EPA 400-K-06-001
March 2006
LOCAL PARTNERSHIPS. HEALTHY COMMUNITIES.
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Introduction
Purpose
This Roadmap will help you and your community to:
₯ Learn about local environmental and environmental health risks and impacts
Build the community consensus necessary to take effective action
₯ Mobilize a community partnership to take action to reduce impacts and risks
₯ Build long-term capacity within your community to understand and reduce environmental
impacts and risks
Origin of the Roadmap
This Roadmap is the result of an effort by the CARE (Community Action for a Renewed Environ-
ment) Program of the Environmental Protection Agency (EPA) to develop a practical tool for
communities that incorporates the perspectives of the National Environmental Justice Advisory
Council (NEJAC) report on ensuring risk reduction in communities with multiple stressors and
EPA's Framework for Cumulative Risk Assessment. With permission of the author, the Roadmap
also incorporates and builds on the Community Environmental Health Assessment Workbook
published by the Environmental Law Institute. To find more information on the CARE Program and
these documents, please see the General Resources section on page 15.
How this Roadmap differs from existing guides
This Roadmap differs from previous assessment guides in two ways. First, it looks at risk from the
community perspective by outlining a method to develop as comprehensive an understanding of
local environmental risks and impacts as possible, including both considerations of combined
concerns resulting from multiple sources and the contribution of community vulnerabilities to
risk. This comprehensive overview of concerns gives the community the information it needs to
ensure that efforts to address concerns will do the most to improve the health of the community
and its environment.
Second, it incorporates NEJAC's "bias for action" perspective. This means that the Roadmap
encourages partnerships to take actions to reduce risk as soon as possible. This does not mean
that collecting and analyzing information is not importantin fact, a community's work to
improve its understanding of risk is an essential part of the "bias for action." Without a shared
understanding of risk, mobilizing your community will not be possible and without a clear
understanding of the sources of risk, community actions may not be focused where they can do
the most good. The Roadmap encourages communities to take action on known risks from the
start, and suggests practical ways to collect and analyze the information needed to build consen-
sus and target risk reduction efforts where they will do the most good.
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The Roadmap: Ten Steps to a Healthier Community and Environment
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How to use the Roadmap
₯ How can you build an effective partnership? Broad and effective partnerships are the key to
mobilizing the whole community to take action. Because strong partnerships are key, all the
work described in this Roadmap should be done in a way that builds both the partnership and
trust among the partners. This can be accomplished if everyone in the partnership has the
opportunity to be heard and to participate fully as equals in the work and decisions of the
partnership. Since members of the partnership will come to the partnership with different
backgrounds and resources, the partnership may have to find ways to work with these
differences. All the time and effort required up-front to build real trust and a strong partner-
ship will pay off in the long run when the broader community is mobilized to take actions
that make a difference.
Do the steps need to be done in order? The order in which a community takes the steps listed
below will vary depending on the situation in the community. For example, some residents
will want to begin with Step 2 and develop a summary of environmental and health concerns
and community assets before starting the work to form a partnership. In other communities,
the work to form a partnership will come first and all parts of the community will work
together to complete Step 2. Communities will have to decide how to sequence the steps,
choosing the approach that best helps to get the necessary information and build the consen-
sus and broad partnership that will be needed to reach community goals.
₯ What should the scope of the environment and health assessment be? The definition of
"environment" will vary from community to community so the scope of the assessment will
also vary. In communities that have ongoing development, crime prevention, or education
projects, the scope of the environmental health assessment may stick to traditional environ-
mental concerns. But communities without these efforts may need to interpret "environment"
more broadly to include such things as jobs, lack of adequate health care, and crime. You
may need to bring other partners to the table to address all the issues. And even in communi-
ties that define environment more narrowly, addressing vulnerabilities may also broaden the
scope of the work.
₯ Should all communities do an assessment? A comprehensive environmental and health
assessment is especially valuable as a tool to get everyone in a community on the same
page in their understanding of environmental and health risk. A comprehensive assessment
also helps a community to set priorities and focus resources where they will do the most
good. But some communities may already agree on the need to address a particular priority
risk. Or some communities may need a fairly long trust-building process before they can
agree to work with all stakeholders to get the more complete view of risk. So making the
judgment about when to do a comprehensive assessment will depend on the situation in each
community.
