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          LOCAL PARTNERSHIPS, HEALTHY COMMUNITIES.
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The CARE
Roadmap
               -
          Communi.
                     } 0-Step Plan
                     to Improve
                     Community
                     Environment
                     and Health
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                     www. epa. gov/CA RE

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Introduction
Purpose
    This roadmap will provide you and your community with a process 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
    The 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 to identify, prioritize, and address environmental health risks. It incorporates the
    perspective of the National Environmental Justice Advisory Council (NEJAC) report on ensuring
    risk reduction in communities with multiple stressors (http://www.epa.gov/compliance/
    resources/publications/ej/nejac/nejac-cum-risk-rpt-122104.pdf) and EPA's Framework for
    Cumulative Risk Assessment (http://cfpub.epa.gov/ncea/cfm/recordisplay.cfm?deid=54944).
    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 17.

About EPA's CARE Program
    If your community wants to reduce levels of toxic pollution, the CARE program can help. CARE
    assists communities by providing technical assistance and resources to local organizations
    which form stakeholder groups to address and reduce their most significant risks, especially
    through voluntary programs. For more information, see www.epa.gov/CARE.
    This Roadmap is essential reading for any community that has received a CARE grant. It also
    can be used by any group wishing to improve local environmental quality even without funding
    through CARE.  Participation in EPA's CARE Program is not a requirement for putting this Road-
    map to good use.

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 a comprehensive understanding
    of local environmental risks and impacts: it considers combined risk resulting from multiple
    sources and risk resulting from community vulnerabilities. This comprehensive overview of
    concerns gives the community the information it needs to ensure that its efforts will have the
    greatest positive impact on local health and the environment.

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     Second, it incorporates a "bias for action" perspective. This means that the Roadmap encour-
     ages communities to take action 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 under-
     standing of risk, mobilizing the community will not be possible, and without a clear understand-
     ing 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 consensus and
     target risk reduction efforts where they will do the most good.

A summary of the Roadmap process
     1. Build a Partnership: Build a collaborative partnership representing a broad range of inter-
        ests 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 con-
        cerns and vulnerabilities.
     6. Collect and Organize Information:  Collect and summarize available information on stress-
        ors, concerns, and vulnerabilities. Identify gaps where the information on stressors, con-
        cerns, and vulnerabilities is missing or inadequate.
     7.  Rank Risks and Impacts: Compare and rank community concerns to help identify those
        that have the greatest impact.
     8. Identify Potential Solutions:  Identify and analyze options for reducing  priority concerns
        and vulnerabilities and for filling information gaps.
     9. Set Priorities for Action and Begin Work:  Decide on an action plan to  address concerns,
        fill information gaps, and mobilize the community and its partners to carry out the plan.
     10. Evaluate Results & Become Self-Sustaining: Evaluate the results of community action,
        analyze new information, and develop a plan to restart the Roadmap process. You can
        restart the process as needed to reestablish priorities, develop new plans for action, collect
        information, and  make your partnership self-sustaining.

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The Roadmap: Ten Steps to a Healthier Community and Environment
  3. Identify
     community
     vulnerabilities.
                       Identify
                       community
                       concerns.
             1.  Build a
                partnership.
                          Identify
                          community
                          assets.
ie"% concerns
for immediate
                               6.  Collect and
                                  organize
                                  information.
                                           Rank risks
                                           and impacts.
                                                                    Identify
                                                                    potential
                                                                    solutions.
                                 Q  Set priorities tor
                                    action and begin
                                    work.
                                              se'f-susta/n/ng.

