oEPA
United States
Environmental Protection
Agency
A Pilot Framework for Integrating
Community Health and Wellness
into the Superfund Reuse
Assessment Process
July 2014
5
Jan
Smell Park
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This report was funded by EPA's Superfund
Redevelopment Initiative to provide a summary of
a pilot framework for integrating health, prevention
and wellness considerations into the Superfund
reuse assessment process. Through the Superfund
program, EPA is working to further the cleanup
of contaminated sites and the protection of human
health and the environment. Additional support was
provided by EPA's Office of Environmental Justice
and the EPA Region 4 Superfund program. For
additional information on SRI, please visit: http://
www.epa.gov/superfund/programs/recycle.
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Foreword
Many Superfund sites are located in neighborhoods that suffer from multiple contaminated sites, disinvestment,
lack of services and stark health disparities. During the Superfund cleanup process, Remedial Project Managers
and Community Involvement Coordinators engage with communities to provide updates and gather input on
the cleanup process. Depending on the stage of the remedial process, EPA may also engage with a community
to determine the reasonably anticipated future land use of a site or seek a viable future use and landowner to
ensure long-term stewardship.
When evaluating future use options, EPA may gather community goals, review local plans and initiatives,
assess the surrounding land use context, and factor in natural site constraints and remedial considerations
Reuse options considered may include open space, residential, commercial and industrial uses, or focus 011 more
specific goals of the community. The reuse assessment process also offers an opportunity to evaluate whether
the Superfund site might be suitable to support health and wellness services and amenities. Amenities may
include health care facilities, but can also include a broader set of uses to advance healthy, sustainable, equitable
and resilient communities through amenities such as transportation options, parks and neighborhood retail
services.
This document offers a a summary of a pilot framework to evaluate potentially integrating health and wellness
considerations into the Superfund reuse assessment process. It does not, however, substitute for CERCLA or
EPA's regulations, nor is it a regulation or guidance itself. Thus it does not impose legally binding requirements
on EPA, states, tribes or the regulated community, and may not apply to a particular situation based upon the
circumstances. EPA, state, tribal and local decision-makers retain the discretion to adopt approaches on a
case-by-case basis. Any decision regarding a particular facility will be made based on the applicable statutes
and regulations. If such approaches are not within the scope of the Agency's authority, some other party (e.g.,
state, Potentially Responsible Party, local government, tribe, developer, community partner, etc.) must fund the
additional costs associated with those actions. EPA should ensure that integrity of the CERCLA remedial action
is not adversely affected by any activities carried out by such other parties at the site.
This framework may be useful for EPA staff, local government, organizations and community members who
are considering future use for a Superfund site. If integrated into the reuse planning process, this framework
may help to identify potential reasonably anticipated land uses for consideration, which could supplement
and expand existing health assets for neighborhoods impacted by Superfund sites, and over time contribute to
improved physical, mental and social well-being for these communities
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Table of Contents
I. Introduction 1
II. Background 2
Communities Impacted by Superfund Sites 2
The Superfund Reuse Assessment Process 3
Health, Prevention and Wellness: A Growing National Consciousness 5
Tools for Evaluating Community Health, Prevention and Wellness 6
III. Framework Overview 8
Process Overview 8
Step 1. Identify Community Goals 9
Step 2. Determine Site Suitability 10
Step 3. Conduct Land Use and Health and Wellness Service Analysis 11
Step 4. Determine Health and Wellness Needs 13
Step 5. Develop Summary and Recommendations 15
IV. Case Study 16
Case Study Overview 16
Step 1. Community Goals 17
Step 2. Site Suitability 18
Step 3. Service Analysis 19
Transportation Options 20
Community Amenities 21
Health Care Options 22
Parks and Open Space 23
Neighborhood Retail Services 24
Healthy, Affordable Food 25
Quality Affordable Housing 26
Service Analysis Summary 27
Step 4. Health and Wellness Needs 28
Health Outcomes 28
Potential Environmental Risk Factors 30
Step 5. Summary and Recommendations 32
V. Summary 33
VI. Resources 34
Data Considerations and Resources 34
Selecting a Level of Effort 36
Funding Sources 37
References 39
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Chapter 1. Introduction
Purpose of the Framework
This document provides a summary of a pilot framework for integrating health, prevention and wellness
considerations during the Superfund reuse assessment process. The framework describes health and wellness
considerations that can be integrated directly into each step of the reuse assessment process. It includes
suggested community discussion questions, a set of health and wellness indicators, suggestions for mapping
health and wellness features at the neighborhood scale, considerations for site suitability and a case study
example to illustrate the process. If such approaches are not within the scope of EPA's authority, some other
party (e.g., state, Potentially Responsible Party, local government, tribe, developer, community partner, etc.)
must fund the additional costs associated with these actions. Thus, the framework also includes information on
data sources, funding programs and other resources to assist in the process.
The document is organized into the following chapters:
Chapter 2: Background
This chapter provides background context for the framework, including: a description of the Superfund
reuse assessment process, background on health, prevention and wellness efforts at the federal level, results
of a best practices literature review of health assessment tools, and a set of criteria to identify Superfund
sites that might be good candidates for a health and wellness assessment.
Chapter 3: Framework Overview
This chapter provides an overview of the health and wellness framework as it relates to the steps in the
Superfund Reuse Assessment process. It also offers details on factors to consider during each step along
with further detail on data sources, mapping and additional considerations.
Chapter 4: Case Study Example
This chapter provides an example of the application of the framework to the Fairfax St. Wood Treaters
Superfund Site in Jacksonville, Florida.
Chapter 5: Summary
This chapter provides a summary of the health and wellness framework and its potential for leveraging
reuse assessment investments to improve neighborhood health and wellness in overburdened communities.
Chapter 6: Resources
This chapter includes data sources, funding programs and other references to assist in the process.
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Chapter 2. Background
Communities Impacted by Superfund Sites
Many Superfund sites are located in neighborhoods that suffer from multiple contaminated sites, disinvestment,
lack of services and stark health disparities. These neighborhoods are also often communities of color. One of
the earliest studies to draw a clear connection between communities of color and the location of contaminated
sites was Toxic Wastes and Race in the United States, published by the United Church of Christ in 1987.1 This
study "found race to be more important than socioeconomic status in predicting the location of the nation's
commercial hazardous waste sites."2 A 1998 study of Superfund sites in Florida found that African Americans
and Latinos are more likely to live in neighborhoods impacted by Superfund hazardous waste sites and that the
spatial association between race, ethnicity and Superfund sites is increasing overtime.3 In 2007, Toxic Wastes
and Race at Twenty concluded that these race-based disparities continue to persist.4
These conditions have a direct effect on the health and wellness of residents of overburdened communities.
The U.S. Department of Health and Human Services (HHS) states, "Minority and low-income populations and
Indian Tribes have greater exposure to adverse environmental and occupational hazards. For example, people
of color make up 56 percent of those living in neighborhoods located near the nation's commercial hazardous
waste facilities. This disproportionate exposure is compounded by the fact that minorities are more likely to
have inadequate access to a primary care physician, often receive poorer quality of care and face barriers in
seeking preventive and acute care. Such communities often have the most pressing need for health care and
social services."5
Perhaps not surprisingly, given this context, communities of color and low-income communities are also more
likely to experience disparities in health outcomes and costs. Disparities have been documented for many
serious health conditions, including infant mortality, low birth weight births, asthma, cancer and cardiovascular
disease; many of these conditions are known to be influenced by environmental pollutants.6 For instance,
according to HHS, "African American children are twice as likely to be hospitalized and more than four times
as likely to die from asthma as non-Hispanic White children/'7 These disparities are costly. A study by the Joint
Center for Political and Economic Studies concluded that "between 2003 and 2006 the combined costs of health
inequalities and premature death in the United States were $1.24 trillion [... and that] 30.6% of direct medical
care expenditures for African Americans, Asians, and Hispanics were excess costs due to health inequalities."8
Disparities in health outcomes and healthcare costs are serious environmental justice concerns in many
communities of color and low-income communities.
1 United Church of Christ. Toxic Wastes and Race in the United States. 1987. Online. Downloaded October 29, 2013, from http: //www.
itcc. org/abont-us/archives/pdfs/toxwrace8 7.pdf.
2 United Church of Christ. Toxic Wastes and Race at Twenty: 1987-2007. 2007. Online. Downloaded October 29, 2013, from: http://
www.ucc.org/assets/pdfs/toxic20.pdf p. xi.
3 Stretskv, Paul and Michael J. Hogan. Social Problems. "Environmental Justice: An Analysis of Superfund Sites in Florida. " 45(2).
May 1998, pp. 268-287.
4 United Church of Christ. Toxic Wastes and Race at Twenty: 1987-2007. 2007. Online. Downloaded October 29, 2013, from: http://
www. ucc. org/assets/pdfs/toxic20.pdf.
5 U.S. Department of Health and Human Services. 2012 Environmental Justice Strategy and Implementation Plan. 2012.
6 California EPA and Office ofEnvironmental Health Hazard Assessment. Cumulative Impacts: Building a Scientific Foundation. 2010.
7 U.S. Department of Health and Human Services. HHS Action Plan to Reduce Racial and Ethnic Disparities: A Nation Free of Dispari-
ties in Health and Health Care. 2011.
8 Joint Center for Political and Economic Studies. The Economic Burden of Health Inequalities in the United States. 2009.
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Chapter 2. Background
Addressing environmental justice concerns for overburdened communities is apriority for the EPA.9 Plan EJ
2014 outlines a strategy for advancing environmental justice, which places priority on initiatives that:
"Protect the environment and health in overburdened communities.
Empower communities to take action to improve their health and environment.