₯ How can you incorporate a bias for action? The steps below should be completed from
existing data and the knowledge of the participants in a short time frame so that consensus
priorities can be quickly identified and actions can be taken to reduce risks and impacts. The
first review will also identify data gaps and areas where there will not be consensus. Once
preliminary priorities are identified, the partnership will organize efforts to fill in significant
gaps at the same time as taking action on the identified priorities. Once the community has
new information, the assessment steps will need to be repeated using the more complete
information so that the priorities and actions can be reset as needed.
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Basic elements of the process
₯ Organize a broad partnership needed to reach community goals (Step 1)
₯ Collect the information needed to understand community impacts and risks (Steps 2-6)
Analyze the information to identify community priorities and to identify options for reducing
risks (Steps 7-8)
₯ Mobilize the community and its partners to take action (Step 9)
₯ Evaluate the work of community, measure progress, and begin a new effort to address
remaining risks (Step 10)
A summary of the Roadmap
1. Build a Partnership: Build a collaborative partnership that is able to identify environmental
risks and impacts, build consensus, and mobilize all the resources necessary to achieve
community goals.
2. Identify Community Concerns: Identify the environmental, health, and related social and
economic concerns of the community.
3. Identify Community Vulnerabilities: Identify community vulnerabilities that may increase
risks from environmental stressors.
4. Identify Community Assets: Develop a list of community assets in order to build on the
existing strengths of the community.
5. Identify Concerns for Immediate Action: Identify and begin to address immediate concerns
and vulnerabilities.
6. Organize Available Information: Collect and summarize available information on stressors,
concerns, and vulnerabilities. Identify information gaps where the information on stressors,
concerns, and vulnerabilities is missing or inadequate.
7. Prioritize Concerns: Identify priorities for possible community action and establish baseline
indicators and standards.
8. Identify Potential Solutions: Identify and analyze options for reducing the priority concerns
and vulnerabilities and for filling information gaps.
9. Select an Option & Take Action: Decide on an action plan to address concerns, fill informa-
tion gaps, and mobilize the community and its partners to carry out the plan.
10. Evaluate Results & Revisit Priorities: Evaluate the results of community action, analyze new
information, and start the process again to reset priorities as needed and to develop new
plans for action and, if needed, for information collection.
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The Roadmap
The following brief descriptions are designed to provide communities with an overview of the
steps needed to build consensus on community environmental and environmental health priori-
ties. A list of general resources with more detailed information and guidance can be found on
page 15. Links to additional resources to help communities accomplish each of these steps can
be found on the CARE website at: www.epa.gov/CARE/tools.
1. Build a partnership.
Build a collaborative partnership that is able to identify environmental risks and impacts, build
consensus, and mobilize all the resources necessary to achieve community goals.
Partnership members should consist of a broad cross-section of the community who are concerned
and involved with the environment, as well as the human and socioeconomic health and well-
being of the community.
Partnerships will need to make special efforts to ensure that all sectors of the community partici-
pate fully in this effort. Special efforts to involve some sectors of the community may be neces-
sary, especially sectors not used to being involved in partnership efforts, such as affected resi-
dents or small businesses in the community. Partnerships should lay out clear plans for involving
these members of the community and provide the support they need to participate fully in all
aspects of the partnership's work and in the leadership of the partnership. The success of the
partnership will depend on its ability to fully engage all sectors of the community.
POTENTIAL PARTNERSHIP MEMBERS
Community members from the focus community
Minority members of the focus community
Local environmental justice organizations
Local, regional, and national environmental organizations
Health care providers
Faith-based organizations
Local churches
Business organizations
Civic organizations
Local economic organizations
Educational institutions (schools, universities, and colleges)
Community development groups
Environmental and natural resource agencies (local, State, and Federal)
Health agencies (local, State, and Federal)
Elected officials
Local governmental agencies
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2. Identify concerns.
Identify the environmental, health, and related social and economic concerns of the community.
Community groups often focus on one or a few issues of greatest interest or immediate concern.
In order to address community issues on a comprehensive and cumulative basis, a broader look at
community issues will be needed. Taking a broader view will ensure that important risks are not
overlooked and that the actions that can most effectively improve community health can be
identified.
