A Synopsis of Stakeholder
Representatives' Views
Regarding
Community-Based Health Research Models
Mav 15, 2000
A Preliminary Report
Prepared for the U.S. Environmental Protection Agency
Office of Environmental Justice
By
Adrienne L. Hollis, Ph.D.
Florida A&M University
Institute of Public Health
Tallahassee, Florida
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Table of Contents
Introduction 1
Purpose of NEJAC Meeting 3
Purpose of Stakeholder Interviews 4
Description of Stakeholders and Interview Process , 4
Results - Themes and Accompanying Comments 5-15
1. Developing Effective Partnerships 5
2. Intervention and Prevention Activities 6
3. Community-Based Research 7
4. Current Models of Community-Based Research 10
5. Barriers and Data Gaps and Their Relationship to Health Effects 11
6. Socioeconomic Vulnerabilities and Cultural Factors 12
7. Effective Risk Communication 13
8. Sustainability 14
9. Federal Agencies as Partners 14
10. Other Stakeholder Comments 15
Appendices
A. List of Stakeholder Interviewees 16
B. List of Interview Questions 19
C. Models of Community-Based Research , 23
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SUMMARY OF STAKEHOLDER INTERVIEWS
Introduction
Protecting the health of all communities represents a formidable challenge for the Environmental
Protection Agency (EPA). According to the 1997 Strategic Plan, the mission of the U.S.
Environmental Protection Agency is to protect human health and to safeguard the natural
environment-air, water, and land-upon which life depends for all Americans. EPA must carry
out this mission consistent with Executive Order 12898 on environmental justice, and existing
protective environmental laws.
The Surgeon General of the Department of Health and Human Services issued in January 2000
the publication, "Healthy People 2010-Understanding and Improving Health." The second goal
of Healthy People 2010 is to eliminate health disparities among different segments of the
population, including differences that occur by race or ethnicity, education or income. These
disparities are especially apparent in minority, low-income, and/or indigenous communities.
Many of these same communities bear a disproportionate exposure to environmental pollutants
that may underlie and/or contribute to these disparities. When such exposures are combined
with other social and physical living conditions present in these environments, the potential for
health disparities is magnified even further.
The Office of Environmental Justice requested the National Environmental Justice Advisory
Council (NEJAC) to focus its attention on federal efforts to secure disease prevention and health
improvement in communities where health disparities exist that may result from, or be
exacerbated by, disproportionate effects of environmental pollutants and certain socioeconomic
or cultural factors. This report presents the results of interviews with twenty-one (21)
stakeholders drawn from government, academia, industry and community organizations.
The stakeholders interviewed here, though from a variety of backgrounds, shared some common
beliefs and expectations. Everyone supported the need for developing an integrated model to
address community-based health needs. They believed that assessment, intervention and
prevention are three major components of a community-based health model. Most emphasized
the need for an evaluation component to that model. This is a dynamic model, which requires
concerted efforts not just by EPA but by many other federal departments and agencies.
Responding appropriately to the multi-agency public health concerns of communities requires a
multi-faceted response. Moreover, it was noted that a static definition of health is a barrier to
disease prevention and health improvement. Health is not merely an outcome, but a proactive
process that lead to an outcome.
A central theme which emerged from the interviews was a need for partnerships. There was
strong focus on the issue of working with communities. All stakeholders were emphatic that
actions be conducted in the community with having the community as an equal partner. In fact,
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there was unanimous agreement that the community, or a community-based organization, is the
most critical component of a successful partnership. This theme is a critical element to the
success of a community-based public health model. Going beyond the notion of research done
"in or to" a community to research that "works with" a community is viewed as a critical link for
translating assessment efforts into needed intervention and prevention activities.
There was strong support on the part of all interviewees for the concept of community-based
health research models. Given the central role of community-based organizations, community-
based research is, thus, an absolutely essential element of any successful federal effort to
achieving an integrated community model that includes health assessment, intervention and
prevention. Interviewees were able to identify many such successful partnerships. They point to
the support of such partnership models by federal agencies, in particular, the National Institute
for Environmental Health Sciences. There was general consensus that an evaluation of existing
models would provide valuable information, as well as specific tools which can be adapted for
specific projects.
There also existed uniformity of opinion that federal agencies must learn to better partner with
each other. Currently, there is a prevailing impression among all stakeholders that federal
agencies are working in an isolated manner. This was seen as a requisite condition for better
partnerships with community and other stakeholders. A number of federal agencies were
identified as potential partners in a community-based health research model. These included not
only EPA and public health agencies but also agencies such as the Department of Transportation,
Department of Energy, Department of Housing and Urban Development, Department of
Agriculture, Department of Labor and others.
Special attention should be given to overcoming specific barriers to success of such community-
based health research models. One such barrier is the need to capacity building for community-
based organizations. Another is recognition of the time-intensive nature of a partnership
building process. There are many issues related to communications, cultural sensitivity and trust
that must be overcome. Thought should be given to these issues in project design.
While it was agreed that there exists gaps in information to determine a direct causal relationship
between environmental pollution and health effects, it was also the consensus that the inability to
show a direct causal relationship should not hinder prevention and intervention activities.
Barriers to determining direct causal relationships include the absence of human exposure and
health surveillance information. Another is the lack of health data to better elucidate
socioeconomic and racial factors. Lastly, analysis of health impacts "one chemical at a time"
precludes an understanding of cumulative environmental and human health effects.
Socioeconomic and cultural factors are important in addressing community health concerns. It
was the general consensus that ample evidence exists of a relationship between socioeconomic
and/or cultural factors and health effects. This raised the question of the type of scientific
disciplines needed to fully understand the cumulative effects of environmental impacts on
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minority, low-income, and/or indigenous populations. Input should be obtained from social
scientists as well as physical scientists.
Interestingly, the majority of the comments and views presented in the report parallel the
recommendations contained in the 1994 Federal Interagency Symposium on Health Research
and Needs to Ensure Environmental Justice and the 1999 Institute of Medicine Report entitled,
Towards EnvirotimemalJiistice: Research, Education, and Health Policy Needs. This suggests
that most people have similar concerns and recognize similar gaps in current strategies and
activities. The majority of the stakeholders look forward to the discussions at the upcoming
NEJAC meeting. They also expressed considerable excitement at the possibilities for stronger
partnering and collaboration efforts.
Purpose of the National Environmental Justice Advisory Council
(NEJAC) Meeting
The charter of the NEJAC directs that entity to provide independent advice to the Environmental
Protection Agency's (EPA) Administrator on areas which may include, the direction, criteria,
scope, and adequacy of the EPA's scientific research and demonstration projects, relating to
environmental justice. To that end, EPA's Office of Environmental Justice (OEJ) has requested
the NEJAC hold an issue-oriented, focused public meeting in Atlanta, Georgia. That meeting
will be held May 23"1 through 26*, 2000.