Establish partnerships with local, state, tribal, and federal governments and organizations to achieve
healthy and sustainable communities/'1"
The 1994 Presidential Executive Order 12898 on Environmental Justice requires all federal agencies to
consider EJ in their policies and actions. EPA defines environmental justice as "the fair treatment and
meaningful involvement of all people regardless of race, color, national origin, or income with respect
to the development, implementation, and enforcement of environmental laws, regulations, and policies.''
This means that no group of people should bear a disproportionate share of the negative environmental
consequences resulting from industrial, commercial and governmental operations or land use decisions. All
people should have the opportunity to participate in decisions that may affect their environment and their
health. In addition to a focus on removing harms, environmental justice also addresses the fair distribution of
benefits from government activities.
The Superfund Reuse Assessment Process
Future land use is an important factor in the remedial process to ensure a cleanup will be protective of human
health and the environment. In 2001, EPA's Office of Solid Waste and Emergency Response (OSWER)
released a memorandum titled Reuse Assessments: A Tool To Implement The Superfund Land Use Directive
(Reuse Assessment Memorandum). The memorandum offers a guide for conducting reuse assessments
- a process for determining reasonably anticipated future land use at Superfund Sites, and also provides
recommendations about the types of information that should be evaluated. Table 1 provides an overview
of the process and the information evaluated during each step. The Agency reaffirmed its committment to
integrating cleanup with future land use in the 2010 memorandum titled Considering Reasonably Anticipated
Future Land Use and Reducing Barriers to Reuse at EPA-lead Superfund Remedial Sites.
Reuse assessments can occur at various points in the remedial process. Early in the remedial process,
anticipating future use can help inform: the baseline risk assessment, the development of remedial objectives
and alternatives, and the selection of a remedy that ensures protection of human health and the environment.
Once the remedy is in place, EPA may also evaluate future use options to facilitate long-term site stewardship.
When evaluating future use options, EPA may gather information on community goals, review local plans
and initiatives, assess the surrounding land use context, and factor in natural site constraints and remedial
considerations. The 2001 memorandum states, "Site location in relation to residential, commercial, industrial,
agricultural and recreational areas, current and past uses, neighboring activities and land uses, relevant public
infrastructure: roads, utilities, transit, parks, etc."11 In addition, site ownership (whether public, private or
uncertain) can inform the reuse planning approach.
9 According to Plan EJ 2014, "EPA uses the term "overburdened" to describe the minority', low-income, tribal, and indigenous
populations or communities in the United States that potentially experience disproportionate environmental harms and risks as a
result of greater vulnerability' to environmental hazards. This increased vulnerability' may be attributable to an accumulation of both
negative and lack of positive environmental, health, economic, or social conditions within these populations or communities. " For
more information, see page 1 of Plan EJ 2014.
10 U.S. Environmental Protection Agency. Plan EJ 2014. 2011. http://www.epa.gov/environmentaljustice/resources/policy/plan-
ej-2014/plan-ej-2011-09.pdf.
11 U.S. Environmental Protection Agency. Reuse Assessments: A Tool To Implement The Superfund Land Use Directive (Reuse Assess-
ment Memorandum). 2001. http://www.epa.gov/superfund/programs/recycle/pdf/reuseassessment.pdf.
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Chapter 2. Background
Table 1. Reuse Assessment Process
Reuse
Assessment
Process
Information Evaluated
Gather Community
Goals
Determine Site
Suitability
Identify Stakeholders
Identify stakeholders and their connection to the site
Determine which stakeholders are responsible for local land use
Document the stakeholders who participate in the Reuse Assessment
Gather Community Input
Future reuses that community members would support
Future reuses that community members would oppose
Cultural factors that may create barriers or assets to any type of future reuse (historic buildings,
Native American sacred lands)
Environmental justice issues (e.g., disproportionate exposures to environmental risks)
Review Public Initiatives
Infrastructure plans that may influence the site uses
Potential municipal/public uses
Publicly initiated private sector redevelopment project
Funds available/committed for the redevelopment of the site
Site Description
Physical features: size, shape, topography, special features
Existing buildings and other site improvements
Surrounding residential, commercial, industrial, and recreational areas
Current and past uses
Neighboring activities and land uses
Relevant public infrastructure: roads, utilities, transit, parks, etc.
Environmental Considerations
Contaminants and their location(s), technology constraints, to the extent this information is
known
Potential restrictions resulting from the environmental contamination
Areas that are "clean" (i.e., where risks are acceptable, consistent with their planned use) and
potentially available for immediate reuse
Ground water use classification/determination
Other site characteristics (e.g., wetlands, surface waters, upland habitat, forested habitat, flood
plains)
Site Ownership
Person or entity that holds title to the site; who controls access to the site
Any property liens, bankruptcy considerations
Site owner(s) preferences and plans
Any plans for the sale of the property Local planning department
Conduct Land Use
Land Use Considerations and Environmental Regulations
Analysis
Zoning
Existing area master plans
Federal, state or tribe and local environmental regulations (e.g., wetlands, flood plain, etc.)
impacting reuse
Institutional controls (e.g., easements, covenants) already in place
Historical and cultural resources
Develop
Future Use
Recommendations
Most Likely Future Uses
Summarize the information as the basis for concluding the most likely future use(s)
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Chapter 2. Background
Health, Prevention and Wellness: A Growing National Consciousness
At the federal level, several recent initiatives have focused on health, prevention and wellness, including:
National Prevention Strategy (NPS): Released in 2011 by the Office of the Surgeon General, the NPS
provides a strategy for "increasing the number of Americans who are healthy at every stage of life/'12
HUD-DOT-EPA Partnership for Sustainable Communities: This partnership between EPA, the Department
of Housing and Urban Development, and the Department of Transportation was founded in 2009 to
"improve access to affordable housing, increase transportation options, and lower transportation costs
while protecting the environment."13
The Federal Interagency Working Group on Environmental Justice: Composed of 17 federal agencies and
White House offices, this group seeks to "guide, support and enhance federal environmental justice and
community-based activities."14
OSWER Community Engagement Intiative: This initiative, developed by EPA's Office of Solid Waste and
Emergency Response (OSWER), encourages collaboration with federal agencies to provide public health
information on OSWER projects.15
A common theme across all of these initiatives is the recognition that improving community health and
wellness has benefits that stretch far beyond improved individual health. Creating healthier neighborhoods
is an important factor in strengthening our local and national economies. These initiatives also highlight the
importance of specifically addressing health and wellness impacts on overburdened populations.
Nationwide, there is a growing consciousness regarding
health, prevention and wellness. First Lady Michelle
Obama has dedicated her Let's Move! program to solving
the growing problem of childhood obesity in America.
The community garden movement has produced an
explosion of vegetable gardens across our nation's
neighborhoods that have resulted in expanded access
to fresh, healthy food as well as an increased sense of
community. Additionally, there is a growing emphasis
in the field of community planning on neighborhood
completeness and walkability to encourage healthy
lifestyles.
"The physical and emotional health of
an entire generation and the economic
health and security of our nation is at
stake."
- First Lady Michelle Obama at the Let's
Move! launch on February 9,2010
12 National Prevention Council. National Prevention Strategy'. U.S. Department of Health and Human Services, Office of the Surgeon
General. 2011.
13 Partnership for Sustainable Communities. About Us. 2013. http://www.sustainablecommunities.gov/aboutUs.html.
14 Federal Interagency Working Group on Environmental Justice. Overview. Retrieved October 29, 2013. http://www.epa.gov/
compliance! ej/interagency.
15 EPA Office of Solid Waste and Emergency Response. Community Engagement Initiative. Retrieved November 3, 2013. http://www.epa.
gov/oswer/engagementinitiative.
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Chapter 2. Background
Tools for Evaluating Community Health,
Prevention and Wellness
The World Health Organization defines health as:
"a state of complete physical mental and social
well-being and not merely the absence of disease or
infirmity. "I6
Based on this definition, many of the land use factors
analyzed in a reuse assessment have public health
implications. Further, there are additional health
indicators related to land use and built environment
factors that could be integrated into a reuse assessment
to strengthen the evaluation of health, prevention and
wellness considerations.
More frequently, local government and community
organizations are using the Health in All Policies
model, the Health Impact Assessment paradigm and
other models to evaluate this broader definition of a
community's health and wellness.17 The framework
outlined in this document was developed by selecting
and modifying the community health assessment tool
that best fit project needs based on a literature review of
best practices.
The literature review included a broad survey of peer-
reviewed journals and agency publications addressing
the intersection of planning and public health (a list of
sources reviewed is included in the Resources section).
Within the literature, a set of nationally-recognized
municipal and agency models were identified and
compared based on the following criteria: recognition in
peer-reviewed literature, adaptability, and functionality
at neighborhood scale.
Of these models, the City of San Francisco's Sustainable
Communities Index (SCI), formerly known as the Healthy Development Measurement Tool, was found to be
one example of a comprehensive, widely recognized and adapted model for integrating public health and quality
of life factors into community and neighborhood planning initiatives.18 For more information on the SCI, see
the text box on the right.
16 World Health Organization. Preamble to the Constitution of the World Health Organization as adopted by the International Health
Conference. 1946.
17 More information about Health in All Polices can be found here: http://www.naccho.org/topics/environmental/HiAP/upload/HiAP-
one-page-FINAL.pdf; http://wwMKnaccho.org/topics/environmental/Hi4P.
18 Ewing, etal. Understanding the Relationship betM'een Health and the Built Environment: A report prepared for the LEED-ND Core
Committee. 2006.
The Sustainable Communities Index
The Sustainable Communities Index (SCI) is
a land use and public health evaluation tool
that was developed during the San Francisco
Eastern Neighborhoods Community Health
Impact Assessment (ENCHIA) project.19 At the
conclusion of the ENCHIA process, the San
Francisco Department of Public Health made
the tool available online. It has been used
as a model in many other land use planning
and public health evaluation processes by
communities nationwide.