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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 identify options for reducing
        risks (Steps 7-8)
     *  Mobilize the community partnership to take action (Step 9)
     *  Evaluate the work of the community partnership, measure progress, and begin a new pro-
        cess to address remaining risks (Step 10)

Tips on using the Roadmap
     *  How can we 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 partner-
        ship and trust among the partners. This can be accomplished if everyone in your partner-
        ship has the opportunity to be heard and to participate fully as equals. Since partnership
        members will bring different backgrounds and resources, your partnership must find ways
        to work with these differences. All the time and effort required up-front to build real trust
        and a strong partnership will pay off in the long run when the broader community is mobi-
        lized to take on efforts that make a  long-lasting difference. Such collaborations have the
        greatest potential for sustaining their activities over the long term.
     *  Do the steps need to be done in order? No. 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 com-
        munity will work together to complete Step 2. You and your community partners will have to
        decide how to sequence the steps, choosing the approach that best provides the necessary
        information and builds the broad partnerships necessary to reach community goals. Com-
        munities may also choose to combine steps. For example, the work to identify concerns,
        vulnerabilities, assets, and issues that need immediate attention, Steps 2 through  5, could
        be done simultaneously. And most importantly, communities will almost certainly have to
        revisit different tasks as the work progresses. For example, as new concerns are identified
        and new solutions are proposed, the work to build the partnership, Step 1, will need to be
        revisited so that members of the community affected by these decisions are brought into
        your partnership.
     *  What should the scope of the environmental and health assessment be? What should
        the scope of the environmental and health assessment be? The  definition of "environment"
        varies from community to community so the scope of the assessment will also vary. In com-
        munities that have ongoing development, crime prevention, or education projects, the scope
        of the environmental health assessment may stick to traditional  environmental concerns
        (e.g., ecological, pollution risks). But communities without these  efforts underway may need
        to interpret "environment" more broadly to include such things as jobs, lack of adequate
        health care, and crime to motivate and enroll the support of the community. Having other
        partners at the table is important to the process, especially if the community chooses to

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address issues outside of EPA's authority. And even in communities that define environment
more narrowly, when addressing vulnerabilities you may end up broadening the scope of
work.
Should all local 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 risks. A comprehensive as-
sessment 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 priority of a particular risk.
Other communities may need a fairly long trust-building process before they can agree to
work collectively to do a comprehensive assessment. So, making the judgment about when
to do a comprehensive assessment will depend on the situation in each  community.
How can we incorporate a bias for action? The steps of the Roadmap should be com-
pleted from existing data and the knowledge of the participants in a short time frame so
that priorities can be quickly identified and actions taken to reduce risks and impacts. In
your first pass along the Roadmap, you will also identify data gaps and areas where there is
not consensus. Once preliminary  priorities are identified, your partnership should create a
plan to fill in significant gaps while at the same time taking action on the identified priorities.
Once your community has new information, you will need to repeat the assessment steps
using the more complete information in order to reestablish the priorities and actions as
needed.
How can we fund and sustain this work? Aspects of this  Roadmap process can be built
into any existing project addressing local environmental concerns. Implementing the entire
process can often require additional planning and resources, however. Several agencies
and foundations provide funding for partnership- and capacity-building work, including EPA's
CARE program described above. As your community partnership grows in size and strength
through implementation of the  Roadmap process, you should be able to  sustain yourself
with greater investments made by partners and newfunders. Further, partnership members
should pay careful attention to retaining skills and knowledge acquired through the Road-
map's implementation so that this enhanced capacity remains in  the community.

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         The Road map:  More on Each Step
              The following brief descriptions are designed to provide communities with an overview of the
              steps needed to build consensus on community environmental and health priorities and take
              action to reduce them. A list of general resources with more detailed information and guidance
              can be found on page 17. Links to additional resources to help communities accomplish these
              steps can be found on the CARE website at: www.epa.gov/CARE. under Resource Guide.