The NEJAC meeting will focus on federal efforts to secure disease prevention and health
improvement in communities where health disparities exist that may result from, or be
exacerbated by, disproportionate effects of environmental pollutants and certain socioeconomic
and cultural factors. The meeting will center around three important questions, provided below.
(1) What strategies and areas of research (research in this context encompasses a
broad range of studies that may include basic science, applied research, and data
collection. These may be carried out by the following: federal, state, tribal or
local governments; universities; communities; industry; and/or individuals)
should be pursued to achieve more effective, integrated community-based health
assessment, intervention, and prevention efforts?
(2) How should these strategies be developed, implemented and evaluated so as to
insure substantial participation, integration and collaboration among federal
agencies, in partnership with the following: impacted communities; public health,
medical and environmental professionals; academic institutions; state, tribal and
local governments; and the private sector?
(3) How can consideration of socioeconomic vulnerabilities: a) contribute to a better
understanding of health disparities and cumulative and disproportionate
environmental effects; and b) be incorporated into community health
assessments?
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Purpose of the Stakeholder Representatives Interview
In order to have an intensive, focused meeting, the OEJ determined that conducting preliminary
interviews of stakeholders would lead to the elucidation of particular issues, which would then
serve as the starting point for discussions at the NEJAC meeting. To that end, a number of
individuals, representatives from academia; industry/business; federal, state and local
governments; community groups; and tribal entities were interviewed. Specific questions were
designed by OEJ, with input from the reporter, Dr. Adrienne Hollis. During the summary of the
questionnaires, a number of recurring issues and recommendations emerged. Those have been
categorized into themes, for use in focusing the NEJAC meeting.
Description of Stakeholder Interviewees
Twenty-one interviews were conducted with stakeholders representing the federal government
(6), state health and environmental agencies (3), academic institutions (8), and community
organizations (3). In addition, there was one representative from industry/business. These
individuals have been involved in some form of community-based activity, including funding
research projects, conducting assessment, intervention, evaluation, and/or prevention activities
with communities, or by working directly in and with communities. They each bring a wealth of
knowledge and expertise to this process. A list of the stakeholders interviewed is provided in
Appendix A, and the list of questions utilized during the interview process is provided in
Appendix B.
In addition, a draft copy of the initial results of the questionnaire was shared with members of
the May 2000 NEJAC Meeting Planning Committee. Their comments and recommendations are
also incorporated into this document.
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Themes and Accompanying Comments
(1) Developing Effective Partnerships
Who Should Partner in a Community-Based Health Research Model?
There was almost unanimous agreement on the part of stakeholders that the community, or
community-based organization was the most critical component for a successful partnership.
One community stakeholder, who suggested that academia and community partnerships were the
most critical, explained that "...communities alone will not have the credibility or capacity to
address health issues in a way that would lead to policy change, but these partnerships can help
communities push a public health agenda...." They further stated that "...until the finding
process changes, the research needed to do work in communities needs to go through academic
institutions...." A number of stakeholders discussed the definition of 'community'. Some non-
community stakeholders pointed out that there should be a mechanism to define community.
One stakeholder from a state health/environmental office stated that the community should
include "...people from affected community and folks who are not necessarily affected by an
event...pollutants do not know barriers, and may eventually affect other areas...". A
representative from academia stated that "...we are also community organizations, we employ
from and live in the community...academicians are part of the community...." A stakeholder
from the federal government stated that "...leadership in communities must be defined by
communities... we should not try to define community leadership, let them (the community)
identify leaders...." Other entities that were identified by the majority of the stakeholder
representatives as a necessary component included; academic research institutions, federal, state,
and local government, health care providers, local environmental and health departments, and
funding agencies.
A few representatives (one each from academia and a state health/environmental office, and two
from government) felt that industry/business should be included in the partnership, in order to
achieve success. Interestingly, one stakeholder from academia was very vocal against bringing
industry to the partnership. This particular stakeholder stated "...industry has always done
something with an ill intent. They are not to be trusted, and most people are not convinced that
they [industry] have the interest of the people at heart...." In contrast, a stakeholder from the
state health/environmental agency stated that "...industry plays a key role as a stakeholder in this
process... industry is not explicitly included in the process... they should not be considered a
barrier, but they should be included in the partnership..."
Critical Elements for Success
When asked what elements were needed for a successful partnership, it was the general opinion
of the stakeholders that trust and credibility MUST be established among the partners. As one
stakeholder explained "...trust from the community and from the stakeholders is one of the
critical elements for success...." A second stakeholder from academia stated that "...partnerships
will work if accountability and structure are incorporated into the process..." The
overwhelming majority of the stakeholders agreed that establishing trust and credibility is time
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and resource intensive, and that this should be recognized and acknowledged by all stakeholders.
According to one federal stakeholder, "...trust is a critical element in anyparttjership...ifyou
outline what you are going to Jo, Jo what you say will do and say what you cannot do, that will
go a long way toward establishing trust and credibility..."
A stakeholder from academia stated that the foundation for this model would be developed with
education, training or outreach to the community, to ensure that everyone is "...OH the same
page.... " A second stakeholder from academia stated that "...// is incumbent upon fending
agencies to verify'partnerships, to insure that it is not some inequitable, patched together, kind
of network. This effort requires the evaluation of whether a partfjership described on paper, on a
grant application, actually exists and will survive post-funding..."
(2) Intervention and Prevention Activities
When Should Intervention and Prevention Activities Occur?
Intervention and prevention, two of the components of a community-based health model,
generated a great deal of discussion. One federal stakeholder suggested that after assessment is
complete, the partners should analyze whether intervention is needed. The partners should first
discuss what is meant by intervention, then decide what is needed.
A stakeholder from the community and a representative from the NEJAC May 2000 Planning
Committee, both discussed the importance of the "Precautionary Principle", which involves
taking appropriate measures to protect public health. Although other stakeholders did not use the
term "precautionary principle" in their discussions, most, if not all, felt that in the presence of or
threat of adverse health effects, there was no need to wait before initiating
intervention/prevention activities. These activities should be a major element of the way business
is conducted when dealing with environmental issues. One community stakeholder stated that
both intervention and prevention activities must be conducted with the community, not on the
community in order to be successful. They further stated that the community believes that any
research conducted must include an intervention component. In addition, when dealing with
federal agencies in these activities, there should be some protocol or guideline on interaction
with the community. For example, when ATSDR conducts public health assessments and health
consultations, and when EPA conducts risk assessments, there should be a methodology in place
for working with communities.
According to a number of stakeholders, prevention is often placed last, both in design and in
thinking, when addressing environmental issues. As one federal stakeholder stated,
".. .Individuals who are adept at prevention activities have been trained to look upon it as a 'final
step' in the process...." That stakeholder provide the example of EPA's role in public health,
which is for the most part, according to the stakeholder, not health related. Their strongest work
is in the area of prevention, looking at enforcement of environmental guidelines and laws. Along
those same lines, the National Institute for Environmental Health Sciences (NIEHS) has been
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attempting to address the prevention portion of the model (along with assessment), and has
recently begun looking at prevention efforts.
