits and collected data on follow-up visits to
monitor retention of the information
disseminated. In 6 months, over 400 initial visits
and 200 follow-up visits were conducted. An
increase in lead prevention and hazard
knowledge decreased blood lead levels in
children by anywhere from 30 to 50 percent.
Ms. Schneider reported that CHA declared the
program a success. CHA hopes that lead
poisonings were prevented and blood lead levels
decreased. The CHA committed substantial
resources and paid their employees and
partners. Ms. Schneider said that, in retrospect,
the CHA would have eliminated follow-up visits
by the peer educators to save money and
clarified program goals to avoid unnecessary
financial expenditures.
Engaging Physicians in Lead
Poisoning Prevention
J
Dr. Helen Binns of Children's Memorial Hospital
and the Chicago Area Health Professionals Lead
Consortium spoke about educating medical
doctors and health professionals about lead
poisoning prevention.
Dr. Binns reported that changes in clinical care
are hard to bring about. Dr. Binns found that
more lead screening and information
dissemination is done by young doctors than
older doctors. First, health care professionals
must be schooled in lead hazards and lead
poisoning prevention. Then, the clinics must
transfer the knowledge to their patients and
families.
Dr. Binns stressed that information should not
just be mailed or handed out at the clinic.
Information is more successfully transferred by
encouraging patients and their families to visit
hospitals and clinics. Clinical acceptance and
screening patterns vary extensively. Clinics
need to stress to patients that lead poisoning
can cause several problems and that blood lead
level screening is a logical step if the patient may
be at risk of exposure to lead. To help clinics
identify patients that may be exposed to lead
hazards, information should be provided to
hospitals and clinics regarding high-risk zip code
areas that have old housing and a history of high
blood lead levels.
Facilitated Discussion
J
Ms. Patty Krause of EPA Region 5 facilitated a
discussion on lead poisoning prevention and
education of lead hazards. The following key
issues were raised during the discussion:
* Focus on older and low-income housing
areas that are at high risk for lead.
«3> The need for increased awareness about
lead hazards in the medical community.
•:» The need for increased awareness in parents
and children.
* Provide permanent funding for voluntary
lead analysis in high risk homes.
* Mandate blood lead level screening for
young children.
* Create a lead awareness program.
CONTACTS:
IngaBack
Inter-Tribal Council of Michigan, Inc.
3601 Mackinaw Trail
Sault. Ste. Marie, MI 49783
Phone: (906) 635-4208
Fax: (906) 635-4212
e-mail: ingab@up.net
Lisa Schneider
Chicago Housing Authority
626 W. Jackson Boulevard, 6th floor
Chicago, IL 60661-5601
Phone:(312)791-8500
Fax:(312)454-5883
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Helen J. Binns. MD. MPH
Division of General Academic Pediatrics
Children's Memorial Hospital, 2300
Children's Plaza #208
Chicago, IL 60614
Phone:(312)880-4281
Fax:(312)880-8337
e-mail: hbinns@nwu.edu
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x6^
" *<^01fr** ^
^
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* Special injury prevention projects;
•:• Alcohol injury reduction projects;
»> Driving-under-the-lnfluence (DUI) reduction
projects;
•* Roadside hazard evaluation;
* Car seat distribution;
* Smoke detector distribution; and
* Bicycle helmet distribution.
Mr. Etchison reported the national statistics
summarized below from the Center for Disease
Control for 1984 through 1995.
«:• Injury is the leading cause of death among
children more than 1 year old.
»> Motor vehicle crashes rank first or second as
the cause of death for children aged 1
through 19.
* Pedestrian deaths comprise 73 percent of
the total deaths among children.
* Other causes of death among children
include homicide, suicide, fire, and
suffocation.
In comparison, a database maintained at Bemidji
for the years 1986 through 1997 reports the
statistics below.
* Falls are the primary cause of injury for
children aged Oto 14.
* Motor vehicle crashes are the primary cause
of death, almost twice the national average.
* Children less than 1 year old are primarily
dying from suffocating, choking, or
submersion.
Collaboration of Health and
Environmental Tribal Resources:
A Case Study
Ms. Carol Rollins, Director of Environmental
Health with the Ho-Chunk Nation in Wisconsin,
described experiences of the Ho-Chunk Nation's
Environmental Services Program, which is
based in the health department. She stated that
the Ho-Chunk Nation is located in central
Wisconsin and consists of scattered Indian lands
across 14 counties. Because of this spread, it is
difficult to deliver health services. Ms. Rollins
reported that the health department currently
manages six community water systems and six
wastewater treatment systems throughout the
Reservation.