         1.   Build a partnership.
              Build a collaborative partnership that is able to identify environmental risks and impacts, build
              consensus on priorities, and mobilize all the resources necessary to achieve community goals.
              Your partnership should include a broad cross-section of community members who are con-
              cerned and involved with the environment, as well as the human and socio-economic health
              and well-being of the community. Involving all sectors of the community, including residents,
              churches, businesses, schools and  colleges, and government, will help ensure that your part-
              nership has the knowledge and resources necessary to succeed. To get your partnership off to
              a strong start, it will be important to clarify the roles and expectations of each of your partners
              and establish clear procedures for making partnership decisions. Special efforts to involve some
              sectors of the community may be necessary, especially sectors not used to being involved in
              partnership efforts—such as the residents most impacted by environmental stressors or small,
              local businesses. 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, including its
              leadership.
              Plan for ongoing partner recruitment, as needs change and some initial partners drop off. In
              addition, project partners will have to find creative ways to fund the  process. Successful partner-
              ships draw human and financial resource support from multiple sources to sustain themselves
              over the multiple iterations prescribed by the Roadmap. Remember to build the philosophy of
              self-sustainability  into every step of the Roadmap, being careful not to become dependent solely
              on any one funding source or member of the collaborative.
*
              POTENTIAL PARTNERSHIP MEMBERS
              *  Local community members
              *  Minority members of the community
              *  Local environmental justice organizations
              *  Local, regional, and national environmental
                 organizations
              *  Health care providers
              *  Faith-based organizations
              *  Local churches
              *  Local Chambers of Commerce and
                 other business organizations
              *  Civic organizations
              *  Local economic development organizations
Educational institutions
(schools, universities, and colleges)
Community development groups
Environmental and natural resource
agencies (local, state, federal, and
tribal)
Health agencies (local, state, and fed-
eral)
Elected officials
Local governmental and tribal agencies
Business owners and managers
Unions

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2.   Identify concerns.
     Identify the environmental, health, and related social and economic concerns of the commu-
     nity.
     Community groups often focus on one or a few environmental issues of greatest interest or im-
     mediate concern. In order to address community environmental health issues on a comprehen-
     sive 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 knowledge  and resources of all of
     your partners. Create opportunities for residents and experts to share information and learn
     from each other to identify all the environmental stressors facing the community. Ensure that
     partners are working together to consider types of concerns such as:
     *  Community environmental health
     *  Disease incidence in the community
     *  Sources of pollution
     *  Routes of exposure
     *  Effects of chemical and biological hazards on the community and its natural environment
     *  Social and economic conditions
     Assembling these issues into a matrix format may enable your partnership to better appreciate
     the scope of issues impacting the environment and health of the community. As an example,
     the following page shows a matrix prepared by a community group for the Vietnamese Fisher-
     man Community in Louisiana:

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        Potential Multiple,  Aggregate, Cumulative Risks and Impacts
                   in Vietnamese  Fishermen Community, Louisiana
          Demographics
                   Pollution Sources
      Existing Health Problems
Vietnamese: 100%
• Read and write English/Non-English
  speaking: 95%
• English speaking: 5%
• Commercial hazardous waste incinerator, imported hazardous
  waste from across the U.S. and foreign countries
• Large number of hazardous and waste dump sites in residential
  areas
• Drinking water source (surface water) contaminated with
  organic toxins and heavy metals from upstream industrial and
  agricultural sources
• Runoff or drift of pesticides or fertilizers from agricultural
  fields
• Burning of agricultural fields and marsh ecosystem
• Improper sewage and sanitary infrastructure in community
  — raw sewage flowing in ditches
• Lack of proper nutrition due to long
  periods of time on fishing boats
• Lack of access to proper health care
  and lack of medical  insurance
• Drug addiction
• Alcoholism
• Medical conditions including cancer,
  respiratory diseases, skin rashes,
  asthma, and frequent bacterial
  infections
Air
• Emissions of hazardous chemicals
  from the hazardous waste
  incinerator
• Burning of the agricultural fields
  and marshes releasing toxic
  chemicals and particulate matter
• Potential drift of pesticides from
  agricultural spraying
Water
• Contaminated drinking water
  sources
• Contaminated food resources-
  garden crops, terrestrial animals,
  aquatic species
• Vietnamese fishing community must compete with white
  fishermen from Louisiana and Texas.
• Large investment in boats; unable to make payments due to
  dumping of foreign imports of seafood. Banks are repossessing
  boats.
• If the community members cannot fish, there is no way to
  make a living and remain together as a society
• Live in clusters and small towns with life centered around their
  churches; priests serve in community leadership roles
• Community members are hard workers and willing to work
  under substandard conditions
• Low economic conditions and hard lives takes thier toll on the
  fishers and their families even in good times
• Fishing trips require the men to be away from their families for
  2 to 3 weeks at a time
• Lack of environmental/biological diversity awareness
• Lack of technical assistance to identify and apply for
  assistance resources
                                                                                               Community Capacity and
                                                                                               frastnicture/Social Capita
• Substandard housing
• Many generations living in single
  dwellings
• Children perform well in school and
  provide assistance to adults. Deep
  respect on the part of the younger
  generations for elders.
• Lack of social capital/assets
• Lack of economic capital
• Lack of medical insurance
• Lack of adequate processing plants
  for harvested seafood
• Lack of financial resources to
  capitalize investments
• Lack of infrastructure to ensure
  ability to sell harvested seafood
• Severely  impacted by the dumping of
  foreign seafood on U.S. markets