A number of stakeholders felt that intervention was an area needs more attention. An example
provided by a state stakeholder, is the issue of asthma. There is a lack of activity in addressing
the incidence of asthma, particularly in children. A second example involves lead exposure and
toxicity. A number of stakeholders suggest that appropriate intervention and prevention efforts
have not been applied to this issue. In addition, it was suggested that intervention and
prevention may not be that different. After a partnership has assessed a problem, they should
analyze whether intervention is needed, and then decide on an appropriate intervention.
Barriers to Effective Intervention and Prevention
According to input from a number of members of the NEJAC May 2000 Planning Committee, a
major barrier to effective intervention and prevention activities stems from the perception that
city, state, county, tribal agencies, and/or municipalities are supportive of the activities of the
polluting industry or business. This is true even when dealing with federal facilities. Their
interest may be directed more towards economic interests than the health of the community.
According to the Committee members, pollution prevention and enforcement activities should be
a major emphasis of these entities when dealing with industry/business.
One stakeholder from a state environmental health office stated that a major barrier is the lack of
action on the part of the EPA. He discussed the issue of lead contamination in communities as a
major example. He felt that this was an established issue that has had virtually no intervention.
He further stated that in order for intervention and prevention activities to work, the federal
government could not go directly to communities, the state and local health and environmental
regulator entities must be involved.
(3) Community-Based Research
What is Community-Based Research?
Initial discussion surrounded the definition of community-based research. The consensus is that
the model has to be participatory, with the community as an equal partner, in order to be
community-based. It was suggested by a member of the NEJAC May 2000 Planning Committee
that the name be changed to "community-based participatory research," to differentiate it from
research done "in or to" a community. According to a number of stakeholders, in this model
(participatory research), the community has a leadership role in activities planned by the
partnership. This is an issue that both NIEHS, through its environmental justice partnership
grants, and ATSDR, through the Minority Health Association Foundation grants, have been
attempting to address.
Most stakeholders (with the majority from academia and the federal government) stated that
research in the community-based health research model should be more broadly designed. The
definition of this research should be qualitative, rather than quantitative. Assessment of this
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model has to be rigorous and detailed, and must include what may be non-conventional
methodology, including the use of biomarkers. When discussing risk assessment, EPA must be
open to incorporating unconventional data into that model. The design of the model should be
done by the partnership with all stakeholder.
A representative from the NEJAC May 2000 Planning Committee stated that it was important to
note that there are other types of research, besides participatory, which should not be
overlooked, because of the value of the data obtained. No additional details, however, were
provided.
In addition, a community representative on the NEJAC May 2000 Planning Committee
suggested that there should be some protocol or guideline developed which would allow the
community to participate in "agency" research, with the term 'agency' inclusive of academic
institutions and other entities conducting research. A stakeholder from academia suggested that
efforts be made to promote opportunities to increase technical proficiency or empower local
communities to conduct small scale studies, using valid methodologies, such as accepted
analytical methods for environmental sampling. Funds should be provided which would allow
communities to work with researchers who can train and bring communities 'up to speed' on
sampling and research methods. Competition for funding between community organizations,
academic institutions, and other organizations to work with a specific community, should be
eliminated.
Quality and Quantity of Data Produced
The general consensus of the majority of the stakeholders was that data obtained through
community-based efforts are useful. The concern is that because of the size of the population,
there may not be statistical significance, which is a concern when using data to generate policy.
One stakeholder from academia stated that there is tension between the desire for rigorous study
design and the reality of actually conducting that research in the community. According to
another stakeholder, a great deal of data are produced, but there is concern about the internal
validity of the design.
One stakeholder suggested that efforts should be made to increase technical proficiency or
empower local communities to do small scale studies, using valid methodologies and accepted
analytical methods for environmental sampling. This should improve the quality of any data
produced.
Data Gaps in Community-Based Efforts
One stakeholder from academia stated that data should be gathered on different levels. For
example, data is needed on issues surrounding residential and occupational segregation, racial
and economic segregation, gender, schedules of exposure, and links between exposure to
hazardous substances in hospitals, to name a few.
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In addition to the stakeholders mentioned previously, scientists from the social sciences
(sociology, psychology, behavioral sciences, anthropology, psychometrics, etc.) should be
included in research activities. The community model would benefit from social science. They
have a great deal to offer in the area of social behavior, psychological stress etc.
When dealing with the issue of research, there needs to be some guidelines on how rigorous the
research and science needs to be in order to be relevant to policy development. While it is
agreed that there should not be tradeoffs between scientific rigor and policy relevance, there
needs to be consideration for the value of this type of research. While the data may not meet the
certain standards required for scientific rigor, the data can be important in its own right. The
question becomes: 'How much research is needed before actions are taken, particularly around
issues of health disparities?'
Assessment. Intervention, and Prevention in the Community-Based Research Model
Although all stakeholders agreed with the inclusion of these components in a community-based
model, a few stakeholders have suggested that communities have had enough "assessment."
Those stakeholders, representatives of community, academia and state health/environmental
entities, stated that we are very good at assessment, but need to focus on intervention and
prevention activities. In contrast, one federal stakeholder stated that assessment was the element
most in need of improvement. It was almost unanimous that communities play a major role in
assessment, intervention and prevention. In addition, one federal stakeholder stated that "...the
assessment describes -what is or -what exists, and -what has been done concerning particular
issues...." One stakeholder from academia stated that assessment is core, in terms of what kind
of data is required. Assessment is also important because community and scientists' perceptions
needed to be discussed.
Evaluation in Community-Based Research
A fourth component, in addition to assessment, intervention and prevention, has been suggested
by a number of stakeholders, including representatives from the federal government, academia,
state health/environmental agencies, and community groups. According to these stakeholders,
evaluation should be a major part of any health model. One stakeholder from academia also
pointed out that evaluation is also a barrier to implementation of the model, as very few
stakeholders are trained to conduct evaluation. Rigorous evaluation is needed throughout the
research project, to prevent delayed intervention in some communities. One stakeholder stated
that, in the past, evaluation had been conducted via a traditional approach, which does not
recognize social assets (i.e., how we build models or pilot projects that leave the community
more empowered). This would require quantitative evaluation. The type of evaluation needed is
foreign to researchers, because it is qualitative and formative in nature. One stakeholder stated
that all partners must feel comfortable with the tools of evaluation, and that training in
evaluation should be required for everyone, including the funding agency. A number of
stakeholders discussed the need for input from individuals in the social and behavioral sciences,
as they would have expertise in evaluation.
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One federal stakeholder opined that evaluation is different from assessment. Evaluation is
inherent with value, assessment describes what is or what exists concerning particular issues, as
well as what has been done. It was also suggested that in addition to the evaluation conducted by
the partners, outside evaluation would provide invaluable insight and feedback on the activities
conducted.