Ms. Rollins acknowledged Mr. Jim Dunning, an
environmental specialist sponsored by the U.S.
Environmental Protection Agency (EPA), who set
up the Ho-Chunk Nation's water monitoring
program. Several challenges that Mr. Dunning
encountered at the start of his efforts included a
high turnover rate among plant operators and
unsophisticated water systems. Ms. Rollins
stated that the success of the Reservation's
casinos provided funds for newer pumphouses
with filtering and monitoring equipment. The
upgrade has taken place over a period of about
5 years.
Ms. Rollins then described joint efforts between
her environmental department and the public
health department to deal with open dumping in
a ravine on the Ho-Chunk Nation's grounds.
Attempts to close the dump site were
unsuccessful in the past. The primary public
health concerns included rodent infestation and
children climbing into the ravine and getting
injured. Using grant money from the Bureau of
Indian Affairs, the two departments excavated
what they could and filled the ravine with soil.
Manholes and piping were installed to drain the
landfill. The flattened area was then covered
with clay and seeded. Ms. Rollins showed a
recent photograph of the site, now covered with
grass.
Ms. Rollins also described several public works
projects that are also funded by casino profits.
The environmental services program strives to
be involved in construction of buildings to ensure
that health codes are met. Joint funding by the
Indian community and a Wisconsin medium-
security prison resulted in the construction of a
wastewater treatment plant to serve both places.
The plant relies on oxidation and ultraviolet
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disinfection to decontaminate water before
discharging it into the Black River.
CONTACTS:
Eli O. Hunt
Leech Lake Band of Ojibwe
6530 U.S. Highway 2 NW
Cass Lake, MN 56633
Phone:(218)335-8225
Fax:(218)335-8309
Captain Bruce M. Etchison
U.S. Public Health Service, Indian Health
Service
Bemidji Area Indian Health Service,
522 Minnesota Ave. NW
Bemidji, MN 56601
Phone:(218)759-3360
Fax:(218)759-3504
Carol L. Rollins. R.S.
Director of Environmental Health
Ho-Chunk Nation, P.O. Box 636
Black River Falls, WI 54615
Phone:(715)284-1548
Fax:(715)284-9592
*
Cross-train health and environmental
professionals in both areas.
Suggest having more localized fish
advisories in addition to the regional ones
and target the primary fish eaten by
individual Tribes.
Start educating youth in environmental areas
of concern.
Facilitated Discussion
J
Ms. Dolly Tong and Ms. Peggy Donnelly of EPA
Region 5 facilitated a discussion on bridging
Tribal environmental health and public health
programs. The following key issues were raised
during the discussion:
»;» Coordinate county, state, federal, and Tribal
entities and their health concerns without
compromising sovereignty.
* Explore available resources for Tribes to
implement joint environmental and health
programs.
* Address environmental justice concerns.
•> Strive for sustainable economic
development.
* Promote conferences such as
Environmental WATCH to bring together
county, state, federal, and Tribal
representatives.
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Ms.M.E.SjolinfromtheUniversityofWisconsin
ExtensionFamilyLivingProgram.Ms.Faith
CovicifromlnsureKidsNow.Ms.PegDublin
andMs.AnitaSandersfromtheChicagoHealth
Corps, andMs.DeniseTaylorfromHealthyKids,
HealthyMindsspokeaboutresourcesavailable
tocommunitiestoimprovechildren'shealth.
Issuesdiscussedaresummarizedbelow.
Family Living Programs: Cooperative
Extension
Ms. Sjolin presented information on the
Cooperative Extension program she has been
involved with at the University of Wisconsin
Extension. The following program areas are
under the Wisconsin Cooperative Extension
program:
* Agricultural and Natural Resources
* Community Natural Resources and
Economic Development
* Youth Development
* Family Living Education
This program is supported by three groups: the
state university, the county, and the federal
government.
Ms. Sjolin works in the family living department.
The department's mission in family living
education is to provide education, improve family
strengths, and help communities to become
positive environments for families. Family living
goals are as follows:
* Encouraging family self sufficiency,
* Helping people manage transitions in
their lives,
* Improving parent education and
community partnership, and
* Improving community nutrition, health,
and safety.