These broader issues can be identified by drawing on the resources of all of the partners and by
considering a number of types of concerns such as:
₯ Community environmental health concerns
₯ Disease incidence in the community
₯ Sources of pollution
₯ Routes of exposure
₯ Chemicals and biological health and ecological hazards
₯ Effects of chemicals and biological hazards identified in the community
₯ Social and economic conditions
Assembling these issues into a matrix format may enable your community partnership to better
appreciate the scope of issues impacting the environment and health of the community. As an
example, here is a matrix prepared by a community group for the Mississippi River industrial
corridor:
Multiple, Aggregate, and Cumulative Risks and Impacts in the Mississippi River Industrial Corridor
Demographics
African
American: 63%
Caucasian: 35%
Asian: 3%
Pollution Sources
Petrochemical facilities
Refineries
Wastewater treatment facilities not
meeting permit limits and bypassing
raw sewage due to under capacity
Drinking water taken from Mississippi
River
Toxic organics, pesticides, and heavy
metals in drinking water
Atrazine from Midwest agricultural
fields present year round in raw and
finished water
Pesticides, herbicides, and fertilizers
applied to sugar cane crops
Aerial and tractor application drifts
onto adjacent residential areas and
school yards
Burning sugar cane during fall harvest
season results in particulate matter
and pesticides being dispersed into
the air for 1/3 of the year
Existing Health
Problems &
Conditions
Asthma
Respiratory distress
Skin rashes
High rate of a large
variety of cancers
Lack of access to
health care
Lack of trained
environmental
health physicians
Unique Exposure Pathways
Air
Industrial facilities: semi-
volatile and volatile organics,
dioxins, pesticides and
herbicides, toxic heavy
metals, and smoke from sugar
cane burning
Water
Drinking water contaminated
Surface water contaminated
with industrial and
agricultural chemicals and
partially treated waste water
Contaminated crops
Contaminated terrestrial game
species
Seafood contaminated with
pesticides, industrial
chemicals, mercury from
chlor-alkali facilities by way
of air deposition
Social/Cultural
Conditions
Very poor/ minority
communities
Live off land and
gardens
contaminated with
air deposited
chemicals
Hunting and
fishing of
contaminated
organisms
Generations have
lived off the land
and not profited by
industrial
development in the
area
Community Capacity
& Infrastructure/
Social Capital
Good infrastructure in
areas of low-income
communities of color
with respect to roads and
rail; the industry needs
these items
Poor infrastructure
within the communities:
poor road conditions,
improper drainage, waste
water collection and
treatment system
Inadequate
Very little to no social
capital: education system
very minimal; the area
was impacted by white
flight; primarily African
Americans attend the
public schools
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3. Identify vulnerabilities.
Identify community vulnerabilities that may increase risks from environmental stressors.
A community or part of a community may be vulnerable if it is more likely to be adversely
affected by poor environmental conditions than the general population. Disadvantaged,
underserved, and overburdened communities may have existing physical and social conditions
that make the effects of environmental pollution (or "stressors") more, and in some cases unac-
ceptably, burdensome. It is important to consider these conditions when determining the extent of
risks or impacts. Understanding community vulnerabilities may also allow communities to
identify effective options for risk reduction. For example, if a group within the community is
more vulnerable to the effects of lead paint because of language barriers in health care, increas-
ing access to health care materials in the appropriate language may be an effective option to
reduce risk.
EXAMPLES OF VULNERABILITY FACTORS
Susceptibility/Sensitivity. Pre-existing health conditions can make a group more sensitive to
negative impacts from stressors than the general population. These susceptibility/sensitivity
factors could include:
₯ Genetic predisposition to disease
A young populationinfants and children may experience different impacts
An elderly population
Compromised immune system
₯ Other preexisting health conditions
Exposure Conditions. Living or working near a source of pollution could lead to exposure to a
higher level of pollution than the general population. For example, higher exposure could be due
to:
₯ Proximity to pollution sources
₯ Employment in jobs that involve hazardous chemicals
₯ Past exposure to environmental pollutants
₯ Multiple routes of exposure to one chemical
₯ Multiple exposures to different pollutants
₯ Subsistence consumption
₯ Discrimination
₯ Lack of information
₯ Lack of social capital, such as poor education
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Preparedness/Ability to Recover. In addition to increased sensitivity and exposure, other
existing conditions in some communities make them less prepared than the general population
to withstand and recover from environmental stressors. Such conditions could include:
₯ Poor nutrition
Compromised health/immune system
₯ Limited health care
₯ Cultural practices
₯ Lack of recreational facilities
Poor community services
₯ Low income
₯ Low education
₯ Poor housing conditions
₯ Emotional stress
₯ Crime
₯ Vermin (insects and rodents)
₯ Unemployment or underemployment
₯ Discrimination
₯ Lack of information
₯ Lack of social capital
4. Identify community assets.
Develop a list of community assets in order to build on the existing strengths of the community.