A community stakeholder stated "... when people think about evaluation, it is intimidating. We
should embrace it. It is usually one way, from the funding agency...it needs to come back the
other way - what is the agency internally doing to evaluate how it does its work...."
(4) Current Models of Community-Based Research
General Comments
The prevalent opinion among stakeholders interviewed, including those from the scientific
community, is that there are successful models of community-based research. Several
interviewees took note of the following community-based research models. It is beyond the
scope of an interview process to describe each in sufficient detail and accuracy. Most suggested
that someone should compile the results of those activities, detailing the types of community
interactions and the models used. A description of some of these projects can be found in
Appendix C.
The majority of these examples incorporate environmental justice principles into the partnership
activities, but this is not true for all examples. A general suggestion, made by a stakeholder
representative from federal government was to examine the results of grants funded in the past.
These grant programs include Environmental Justice Community University Partnerships for
Communications (NIEHS), Community-Based Intervention/Prevention Strategies (NIEHS),
Environmental Justice Pollution Prevention Grants (EPA), Environmental Justice Community-
University Partnerships (EPA), and the Environmental Justice Small Grants (EPA).
It should also be noted that there was general consensus that an evaluation of models currently in
use would provide valuable information, as well as provide a number of tools which can be
adapted for specific projects.
Critical Elements for Success of the Model
Critical elements for success, as identified by the majority of the stakeholders, include respect,
equity and empowerment. According to one stakeholder, "...respect deals with the fact that
culture and community concerns deserve equal merit from the partners. Equity involves sharing
the wealth with the community, and empowerment involves being committed to the principle of
making the community self sufficient...."
A number of stakeholders also identified 'having an open mind', and 'stepping outside of the
box' is also critical to the success of the project. According to the stakeholders, this involves a
willingness to conduct activities differently, to see value in collaboration with other partners. An
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additional element identified as important to the success of the model, is capacity within each
component to work together.
One government stakeholder stated that current risk assessment methodologies are not designed
to address non-chemical stressors. They (risk assessments) are not epidemiological studies.
Consideration should be taken in addressing this issue.
Barriers to the Success of the Model
Special attention should be given to specific identifiable barriers to the success of the model.
One such barrier, identified by state health/environment, community, and academic stakeholders,
is the lack of capacity-building for community based organizations, to enable them to partner
with scientists and health care providers. A second barrier is the time intensive activities needed
in the initial stages of the partnership development. The consensus among the stakeholders that
the time-intensive nature of the partnership could be a barrier, from a funding perspective as
well as a commitment (by stakeholders) perspective. An additional barrier is the complexity of
the model design. The more complex the model, the more difficult it is to plan, implement and
evaluate. This is true for any model. Other barriers identified by numerous stakeholders
included resources, such as computer equipment, and economic issues (including simple issues
such as travel of community members to partnership meetings).
One stakeholder from academia discussed institutional barriers, related to tribal council changes
and cultural sensitivities as a major impediment to the success of the model.
A community member stated that the barriers around relationship are not as important when
community capacity is built-in. The focus becomes more on prevention and dealing with the
current exposure than trying to figure out what happened in the past.
(5) Barriers and Data Gaps and their Relationship to Health Effects
While it is agreed that there are a number of barriers and data gaps in current research activities
directed toward addressing health effects, it is also the consensus of the majority of the
stakeholders that the inability to show a causal relationship between exposure and effect should
not hinder prevention and intervention activities. One of the barriers identified time and again,
is the continual effort to determine past exposure and health effect. It has been suggested that
efforts should focus on dealing with current exposure instead.
One federal stakeholder stated that the work started in the 1985 Secretary's Task Force on Black
and Minority Health Report, which identified both the current state of the health of people of
color and the data gaps, is the place to start. That stakeholder also stated that the Institute of
Medicine Report on Environmental Justice would prove invaluable. Other resources mentioned
include the National Medical Association, the Hispanic Health Association, and organizations
for Asian and Native Americans.
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When asked what the three greatest barriers to determining the relationship between exposure
and health effects, one federal stakeholder stated that little is known about the latency period
between exposure and health effect. There is also the perception that health and environment are
not related. The environment has not been associated with adverse health effects in the past. A
number of stakeholders from academia stated that the type of exposure is important, and that it is
difficult to determine, given the latency period, what the exposure was.
Another barrier identified is the issue of an absence of sufficient human exposure and health
surveillance information, beyond that provided through the Toxic Release Inventory (TRI) or
emissions data. In addition, although health data is collected by race and ethnicity, there are no
indicators of social class on the birth certificate, no information on income, health insurance, etc.
This makes it difficult to determine the impact of race versus socioeconomic status when
examining health effects. One federal stakeholder identified the definition of 'health' as a
barrier. He stated that health is not an outcome, it is a process which leads to an outcome. That
outcome must be defined by an individual group.
One community stakeholder stated that one barrier is the procedure used which only analyzes
one chemical at a time, instead of studying synergistic effects. In addition, they stated that little
information is available on new chemicals, and transient exposures (the effects of exposure at
different times in our life...past and current exposure). An additional barrier mentioned is poor
health record keeping, where people receive services from different clinics, with no uniform way
to keep track. In addition, the lack of a universal health plan was identified by the community
stakeholder as a barrier.
(6) Socioeconomic Vulnerabilities and Cultural Factors
The overwhelming consensus is that all socioeconomic and cultural factors are important in
addressing community health concerns. According to one stakeholder, risk factors are
socioeconomic and behavioral, so interventions must be the same. These factors include social,
behavioral, economic, cultural, and political issues. It is the general consensus of stakeholders
that ample evidence exists of a relationship between socioeconomic and /or cultural factors and
health impacts. A federal stakeholder stated that".. you cannot assume that issues around race
and ethnicity are the same as those surrounding socioeconomic concerns...holding
demographics constant, race and ethnicity continue to be significant, holding race constant,
demographics and ethnicity are significant and soon...."
According to one academician, socioeconomic conditions and health, absolute and relative
poverty, standard of living, access to healthy foods, position at work (occupational
environment), are all factors relevant to health. They continued by stating that "...culture
includes behavioral differences, cultural disparities, such as language barriers, culture mixed
with racism, etc.,...."
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Interviewees recognized socioeconomic vulnerabilities and cultural factors as being important
contributors to health disparities. Consideration and attention need to be directed at the role of
other factors, such as psychological stressors (i.e., job security, safety issues, housing, etc.),
class, outside stressors, environmental stressors, economic and racial segregation and others,
may play in relation to health disparities.