The family living program uses many different
media including radio, television, newspaper,
newsletters, and web sites, to educate families in
the community.
Cooperative education programs exist in all
states and can be contacted for further
information.
Insure Kids Now: Health Insurance for
Children
Ms. Covici gave an overview of the Children's
Health Insurance Program in Region 5. The
Insure Kids Now initiative is a nationwide effort to
enroll kids in low-cost or free health insurance
programs. About 11 million children in the
United States do not have health insurance, and
6 million of those children are eligible for free or
low-cost health insurance through state
programs. Insure Kids Now wants to make sure
that these eligible children are enrolled in health
insurance programs.
The Children's Health Insurance Program is a
$20 billion program created in 1997 to extend
the age eligibility for children's insurance up
through age 18. States have the option to
expand their current Medicaid programs or to
create new state-specific programs. In Region
5, the individual programs are as follows:
Illinois - Kid Care
Indiana - Hoosier Health Wise
Michigan - My Child
Minnesota - Minnesota Care
Ohio - Healthy Start
Wisconsin - Badger Care
Insure Kids Now is striving to enroll eligible
children in these new health care programs.
Members of the workshop spent time
brainstorming different ways they could help
spread the word about these health insurance
programs. Ms. Covici noted that it is important
that organizations dealing with public health
issues have information about their state's health
care program available to the families they
serve.
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Chicago Health Corps: An Integrated
Approach to Outreach
promoting Kid Care. Through working at the
clinic and conducting home visits, she is trying to
educate families about health issues.
Ms. Dublin and Ms. Sanders presented
information about Americorp and the Chicago
Health Corps.
Ms. Dublin spoke about Americorp, which is the
domestic Peace Corps. There are about 350
Americorp programs in the United States
covering the following four major areas:
1.
2.
3.
4.
Human needs
Education
Public safety
Environment
Ms. Dublin is a staff member of the Chicago
Health Corps, which is based at the University of
Illinois at Chicago and partnered with the College
of Nursing and the Illinois Area Health Education
Centers Program. The program focuses on
asthma management and lead poisoning
prevention.
The training curriculum for members of the
Chicago Health Corps is summarized below.
Primary Health Care Framework: This is an
approach to health care that examines health
promotion and sickness prevention through
collaboration of the community and health
professionals.
Public Health Issues: Corps members learn
about different health issues and how to relate to
people, promote trust, and build relationships
using poplar education techniques. Corps
members are trained on the following topics:
<• Health promotion
* Skill building
•> Team building
•> Workplace expectations
Through this training, Corps members learn to
see people in a holistic way by realizing that the
families they serve have a variety of needs and
assets.
Ms. Sanders is a Chicago Health Corps
volunteer. She spoke about experiences she
had during her first year in the corps. Ms.
Sanders works in a medical clinic that serves
low-income families in Chicago. She deals with
asthma prevention, lead poisoning issues, and
Case Study: Healthy Kids, Healthy
Minds
Ms. Taylor is the director of the Chicago Public
Schools Healthy Kids Healthy Minds Program.
This program is a citywide initiative designed to
increase access to primary health care services
linking each of the city's 589 public schools to a
federally qualified health center, hospital-based
clinic, or other community provider. She spoke
about her first-hand experience with enrolling
children in health care programs in Chicago.
She estimates that about 180,000 children in
Illinois are eligible for Kid Care but are not
enrolled.
The Chicago Public School System has many
health resources available to children in school,
including psychologists, social workers,
counselors, youth outreach workers, and crisis
intervention teams. Unfortunately, these people
usually rotate between two or three schools and
do not always have the time to make follow-up
visits.
Chicago Public Schools is trying to collect health
data information on all the schools in Chicago.
With information such as the percentage of
students without health insurance and average
number of days missed per student, particularly
needy schools can be targeted.
The future goals of Healthy Kids, Healthy Minds
are as follows:
* To assign all Chicago public schools to a
consistent health care provider
»:• To develop a policy of procedures
manual so that health care procedures
are formalized and clear
* To establish community based councils
backed by local schools in
neighborhoods
* To plan a citywide Healthy Kids, Healthy
Minds conference in 2000.