The SCI provides "over 100 performance
indicators for livable, equitable and prosperous
urban cities."20 SCI indicators are organized
into eight categories: transportation,
community, public realm, education, housing,
economy, health and environment. Indicators
are selected based on direct research links to
health outcomes and include a range of built
and social environment factors.
For more information, visit: http://www.
sustainablecommunitiesindex.org/
19 Dannenberg, Andrew L., Rajiv Bhatia, Brian L. Cole, Sarah
K. Keaton, Jason D. Feldman, and Candace D. Rutt. 2008.
American Journal of Preventative Medicine. "Use ofH ealth
Impact Assessment in the U.S.: 27 Case Studies, 1999-2007. "
Retrieved November 29, 2012.
20 Dannenberg, Andrew L., Rajiv Bhatia, Brian L. Cole, Sarah
K. Keaton, Jason D. Feldman, and Candace D. Rutt. 2008.
American Journal of Preventative Medicine. "Use ofH ealth
Impact Assessment in the U.S.: 27 Case Studies, 1999-2007. "
Retrieved November 29, 2012.
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Chapter 2. Background
The SCI provides one option for an adaptable model that can be integrated into the reuse assessment process
at Superfund sites to help evaluate opportunities at the site or neighborhood scale to improve health and
wellness in the surrounding community. The following considerations were used to adapt the SCI for the reuse
assessment process:
Select categories, objectives and indicators that easily fit into the land use analysis of a reuse assessment.
Ensure objectives and indicators are relevant in both urban and rural settings.
Include a range of indicators using readily available national and local data sources.
Provide a range in levels of effort for each indicator so that the assessment can be used across sites with
varying levels of funding and local capacity.
Criteria for Selecting Candidate Sites
The following chapter outlines a framework and specific factors selected from the SCI that appear to be well-
suited to integrate into the reuse assessment process. Although this framework can be integrated into any reuse
assessment process, Superfund sites meeting the following criteria might be good candidates for considering
health and wellness in the reuse assessment process:
The surrounding community has the characteristics of an overburdened community.
The surrounding community has raised environmental justice or disease disparity concerns.
The surrounding community has raised health and wellness concerns or goals.
For more context on overburdened communities, see the section on Communities Impacted by Superfund Sites
earlier in Chapter 2.
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Chapter 3. Framework Overview
PROCESS OVERVIEW
This chapter describes each of these steps in the reuse assessment process and provides information on health
and wellness-related factors and considerations. The process diagram in Figure 1 organizes the information
gathered during a reuse assessment into a series of steps. The items in blue indicate additional information
or steps that may be included when specifically integrating health and wellness considerations into the reuse
assessment process.
Chapter 4 provides further detail on data sources Figure 1. Process Diagram
and considerations for each of the health and
wellness factors, along with a case study to illustrate
examples of maps showing service analysis and
potential health and wellness needs. As noted in
the 2001 Reuse Assessment Memorandum, each
reuse assessment will differ in scope and level of
detail depending on the conditions at the site. For
additional detail on the common elements of a reuse
assessment, the reader may refer to the 2001 Reuse
Assessment Memorandum.
Integrating Health and Wellness
into the Superfund Reuse Planning Process
G
I
Identify Community Goals
Identify stakeholders
Gather community input
Review public initiatives
Determine Site Suitability
Analyze site description and features
Evaluate environmental considerations
Consider site ownership
Conduct Land Use and Health and Wellness
Service Analysis
Evaluate surrounding land use
Identify assets and gaps in health and wellness
features and services
Determine Health and Wellness Needs
Review health outcome data
Review potential environmental risks
Develop Future Land Use Recommendations
Remedial Considerations
Local Planning Considerations
Health and Wellness Opportunities
Please note: Items in blue indicate additional information or steps
that may be included when specifically integrating health and
wellness considerations into the reuse assessment process.
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Chapter 3. Framework Overview
STEP 1. IDENTIFY COMMUNITY GOALS
Reuse Assessment Approach
During a reuse assessment, community goals for future use are typically
identified through interviews with key stakeholders, community meetings,
and reviewing public initiatives and planning documents. Discussion of reuse
with community stakeholders typically asks for stakeholder feedback on the
following questions:
What are future use goals for the site?
What uses would be suitable for the site?
What local public initiatives might inform future use considerations?
What community groups may have an interest in the future use of the
site?
Health and Wellness Considerations
Defining Community
Community can be defined
in many ways. For the
purposes of this document,
"community" may include
study area residents as
well as community-based
organizations representing
them. Other stakeholders,
including local government,
can be included in community
discussions as valued resource
partners.
To integrate health and wellness considerations into the Community Goals, additional stakeholders and planning
documents specific to public health and wellness will need to be included in the process. In addition, the
stakeholder and community discussion may include questions focused on health and wellness goals and issues.
Table 2 identifies health and wellness considerations for each element of this step.
Table 2. Health and Wellness Considerations when Identifying Community Goals
Information for Identifying
Community Goals
Health and Wellness Considerations
Identify stakeholders
Gather community input
Review public initiatives
Stakeholders with expertise in health and wellness may include:
Neighborhood residents
Representatives of community-based organizations
Representatives from public institutions such as the public
school system, local academic institutions or a Federally
Qualified Health Center
County and state health agencies
Local government staff and elected representatives with
expertise in fields such as parks and recreation, multi-modal
transportation, and community planning and sustainability
In addition to gathering community input on general goals for future
use of the site, specific discussion topics may include:
The community's need for health and wellness features
(examples of specific questions are outlined in Table 3).
The community's health concerns (examples of specific
questions are outlined in Table 5).
Discussions with stakeholders should consider access to health and
wellness features and services in the broadest sense (e.g., financial
access, transportation options, operating times, safety).
In addition to general land use plans and community development
initiatives, additional documents may include recent community
health studies by the local county health department.
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Chapter 3. Framework Overview
STEP 2. DETERMINE SITE SUITABILITY
Reuse Assessment Approach
Health and Wellness Considerations
The site suitability step requires very little modification
to incorporate health and wellness considerations since
it is a technical analysis of existing site characteristics.
A reuse assessment that considers health and wellness
might include determinations about whether the site is
suitable for the following types of general health and
wellness uses:
Civic or institutional uses (e.g., a health care
facility).
Open space and recreation (e.g., a park or a
walking trail).
Neighborhood amenities (e.g., retail services with
health and wellness components, healthy food
services, affordable housing).
10
In a reuse assessment, a site's physical and institutional constraints and assets can be evaluated to determine its
suitability for a range of future uses. This evaluation typically includes analysis of a site's physical features and
background, environmental and remedial considerations, and site ownership. Results from this analysis identify
areas of the site that will be suitable for development, and which areas may have land use restrictions, long-term
remedial features or natural site constraints that may
limit future use. The size and location of the resulting
area that will be available for development may limit
what uses are suitable for the site. After evaluating site
information, the outcomes can be compared to future
use goals to see if the site could be suitable for the
desired future uses.
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Chapter 3. Framework Overview
STEP 3. CONDUCT LAND USE AND HEALTH AND WELLNESS
SERVICES ANALYSIS
Reuse Assessment Approach
At this stage of a reuse assessment, an analysis of surrounding land use, infrastructure and mobility is conducted
to help determine the future land use. The analysis may include reviewing existing land use, zoning, area master
plans, and environmental regulations (e.g., wetland regulations, flood plain regulations). The analysis is often
map-based, using geographic information systems (GIS).
Health and Wellness Considerations
In addition to general land use analysis, an analysis of specific health and wellness features and services may
be conducted to identify assets and gaps in the study area around the site. The analysis should consider both
whether the features exist within the study area and whether the features are accessible to study area residents.
Accessibility should be considered in the broadest sense of the concept (financial, transportation, operating
time, safety, etc.). Tins information may be obtained during the community discussion or supplemented with
additional research into accessibility and programming of high priority health and wellness amenities.
Table 3 identifies the types of features that may be evaluated in the Service Analysis. This table includes
questions that may be used during community meetings or interviews with key stakeholders during Step 1.
The table could be used as a template to guide these conversations. It may also be useful for summarizing both
stakeholder feedback and the outcomes of the map analysis, which is discussed further below.
Options for Mapping Health and Wellness Services
The maps below illustrate two different approaches to mapping assets in a community. Proximity Maps use
diameter rings to map the relative distance of features to the site. Service Area Maps use a buffer to approximate
the service area of an amenity for the residential areas, as well as identify residential areas outside that service
area distance. Service Area Maps require a higher level of effort due to the more advanced understanding of
GIS required to perform buffer analysis and queries. Additional considerations on how to conduct a map-based
Service Analysis using GIS and a case study example illustrating a range of factors are discussed in Chapter 4.
For information on relevant data resources and considerations regarding level of effort, see Chapter 6.
Legend
Fairfax Site Locator
Fairfax Site
25, .5, and 1 Mile around the Site
Community Center
Library
Ms and Cultural Facilities
Legend
Fairfax Site Locator
Fairfax Site
, .25, .5, and 1 Mile around the Site
Residential Land Use
Community Center
.25 miles around a Community Center
Library
| .5 miles around a Library
Arts and Cultural Facilities
.5 miles around Arts and Cultural Facilities
Figure 2. Example of a Proximity Map
Figure 3. Example of a Service Area Map
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Chapter 3. Framework Overview
Table 3. Health and Wellness Features Checklist
Feature
Do the features exist?
Accessibility
Considerations?
Yes
No
Unknown
Transportation Options
Does the site include sidewalks along all street edges?
Does the site include street trees along all street edges?
Does the site support the street grid of through-access?
Is there access to public transportation?
Community Amenities
Is there a community center?
Are there art and cultural facilities?
Is there a public library?
Health Care Options
Are there emergency services?
Is there a Federally Qualified Health Center?
Are there affordable primary care services?
Are there affordable dental services (including dental van stops)?
Are there affordable vision services?
Are there affordable mental health services?
Parks and Open Space
Is there a park?
Does the park have amenities and desired programming?