Assets are your community's existing strengths, skills, and resources. Communities with environ-
mental, social, and economic problems and stressors still have many assets. Developing a list of
your community's strengths can help in choosing an action plan later in the process. For ex-
ample, if a community has a strong network of churches, their ability to communicate effectively
with large sections of the community is an asset that can be used to meet partnership goals.
EXAMPLES OF COMMUNITY ASSETS
₯ Special skills and capacities of community members
₯ Detailed knowledge of all aspects of community
₯ Ability and networks to communicate with community members
Culture
Longevity
Neighborhood associations
Religious institutions
Businesses
Civic and community leaders
Political abilities
Community building resources
Human resources
Outreach
Historical information
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5. Identify concerns for immediate action.
Identify and begin to address immediate concerns and vulnerabilities.
After your group has identified environmental, health, and other concerns (Step 2), as well as
vulnerabilities and assets that can impact the risks from those concerns (Steps 3 and 4), it is time
to identify any risks that need immediate attention. Working as a group, the stressors, concerns
and vulnerabilities should be evaluated and those that everyone (or the majority) agrees need
immediate action should move forward to Step 8 to identify options for action. Since there is
agreement on these concerns, risk reduction actions should begin as soon as possible. This will
allow the community to begin work as quickly as possible on key concerns.
At the same time as the partnership takes action on some key concerns, the remaining stressors,
concerns, and vulnerabilities should be analyzed further using Steps 6 and 7. Once additional
priorities are identified, the work that has begun to address key concerns can be adjusted as
necessary.
6. Organize available information.
Collect and summarize available information on stressors, concerns, and vulnerabilities. Identify
information gaps where that information is missing or inadequate.
Before your community can set priorities on the remaining stressors and concerns, you will need
to collect and organize available information, and identify where information is missing or
inadequate.
Gather information
To estimate the magnitude of each of the identified environmental, health, and socioeconomic
issues, the partnership should collect all available information on stressors, observed impacts,
potential risks, and vulnerabilities. Some sources of information include:
Members of the partnership, especially those directly affected by a stressor
Databases with information on the amounts and sources of releases of pollutants to your
environment
Information on levels of chemicals measured in your environment
Formal studies of risk in your community, if they are available
Studies done to estimate the risk for similar communities
Studies done to estimate the health and vulnerability of your community
National studies of risk
Residents of the community, local businesses, and local doctors and public health staff can help
locate and collect available information. Government and university staffs can identify any
existing studies of the community and of similar communities. The partnership will require the
participation of all of its members to complete this part of the process.
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Identify where more information is needed
Communities beginning to collect information on stressors and risks are likely to find many areas
with little or no available information. All information gaps should be noted so that the partner-
ship can decide, in the next step, how to address this lack of information.
Summarize findings
For each stressor or combination of stressors, summarize the available information, and describe
the impacted community members or impacted environment. Organizing this information in an
easily viewed format, such as a table or flowchart, may help the partnership choose priorities in
the next step. See an example format including priority rankings in Step 7 below.
7. Prioritize concerns.
Identify priorities for possible community action and establish baseline indicators and standards.
Using the organized information on concerns, your partnership can choose the most important
concerns the community needs to address to improve the environment and health of the commu-
nity. At this point, whether or not something can be done about an issue should not be a concern.
This priority-setting exercise should be based strictly on how important the issue is to the health
and quality of life of the community and its environment. It is important for a community to
know which concerns are most significant, even if it is not possible to do something about some
of them immediately.
This priority-setting exercise will depend heavily on your community's goals and values. The
partnership will need to consider issues that are very different, and difficult to compare. A clear
view of community values will provide a basis for making the judgments necessary to set com-
munity priorities. It will also be important for members of the partnership to keep in mind that the
goal is to reach an agreement on the priorities that best meet community needs, so there is the
consensus needed for mobilizing everyone to take action.
Setting community priorities
To use the information organized in Step 6 to identify priority concerns, communities will need to
adopt a method, such as a numerical (e.g., 1-10) or a "high" to "low" scale that will allow all
the concerns to be compared. The ranking method used by the community will need to take into
account the severity of the impact, including the vulnerability of the affected people, as well as
the number of people exposed or the extent of the environment affected. The number of high
priority concerns should be reasonable; not so many that addressing them all will be impossible.
The high priority concerns could include risks, impacts, vulnerabilities, or information gaps. For
example, you could choose lead exposure as both a priority risk and a priority information gap.