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CONTACTS:
Faith K. Covici
Health Insurance Specialist
Health Care Financing Administration
U.S. Department of Health and Human
Services, 105 W. Adams
Chicago, IL 60603
Phone:(312)353-7385
Fax:(312)353-5927
e-mail: Fcovici@shcfa.gov
Peg Dublin
Chicago Health Corps
845 S. Damen, Room 1114,
Chicago, IL 60612
Phone:(312)996-7393
Fax:(312)996-8945
Denise Taylor
Chicago Public Schools
125 S. Clark Street - 8th floor
Chicago, IL 60603
Phone:(773)553-1839
M.E. Sjolin
Clark County University of Wisconsin
Extension
Box 68
Neillsville, WI 54456
Phone:(715)743-5121
Fax:(715)743-5154
Email: mesiolin(S),facstaff. wisc.edu
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. ' -
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Ms. JoAnne Chiakulus from the Illinois Department
of Health, Center for Minority Health Services, led
a discussion of how to successfully deliver health
or environmental services within the context of a
community's culture.
Cultural Issues
Ms. Chiakulus pointed out that cultural issues are
becoming increasingly important in today's society
because the number of non-Caucasian children is
growing rapidly. Furthermore, different cultural
groups still receive disparate health care.
A survey of people from various cultural groups
found that the main reason people often did not go
to health care providers was cost. Other reasons
included several cultural issues related to service
received from health care providers, including
* Perception of cultural bias,
* Offensive communication,
* A lack of understanding of values, and
«> Language barriers.
A member of the public commented that in his
experience, health care providers often show a
lack of manners when dealing with patients.
Various members of the audience, as well as Ms.
Chiakulus, discussed this issue. Some felt that
people from other cultural backgrounds may take
a lack of manners as a personal affront. Ms.
Chiakulus pointed out that this issue was a matter
of perception.
Ms. Chiakulus defined perception as a process
through which people select and interpret
information from their environment. One issue
discussed was that intragroup differences are
often greater than intergroup differences and that
treating a patient in one fashion simply because of
his or her ethnic background is an example of
stereotyping. The audience discussed
stereotypes, and concluded that everybody forms
them to some extent.
Ms. Chiakulus listed the following barriers to
communication:
* Differences in perception
* Listening ability
* Interpretation
* Status
* Bias
•> Gender differences
* Organizational climate
* Cross-cultural differences
During further audience discussion, the need for
cultural competency training was discussed. Ms.
Chiakulus listed several steps to culturally
competent care, including the following:
* Identify possible issues,
* Ask appropriate probing questions,
•> Include appropriate family members,
«:• Involve social service staff from the
community in the diagnosis and treatment
plan when necessary,
* Address language barriers by providing
trained and culturally appropriate interpreters,
•> Incorporate the patients' medical beliefs and
practices that will add value to the treatment
plan,
* Be aware that cultural differences are not
always the only cause for the problem,
* Make an effort to include diverse people in
your groups,
* Treat people with dignity.
CONTACTS:
JoAnn Chiakulas
Illinois Department of Public Health - Center
for Minority Health Services
100 W. Randolph, Suite 6-600
Chicago, IL 60601
Phone:(312)814-2608
Fax:(312)814-1503
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Ms. Jane Neuman of the U.S. Environmental
Protection Agency facilitated the asthma action
plan development working session. Participants
discussed various issues related to asthma
prevention that had been brought up during the
workshop. The group narrowed its discussion to
the following four important actions items:
•> Build coalitions to address respiratory
concerns made up of people from many
different community groups (such as medical,
community, parent, environmental, housing,
school groups)
* Improve education
* Promote socio-economic and racial justice
and equality
* Implement holistic approaches
The group voted to build a coalition. The driving
force behind this decision was that morbidity and
mortality from asthma are too high. The problem
statement agreed upon was: There is a lack of
commitment and understanding in communities to
take measures to reduce asthma and a lack of
collaboration among the stakeholders (such as
families, child care facilities, and environmental
agencies).
Charts were then drawn up and summarized to
describe actions that should be taken to develop
an asthma coalition and who would need to be
contacted to complete the actions.
Identify the stakeholders: It was decided that
each community could identify who the
stakeholders were separately.
Gather background data: Data must be
standardized and gathered by reputable bodies
such as schools and hospitals.
Disseminate information: Informative literature
and success stories should be available to all
localities.
The coalition should be effective at penetrating
communities with community outreach. It is
important to find the people of most need and
organize closest to them. The coalition should
also educate parents and the community through
mass media and other routes about coping with
asthma attacks, preventive behavior, and other
issues.
