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 important—in 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 population—infants 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.
                                                                                             11

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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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