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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 af-
     fected by poor environmental conditions than the general population. Disadvantaged, under-
     served, and overburdened communities may have physical and social conditions that make
     the effects of environmental pollution  (or "stressors") more, and in some cases unacceptably,
     burdensome. Also, children and older  members of the community are at greater risk from some
     environmental stressors. Consider these conditions when determining the extent of risks or
     impacts. Understanding community vulnerabilities may also allow communities to identify ef-
     fective options for risk reduction. For example,  if a group within the community has a language
     barrier that impacts its ability to understand the potential health effect of lead paint, increas-
     ing access to health-care materials in  the appropriate language may be an effective option  to
     reduce risk. Use the following sample  lists to generate your own list of factors.

     EXAMPLES OF VULNERABILITY FACTORS
     Susceptibility/Sensitivity. Pre-existing health  conditions can make a group more sensitive to
     negative impacts from environmental  health  issues than the general population. These suscep-
     tibility/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 food production and consumption
     *  Lack of information needed to avoid exposures because of poor education, unavailability, or
        language factors

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              Preparedness/Ability to Recover. In addition to
              conditions in some communities make them less
              stand and recover from environmental stressors.
              *  Poor nutrition
              *  Compromised health/immune system
              *  Limited health care
              *  Cultural practices
              *  Lack of recreational facilities
              *  Poor community services
              *  Low income
              *  Low education
increased sensitivity and exposure, other
prepared than the general population to with-
Such conditions could include:
*  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 en-
              vironmental, social, and economic problems and stressors still have many assets. Develop a
              list of your community's strengths to help in choosing an action plan later in the process. For
              example, if your community has a strong network of churches, the network's ability to com-
              municate 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
              *  Business and industry
              *  Civic and community leaders
              *  Political abilities
              *  Community building resources
              *  Human resources
              *  Outreach networks and skills
              *  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, evaluate these
     stressors, concerns, and vulnerabilities. Identify those that everyone (or a majority) agrees are
     a high priority and need immediate attention; risk-reduction actions to address these items
     should begin as soon as possible. Starting work on pressing community concerns will  demon-
     strate your partnership's commitment to improving community health. Early successes will also
     build trust in the community and help to strengthen and sustain the partnership.
     As your partnership takes action on some key concerns, all the stressors, concerns, and vulner-
     abilities should be analyzed further using Steps 6 and 7. Once this analysis is completed and
     additional priorities are identified, existing efforts to address the concerns identified for immedi-
     ate action can be adjusted as necessary.

6.   Collect and organize information.
     Collect and summarize information on environmental health concerns (or stressors), taking into
     account the factors that may make the community more vulnerable.
     For the community to rank its concerns and identify those that have the most impact,  you will
     first have to collect and organize the information on each concern. If you are not able to  find or
     collect this information, you will need to identify any gaps and  consider ways to fill them  when
     you prioritize your community actions in Step 9.