At the end of the session, participants spoke about
the success of the Chicago Asthma Coalition and
suggested other communities that could model
similar organizations after it,
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About 12 participants attended the pesticides and
mercury action plan breakout session. This
breakout session provided an opportunity for
participants to recommend actions that will drive a
regional effort to protect children from exposure to
pesticides and mercury. The ideas and
recommendations generated during this breakout
session transpired from concurrent session
discussions held prior to this one.
Ms. Cynthia Curtis of the U.S. Environmental
Protection Agency (EPA) Region 5 facilitated the
discussion on issues raised during previous
presentations on pesticides and mercury, and the
group ultimately decided on the issues to be
addressed in the action plan. Issues discussed
are summarized below.
Mission
J
The attendees decided to focus on a Regional/
National Children's Environmental Health
Clearinghouse (Clearinghouse) for the action plan.
The Clearinghouse would encompass all children's
health issues; however, the group focused on
pesticides and mercury for the purpose of creating
a model that can ultimately be used for other
children's environmental health issues.
Components of the Clearinghouse
J
The purpose of the Clearinghouse is to develop a
resource that provides "one-stop shopping" for all
target audiences. This resource will distribute all
information regarding child health issues such as
pesticides and mercury. In order to accomplish
this mission, the following components were
proposed:
* Central location to house all resources relating
to pesticides and mercury
* Master resource list or database
* Hotline and referral hotline for diagnosis and
treatment
* Internet access
* Dual-language material
Concerns relating to the Clearinghouse include the
following:
* How to target all audiences, such as the
community, professional, official, and parent
audiences.
* How to geographically divide the
Clearinghouse (for example, by state or
region).
* How accessible the Clearinghouse will be to
all target audiences.
Core Elements Needed to Address
the Issue
The group discussed the following tasks
fundamental to successfully creating a
Clearinghouse:
1. Conduct research and gather technical
information regarding pesticides and mercury.
2. Institute the Clearinghouse as a source to
distribute information regarding pesticides and
mercury health concerns for children.
3. Establish key players to execute a pesticides
and mercury program, including the Agency
for Toxic Substances and Disease Registry
(ATSDR) and EPA's Office of Children's
Health.
4. Follow the lead of other pesticides and
mercury program success stories, including
success stories of the Indiana Department of
Environmental Management (IDEM) Mercury
Program, the Seattle King County Mercury
Program, and the Santa Monica Pesticides
Program
While developing the Clearinghouse for the action
plan, the group identified barriers that may be
encountered. To counter the barriers, the group
also devised solutions. The table below
summarizes these barriers and solutions.
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Barriers
Cost, advertising, and the media
Political climate
Industry (for example, the agriculture business)
Information overload
School board association (in Minnesota)
Ritualistic and personal uses
Reintroduction of recycled products into commerce
Solutions
Encourage use of alternative methods (product development)
Improve access to grant reports
Provide more accessible and free hazardous waste drops and mercury collection
Introduce public service announcements on consumption offish
Legislate elimination of the mercury in manufacturing of items such as shoes
using mercury
Provide cash incentives and pre-disposal fees for hazardous materials
Require reclamation by manufacturer (extended producer responsibility)
Implement creative solutions for outreach
Institute train-the-trainer programs (for example, educate health care
professionals)
Develop better marketing strategies (for example, advertise in Parents magazine)
Share materials (for example, among states)
In the end, the attendees devised the following
"ideal solution" statement for the action plan:
Implement collaborative initiatives involving both
public and private sectors that educate a target
audience about the need to replace less desirable
or less sustainable products and practices with
safer alternatives and offer opportunities and
incentives to actually do so.
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Mr. John Perrecone of the U.S. Environmental
Protection Agency (EPA) facilitated a discussion of
the problems faced by environmental health
groups attempting to foster community
involvement. The participants devised an action
plan to address these problems. Issues discussed
are summarized below.
The Problem
I
The participants determined the following four
major issues pertaining to the community efforts
they had undertaken:
* Dissemination of information to the community
* Hesitation to talk about community
involvement
* Lack of willingness of the community to "come
out" to meetings and other activities
* Lack of "ownership" of environmental health
issues on the part of the community
The group then identified more specific barriers
and problems related to community involvement in
environmental and health issues. These barriers
and problems are summarized below.
* Communities lack access to resources,
including computers, transportation, money,
and networks of other people.