Is there a community pool?
Is there access to a bike trail or greenway?
Neighborhood Retail Services (based on services included in the SCI's Neighborhood Completeness indicator)
Is
there
bank or credit union?
Is
there
an auto service center?
Is
there
a beauty/barber shop?
Is
there
a bike shop?
Is
there
a dry cleaner?
Is
there
a gym?
Is
there
a hardware store?
Is
there
a laundry mat?
Is
there
a pharmacy?
Is
there
a movie theatre?
Is
there
a gas station?
Affordable, Healthy Food
Is there a grocery store?
Is there a farmers market?
Is there a community garden?
Quality Affordable Housing
Are ownership rates equal to or higher than the city or county?
Are vacancy rates higher than within the city or county?
Are health and safety code violations a challenge?
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Chapter 3. Framework Overview
STEP 4. DETERMINE HEALTH AND WELLNESS NEEDS
Reuse Assessment Approach
Historically, reuse assessments typically have not addressed health and wellness considerations, however
developing a summary of the community's relative health and wellness needs may assist the community in
providing informed input for potential future land use assumptions. This data could also help the community
advocate for resources, technical assistance or programs from local, state, tribal or federal partners that could
help to support additional planning and implementation of future land uses related to health and wellness, or to
address community needs outside of the scope of the Superfund program authority.
Health and Wellness Considerations
Relative health and wellness need in the community can be evaluated by looking at existing conditions data,
including:
Community health outcomes data.
Potential environmental risks.
Table 4 suggests indicators and the types of data that might be evaluated during this step to contextualize
the need for health-based interventions in the built environment. These indicators focus on infant health and
hospitalization rates for ambulatory care sensitive conditions (ACSCs), which can be indicators of access
to primary care. Other health conditions may be added for analysis based on data availability and additional
priorities identified by stakeholders.
Consider gathering data from existing studies and national data sources, or both. Local and neighborhood-scale
health data can be challenging to access due to privacy concerns, therefore more time and resources may need to
be allocated if this level of detail is desired.
When developing maps of health indicators, evaluating health outcomes at the city or county scale will help
highlight any disparities between the study area and the surrounding community.
Chapter 4 includes additional considerations for gathering health and wellness data, suggested metrics for
ACSCs and birth outcomes, and map examples from a case study.
Table 4. Health and Wellness Needs.
Documenting Health and
Wellness Needs
Factors for Consideration
Health Outcomes Mortality rates for ambulatory care sensitive conditions (e.g.
Does the neighborhood/community asthma' diabetes. heart failure. chronic obstructive pulmonary
have documented health disparities? disease)
Morbidity rates for ambulatory care sensitive conditions
Birth outcomes
Environmental Risk Factors
Does the neighborhood/community
contain potential environmental or
health risks?
Proximity to contaminated sites
Water quality
Air quality
Proximity to unhealthy food and alcohol
13
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Chapter 3. Framework Overview
Many Superfund sites are located in neighborhoods that suffer from multiple contaminated sites, lack of health
services and stark health disparities. For many of these overburdened populations without access to health care,
health conditions may go undiagnosed and untreated. For example, the Center for Disease Control estimates
that 7 million people in the United States have undiagnosed diabetes.1 Therefore, it is essential to complement
objective data indicators with careful consideration of the lived experience of residents in communities with
environmental justice concerns. Table 5 offers discussion questions that may be used during community
meetings or interviews with key stakeholders during Step 1.
Table 5. Potential Questions for Neighborhood Residents and Community Stakeholders
Potential Questions for Neighborhood Residents and Community Stakeholders
The discussion questions below are intended to help identify the lived experience of community residents
and stakeholders. Local knowledge from these subjective sources can be supplemented with the objective
data indicators listed in Table 4. The questions may be used during community meetings or interviews with
key stakeholders to assess need from the community's perspective:
Are any of the following health conditions of concern to community residents?
o Asthma
o Diabetes
o Heart failure
o Chronic obstructive pulmonary disease
o Infant mortality
o Low birth weight births
Are any additional community health conditions or issues of concern to community residents?
Does the neighborhood study area have a disproportionate number of mortality rates, morbidity rates
and/or emergency room visits relative to the rest of the county?
Does the neighborhood contain environmental or health risks, such as:
o Potentially contaminated sites?
o Water bodies with fish consumption or swimming risks?
o Poor air quality?
o Retailers selling alcohol or unhealthy food?
1 Center for Disease Control. National Diabetes Fact Sheet. 2011. Retrieved 2013. http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf.
14
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Chapter 3. Framework Overview
STEP 5. DEVELOP SUMMARY AND RECOMMENDATIONS
Reuse Assessment Approach
Following completion of the previous steps, the reuse assessment concludes with a set of recommendations
that may include identification of future land use options as well as remedial considerations and considerations
for local planning efforts. In some cases, when there is momentum around a particular future use, the reuse
assessment recommendations may also include a set of next steps to move forward with the desired reuse.
Health and Wellness Considerations
The typical summary and recommendations of a reuse assessment may be supplemented with a summary of
findings related to health and wellness considerations. The summary may identify:
Community goals related to health and wellness.
Health and wellness features that could be suitable for future use at the site.
Health and wellness assets and needs in the neighborhood around the site.
Health outcomes disparities and potential environmental risks experienced by the neighborhood around the
site.
Considerations for next steps and implementation of recommended future health and wellness uses.
15
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Chapter 4. Case Study
CASE STUDY
This chapter shares a case study to illustrate additional data considerations and map suggestions for each of the
health and wellness factors discussed in Chapter 3. The case study is organized into the reuse assessment steps
outlined in Chapter 3 with additional guidance offered at the top of each page and the case study illustration
at the bottom. The case study example is not intended to explain all aspects of a reuse assessment, but instead
highlights considerations and examples specific to the additional health and wellness factors.
Fairfax St, Wood Treaters Site
This case study highlights the Fairfax St. Wood Treaters Superfund site (FSWT site) located in an
environmentally overburdened neighborhood in Jacksonville, Florida. Wood treating operations active at the
site from 1980 until 2010 resulted in the contamination of site soils and neighboring residential yards and
school property. After conducting emergency removal actions at the site in 2010 and 2011, EPA Region 4
placed the site on the National Priorities List and initiated a Remedial Investigation Feasibility Study (RI/FS).
Recognizing that the site is well-positioned to serve as a positive center of community activity, EPA initiated
a reuse assessment in parallel with the RI/FS. The site's context and the timing of remedial process provide a
useful reference to illustrate how the health and wellness framework can be integrated into a reuse assessment.
Study Area Boundary
Study Area Demographics
The Study Area's population in 2010 was
approximately 21,000, a 15 percent decline since
2000.
Ninety four percent of the area's residents are
African-American (compared to 29 percent for all
of Duval County)
The Study Area's median household income in
2010 was $21,481 (43 percent of the median
household income for all of Duval County).
Source: 2000 and 2010 U.S. Census Demographic Profile (Tables
DP-1:2000 and DP-1:2010) forDuval County, Pit and Census
Tracts 15, 16, 28.01, 28.02, 29.01, 29.02.) Median Household
income data derived from US. Census Bureau, 2006-2010
American Community Sur\>ey; data are based on a sample and
are subject to sampling variability
Figure 4. Fairfax Site Study Area
16
The Fairfax St. Wood Treaters Superfund Site is located in the Northwest Jacksonville approximately 2 miles
from the City's downtown. The study area (Figure 4) is delineated to help characterize the site relative to
surrounding land use, infrastructure and access. The
study area is defined by 1-95 to the east and active
rail lines to the north, south and west. The study
area includes primarily residential neighborhoods,
interspersed with commercial corridors and
industrial uses along the rail lines. The FSWT reuse
assessment study area boundary defines the site s
context and provides a common geographic area
for use in the Health and Wellness Service Analysis
discussed in Step 3.
Legend
Fairfax Site
Residential Street
Collector Road
Arterial Road
Freeway
Railroad
Stream
-------
Chapter 4. Case Study
STEP 1. IDENTIFY COMMUNITY GOALS
Reuse assessments typically engage community stakeholders in discussions about site reuse opportunities and
goals through an iterative process. Several commonly used types of outreach conducted to gather community
goals are outlined below.
1. A site visit and initial discussions with a small group of stakeholders such as EPA and state agencies,
site owners, municipal staff and community groups offers an opportunity to define the purpose and
scope of the project, identify additional stakeholders, and document preliminary goals and priorities.
2. Follow-up interviews with community leaders, planning and development professionals, neighborhood
residents and community members can help to further identify a community's health and wellness
issues and concerns based on local experiences.
3. Community meeting(s) or workshops serve as an opportunity to bring a broad range of stakeholders
together to confirm health and wellness issues and priorities, review study area analyses and identify
reuse options.
Fairfax St. Wood Treaters Site
During the FSWT site reuse assessment, the process of
identifying community goals began with an initial site
visit with EPA's Remedial Project Manager to identify
the site's status, contamination issues, anticipated
remedial timeline and key community stakeholders that
have been actively involved in discussions about the
site. Stakeholder perspectives on the reuse of the site
were gathered through interviews with neighborhood
residents, city and county agencies and local organiza-
tions to help identify reuse goals and potential future
uses for the Fairfax site (see Community Health and
Wellness Considerations Identified by Stakeholders at
right).
Following analyses of the site's context, access to
services and site suitability, the reuse assessment
process convened a group of 45 residents, community
development corporations, elected officials and
municipal staff in a workshop to refine reuse priorities
for the site (see Community Reuse Goals at right).
The FSWT site reuse assessment included a
community engagement process that provided multiple
opportunities for input that led to a refined set of reuse
goals affirmed by a diverse group of stakeholders.
This input provides valuable insight into the needs of
the community based on lived experience that helps
to inform the service analysis and recommendations
discussed in Steps 3 and 5.