     Gather information
     To estimate the magnitude of each of the identified environmental, health, and socioeconomic
     issues, collect all available information on observed environmental health impacts, stressors,
     and potential risks, considering the community's vulnerabilities. Some sources of information
     include:
     *  Partnership members, especially those directly affected by a stressor
     *  Databases with information on the amounts and sources of pollutant releases
     *  Information on levels of chemicals measured in your environment
     *  Formal studies of risk in your community, if they are available
     *  Studies that estimate  the risk for similar communities
     *  Studies that estimate  the health and potential vulnerability of your community
     *  National studies of risk
     Engage residents of the community, students and teachers at local schools, local businesses
     and organizations, local doctors, and local and state public health and environment staff to
     help locate and collect this information. Government and university staff can identify any exist-
     ing studies of the community and/or similar communities. Your partnership may also be able
     to organize teams to collect some of the key information needed to rank risks. For example,
     partnership members  may be able to locate all the small businesses that may impact  the com-
     munity, or your partnership may organize  high school or college students to survey traffic to
     better estimate the risks from mobile sources. Collect as much information as possible with the

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              resources available and within the time set for the initial ranking of concerns. The information
              gathered in this step is intended to support a risk-ranking process in Step 7. The goal should be
              to gather the information that is immediately available, with a priority on gathering health-based
              risk data. Then, discuss with the CARE partnership whether this information is sufficient to
              move forward in the ranking, or if more information is necessary. The process is likely to involve
              a series of discussions with the partnership members, at various points.

              Identify where more information is needed
              Communities beginning to collect information on stressors and risks are unlikely to find all the
              information they need. In some cases, the information needed to understand and rank a con-
              cern will require more resources or time than are immediately available to the partnership. For
              example, if blood-lead levels have  not been tested in your community, this is probably not some-
              thing that your partnership will be able to collect in time for the initial ranking exercise. Note all
              information gaps so that your partnership can decide how to address this lack of information.

              Summarize findings
              For each environmental concern or stressor, 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 your partnership choose priorities
              in the next step. See an example format including priority rankings in Step 7 below.

         7.   Rank Risks and Impacts.
              Rank risks and impacts to identify the community's concerns.
              Using the organized information on concerns, identify the most important concerns to address
              to improve the environment and health of the community. At this point, whether or not some-
              thing can be done about an issue should not be considered. This risk-ranking 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 have the greatest
              impact, even if it is  not possible to do something about them immediately.
              This step in the process will require your partnership to rank impacts that may be very difficult
              to compare. For example, a community may have concerns about  impacts on both human
              health and on the health of an ecosystem or habitat. Impacts on quality of life concerns, such
              as odors, will also be hard to compare to health risks. Ranking diverse impacts will involve value
              judgments, so this will present an opportunity for your partnership and community to discuss
              values  and work towards a consensus on how to improve the community.

              Select a method for ranking
              To use  the information organized in Step 6 to rank risks and impacts, adopt a method, such as
              a numerical (e.g., 1-10) scale  or a "high" to "low" scale that will allow all the  identified concerns
              to be compared. When selecting a ranking method, take into account the severity of the impact,
              including the level of vulnerability of the people affected, as well as the number of people ex-
              posed or the extent of the environment affected. Examples of priority setting methods, including
              quantitative methods, can be  found in PACE EH: Protocol for Assessing Community Excellence
              in Environmental Health (National  Association of County and City Health Officials, 2000) (http://
              www.naccho.org/pubs/productl.cfm7ProductJD=60) and in the Air Toxics Risk Assessment
              Reference Library, Volume 3:  Community Scale Assessment (United States Environmental
#

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Protection Agency, Office of Air Quality Planning and Standards, 2006) (http://www.epa.gov/
ttn/fera/risk atra vol3.html). The number of highly ranked concerns should be reasonable, but
not so many that addressing them all will be impossible. Highly ranked concerns could include
risks, impacts, vulnerabilities, or information gaps. For example, you could give a high ranking
to lead exposure as both a risk and an information gap.