One stakeholder from academia stated "...ifyou are talking about environmental justice, you
must discuss issues of class in relation to race, gender, and other factors. This should include
informed social scientist' input, not just physical science... "
(7) Effective Risk Communication
It was the general opinion of most stakeholders that in order for a partnership to be successful
and for community-based research to be effective, all stakeholders should be able to
communicate with each other. One federal stakeholder stated that "...we have to find a way to
talk to communities about what we can and cannot do in a better way. This should be different
from the risk assessor coming in and calculating risk, or saying that they cannot calculate
it...scientists and policy makers have to be more helpful to communities, or they -will lose
credibility...." According to one federal stakeholder, "...the key is communication, we do not
talk each other's language (i.e., toxicology, chemistry, etc., tend to resolve problems, but need to
learn to listen betterthey fail the community as scientists...." A number of stakeholders stated
that communication was especially important when a representative from the medical profession
is speaking with lay people about health issues or an academician is speaking about research in
scientific terms, or when a risk assessor or health assessor is speaking in technical terms.
Quite a number of stakeholder representatives stated that, in order to avoid confusion and
misunderstandings later in the partnership, expectations and limitations of EACH entity should
be identified in the initial stages of development. As one stakeholder stated "...communication,
good up-front understanding of the capabilities and limitations are essential...." In addition, the
community's (or any other stakeholders') perception of risk should be taken into account when
determining or communicating risk.
A stakeholder from academia suggested that all partners receive some training in effective risk
communication before activities are initiated. In addition, cultural competency is important when
attempting a risk communication effort. An example of this was presented by a federal
stakeholder. In efforts to address pollution at the United States and Mexican border, a number of
documents were developed^ for different educational levels. This major risk communication
effort was very successful. According to that same stakeholder, the goal of risk communication
is understanding, not consensus. A second stakeholder from academia stated that we need to be
conscious of how risk is communicated. The meetings where information is provided should be
continuous consensus building sessions. There needs to be growth and updating of activities
occurring since the last meeting. The connection and partnership should be one in which the
lines of communication should have already been open, there should be no surprises.
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All stakeholders must agree, as a part of their initial standards of conduct, to accept the
information provided, even though it may not be the particular results/conclusions they were
expecting. If trust and credibility have been established, this will occur as a normal part of the
partnership interactions.
(8) Sustainability
Sustainability of the Community-based Health Model
This particular topic, Sustainability, is related to a number of issues. Most stakeholders identified
the need for the community-based health model must be sustainable. It must contain certain
strategies for building capacity, so that activities continue, even after the funding period ends.
To that end, resources are an integral part of Sustainability. Both Sustainability of the partnership
(the model) and of the planned intervention were identified as resource intensive activities.
Sustainabilitv of the Activities
As mentioned earlier, the initial activities, where trust and credibility are established, are time
intensive. Most stakeholders, the majority from academia, believe that funding entities must take
into consideration the fact that this effort will be time and resource intensive, particularly when
placing time limits on grants. For example, a one year funding period is not feasible for
establishing a partnership and initiating activities. Funds should be set aside to create
partnerships for projects that are beneficial to everyone, that do not cost billions of dollars, and
that will allow stakeholders (academia, community, etc.) to work together, instead of competing
for limited funds.
As one NEJAC May 2000 Planning Committee member stated, there should be some way to
determine, other than the ending of the funding period, when it is time to end a project. In
some cases, if the research goes further than the allotted time, it will impact agencies and
entities that were thought to be out of reach. This type of success would only be due to the
sustained efforts of the partners involved.
(9) Federal Agencies as Partners
Role of Federal Agencies in Partnerships
Most stakeholders stated that before federal agencies can partner with communities and other
organizations, they must first learn to work together. Currently, the prevailing thought among
stakeholders is that federal agencies are each "doing their own thing", addressing their agenda,
although there are some agencies that are attempting to establish a more coordinated working
relationship with others. For example, the National Institutes of Health is trying to create a cross-
initiative around health disparities.
A number of federal agencies were identified as potential partners in a community based model.
Most stakeholders agree that the appropriate federal agencies would simply depend on the
issue(s) which need to be addressed through the model. Some agencies identified include EPA,
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ATSDR, CDC, DHHS, DOE, USD A, FDA, OSHA, DOT, HUD. Other agencies should be
willing and waiting to participate, as the need arises and they are identified by the partnership.
Also, as partners in this process, federal agencies should realize the time it takes to form
partnerships, and be willing to provide funds to conduct appropriate activities.
The Role of Federal Agencies in Addressing Health Disparities
According to one academician, the current problem federal agencies face when addressing health
disparities stems from the idea that their role is stove-piped. For example, one agency may be
studying asthma, another may be concentrating on genetics, while a third may be focused on
surveillance. He further stated that these agencies have tunnel vision, and should attempt to
develop an integrated plan to attack health disparities. They should also move toward a more
integrated effort for exposure data gathering. A second stakeholder from academia stated that
they have been encouraged by the explosion of interest of federal agencies in addressing health
disparities. The level of interest and willingness to fund projects by NIEHS, the National
Institute on Aging, the National Cancer Institute, CDC and others has been good.
One federal stakeholder opined that a second role of federal agencies is assurance and policy
development, as outlined in the IOM report. The policy development is at the federal, state, and
local level. A second stakeholder stated that state and federal government are involved in
monitoring health, and that a good contact person for information on this effort would be Dr.
Diane Rowley from the CDC.
OTHER STAKEHOLDER COMMENTS
Some important stakeholder comments were not included in the main part of the document, as
they did not lend themselves to any particular theme. They are nonetheless, important. Those
comments are provided here.
One comment from a federal stakeholder was "...we know what to do, we don't have the courage
to do it. It is not an issue of health, but an issue of liability. Whose responsibility is it? That is a
whole set of issues that do not get resolved. This is an overwhelming issue. There are so many
unanswered questions... when in doubt, we should err on the side of public health. We don't
have to wait for illness or risk factors before doing something. That is almost unethical. Why
wait for the dead bodies...."
A representative from academia stated that "...it is wonderful that attention is being paid to the
importance of developing community based models. This activity needs real resources, lip
service and not following through will cause more problems and distress..."
A comment that was made by a stakeholder from the community and academia, is that a
mechanism be provided to educate youth so that they may continue the work started by these
individuals.
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APPENDIX A
ENVIRONMENTAL JUSTICE STAKEHOLDER INTERVIEWEE LIST
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STAKEHOLDER INTERVIEWEE LIST
1. Mr. Michael Callahan
2. Dr. David Carpenter
3. Mr. Cecil Corbin Mark
4. Ms. Carolyn Covey-Morris
5. Dr. Allen Dearry
6. Ms. Paula Goode
7. Dr. Richard Gragg
8. Dr. Walter Handy
9. Dr. Cynthia Harris
10. Dr. Bruce Kennedy
11. Dr. Patrick Kinney
12. Dr. Nancy Krieger
13. Dr. Paula Lantz
14. Ms. Yin Ling Leung
15. Dr. Andrew McBride
16. Dr. Karen Medville
17. Dr. Ngozi Oleru
18. Dr. Bill Sanders
19. Ms. Samara Swanston
EPA Office of Research and Development
School of Public Health, University of Albany, SUNY
WHEACT
SOCMA, VP Government Relations and Public Affairs
(Industry/Business)
National Institute of Environmental Health Sciences
EPA Office of Children's Health
Environmental Sciences Institute, Florida A&M University
Cincinnati Health Department
Institute of Public Health, Florida A&M University
Health and Social Behavior, Harvard University School
Columbia University School of Public Health
Harvard School of Public Health
University of Michigan
Asian Reproduction Rights
North Carolina Department of Health
Arizona State University, West. American Indian
Environmental Health Sciences Program
Environmental Health Department,
Seattle Health Department
EPA OPPT/OPPTS
The Watch Person Project
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20. Dr. Reuben Warren The Agency for Toxic Substances and Disease Registry
21. Dr. Hal Zenick EPA's Office of Research and Development
OTHER PLANNED INTERVIEWEES
22. Ms. Katsi Cook Akwasasne Nation (could not be interviewed due to
scheduling conflicts)
23. Mr. Michael Sage National Center for Environmental Health,
Centers for Disease Control and Prevention (could not be
interviewed due to scheduling conflicts)
24. Another Industry Representative - Several unsuccessful attempts were made to find an
additional industry representative.