* Government institutions, well-intentioned
advocacy groups, and funding groups often
fail to work with "existing resources" within a
community.
»> There is a lack of trust by communities of
"outside groups," especially those that offer
funding for short-term programs. Community
groups often feel that 1-year grants do not last
long enough for a problem to be adequately
addressed.
Community groups sense a lack of cultural
sensitivity and cultural competency on the part
of advocacy groups and institutions.
There is a lack of coordination of resources
among Federal agencies.
The Solutions
J
The participants discussed ways for groups
working within communities to encourage
involvement of community members. They agreed
that environmental health advocates have to
become part of the community. Some people
suggested attending meals and other social
occasions in the community. Ms. Susan Gust
(Sustainable Resources Center, Minneapolis)
reported that the Sustainable Resources Center
pays community members to attend meetings.
Participants also discussed sources of information.
One person suggested that churches were a
source of information about community issues.
Another suggested using the Internet to gather
information about issues.
Successes
Several participants identified their past successes
in encouraging community involvement. The
successful programs mentioned included the
following:
* The Integrated Pest Management (IPM)
program implemented by high school students
in Detroit, to teach residents about basic
issues involved in pest management
* The Phillips Neighborhood Health Housing
Collaborative
* A Head Start program to teach community
members about nutrition, sanitary skills, and
raising children to become good parents and
leaders
* The Tulane University Lay Health Advisory
Program.
•* The Chicago Asthma Initiative
The Action Plan
The participants determined that they should
create an action plan in order to:
1. Promote community leadership to address
local environmental and health issues and
-------
2. Look to communities to lead themselves, with
less government involvement.
The five objectives of the Action Plan were as
follows:
1. Increase two-way sharing; do not separate
people by "class" or technical ability.
2. Identify communities with limited resources to
ensure economic justice.
3. Develop strategic partnerships with corporate
and academic America to aid in addressing
environmental issues.
4. Use environmental and health issues to
further economic and environmental justice in
communities.
5. Transfer knowledge of current success to a
wider market.
Workshop members then decided that the most
important objective was to develop strategic
partnerships with corporate and academic America
to aid in addressing environmental issues. They
brainstormed the following potential methods for
achieving this objective:
«> Conduct educational seminars for
communities
«> Conduct train-the-trainer seminars
* Identify community organizations that have a
stake in environmental and health issues
<» Identify "informal" community leaders who
know how to "get the word out"
* Integrate community "assessment mapping"
into planning steps
* Involve community entities in program
planning and evaluative-type research
* Promote community economic growth by
paying community members who work to
address environmental and health issues
* Look beyond the status quo and the members
of the community who usually get involved
* Facilitate community dialogue
The group also made a list of the people who
should be involved in the implementation of the
action plan and the skills they could contribute.
This list is summarized below.
People
Parents of school-aged children
Grandparents and senior citizens
Teachers and school administrators
Faith communities
Maintenance people
Elected officials
Technical experts
Children
Parents of all-aged children
College students
Academic community
Religious leaders
Others
Skill Mixes
May have time to do work during the day
Provide historical perspective of community
Can coordinate and offer management, technical and legal skills
Can be involved if adults are not sensitive about the amount of
time the children are asked to spend working
Nurturers; can provide refreshments
Spiritual civility
Perform public and community relations activities
Write grant applications
Provide writing or media skills
Can be visionary and passionate about the issues
Can provide wealth, work, and wisdom
-------
The participants devised the following action items
to achieve the objective of the action plan of
developing strategic partnerships with corporate
and academic America to aid in addressing
environmental issues.
EPA staff were tasked with the following action
items:
•:» Attend the Head Start National Conference,
and conduct environmental workshops
«:» Attend state-wide teacher meetings to present
environmental information on workshop.
Other actions items include the following:
* Develop a handbook to synthesize existing
work around this WATCH Conference. A
suggested title is "Promoting Community
Leadership."
* Collaborate with the medical community on
"basic" environmental concerns such as
medical education for physicians, nurses, and
health service providers.
* Collaborate with community housing and
neighborhood organizations in order to create
links between environmental health and
housing, energy and "green" architecture.
Finally, the group presented a challenge to the
entire WATCH forum: "Walk the walk, talk the
talk!"
