The CARE Roadmap
10-Step Plan to Improve Community Environment and Health
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.
Second, it incorporates a "bias for action" perspective. This means that the Roadmap encourages
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 understanding of risk, mobilizing
the 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 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 interests
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
6.	Collect and Organize Information: Collect and summarize available information on stressors,
concerns, and vulnerabilities. Identify gaps where the information on stressors, concerns, 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.

The Roadmap: Ten Steps to a Healthier Community and Environment
3. Identify
1. Build a
6 Collect
and Organize

' 8. Identify
Evaluate Set

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 process 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 partnership and trust among the partners. This can
be accomplished if everyone in your partnership 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
mobilized 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 community 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. Communities
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? The
definition of "environment" varies 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 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 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 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 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
completed 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. 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 new
funders. Further, partnership members should pay careful attention to retaining
skills and knowledge acquired through the Roadmap's implementation so that
this enhanced capacity remains in the community.

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.
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 concerned
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 partnership 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 partnerships
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 ofself-
sustainability into every step of the Roadmap, being careful not to become dependent solely on any
one funding source or member of the collaborative.
*	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 federal)

*	Elected officials
*	Local governmental and tribal agencies
*	Business owners and managers
*	Unions
2.	Identity concerns.
Identify the environmental, health, and related social and economic concerns of the community.
Community groups often focus on one or a few environmental issues of greatest interest or
immediate concern. In order to address community environmental health 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 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.
3.	Identity 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 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 effective 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, increasing 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.

Susceptibility/Sensitivity. Pre-existing health conditions can make a group more sensitive to negative
impacts from environmental health issues 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 food production and consumption
*	Lack of information needed to avoid exposures because of poor
education, unavailability, or language factors
Preparedness/Ability to Recover. In addition to increased sensitivity and exposure, other 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.	Identity 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
environmental, 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 communicate effectively
with large sections of the community is an asset that can be used to meet partnership goals.
*	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
5.	Identity 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 demonstrate 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
vulnerabilities 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 immediate
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 existing 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 community, 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 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 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 concern 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 something 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
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 something 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 exposed or the
extent of the environment affected. 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 environmental
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 information 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 agreement
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.
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 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 vulnerabilities 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, 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 assessments may provide
information to help your partnership identify its priorities.
8. Identity potential solutions.
Identify and analyze options for reducing priority concerns and vulnerabilities and for filling
iinformation 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 information. 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 resources 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 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 example, the siting of major highways or the cleanup of a
river, stream, or lake shared by other communities may require cooperative
* Missing information. A similar effort will be required to develop options for
collecting missing 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 actions that are
not as effective as they could be in reducing risk.
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.
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 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 importantly, 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 maintain a healthy
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 partnership
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. 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 investments from partners. Well-organized
community partnerships with knowledge of risks and priorities are better equipped to apply for
grants through foundations and government, 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.