Community Health and Wellness
Considerations Identified by Stakeholders
The neighborhood has a stable, historically
African American population and many
neighborhood residents are senior citizens.
There is an adequate supply of single-
family housing but a shortage of quality
multi-family housing.
Primary neighborhood concerns include
reducing crime and ensuring that people
feel safe leaving their homes.
Area residents and organizations see a need
for additional activities for young people
and senior citizens, including structured
community-oriented programs; health and
wellness services; accessible open space
for neighborhood residents; and multi-
family, senior housing.
Community Reuse Goals
Mixed-use space to support small businesses
Grocery store
Banking services
Health clinic/pharmacy
Senior housing center
Police stop station
17
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Chapter 4. Case Study
STEP 2. DETERMINE SITE SUITABILITY
A typical reuse assessment includes consideration of site specific features in addition to the site context in order
to determine areas of the site suitable for development of buildings, parking or open space. The suitability
analysis should examine whether a site's size, features and location could support neighborhood health and
wellness features. Components of a site suitability analysis may include: access, compatibility with surrounding
land use, remedial features, institutional controls, notable natural or built environment features, and the historic
and/or cultural significance of the site or buildings on the site.
In addition, it should be noted that more complex cleanups and waste left in place could have a significant
impact 011 the area suitable for buildings. Considerations may include physical remedy components (e.g., grades
from a containment cell, cap or ground water collection) and institutional controls that may create additional
limitations on specific areas of the site or the types of activities that are permissible.
Fairfax St. Wood Treaters Site
Site Suitability Analysis
The two suitability maps (Figure 5) for the FSWTSite
show how slabs, buildings or other site and remedial-
features may determine the future area available for
development. The FSWT Site could o ffer 9.5 acres
of developable area, based on grades, remedial
approach and site features.
The site is one of two vacant parcels of this size in
the study area, making it a highly valuable asset
for adding community-oriented health and wellness
amenities to the neighborhood. The large size of the
site offers an opportunity to provide institutional
sei~vices that may need a larger footprint for building/
parking, or a mixed-use development that includes
neighborhood services. Given that the site is not on
a major commercial corridor, retail or other services
may need to be scaled to a neighborhood market.
Further, given the site's proximity to two schools,
some land uses with health risks (e.g., fast food
restaurants and stores with licenses for the sale of
alcohol) may not be appropriate.1
Reuse Scenario A
Reuse Scenario B
Area Available for
New Development
Remaining Buildings
Remaining Concrete Slabs
Stormwater Management
Area Available for
New Development
Stormwater Management
_ . _. FSWT Parcel Boundary
1 For further information on school siting guidelines, see http://
www.epa.gav/schools/sitmg.
FSWT Parcel Boundary
Figure 5. Fairfax Site Reuse Scenarios
18
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Chapter 4. Case Study
STEP 3. CONDUCT HEALTH AND WELLNESS SERVICE ANALYSIS
The purpose of the Health and Wellness Service Analysis is to supplement the land use analysis typically
conducted in a reuse assessment with an analysis that is specific to health and wellness considerations. The
analysis should include an evaluation of:
Health and wellness assets in the study area.
Any gaps in amenities and services that support health and wellness.
As discussed in Chapter 3, this analysis may be conducted using Proximity Maps or Service Area Maps.
Examples of both types of maps are included throughout this section. Table 11 in Chapter 6 offers additional
considerations on the level of effort required by different types of analysis.
The following pages provide additional detail on what factors to map, data considerations, and explain the
connections to health and wellness for each of the following health and wellness factors:
Transportation Options
Community Amenities
Health Care Options
Parks and Open Space
Neighborhood Retail Services
Healthy, Affordable Food
Quality Affordable Housing
Each factor is illustrated by an example from the case study at the bottom of each page. As noted previously,
the service analysis should be supplemented by community discussion to determine other factors that may be
limiting access to service. Additional follow up research may be conducted as well for priority services. If data
or resources are limited, the community goals and site suitability conducted in steps 1 and 2 can help prioritize
which factors to map and evaluate.
A summary of the service analysis is provided at the end of the section to provide an overview of gaps and
assets of the health and wellness services.
19
-------
Chapter 4. Case Study
STEP 3. CONDUCT SERVICE ANALYSIS I Transportation Options
Factors to Map
Map analysis can include
transportation features such
as sidewalks, street trees,
street grid connectivity, bike
lanes, walking trails, bus
routes and mass transit. The
map could be scaled to the
area around the site, in order
to examine site features such
as sidewalks, street trees and
street connectivity that support
pedestrian access. Or, the map
could be scaled to the study
area, in order to examine broader
transportation options across the
full study area, provided there
is a potential connection to the
future use of the site.
Data Considerations
Most transportation data can be
obtained from local data sources
such as a planning department or
transit authority. In some cases,
GIS data such as the locations of
sidewalks and bike lanes may not
have been developed by the local
government. The website United
We Ride (http://www.unitedweride.
gov/) has links to transit authorities
in many communities across the
U.S.
Connection to Health
According to the SCI,
transportation systems affect health
and sustainability through:
"Access to jobs, goods and
services,
The livability of neighborhoods,
including opportunities for
physical activity and social
interaction...
Safety from traffic injury, and
Exposure to environmental
pollution including noise,
air pollution and water
contamination. "2
For more information, see:
/WWW.
snstainablecommiinitiesindex.org/
webpages/view/51
2 Sustainable Communities Index. Trans-
portation Systems. Retrieved 2013. Imp:
www.sustainablecommunifiesindex.org/
webpages/view/51.
MARTIN LUTHER KING JR
21ST
Raymond E.
Davis
Park
C = --T-
n
I
^R.V. Daniels
Elementary School
ฃsusie ฃ Tolbert
Elementary School
ฃri'
i i
Tempette
Learning
Academy
Fairfax St.
Wood Treaters ฆ
Site
16TH
1
A
LEGEND
[IIIIII Fairfax Site
Potential street extensions
Gap in street trees
Sidewalks
Grunthal
Park
1 Feet
0 100200300400
Fairfax St. Wood Treaters Site
Mobility at the Site
Fairfax Street already has
sidewalks adjacent to the FSWT
site. However it is important to
note that proximity does not always
indicate accessibility. Physical
barriers to pedestrian activity
(such as train tracks) that may limit
access to parks and other amenities
for community residents who do not
have automobiles.
There is gap in street trees adjacent
to the FSWT Site, which could be
addressed during reuse.
The street grid could be extended
through the site; however in this
case this would not have a large
impact on neighborhood connec-
tivity because of the railroad and
schools bordering the site.
Figure 6. FSWT Site Mobility Features
20
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Chapter 4. Case Study
STEP 3. CONDUCT SERVICE ANALYSIS 1 Community Amenities
Factors to Map
Map analysis could include
locations of community centers,
public libraries, and arts and
cultural facilities. The SCI
recommends defining arts
and cultural centers using the
following criteria: "(1) There is
an actual, non-changing physical
location for the facility, (2) The
facility is open to the public
throughout the year, not just
a short term or one-time per
year activity, (3) The primary
function is public display of
artistic/cultural entertainment or
education."3
Data Considerations
Most community amenity data can
be obtained from local data sources
such as a planning department or
parks and recreation department. In
some cases, when data has not been
digitized by the local government,
data can be manually digitized by
using a public data source; this can
be a resource-intensive process,
depending on the study area size.
Connection to Health
Community amenities function
as "third places," or those places
between work and home that serve
as community gathering points
and foster the development of
strong social networks. For more
information see:
http://www.sustainablecommuni-
tiesindex.org/indicatorsMew/235
http://www.sustainablecommiini-
tiesindex. org/indicators/view/100
http://www.sustainablecommiini-
tiesindex.org/indicators/view/99
3 Sustainable Communities Index. Art
& cultural facilities. Retrieved 2013.
http://www.sustainablecomrmmitiesin-
dex. org/indicators/vieM'/l 00.
Fairfax St. Wood Treaters Site
Access to Community Amenities
Community amenities within a mile
of the site include:
Community centers
A public library>
A farmers market is located within
1.5 miles of the site.
Residential access to these
amenities is more limited in the
western part of the study area.
Figure 7. Community Amenities
I l-H . I I
Legend
Fairfax Site Locator
| Fairfax Site
! .25, .5, and 1 Mile around the Site
Residential Land Use
Community Center
.25 miles around a Community Center
Library
.5 miles around a Library
Arts and Cultural Facilities
I .5 miles around Arts and Cultural Facilities
-------
Chapter 4. Case Study
STEP 3. CONDUCT SERVICE ANALYSIS Health Care Options
Factors to Map
Map analysis can include
locations of hospitals (with
and without emergency
services), Federally Qualified
Health Centers,4 primary care
physicians and dentists who
accept Medicaid or provide free
or sliding scale services, health
department clinics, mobile van
stops, mental health services
and vision services. When
the data are available, these
facilities could be mapped in
relationship to their proximity
to public transit.
4 According to the Health Resources
and Services Administration, "feder-
ally qualified health centers (FQHCs)
include all organizations receiving
grants under Section 330 of the Public
Health Service Act (PHS)."
Fairfax St. Wood Treaters Site
Emergency and Primary Care
Facilities
Two primary care providers who
accept Medicaid are located
within a mile of the Fairfax site.
A Federally Qualified Health
Center as well as a hospital with
emergency services are located
within two miles of the site; both
are located outside of the study
area.6 Challenges with access
and utilization of the FOHC have
been reported. With infrequent
transit services, a distance of two
miles could be a barrier for those
without access to a car.
6 According toHRSA, "FQHCs qualify for
enhanced reimbursement from Medicare and
Medicaid, as well as other benefits. FQHCs
must serve an under served area or population,
offer a sliding fee scale, provide comprehensive
services, have an ongoing quality assurance
program, and have a governing board of
directors."