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Ms. Dolly long and Mr. Derrick Kimbrough of the
U.S. Environmental Protection Agency (EPA)
facilitated a discussion of environmental health
and tribal issues. During the working session,
attendees discussed the following issues from the
morning session:
1. Coordinating with state, Federal, local, and
county representatives without compromising
tribes' sovereignty
2. Identifying and maximizing available resources
among agencies
3. Creating a needs assessment to identify
environmental risks on tribal lands
The attendees discussed the coordination of
agencies and noted that it is also necessary for an
agency to be aware of actions taken by other
agencies. The attendees then turned to the issue
of the needs of people on the reservations. The
following four main action items were developed:
3.
4.
Better coordination with tribes' internal
departments.
Identify components of tribes' needs
assessments by considering the particular
tribe's poverty level, demographics, and
segments with high risk. The needs
assessment should include baseline data
collection, information about perceived
threats, and a map of pollution sources and
pathways of contamination.
Determine what roles and resources other
entities could provide for the needs
assessment and for correcting the problems
Use community outreach and education
programs
An EPA representative pointed out that any tribal
program should include identification of the
following three elements:
* Problems faced by the tribe
* Solutions
«> Potential actions to implement the solutions
The attendees also discussed ways of providing
environmental health information to tribal people,
such as including facts about pollution on electric
bills and making information available at local
clinics.
The attendees identified the following sources of
information that could be used for the needs
assessment:
Resource
Toxic Release Inventory
Health care data
Drinking water data
Injury data
Non-major emitter data
Emergency response capabilities
Lead level in blood of tribe members
Pesticide use
Radon and lead in homes
Demographics and data on children
Poverty level and income data
Mapping
Agency or Group
EPA
Indian Health Service (IHS) and tribes
Tribes
Center for Disease Control (CDC) and IHS
States
Counties and the Bureau of Indian
Affairs (BIA)
Women, Infant, and Children (WIG), Medicaid, and states
States and agricultural departments
Department of Housing and Urban Development (HUD)
and IHS
Census Bureau, schools, BIA, and tribal enrollment
Tribes
Toxic Release Inventory (EPA)
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Action Plan Development
Working Session: Lead
Mr. Chad Cliburn and Mr. Dale Luecht of
the U.S. Environmental Protection Agency
(EPA) facilitated the lead action plan
development working session. Participants
discussed various issues raised during the
previous presentations on lead, and
narrowed its discussion to lead awareness
and increasing lead poisoning prevention
behaviors.
What Is the Issue?
J
Lead awareness is still low because of
relatively low priority with competing
problems, lack of knowledge, and difficulty
in changing people's behavior.
Awareness
i
Low Priority
• people think lead has gone
away
low prevalence
• compare to other problems
Everyone needs more
• some may be more important
Lack of knowledge
Behavior change difficult
Right people are not saying the right
things
No National Strategy because of
targeted marketing
WHO?
• Parents and older Siblings
• C.B. Housing Orgnanizations
• Doctors - move to behavior
change introduce prevention
message
• Anyone who has children
their care kids
Successes in Addressing Issue
J
Tap into existing resources - (i.e.,
Lead Safe America)
Take message to personal level
Message to schools
Speakers Bureau
parents/grandparents of children
with lead
Lead poisoning awareness
successes
Caring attitude get children lead
screened and follow-up
Partner with community
organizations to address lead issues
Barriers to Increasing Awareness of
Lead Poisoning
Competing Problems
People don't know what to do next
Pediatricians not receptive - use
referrals to local/community
organizations
Out of sight - Out of mind
Lead cannot be seen - out of sight
out of mind
Landlords and Renters unaware of
lead in-home disclosure law and
hazards of lead
Limited access to large groups of
very young children
Problem in getting results
How to contact pediatricians
People are too busy competing
demands
Organizations are disappearing -
lead is lower priority
-------
Objective of Action Plan I
Start with EPA
Increase lead poisoning prevention
behaviors in a targeted population.
Solution to Achieve Objective 1
Show measurable increases in lead
poisoning prevention behaviors within a
targeted population.
» Who would be involved - USE
NATIONAL CAMPAIGN
Different message for different
audiences.
a Alliance to End Childhood Lead
Poisoning: 202-543-1147
# for LEAD SAFE AMERICA
« National Lead organizations
promote lead hazard awareness
• Who will pass out information
<• Link with community health
organization
« Daycare workers/homes
Train community workers and social
workers
• Mandate, enforce homeowners and
landlords to eliminate lead hazards
« City organizations are hesitant to
become involved due to liability
° Multi-outreach to parents with
prevention message -baby products
- diapers, diaper wipes
Resources
Lead posters from lead hot line
Get out message to use product
"Cascade" to remove lead
Use community organizations
State resources
Find out where are the resources
-------
Lead Action Plan
ACTION
Have doctor talk to groups of doctors
1. Identify population; where is the population
2. Provide GIS maps to community organization
and others; and vanguard community or other PR
What are current concerns of population:
- how do they receive information
- radio, billboard, product advertising
Where do you focus message.