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APPENDIX B
CONVENER'S QUESTIONS FOR
STAKEHOLDER REPRESENTATIVES
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CONVENER'S QUESTIONS
The EPA seeks advice and recommendations from the National Environmental Justice
Advisory Council (NEJAC) on Federal efforts to improve the health status of communities.
In particular, EPA asks the NEJAC to focus on communities where health disparities exist
and in which those disparities are associated with: environmental stressors; and certain
socioeconomic and/or cultural factors.
(1) Community-Based Public Health Model
The Agency is considering how programs/projects/activities that will address community-based
health concerns can be designed and implemented with the direct involvement of all stakeholders
(community, industry, local government/tribal entities, academic institutions, and State and
Federal agencies). It has been suggested that this integrated, community-based model should
include three components: assessment, intervention, and prevention. In the questions below, the
phrase "community-based health model," includes these three components and substantial
stakeholder involvement.
(1) Do you think that this model is a viable one for addressing community health
concerns?
(b) Are there barriers to implementation of this community-based health model, in
general, and with your agency or organization or community, including tribal
groups, in particular?
(2) Design, Implementation and Evaluation of the Community-Based Health Model
(1) How should each of the components (e.g., assessment, intervention, and
prevention) of this community-based health model be designed, implemented, and
evaluated?
(2) Who should design, implement, and evaluate each or all of these components?
(3) What research would be most useful in the area of community-based health
design, implementation, and evaluation (e.g., methodology, data, etc.)?
(3) Examples of Community-Based Health Efforts in Action/Practice
(1) Can you give an example of a community-based health model in action/practice
and how it was conducted?
(2) What methodology did it follow?
(3) Was this program successful, and, if so, why?
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(4) What was the result(s) of these efforts?
(i) Did significant actions result (e.g., abatement, new policies, or research) or
changes in stakeholder relationships?
(ii) Which stakeholders were involved in affecting these actions?
(iii) What did each stakeholder bring to the process?
(iv) Would increased involvement by any particular stakeholder group have made
the effort more successful?
(4) Critical Elements for Success
(1) What specific elements (e.g., policies, activities, and methodologies/approaches)
of each component are required for the success of this community-based health
model?
(2) For each component, which elements are most in need of improvement?
(3) What specific research would help bring about these improvements?
(5) Environmental Justice
(1) Were environmental justice concerns incorporated into the actions described
above?
(2) How in particular where these concerns integrated and/or addressed?
(6) Partnerships
(1) Which partnerships are most critical to the success of a community-based health
model, and why?
(2) Are you aware of examples of successful partnerships among stakeholders,
including appropriate Federal agencies? Why were these partnerships successful?
(3) Which Federal Agencies should partner in community-based health efforts, and in
which specific components)?
(4) What can be done to promote the formation and use of partnerships among
stakeholders, in general?
(5) What research would be most useful in this area?
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(7) Federal Agency's Role
(1) What is the current role of Federal agencies in addressing health disparities in
communities?
(2) What should be the role of Federal agencies in addressing health disparities in
communities?
(8) Quality and Quantity of Data Produced Through Community-Based Efforts
(1) Are data produced through community-based health assessments/research useable
when drawing conclusions, testing hypotheses, and/or making policy
recommendations?
(2) What types of data gaps are most frequently associated with community-based
efforts?
(3) What research would be most useful to address data gaps?
(9) Consideration of Socioeconomic and/or Cultural Factors in Addressing Community
Health Concerns through Assessment, Intervention, and Prevention
(1) Are specific socioeconomic and/or cultural factors relevant to addressing
community health concerns? Which ones?
(2) Is there a scientific basis or relationship between socioeconomic and/or cultural
factors and health impacts? If so, which ones?
(3) What research would be most useful in addressing these issues?
(10) Relationship Between Exposure and Health Effect
(1) What are the three greatest barriers to determining the relationship between
exposure and health effects?
(2) What role have community-based efforts played in resolving issues of exposure
and health effect? Can you provide examples?
(3) What areas of research or data collection would be most useful in these areas?
(11) What other suggestions would you like to make?
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APPENDIX C
Models of Community-Based Research
THE AKWESASNE FIRST ENVIRONMENT RESTORATION INITIATIVE (Principal
Investigator: Mary Arquette)
OBJECTIVES:
Develop partnerships among community members, health care providers, and research
scientists.
Design community-based strategies for environmental health education, outreach, and
training in the Akwesasne Mohawk community, which is adjacent to a Superfund site
with a history of major environmental contamination.
METHODS:
An initial needs assessment examining health risks, perception of risks, and
communication of risks will be conducted using focus groups.
Develop educational materials with Mohawk language content and symbolism.
Produce an air of "Good Health" show on Akwesasne Mohawk Radio.
Conduct environmental health fairs at local schools.
Implement training workshops for clinicians and traditional practitioners wit a focus on
toxic exposures.
Establish focus groups and workshops to ensure community input into health research
needs.
LOCATION:
The Mohawk Nation at Akwesasne (ST. Regis Mohawk Tribe), located in the Great Lakes
Basin-St. Lawrence River watershed, is exposed to hazards resulting from the rapid transition
from an agricultural to an industrial environment. PCBs have been found in fish, which provide
a protein staple in the Mohawk diet and in human breast milk.
DINE COLLEGE - URANIUM EDUCATION IN THE NAVAJO NATION ( Principal
Investigator: Mark C. Bauer)
OBJECTIVES:
Establish collaboration among the Navajo community, Navajo Community College, local
primary care physicians, the CentraO Consolidated School District, the University of New
Mexico Center for Health Promotion for Rural American Indians, and scientists with
expertise in radiation health issues.
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Conduct qualitative and quantitative research with the Navajo community concerning
knowledge and behavior about radiation.
Produce culturally appropriate educational materials about cancer, birth defects, and
radiation.
Conduct community programs and training sessions leading to greater awareness
regarding radiation dangers.