Give a high ranking to all the concerns that you think need to be addressed by the action plan
that you will develop next. Remember, you will not be able to do everything at once. With
limited resources, some concerns may have to be addressed in the next phase of partnership
work.
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Estimating levels of concern for stressors with missing information
In some, and probably most cases where there are gaps in the information on a stressor, the
partnership should use the available information and its best judgment to estimate the potential
harm that a stressor may have on the community or its environment. For example, if there is a
significant amount of old housing in the community but insufficient information on blood lead
levels to determine how many children are affected, the partnership would likely identify the
potential concern from lead paint, given the likelihood of exposures, as very high. It is important
to note, however, that the information is incomplete and thus this estimate may have some
amount of uncertainty.
In some cases, more information or further analysis will be needed before the partnership can
agree on its level of concern. For example, if the community only has release amounts for a
facility, it may decide to do further work, such as collecting information on the toxicity of the
chemicals released and using modeling to estimate the exposures that result from the releases in
the community, to develop the information needed to estimate the level of concern. (Screening
tools are available that would allow partnerships to estimate levels of concern from releases
relatively quickly.) The partnership will need to decide when more information and further
analysis are needed to estimate the community's level of concern. The partnership could decide
to wait to set priorities until this analysis is completed or it could set priorities for those stressors
with adequate information and then do the analysis on stressors that need more work. Once this
work is completed, the partnership can use this new information to revisit and adjust its priorities
as needed.
You may also need to track those concerns that the partnership was not able to reach agreement
on. If some members of the partnership rank a concern high and some rank it low, your action
plan should also include a process for coming to agreement on this issue.
The following table is an example of a format that could be used to summarize available infor-
mation and community rankings. This example contains only a partial list of stressors and
vulnerabilities.
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Stressor or concern
Diesel particulates
Lack of access to health
care
Contaminated drinking
water from community
wells
Exposure to lead in
water/paint/soil
Odor from water
treatment plant
Level and type of risk
High risk to human
health
High level of
vulnerability for human
health
High risk to human
health
High risk to human
health
High impact to quality
of life
Extent of impact (Who
and what is affected? To
what extent?)
Impacts most members
of community; high
exposure along truck
routes; elderly, children,
and asthmatics
especially vulnerable
High impact on elderly
and children; 80% of
community has
inadequate access to
health care
Small number of
households, about 50,
on private well water
Impacts most members
of community; 80% live
in homes built before
new lead paint
regulations in 1972
Impacts all members of
community
Information used, certainty, and gaps in
information
Based on national studies of similar
exposures; need more detailed
information on local truck traffic
Detailed information on access to health
care used
Little information available on well water
quality
Based on incomplete childhood blood
level screening and no household water
sampling
Well-known impact
Consider combined or cumulative concerns
At this point, it will also be important for the partnership to include, if possible, considerations of
the risks and impacts from all stressors and vulnerabilities combined (the cumulative risk). Given
the limits of science in this area, developing estimates of cumulative risk will be difficult. But,
once the information on known concerns has been collected, the partnership will be able to
develop a sense of the magnitude of the combined concern resulting from all stressors affecting
the community. This information, in the form of a written summary or a matrix displaying all
concerns due to stresses on the environment as well as a summary of the health and vulnerabili-
ties of the community, can be used in the following steps to determine the level of effort and
resources that will be used to address these risks.
If the information is available, the partnership should consider the aggregate impact from indi-
vidual chemicals when they are released from multiple sources. For example, the risk from
particulate matter in the air from an electric generation facility may be compounded by releases
from local traffic. Other things to consider include evaluating the impact from all the chemical
releases from a single source. In addition, you should evaluate the combined effect of different
sources, possibly releasing different pollutants, when the pollutants may have the same effect.
These kinds of assessments may provide information to help the partnership identify its priorities.
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8. Identify potential solutions.
Identify and analyze options for reducing the priority concerns and vulnerabilities and for filling
information gaps.
Once your community partnership has identified its priority concerns and information needs, the
next step will be to find out what can be done to address these priorities. For priority concerns,
the partnership should explore the available options for reducing risk. For example, if diesel
particulates were identified as a priority, the community should do some research to identify
approaches that have been developed to address this issue, such as retrofitting diesel engines on
public and private truck and bus fleets, changing traffic routes, or restricting idling.