What will work, message to groups, individuals.
How to structure campaign.
Involve community groups /people interest in lead
in developing campaign, form coalition
Policy-uniform state/lead law
Seek $$$$$$$
PHASE II
Lead screening as a means to measure lead
levels.
Disseminate information to organizations involved
in target communities, so they will disseminate
information: Medicaid, food stamps, WIG, clinics,
churches.
WHO
State and Local health
departments
EPA
Marketing Agencies: who
will pay PSAs
Whoever disseminates
information; hospitals,
neighborhood groups.
Any stakeholder local
health department
Feds, Foundations,
Universities, Industry
Vans - health department
WHEN
Completed
GIS maps
-------
Action Plan Development
Working Session: "New Ideas"
Mr. Peter Murchie of the U.S.
Environmental Protection Agency (EPA)
facilitated a discussion of "new ideas" to
develop a holistic framework for addressing
children's health issues. The group
discussed how to develop a campaign
theme that would draw people's attention
towards children's health. The goal would
be to increase all sector awareness,
involvement, and action. This would be
encouraged by developing an imagery tool
that would draw people's attention and get
them to visualize the place and role for
children's health.
The group discussed barriers to achieving
this holistic view of children's health
Worker turnover, focus on single issues
and lack of resources lead to continual
problems with holistic awareness of
environmental health issues. Communities
may feel underpowered to solve problems
hohstically. The group noted in order to
encourage a community's involvement its
culture needs to be factored into the
approach to help people help themselves.
The group suggested a "pledge" program
that could help activate communities One
idea was to send out a pledge sheet with a
membership card to people as an
environmental reminder. To ask people to
pledge, a list of principles is needed The
group identified three:
1) Children's health is our first priority.
Children are the most valuable asset
our planet has.
2) In working towards children's health,
I will respect others' opinion, culture,
values and needs.
3) Everything I do affects others and
what they do affects me. "No one is
an island."
The group also suggested forming a
regional advisory group for children's health
that would encourage different entities to
work together and overcome contention.
Develop a Holistic Framework for
Children's Health
Tool
a
Goal
Imagery, like Mississippi River,
Woman's Breast, Seven
Generations
Everyone at table visualizing place
and role for Children's Health
Increase all sector awareness,
involvement and action
Barriers
« Lack of passion
« Turnover
• Conditioning
• Single issue focus
9 Lack of human and $ resources
Bias: "us" vs. "them"
• Unbalanced power
• Lack of knowledge
9 Cultural differences
• Priority differences
Turf
Solutions
• All inclusive
• Involve people/ include in all aspects
• Promote "power with" vs. "power
over"
• Education at all levels (K-12 criteria)
-------
Action Plan
ACTION
WHO*
WHEN*
Letters from EPA to medical
professionals/organizations
to get involvement
-school systems
EPA/ATSDR
Create Imagery/Symbol
-ribbons to wear (green?)
This group and RAG
Pledge with Children's
Environmental Health(CEH)
Principles
RAG, EPA, and HHS
List serve/Internet/Web
Marketing-Workshop on how
to market CEH
Social Marketers
Regional Advisory Group
(RAG) for CEH
• $ involved for staff
time, database
development and list
serve
• linkages
• all inclusive
• workgroups for
individual topics
» Steer Committee and
subgroups
• contact list for CEH
entities
« speakers bureau
• clearinghouse
(centralized) for CEH
Federal agencies
(USDA and FDA may
be against
environment issues,
but it is good to get
the "enemy" to the
table.)
NACHO
Medical profession
NEHA
State agencies
Industries
APHA
Workshop
participants
Chicago American
Lung Association
AEN Education
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Local tribes can identify other sources of data for
the needs assessment.
The IMS, with input from individual tribes, will
develop a draft needs assessment tool consisting
of two to three pages of questions by January
2000.
•&U.S. GOVERNMENT HOOTING OFFICE: 2000 547-932
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