Estimating levels of concern for stressors with missing information
In some, and probably most cases where there are gaps in the information on an environmen-
tal health issue or stressor, use the available information and your collective 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 infor-
mation on blood-lead levels to determine how many children are affected, you may choose to
identify the potential concern from lead paint, given the likelihood of exposures, as very high.
It is important to note, however, that because the information is incomplete, this estimate may
have some amount of uncertainty.
In some cases, more information or further analysis will be needed before your partnership can
agree on its level of concern. For example, if you only have amounts of pollution released for a
facility, you may decide to do further work, such as collecting information on the toxicity of the
chemicals released and using modeling to estimate community exposure. (Screening tools are
available that would allow you to estimate levels of concern from releases relatively quickly.)
Your partnership will need to decide when more  information and further analysis are needed to
estimate the community's level  of concern. You could decide to wait to set priorities until this
analysis is completed or you could set priorities for stressors with adequate information and
then do the analysis on stressors that need more work. Once this work is completed, you can
use this new information to revisit and adjust priorities as needed.
You may also need to track those concerns that your partnership was not able to reach agree-
ment on. If some members of your 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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             Diesel particulates
(1) cancer:  diesel particulate
concentrations above health-
based benchmarks for entire
area; (2) mortality, chronic
bronchitis, asthma, heart
attacks. Local area is above
National Ambient Air Quality
Standard for PM2.5; local
studies suggest that diesel
sources contribute 15-20% of
total PM2.5.
                                                                    Extent of impact
                                                                (Who and what is affected?
                                                                    To what extent?)
                                                            and gaps in information
Higher exposure along truck routes,
although entire area is above
acceptable levels; elderly, children, and
asthmatics may be especially vulnerable
Based on census-tract level modeling
data (1999 National Air toxics
Assessment) and the nearest air toxics/
particulate ambient air monitor (4.5
miles away); traffic data, used as
supporting information, taken from
state Department of Transportation
Web site for highways and metropolitan
planning organization for major
roadways; portion of PM2.5 from diesel
based on university-lead emissions and
photochemical modeling study
             Lack of access to health care
High level of vulnerability for
human health
High impact on elderly and children;
80% of community has inadequate
access to health care
Detailed information on access to health
care used
             Contaminated drinking water
             from community wells
Cancer:  tests from five
private wells indicate that
arsenic may be present in
drinking water above health-
based benchmarks
The extent of the impact is unknown. A
small number of households, about 50,
are on private well water, but only 5
have been tested
Little information available on well water
quality; samples were taken directly from
well water and analyzed by private lab
             Exposure to lead in water/
             paint/soil
Neurological/developmental
effects in children; 5 of 30
children tested were found
to have blood-lead levels in
excess of 10 ug/dL
80% live in homes built before new
lead paint regulations in 1972;
approximately 20% of the housing
stock is in disrepair
Based on incomplete childhood blood
level screening—of approximately 1,000
children in the community, only 30
have been tested for lead exposures;
percentage of housing stock in disrepair
based on foot survey of sample streets;
no household water/paint sampling
             Odor from water treatment
             plant
High impact to quality of life
Impacts all members of community
Well-known impact
*
                 Consider combined or cumulative concerns
                 At this point, it will also be important for your 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, you will be able to develop a
                 sense of the magnitude of the combined concern  resulting from all  stressors affecting the com-
                 munity. 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 vulnerabilities of
                 the community, can be used in the following steps to determine the level of effort and resourc-
                 es  that will  be used to address these risks.

                 If the information is available,  consider the  aggregate impact from individual 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 estimate the combined effect of different sources, possibly
                 releasing different pollutants, when the  pollutants may have the same effect. These kinds of as-
                 sessments may provide information to help your partnership identify its priorities.

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8.   Identify potential solutions.
     Identify and analyze options for reducing priority concerns and vulnerabilities and for filling
     information gaps.
     Once your community partnership has identified and ranked its concerns and information
     needs, the next step is to find out what can be done to address these concerns using risk infor-
     mation. Your partnership should explore the available options for reducing risk. For example, if
     diesel particulates were ranked highly,  do some research to identify established approaches 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 re-
     sources available in the community to address concerns will need to be determined. To do this,
     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 ad-
        dressed through education while other risks, such as diesel retrofits, will also require signifi-
        cant 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 cleanup 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 miss-
        ing information. Gather and summarize different approaches to collecting the information
        and the resources it will require.
     Once all the necessary information has been collected, compile it into a format that will help the
     community partnership 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 ac-
     tions that are not as effective as they could be in reducing risk.
     Consider looking outside of the CARE partnership for entities that could provide potential solu-
     tions. Invite those who can contribute solutions to be part of the CARE partnership.