METHODS:
Establish a radiation education center for the Navajos in geographic areas affected by
uranium mining.
Assess community-identified concerns, priorities, values, goals, and strategies for
education on radiation issues.
Develop culturally appropriate education and communication materials based on the
preliminary community assessment.
Provide in-depth training of community leaders and health care providers.
Develop and implement education, training, and organizing strategies for grassroots
community members.
Perform community-based evaluation of project's effectiveness to determine its progress
in attaining community-defining goals.
LOCATIONS:
The Navajo Nation in NM, AZ, and UT contains >225,000 people, only half of whom
have graduated from high school. Uranium mines operated from 1940 -1980
Radioactive uranium tailings were freely dumped. Lung cancer, silicosis, renal toxicity,
and other disorders occur at a high rate.
ASIAN AND PACIFIC ISLANDERS FOR PRODUCTIVE HEALTH (Principal
Investigator: Yin L. Leung)
OBJECTIVES:
Create a core group of Southeast Asian girl leaders that are knowledgeable and skilled in
educating other community people about environmental hazards and reproductive health.
Improve reproductive health services through joint work with family planning clinics that
serve these communities.
Build capacity between two project sites so communities will recognize their common
environmental justice and reproductive problems.
Seeks to redress the environmental impact Southeast Asians experienced because of the
Vietnam War, to eliminate current exposures issues today and to improve communities
reproductive and overall health and well-being.
METHODS:
Recruit and train a core of Southeast Asians girls on basic issues of environmental justice
and reproductive health to become community trainers.
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Use participatory action research, a systematic investigation with the collaboration of
those affected by the issue being studied, fro purposes of education and taking action or
affecting social change, to improve the health and environment of these communities.
LOCATIONS:
Long Beach, California
Richmond and Oakland, California
Following the Vietnam War, refugees from Southeast Asia settled in the United States.
Exposed to numerous chemicals during the war, they arrived with little money and no job
or language skills, settling in poor and environmentally hazardous areas. Due to lack of
education and jobs skills they work primarily in menial jobs putting them at additional
risk of exposure both at work and at home.
URBAN APPALACHIAN COUNCIL LOWER PRICE H1T.T. ENVIRONMENTAL
LEADERSHIP COALITION (Principal Investigator: Pauletta Hansel)
OBJECTIVES:
Promote neighborhood leadership that has the information, skills, and resources for
successful approaches to environmental pollution, risk communication, and public health
service.
Identify and implement changes to procedures used to address the unique environmental
quality and health status problems of historically under served communities affects by
environmental pollution.
Develop a long-term working relationship among residents and community organizations
in Lower Price Hill, the University of Cincinnati, and the Cincinnati Health Department.
METHODS:
Design and conduct a survey of the community regarding health concerns and
environment pollution.
Develop education and training modules to maintain effective communication between
the Lower Price Hill Environmental Leadership Coalition and the community.
Develop evaluation materials to be used to determine effectiveness of the project.
LOCATIONS:
Lower Price Hill, located in Cincinnati, Ohio, is an urban Appalachian community.
Residents are predominantly low-income Caucasians; 71% have not completed high
school, compared to 28% for the city, as a whole; unemployment is >20%; 90% of
concentrations of lead have been found in playgrounds. Children exhibit learning
disabilities at twice the rate of children from other neighborhoods and are five times
more likely to suffer from acute respiratory infections.
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THE SOUTHERN CALIFORNIA ENVIRONMENTAL HEALTH PROJECT (Principal
Investigator: Carlos Porras)
OBJECTIVES:
Institute a collaboration among community representatives, local health care providers,
and university researchers.
Educate community members and health care providers and promote adoption of
pollution prevention measures.
Establish a community-based strategy for reducing community and worker exposure to
environmental pollutants.
METHODS:
Identify leaders in the targeted community, involving 8 cities, and in the medical
community.
Analyze existing environmental data in the targeted community to identify data gaps.
Identify priority community health issues through surveys and focus groups.
Educate residents, workers, and medical providers.
Develop and implement a pilot program that offers solutions to identified environmental
health problems.
Develop and implement exposure reduction strategies, with an emphasis on pollution
prevention measures.
LOCATION:
South East Los Angeles includes a number of pollution sources, e.g., highly
industrialized tracts where chemicals are released, severe urban smog, occupational
exposures, and lead poisoning. This zip code area is the dirtiest subregion within the
State of California. The area is home to a low-income population, approximately 87%
Hispanic/Latino.
RURAL COALITION - THE COMMUNITY-RESPONSIVE PARTNERS FOR
ENVIRONMENTAL HEALTH (Principal Investigator: Lorette Picciano-Hanson)
OBJECTIVES:
Develop a partnership among members of a National Advisory Board of community
representatives, local health care providers, and environmental health scientists.
Implement a partnership model in two communities which will develop specific
collaborative projects to achieve measurable results in identifying, preventing, and
mitigating exposures.
Build competency in environmental health assessment and community training.
METHODS:
Help train the targeted communities to define the problem, analyze the causes, research
the solutions, and develop community strategies to solve the problem.
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Train community members to conduct exposure assessment, focusing on development of
skills in analysis, record keeping, and attention to detail and protocols.
Train health care providers in occupational and environmental medicine.
Empower community to reduce exposure to hazards through education and training.
LOCATIONS:
Sumter County, AL. Contains the largest toxic waste dump in the U.S. Seventy percent
African-American.
El Paso, TX. Farmworker community in West, TX.
CLARK UNIVERSITY-NUCLEAR RISK MANAGEMENT FOR NATIVE
COMMUNITIES (NRMNC) (Principal Investigator: Dianne P. Quigley)
OBJECTIVES:
Establish collaboration among investigators at Clark University in Worcester, MA and
Native American community and health care organizations in Oklahoma and Nevada.
Increase awareness in Native American communities exposed to radiation contamination
from DOE sites.
Enable these communities to resolve health concerns related to radiation contamination
in their environment.
METHODS:
Identify priority community health research and information needs.
Develop a "train the trainers" program via collaboration among scientists, community
representatives, and health care providers.
Implement community and health care education modules.
Design and implement a plan for risk management and prevention activities.
Share relevant materials and strategies with other Native American communities.
LOCATIONS:
Western Shoshone Nation near the Nevada Test Site.
Cherokee Nation at Sequoyah Fuels, OK, a uranium processing facility in operation for
23 years.
LAOTIAN ORGANIZING PROJECT OF THE ASIAN PACIFIC ENVIRONMENTAL
NETWORK, RICHMOND LAOTIAN ENVIRONMENTAL JUSTICE
COLLABORATION (Principal Investigator: Peggy K. Saika)
OBJECTIVES:
Develop a model of research, outreach, education, and communication that addresses the
immediate environmental health needs of the communities population.
Build community capacity to understand environmental health issues.
Develop appropriate tools to reach this limited-English-speaking population.
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METHODS:
Representatives from the main Laotian tribal groups will participate in recruitment and
training of community organizers.