Information on risk reduction benefits, the costs of risk reduction efforts, the community resources
that will be needed to implement the various approaches, and the assets and resources available
in the community to address concerns will need to be determined. To do this, communities
should consider:
₯ Resources. The resources needed to reduce risks will vary depending on the source. For
example, some risks, such as indoor exposure to tobacco smoke, might be effectively
addressed through education while other risks, such as diesel retrofits, will also require
significant investments in new technology.
₯ Working with other communities. Some risks may not be able to be addressed by a single
community and will require a longer-term effort to work with other communities. For ex-
ample, the siting of major highways or the clean up of a river, stream, or lake shared by other
communities may require cooperative efforts.
₯ Missing information. A similar effort will be required to develop options for collecting
missing information. The different approaches to information collection and the resources it
will require should be gathered and summarized.
Once all the necessary information has been collected, it should be compiled into a format that
will help the community choose the actions it will take. Each community will have to use its
best judgment to balance information collection and risk reduction work. On the one hand,
requiring too much information on available options may delay action unnecessarily. On the
other hand, too little time spent gathering available data to better inform your action plan may
result in actions that are not as effective as they could be in reducing risk.
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9. Select a solution and take action.
Decide on an action plan to address concerns, fill information gaps, and mobilize the community
and its partners to carry out the plan.
Now that your community partnership has prioritized its concerns and information needs and
compiled the possible solutions, the next step is to decide on a plan of action and mobilize the
community to begin work. Depending on the resources that can be mobilized in the community
and partnership, a number of teams may be required to address multiple priorities. You may also
need to develop a short-term plan for immediate actions and a long-term plan to address priorities
that will require more time to collect needed resources. Some communities may decide to
prioritize information collection in order to help build consensus or to make sure that significant
risks have not been overlooked. Others may focus primarily on risk reduction and put less
emphasis on filling gaps in information.
Developing a plan that allows the community to achieve some early successes while pursuing
longer-term goals may help the partnership build community support for its work. Most impor-
tantly, make sure that your plan takes advantage of all your local assets and mobilizes as many
members of your community and partnership as possible. Getting everyone involved in building a
healthy community will not only get results, it will also give everyone a chance to learn about
the local environment and acquire the skills and knowledge needed to sustain a long-term effort
to build a healthy community.
10. Evaluate results and revisit priorities.
Evaluate the results of community action, analyze new information, and start the process again
to reset priorities as needed and to develop new plans for action and, if needed, for information
collection.
To make sure that your efforts are achieving the proper results, it will be important for the partner-
ship to find effective ways to measure progress. For each priority and action plan, the partnership
should develop indicators or measures to evaluate the effectiveness of community action.
Reductions in releases, exposures, and risk, and reductions in health effects can all be used to
measure progress. It is also important to try to measure progress in building the community's
capacity to understand and address risks. To be successful, communities will need to measure
their progress and adjust their work to build on their successes and learn from their mistakes.
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Resources
General Resources
₯ Community Action for a Renewed Environment (CARE) Resource Guide. U.S. Environmental
Protection Agency. Last updated Jan. 2005. Available at: http://cfpub.epa.gov/care/
index.cfm?fuseaction=Guide.showlntro
₯ Community Environmental Health Assessment Workbook, A Guide to Evaluating Your
Community's Health and Finding Ways to Improve It. Environmental Law Institute. 2000.
Available at: http://www.elistore.org/Data/products/d10.09.pdf
₯ Ensuring Risk Reduction in Communities with Multiple Stressors: Environmental Justice and
Cumulative Risks/Impacts. National Environmental Justice Advisory Council, Cumulative
Risks/Impacts Work Group. Report, December, 2004. Available at: http://www.epa.gov/
compliance/resources/publications/ej/nejac/nejac-cum-risk-rpt-122104.pdf
₯ Framework for Cumulative Risk Assessment. U.S. Environmental Protection Agency, Office
of Research and Development, National Center for Environmental Assessment, Washington
Office, Washington, DC, EPA/600/P-02/001 F. 2003. Available at: http://cfpub.epa.gov/ncea/
cfm/recordisplay.cfm?deid=54944
₯ PACE EH: Protocol for Assessing Community Excellence in Environmental Health. National
Association of County & City Health Officials. 2000. Available for purchase at: http://
66.153.70.1 86/NACCHO_eBiz/Default.aspx?tabid=39&action=L&args=ENH
Additional resources for Steps 1-10
References and links to resources to help communities implement each of the 10 steps can be
found on the CARE website at www.epa.gov/CARE/tools.
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