Figure 8. Health Care Options
Data Considerations
Data for this indicator may be
obtained from a variety of sources,
including local planning depart-
ments or health departments, state
agencies, and the Health Resources
and Services (HRSA) Data Ware-
house.5 It should also be noted that
health care access is most often re-
lated to non-proximity-related fac-
tors such as transportation options,
serv ice hours, types of serv ices
offered, and insurance coverage.
Therefore, service area maps may
be less relevant for this indicator,
depending on the local context.
5 Health Resources and Services Adminis-
tration. Data Warehouse. Retrieved 2013.
http:iidatawarehouse.hrsa.gov.
Connection to Health
Access to affordable health care is
critical to community health. Ac-
cess to affordable, quality primary
care promotes early detection and
ongoing management of chronic
disease. In addition, health and
wellness services create jobs and
support local economic vitality.
For more information, see:
http://www.sustainablecommuni-
tiesindex. org/indicatorsMew/112
http://'www.sustainablecommuni-
tiesindex.org/indicators/view/lll
Legend
I 25, .5, and 1 M8e around the Site
~ FairtaxSife Locator
ฆ Fairfax SiB
!ฆ I Stands
Federally Quali fed Health Center
Primary Care Providers that accept Medicaid
f Adult (includes 12+ and 18+ facilities}
-------
Chapter 4. Case Study
STEP 3. CONDUCT SERVICE ANALYSIS I Parks and Open Space
Factors to Map
Map analysis can include
locations of open space
resources (e.g., natural areas,
publicly accessible water
bodies), parks and recreation
facilities, and bike paths
or greenways. Parks and
recreation facilities could be
further distinguished by type or
available facilities.
Data Considerations
Most open space and park data can
be obtained from local sources such
as a planning department or parks
and recreation department. State
conservation or tourism agencies
could also be potential sources. It
is important to note once again that
although proximity is an important
indicator for access to parks and
open space, other issues such as
safety, upkeep and available facili-
ties influence access as well.
Connection to Health
Access to parks and open spaces
has been shown to correlate with
numerous health benefits, including
increased physical activity, devel-
opment of social networks, better
grades for school-aged children,
and reduced body mass index in
adults.2 For more information, see:
http-JAvww.snstainablecomrmini-
tiesindex.org/indicators/view/92
7 Sustainable Communities Index. Recre-
ation facility access. Retrieved 2013. hitp:
ฆwww.sustainablecommunitiesindex.org/
indicators/view/92.
23
ChrcelT.
Brown Park
Raymond E
Davis Park
Grunthal
Park
Legend
Fairfax Site Locator
H Fairfax Site
.25, .5, arid 1 Mite around the Site
A Community Center
^5 Swimming Pool
S-Line Raal Trail
Community Park
Neighborhood Park
Specialty Park
.25 mies sound a park
Residential Land Use
Fairfax St. Wood Treaters Site
Access to Parks and Open Space
Many residences in the study area
are located within a quarter-mile of
a park.
However, the presence of a park
does not indicate how well it is
maintained or whether it has
community-appropriate amenities.
A bike path or greenway is only
available in the southeast corner of
the study area.
Figure 9. Parks and Open Space
-------
Chapter 4. Case Study
STEP 3. CONDUCT SERVICE ANALYSIS Neighborhood Retail Services
Factors to Map
Map analysis can include
locations of commercial and
office zoning or existing land
use. The analysis could also
include locations of specific
neighborhood-oriented services
such as an auto service center,
beauty/barber shops, bank,
bike shop, drug store, dry
cleaner, gym, hardware store,
laundromat, and movie theater.8
8 Services included in the
Neighborhood Completeness indicator
developed by the Sustainable
Communities Index.
Data Considerations
Most neighborhood-oriented
service data can be obtained from
local data sources such as a plan-
ning department. In some cases,
when data has not been digitized
by the local government, data can
be manually digitized by using a
public data source. This can be a
resource-intensive process, depend-
ing on the study area size.
Connection to Health
According to the SCI, "the more
public and retail services in one's
neighborhood, the greater the likeli-
hood of accessing these basic needs
by walking or biking, increasing
physical activity. Local goods and
services can increase 'eyes on the
street" and reduce motor vehicle in-
juries and pollution."'9 In addition
these retail locations may provide
jobs for community residents as
well as supporting local economic
vitality. For more information, see:
http://\vww.siistainablecommiini-
tiesindex.org/webpages/view/53
http://\vww.siistainablecommiini-
tiesindex. org indicators view 115
http^/www.snstainablecommuni-
tiesindex.org/indicators/view/259
9 Sustainable Communities Index. Public
Realm. Retrieved 2013. http://www.sus-
tamablecommunitiesindex.org/webpages/
view/53.
Fairfax St. Wood Treaters Site
Access to Neighborhood Services
Neighborhood retail services* ex-
amined for this map include:
Auto service center
Beauty/barber shop
Bank
Bike shop
Drug store
Dry cleaner
Gym
Hardware store
Laundromat
Pharmacy
Movie theater
All residential areas in the study
area are located within a mile of a
gas station. Some have proximity
to a bank and a drug store. The rest
of the services are not found within
the study area.
* Services included in the Neighborhood
Completeness indicator developed by the
Sustainable Communities Index.
Figure 10. Neighborhood Retail Services
24
MARTIN LUTHER KING JR
Fairfax Site
'13TH
Legend
~ Fairfax Site Locator
| Fairfax Site
25, .5, and 1 Mile around the Site
~ Gas Station
H Auto Service Center
51 Drug Stores
ฎ Banks
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Chapter 4. Case Study
STEP 3. CONDUCT SERVICE ANALYSIS Healthy, Affordable Food
Factors to Map
Map analysis can include
locations of supermarkets,
farmers markets, community
gardens and retailers
accepting Supplemental
Nutrition Assistance Program
(SNAP) benefits,10 Prices
vary at supermarkets and
farmers markets and may
not necessarily be affordable
for residents of low-income
communities.
10 Formerly known as food stamps,
SNAP benefits offer "nutrition as-
sistance to millions of eligible, low-
income individuals and families and
provides economic benefits to com-
munities. SNAP is the largest program
in the domestic hunger safety net. "
(USDA, 2013)
Data Considerations
Most data can be obtained from
local data sources such as a
planning department. SNAP
retailers data can be obtained
from the U.S. Department of
Agriculture (USDA) Food and
Nutrition Service (http://www.
snapretailerlocator.com).
Retailers who accept SNAP
may include corner stores and
convenience stores that do not carry
a wide selection of healthy food.
Connection to Health
Proximity to healthy, affordable
food may decrease rates of obesity
and diabetes. Further, third places
such as community gardens and
farmers markets can increase social
cohesion. For further information,
see:
httpy/Mww.sustainablecommuni-
tiesindex.org/webpages/view/53
http:/7www.sustainablecommuni-
tiesindex. org indicators view II6
http:/7www.sustainablecommuni-
tiesindex.org inilicalors view 246
http://www.sustainablecommuni-
tiesindex.org/indicators/View/32
GOLFAIR
MARTIN
I13TH
Jacksonville Farmers Mar
Fairfax St. Wood Treaters Site
Access to Healthy Food
Most residential areas within the
study area are located further than
one mile from a grocery store or a
farmers market.
Numerous retailers who accept
SNAP are located within the study
area, however retailers who accept
SNAP may include corner stores
and convenience stores that do not
carry a wide selection of healthy
food.
Figure 11. Healthy, Affordable Food
Legend
"fa Fairfax Site Locator
| Fairfax Site
.25, .5, and 1 Mile around the Site
Residential Land Use
Supermarket
1 mile around a Supermarket
o Jacksonville Farmers Market
1 mile around the Jacksonville Farmers Market
~ Community Garden
.25 miles around a Community Garden
Retailers accepting Supplemental Nutrition
Assistance Program (SNAP) benefits
25
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Chapter 4. Case Study
STEP 3. CONDUCT SERVICE ANALYSIS I Quality Affordable Housing
Factors to Map
Map analysis may include
housing code violation data,
home ownership rates, vacancy
rates and median household
income. This information
can help tell a story about
the quality and quantity of
affordable housing in the
community.
Data Considerations
Homeownership rates, vacancy
rates and median household income
can be obtained from the U.S.
Census Bureau. Housing code
violation data may be obtained
from a local data source such as a
code enforcement department.
Connection to Health
Housing costs compose a
significant proportion of household
expenses, and excessive housing
costs may tighten a famccv ily's
budget in other areas affecting
health-related expenditures.
Further, the quality of housing has a
direct effect on health. For instance,
childhood lead poisoning is often
attributed to peeling lead paint in
older or poorly maintained homes.
For more information, see:
http://www.sustainablecommuni-
tiesindex.org/webpages/view/55
I Figure 12. Homeownership
Fairfax St. Wood Treaters Site
Quality Affordable Housing
Housing code violation data
was requested but unavailable
in GIS format.
11,073 housing units are lo-
cated in the study area (2010
Census).
Twenty-four percent of housing
units are vacant (2010 Census).
The study area median
household income is $21,481
(American Community Survey
2006-2010).
Participants at a reuse work-
shop indicated a desire to
increase quality affordable
housing.
Legend
Fairfax Site Locator
| Fairfax Site
25, .5, and 1 Mile around the Site
Residential Land Use
Percent Homeownership
(based on occupied units, ACS 2005
7.1-25.0 %
25.1-50.0%
ฆ 50.1-75.0%
-2009)
26
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Chapter 4. Case Study
HEALTH AND WELLNESS SERVICE ANALYSIS SUMMARY
The health and wellness service analysis can be summarized in a table for easy reference as shown in the case
study below.
Table 6. Health and Wellness Service Analysis Summary' Template
Feature
Assets
Gaps within the Study Area
Transportation options
Community facilities
Health facilities
Open space
Neighborhood retail services
Healthy, affordable food
Quality affordable housing
Fairfax St. Wood Treaters Site
Health and Wellness Services Analysis Summary
The following table summarizes health and wellness services in the FSWT study area.