Design needs assessment strategy and implement community outreach and publicity
activities.
Develop a training curriculum for 39 community advocates to carry out the needs
assessment.
Train community advocates on environmental hazards including location of toxic sites
relative to where Laotians live and garden, consumption offish, occupational health and
safety issues, and determine understanding of lead hazards and knowledge of available
interventions.
LOCATION:
Richmond, CA. Over 350 industrial facilities encircle Richmond, including waste
incinerators, oil refineries, pesticide and fertilizer plants, and other chemical
manufacturers. Laotians in the area have the highest percentage of contaminants from
urban gardens and fish. Few are English literate.
UNIVERSITY OF MARYLAND SCHOOL OF MEDICINE, BALTIMORE
ENVIRONMENTAL JUSTICE YOUTH PROJECT (Principal Investigator:
Barbara Sattler)
OBJECTIVES:
Increase awareness and understanding of urban environmental health issues.
Organize a city-wide Environmental Justice Youth Conference (EJYC):
Develop a comprehensive health assessment plan to be used by non-expert community
residents.
Initiate an environmental health awareness program focused on asthma.
METHODS:
Characterize the distribution of air pollutants and evaluate the contributions of hazardous
particles emitted from major sources, including incinerators and diesel emissions.
Train students in environmental health research via participation in data collection and
analysis.
Introduce students to the complexity of environmental regulatory and policy decisions as
they evaluate research results.
In conjunction with Adolescent Clinics, the EJYC will help develop an awareness
program for teens on environmentally related respiratory problems with a focus on
asthma.
LOCATION:
Baltimore, MD. A wide array of environmental insults, including: poor air quality; aging
industry with variable environmental controls; older housing stock with lead
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contamination; diesel powered buses; significant rodent and pest problems; inadequate
delivery of basic services. Inner-city Baltimore HS students, mostly African-American,
constitute EJYC.
WEST HARLEM ENVIRONMENTAL JUSTICE PARTNERSHIP: EXPANDING THE
COMMUNITY RESEARCH AGENDA (Principal Investigator: Peggy M. Shepard)
OBJECTIVES:
Inform and empower predominantly low income people of color about the
disproportionate levels of pollutants to which they are exposed.
Establish effective communication linkages between community residents, environmental
health researchers, and health care providers who live and work in West Harlem.
Develop environmental health leadership around identified hazards through education
and training provided by environmental health researchers and health educators.
Document and evaluate the efficacy of the proposed project to enhance awareness and
understanding of environmental health concerns that impact Northern Manhattan
communities.
METHODS:
Hold public forums at which environmental issues that impact neighborhoods will be
addressed.
Provide training sessions for health care providers on environmental health awareness.
Recruit, train, and certify twenty residents from each community on environmental
health concepts and issues, including environmental justice, Develop leadership training
manual and informational pamphlets for use in training sessions and during planned
presentations.
LOCATIONS:
Cental Harlem, population of 115,000, 85% African-American, 10% Latino, 41%
unemployed.
West Harlem, population 107,000, 39% African-American, 36% Latino, 19% Caucasian;
73% new arrivals are from Dominican Republic.
Washington Heights, population 190,000, 18% African-American, 67% Latino (mostly
Dominican), 15% Caucasian. There are a wide variety of outdoor and indoor
environmental exposures affecting residents of these areas, including paniculate matter
and carbon monoxide generated by truck and bus traffic, sulfates and nitrates from a
sewage treatment plant, lead paint, and allergenic debris from roaches and rodents.
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UNIVERSITY OF MASSACHUSETTS-LOWELL SOUTHEAST ASIAN
ENVIRONMENTAL JUSTICE PARTNERSHIP (Principal Investigator: Linda Silka)
OBJECTIVES:
Increase community awareness of basic environmental health concepts, issues, and
resources.
Ensure the community has an ongoing role in identifying and defining problems and
environmental risk.
Ensure health providers and environmental health scientists are aware of environmental
risks and concerns of community residents.
METHODS:
Develop a working partnership among the Southeast Asian groups in Lowell that will
provide a culturally organized focus for identification of environmental health problems
with the community.
Develop a culturally appropriate media presentation, including geographic information
systems, to serve as a stimulus to assess environmental health priority concerns as
perceived by the community.
Begin a process of solving identified problems and focus on how to sustain community
activism.
LOCATION:
Lowell, MA contains a Superfund site and 97 additional confirmed and suspected
hazardous waste sites. It ranks fourth in the state in rate of reported toxic released and
has a long history of industrial contamination. The county is fourth in the nation in
hazardous waste generation and ninth in industrial air emission from incinerators. Many
of the residents are Southeast Asian, mostly Cambodian and Laotian.
SILICONE VALLEY TOXICS COALITION -SILICONE VALLEY ENVIRONMENTAL
HEALTH & JUSTICE PROJECT (Principal Investigator: Theodore G. Smith)
OBJECTIVES:
Enable low-income minority communities to identify and effectively address toxic
chemical hazards where they live, work, and play.
Improve the health of the community and workers by increasing knowledge of and
reducing exposure to hazardous chemicals.
Promote pollution prevention and improved .health and safety practices within the high
tech electronics industry and the related service sectors.
METHODS:
Produce educational materials, conduct educational outreach including cultural
programming and conduct a public awareness media campaign.
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Develop and implement a training program for community members and medical care
providers.
Promote institutional change and policy development to reduce and prevent toxic
exposures.
Develop and sustain partnership of community, scientists, and health professionals,
recruit members and develop leaders for community-based organizations and develop the
organizational capacity and funding to sustain the project over time.
LOCATION:
Santa Clara County, CA
The area known as Silicone Valley is home to the electronics industry and contains 29
Superfund sites. A large percentage of the is comprised of people of color, the majority
of whom live near the sites and work in the industries that contribute to the
contamination.
UNIVERSITY OF NORTH CAROLINA, CHAPEL HILL-SOUTHEAST HALIFAX
ENVIRONMENTAL REAWAKENING (Principal Investigator: Stephen B. Wing)
OBJECTIVES:
Expand environmental health knowledge of Halifax County citizens and health
professionals.
Increase local participation in prevention and remediation of environmental health
problems.
Improve environmental health in the rural South by supporting grassroots leadership and
community empowerment.
Develop education and organizing material for use in other areas; provide outreach to
communicate in ten eastern North Carolina counties; offer training in rural environmental
health and environmental justice issues to public health students.
METHODS:
Present collaboratively developing training materials and workshops on environmental
health issues to community members.
Provide quantitative analysis of the racial and socioeconomic characteristics of areas that
host intensive livestock operations.
LOCATIONS:
Tillery, Halifax County, NC
Counties comprising the Black Belt in Eastern NC.
Intensive hog operations have rapidly increased in this area over the last decade. NC
now ranks second in the country in hog production. Ground water pollution is a
particular threat to poor rural residents who depend on shallow wells.
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