9.   Set priorities for action and begin work.
     Decide on an action plan to address concerns, fill information gaps, and mobilize the commu-
     nity and its partners to carry out the plan.
     Now that your community partnership has  ranked its concerns and information needs and
     compiled information on possible solutions, the  next step is to set priorities for 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

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              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. Factors for setting priorities may include the
              risk ranking from Step 7, the ability to affect outcomes, available resources, community values,
              and community capacity to tackle an issue. Priorities may focus  primarily on risk reductions, but
              could also emphasize filling gaps in information.
              Developing a plan that allows the community to achieve some early successes while pursuing
              longer-term goals may help your 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 ef-
              fort to maintain a healthy community.

         10. Evaluate results and become self-sustaining.
              Evaluate the results of community action, analyze new information, and restart the process as
              needed to reestablish priorities, develop new plans for action, and collect information. Consider
              sources for financial and human capital to restart the Roadmap process and make your part-
              nership self-sustaining.
              Restarting the Roadmap steps will require some thought regarding the human and financial
              resources needed to carry out another round of assessment and action work. Aspects of this
              Roadmap process can be integrated into ongoing risk-reduction  projects, but implementing
              the entire process can often  require additional planning and resources. Several agencies and
              foundations provide funding for partnership- and  capacity-building work, including EPA's CARE
              program described above. As your community partnership  grows in size and strength through
              implementation of the Roadmap process, you will likely be able to sustain your partnership with
              greater in vestments from partners. Well-organized community partnerships with knowledge
              of risks and priorities are better equipped to apply for grants through foundations and govern-
              ment, as well. Further, pay careful  attention to retaining skills and knowledge acquired through
              the Roadmap's implementation so this enhanced capacity remains in the community.
#

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Resources
     General Resources
     *  Community Action for a Renewed Environment (CARE) Resource Guide. U.S. Environmental
        Protection Agency. Last updated September 2007.
        Available at: http://cfpub.epa.gov/oarweb/care/index.cfm?fuseaction=Guide.showlntro#
     *  Community Air Screening How-Jo Manual: A Step-by-Step Guide to Using a Risk-Based Ap-
        proach to Identify Priorities for Improving Outdoor Air Quality. U.S.  Environmental Protection
        Agency. October 2004.
        Available at: http://www.epa.gov/oppt/cahp/pubs/howto.htm
     *  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/dlO.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-02/001F. 2003.
        Available at: http://cfpub.epa.gov/ncea/cfm/recordisplay.cfm7deid=54944
     *  RACE EH: Protocol for Assessing Community Excellence in Environmental Health. National
        Association of County & City Health Officials. 2000.
        Available at: http://www.naccho.org/pubs/productl.cfm7Product ID=60
     *  Advancing Environmental Justice Through Pollution Prevention. A report developed from
        the National Environmental Justice Advisory Council Meeting of December 9-13, 2002.
        Available at: http://www.epa.gov/compliance/resources/publications/ej/nejac/p2-
        recommend-report-0703.pdf
     *  Risk Assessment and Modeling — Air Toxics Risk Assessment Reference Library: Volume 3
        -Community Scale Assessment. U.S. Environmental Protection Agency. April 2006.
        Available at: http://www.epa.gov/ttn/fera/risk atra_vol3.html

     Additional resources for Steps 1-10
     References and links to resources to help communities implement this Roadmap can be found
     on the CARE website at www.epa.gov/CARE.

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United States
Environmental Protection
Agency
CARE Program
(8001 A)
EPA 400-K-08-002
June 2008
www.epa.gov/CARE

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