Table 7. Health and Wellness Service Analysis Summary for the FSWT Site
Feature
Assets
Gaps within the Study Area
Transportation options
Sidewalks on Fairfax Street frontage
Limited street trees on Fairfax frontage
Rail line blocks access to the site for
residential areas north of the site
Community facilities
Multiple community centers
Public library
No arts or cultural facilities
Health facilities
Two primary care offices that accept
Medicaid
Dental van stops
No FQHC in the study area
No dental facility that accepts
Medicaid
Vision and mental health facilities
unknown
Open space
Multiple public parks
Limited bike/greenway access
Neighborhood retail services
Gas stations are prevalent
Bank
Limited neighborhood retail
Healthy, affordable food
No grocery store
Retailers with limited health foods are
prevalent
Quality affordable housing
Low homeownership rates
High vacancy rates
Community indicates a desire to
increase affordable housing
27
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Chapter 4. Case Study
STEP 4. DETERMINE HEALTH AND WELLNESS NEEDS
As discussed in Chapter 3 (Step 4), the purpose of the health and wellness needs analysis is to document the
relative need to support health and wellness in the neighborhood around the site related to:
Community health outcomes and
Potential environmental risks.
Health Outcomes
Health outcomes can be documented through community interviews and health outcome data maps. In addition
to the community interview questions outlined on page 14, Table 8 offers a set of recommended indicators and
metrics for mapping community health outcomes.
Table 8. Recommended Health Outcome Indicators and Metrics
Indicator
Health Outcomes Metric
Asthma hospitalizations
Combined adult and pediatric asthma hospitalization rate per 10,000 people
Diabetes hospitalizations
Adult diabetes hospitalization rate per 10,000 people
Chronic obstructive pulmonary
disease (COPD) hospitalizations
Adult chronic obstructive pulmonary disease (COPD) hospitalization rate per
10,000 people
Heart failure hospitalizations
Adult congestive heart failure hospitalization rate per 10,000 people
Infant mortality
Infant mortality per 1000 live births
Low birth weight births Number of babies born with low birth weight, per 1,000 live births
Data Considerations
Additional indicators may be explored depending on the health challenges
that are of concern to the local community. Sources could include:
The SCI offers a number of indicators related to preventable
hospitalizations and early prenatal care that could be incorporated into a
Health Outcomes Assessment if local data is available.11
The Center for Disease Control's Behavioral Risk Factor Surveillance
System (BRFSS) provides metropolitan statistical area, micropolitan
statistical area, and metropolitan division (MMSA)- and county-level
GIS data on a wide range of health behavior indicators.12 The BRFSS
provides valuable baseline county-level data that may be particularly
relevant where neighborhood-scale health indicators are not available or
accessible.
The U.S. Department of Health and Human Services" Area Health
Resource File provides county-level data on over 6,000 indicators
related to health facilities, health professions, measures of resource
scarcity, health status, economic activity, health training programs, and
socioeconomic and environmental characteristics; however, the data
is provided in a format that would require a higher level of effort to
integrate into a spatial analysis.13
11 Sustainable Communities Index. Health Systems. Retrieved 2013. http://www.sustainablecommunitiesindex.org/webpages/view/56.
12 Center for Disease Control. GIS Data and Documentation. 2013. Retrieved 2013. http://www.cdc.gov/btfss/gis/gis_niaps.htm.
13 Health Resources and Services Administration. Overview. Retrieved 2013. http://atf.hrsa.gov/overview.htm.
Topics covered by the BRFSS include:
Alcohol consumption
Arthritis
Asthma
Cardiovascular Disease
Cholesterol awareness
Chronic health indicators
Colorectal cancer screening
Demographics
Diabetes
Disability
Exercise
Fruits and vegetables
Health care access/coverage
Health status
Hypertension awareness
Immunization
. Injury
Oral health
Overweight and obesity
Physical activity
Prostate cancer
Tobacco use
Women's health
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Chapter 4. Case Study
Fairfax St. Wood Treaters Site
Health Outcomes
The Fairfax site is located in Duval County 's Health
Zone 1, which has the highest rates in Duval County
of:
Infant mortality
Heart disease mortality
Asthma-related ER visits
ER visits related to uncontrolled diabetes
The site is also located in the zipcode of Health Zone
1 with the highest rates within Health Zone 1 of:
Teen births
Dental-related ER visits
Ambulatory care sensitive conditions-related ER
visits
Total Adult ER Visits
(dental, COPD, asthma, diabetes, congestive heart)
This map shows that the central zipcode of Health Zone 1 consistently documents
high admission rates for health issues.
Total ER Visits
Fairfax Site Locator
136-259
260 -511
512 - 849
Data obtained from the Health Planning Council of North East Florida.
* Data
Birth Rates (2010)*
Fairfax Site Locator
| I Lower Rates within HZ 1
| | Middle Rates within HZ 1
[ | Highest Rates within HZ 1
from the Duval County Health Department.
Health Department.
ACSC-related ER Visit
Rates per 100K pop. (2009)
Fairfax Site Locator
Teen Births
(per 1,000 females between ages 15-18)
This map shows that teen births in 2010 were distributed across Health Zone 1.
Ambulatory Care Sensitive Condition (ACSC)
-related ER Visits
ACSC are a set of conditions, such as asthma, COPD and diabetes, where appropriate
ambulatory care prevents or reduces the need for admission to the hospital. These
diagnoses are related to access to good primary care.
Figure 13. Health Outcomes in Health Zone 1 of Jacksonville, Florida
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Chapter 4. Case Study
Potential Environmental Risk Factors
Map analysis of environmental risk factors may include the indicators outlined in Table 9.
Table 9. Environmental Risk Factors
Indicator
Health Outcomes Metric
Contaminated sites
Brownfields, Superfund sites
Water quality
Fish consumption
Swimming risks
Air quality*
Air quality attainment status
Mobile air pollution sources
Highly trafficked roads
Truck routes
Rail lines
Stationary air pollution sources
Industrial areas
Ports
Unhealthy food Fast food restaurants
Corner stores
Stores licensed to sell alcohol for consumption off premises
Flood risks Floodway and floodplain areas
Coastal flooding areas
* The California Air Resources Board has recommended buffers for some land uses that pose risks to air quality, and it may be useful to
map these buffers in relationship to the relevant land uses and surrounding residential areas.
Data Considerations
Data related to contaminated air, soil or water may be
obtained from state or federal environmental agencies
Data related to flood risks may be obtained from Fed-
eral Emergency Management Agency (FEMA). Fast
food and corner store locations may be obtained from
a local data source such as the planning department.
In some cases, when data has not been digitized by
the local government, data can be manually digitized
by using a public data source. This can be a resource-
intensive process, depending on the study area size.
Stores licensed to sell alcohol for consumption off of
the premises may be obtained from the state agency
that regulates alcohol sale licenses. For example, in
Florida, this information can be obtained through
the Florida Department of Professional and Business
Regulation (https://www.myfloridalicense.com/wl 11.
asp?mode=0&SID=).
Connection to Community Health
Many Superfund sites are located in neighborhoods
that suffer from multiple contaminated sites,
disinvestment and lack of services. These
environmentally overburdened communities often
face disparate health impacts. For further information,
see: http://www. sustainablecommunitiesindex.org/
webpage s/view/5 0.
Residential areas with higher proximity to fast food
restaurants are associated with a higher risk of obe-
sity.14 A high density of alcohol outlets is associated
with higher levels of crime and violence; for more
information, see: http://www.sustainablecommunities-
index.org/indicators/view/73.
14 Bodor; Nicholas et al. Journal of Urban Health. "The Asso-
ciation between Obesity and Urban Food Environments. " 87(5).
September 2010, pp. 771-781.
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Chapter 4. Case Study
Fairfax St. Wood Treaters Site
Environmental Risks
Risks in chide:
Proximity to streams with fish consumption risks
cmd swimming risks due to poor water quality
Four Superfund sites in close proximity (note
that proximity does not directly correlate to
exposure or health effects).
A multitude of sites under investigation or
cleanup through the State Brownfieldprogram
The California Air Resources Board recommends the
following distances between residential areas and
land uses with air quality risks:
Industry = 500feet
High traffic = 500feet
Duval County meets EPA's National Ambient Air
Quality Standards and is not considered a non-
attainment area.
Figure 15. Land Uses that May Contribute to Air Quality Risks
Figure 14. Contaminated or Potentially Contaminated Sites and
Streams with Fish Consumption or Swimming Risks
Legend
Fairfax Site Locator
Residential Land Use
High Traffic Buffer (500 ft)*
Legend
ฃ , .25. .5,and 1 Mile arourx
Potential Fishing Risk
, Sites Under Investigation or m Active Cleanup *
Petroleum sites- , on from the FDEP Contamination Localor Map
(CLM). which provides locational information on sites that are
other waste cleanup sites- currently under FDEP's cleanup oversight. Although all sites
in CLM are suspected or percewed to be contaminated.
. further investigation may show that some sites are not
Brownse .tes* contaminated.
Freeway
Arterial Road
Industrial Buffer (500 ft)
31
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Chapter 4. Case Study
STEP 5. SUMMARY AND RECOMMENDATIONS
Following completion of steps 1-4, the health and
wellness assessment findings should be summarized.
The typical recommendations of a reuse assessment
maj' be supplemented with an additional set of
health and wellness recommendations based on this
summary.
The summary may identify:
Health outcomes disparities and potential
environmental risks experienced by the
neighborhood around a site,
Health and wellness service assets in the
neighborhood around a site,
Health and wellness service needs in the
neighborhood around a site,
Health and wellness features that could be
suitable for future use at a site, and
Considerations for implementation of
recommended future health and wellness uses.
Fairfax St. Wood Treaters Site
Fairfax St. Woodtreaters Site: Pilot Conclusions
The neighborhood could benefit from the following health and wellness features:
ป A dental facility
ป Extension or expansion of an existing FOHC
ป A grocery store
ป Neighborhood retail services
ป Affordable housing
ป Arts and cultural facilities
The site could be suitable for any of these uses, however:
ป Retail size may need to be suited to neighborhood scale
ป Access may need to be improved for a large volume of users
Residents in this zipcode suffer from the highest health disparities within the county based on birth,
mortality and emergency room data.
The neighborhood is also burdened with environmental risks, as well as land uses associated with
health risks.
32
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Chapter 5. Summary
In summary, the Superfund reuse assessment process provides a significant opportunity for advancing health and
wellness interventions in communities impacted by Superfund sites. In many of these neighborhoods, residents
and stakeholders have environmental justice concerns about the state of community health and wellness. As
discussed in Chapter 2, communities of color and low-income communities are more likely to experience
disproportionate exposure to the cumulative risks of contaminated sites, poor air quality and poor water quality.
These communities are also more likely have a history of economic and social disinvestment, leading to lower
levels of access to health and wellness amenities. These same communities often bear the weight of significant
health outcomes disparities.
Reversing this trend is an important part of EPA"s emphasis on environmental justice initiatives that:
"Protect the environment and health in overburdened communities.
Empower communities to take action to improve their health and environment.
Establish partnerships with local, state, tribal, and federal governments and organization to achieve healthy
and sustainable communities."1
This document provides a summary of a pilot framework for integrating health and wellness considerations into
each of the following steps of the Superfund reuse assessment process.
1. Identifying community goals provides an opportunity to capture local stakeholder priorities and public
initiatives for health and wellness improvements and interventions at the local scale.
2. During the site suitability step, the site can be evaluated to determine which more general health and
wellness amenities it can support, ranging from institutional, open space or neighborhood services.
3. The land use analysis step may be expanded to include a review of what health and wellness amenities are
within the neighborhood and which ones may be missing, or inaccessible.
4. An additional step in the process may include summarizing health outcome data and identifying
potential environmental risks that may signify an additional need for health and wellness amenities in the
community.
5. And finally, future use recommendations can summarize community goals, site suitability, service
availability and relative need for health and wellness amenities.
Using this framework to integrate health and wellness considerations into Superfund reuse assessments may
provide an opportunity to leverage an existing tool to advance improved health outcomes in communities
impacted by Superfund sites. Developing a summary of the community's relative health and wellness needs
may assist the community in providing informed input for potential future land use assumptions. This data could
also help the community advocate for resources, technical assistance or programs from local, state, tribal or
federal partners that could help to support additional planning and implementation of future land uses related to
health and wellness, or to address community needs outside of the scope of the Superfund program authority.
This framework could be used by EPA staff, local government, community-based organizations and community
residents to forge new and effective collaborations around health and wellness goals and to take action, in
partnership with EPA, to improve community health and wellbeing.
1 U.S. Environmental Protection Agency. Plan EJ 2014. 2011. http://www.epa.gov/compliance/ej/resources/policy/plan-ej-2014/plan-
ej-2011-09.pdf.
33
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Chapter 6. Resources
DATA CONSIDERATIONS AND RESOURCES
Data collection can be a time-consuming process, depending on data availability. The indicators recommended
in this report were selected in part because they typically have readily available national and local data sources.
Table 10. Data Considerations and Resources
Indicator
Considerations
Resources
Transportation
Options
Most transportation data can be obtained from local data
sources such as a planning department or transit authority.
In some cases, GIS data such as the locations of sidewalks
and bike lanes may not have been developed by the local
government. United We Ride has links to transit authorities
in many communities across the U.S.
Local planning department
Local transit authority
United We Ride: http://www.
unitedweride.gov
Community Most community amenity data can be obtained from Local planning department
Amenities local sources such as a planning department or parks and Local parks and recreation
recreation department. In some cases, when data has not department
been digitized locally, data can be manually digitized using Manual digitizing from a
a public data source. This can be a resource-intensive public data source
process, depending on the study area size.
Healthcare
Options
Data for this indicator may be obtained from a variety of
sources including local planning departments or health
departments, state agencies or the Health Resources and
Services Data Warehouse. It should also be noted that
healthcare access is most often related to non-proximity
related factors such as transportation options, service
hours, types of services offered, and insurance coverage;
therefore, service area maps may be less relevant for this
indicator depending on the local context.
Local planning department
Local health department
State agencies
Health Resources and
Services Data Warehouse:
http://datawarehouse.hrsa.
gov
Parks and Most open space and park data can be obtained from Local planning department
Open Space local sources such as a planning department or parks Local parks and recreation
and recreation department. State conservation or tourism department
agencies may also be potential sources. As previously State conservation or tourism
noted, although proximity is an important indicator for agencies
access, other issues such as safety, upkeep and available
facilities influence access as well.
Services
Most neighborhood-oriented service data can be obtained
from local data sources such as a planning department.
In some cases, when data has not been digitized by the
local government, data can be manually digitized by using
a public data source. This can be a resource-intensive
process, depending on the study area size.
Local planning department
Manual digitizing from a
public data source
Healthy, Most data can be obtained from local data sources such Local planning department
Affordable as a planning department. SNAP retailers data can be USDA Food and Nutrition
Food obtained from the USDA Food and Nutrition Service. Service: http://www.
snapretailerlocator.com
Quality
Affordable
Housing
Homeownership rates, vacancy rates and median
household income can be obtained from the U.S. Census
Bureau. Housing code violation data may be obtained
from a local data source such as a code enforcement
department.
Local code enforcement
department
U.S. Census Bureau: http://
www.census.gov
American FactFinder: http://
factfinder2.census.gov/faces/
nav/jsf/pages/community_
facts.xhtml
-------
Chapter 6. Resources
Table 10. Data Considerations and Resources (cant.)
Indicator
Considerations
Resources
Environmental
Risk Factors
Data on brownfields, Superfund sites, air quality and
water quality can typically be obtained from EPA or the
state environmental protection agency. Analysts may
work with their EPA contact at the site to determine the
best venue for obtaining data relevant to the site.
. U.S. EPA
- Superfund: http://epa.gov/
superfund/
- Brownfields: http://www.epa.
gov/brownfields/bfwhere. htm
- Air Quality: http://www.epa.
gov/air /
- Water Quality: http://water.
epa.gov/
State environmental protection
agency
Health Data on health outcomes, such as emergency room
Outcomes visits or cause of death, may often be obtained from
local or state health agencies. Privacy concerns
associated with this data may make it difficult to obtain
neighborhood-scale data in some cases.
The Sustainable Communities Index offers a number of
indicators related to preventable hospitalizations and
early prenatal care that could be incorporated into a
Health Outcomes Assessment if local health department
data is available
Local or state health agencies
Sustainable Communities
Index: http://www.
sustainablecommunitiesindex.
o rg/we b pages/v i ew/5 6
Centers for Disease Control:
http://www.cdc.gov/brfss/gis/
gis_maps.htm
U.S. Department of Health and
Human Services: http://arf.hrsa.
gov/overview.htm
The Center for Disease Control's BRFSS provides
county-level GIS data on a wide range of health
behavior indicators and could easily be incorporated
into a Health Outcomes Assessment. The BRFSS
provides valuable baseline county-level data that may
be particularly relevant where health indicators are not
available or accessible from local health departments.
The U.S. Department of Health and Human Services'
Area Health Resource File provides county-level data on
over 6,000 indicators related to health facilities, health
professions, measures of resource scarcity, health
status, economic activity, health training programs,
and socioeconomic and environmental characteristics;
however, the data is provided in a format that would
require a higher level of effort to integrate into a spatial
analysis for a Health Outcomes Assessment.
35
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Chapter 6. Resources
SELECTING A LEVEL OF EFFORT
Recognizing that time and resources to evaluate reuse options may vary from site to site, the following chart
outlines a range in level of effort that could be applied during the Superfund reuse assessment process. A lower
level of effort does not imply that the information being gathered is less valid or important. The community
discussion, for example, is critical to integrating health and wellness considerations into a reuse assessment.
Table 11. Level of Effort Options
LOE
Approach
Community Discussion Low Discussion Questions
Use the discussion questions during stakeholder interviews
or community meetings to identify community health and
wellness needs.
Asset and Gap Analysis
Approaches
Medium
Proximity Maps
Map the location of features related to health and wellness in
the community relative to the site.
High
Service Area Maps
Map the gaps in service area for features related to health and
wellness.
Health Conditions Approaches Low Existing Health Risk and Disparity Studies
Identify existing resources on health risks and disparities.*
High Health Risks and Disparity Maps
Map health disparities and potential neighborhood health risks.
*These might include local health studies, information from the EPA EJ screening tools (required during R1FS), Agency for Toxic-
Substances and Disease Registry (ATSDR) public health assessments, and other existing studies.
36
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Chapter 6. Resources
FUNDING SOURCES
Federal Funding Sources for Health Amenities and Health Centers
The U.S. HRSA funds community health centers to provide quality primary health care services to medically
underserved populations or people with limited access to health care services. FQHCs must be a public
or private not-for-profit organization and serve a federally-designated Medically Underserved Area or
Medically Underserved Population. FQHCs must be governed by a community board, representative of the
population served, and composed of a majority (51 percent or more) of health center patients. FQHCs provide
comprehensive primary health care and supportive services (education, translation, transportation, etc.) to all
people in their service area on a sliding-scale fee basis. In addition, there are several other performance and
accountability requirements regarding administrative, clinical and financial operations for FQHCs. Public and
private non-profit health care organizations may apply to receive federal funding for the Health Center Program
through section 330 of the Public Health Service Act.
There are several types of federal funding opportunities for FQHCs including planning grants for new facilities,
grants for new service delivery sites (new access points), grants for the expansion of existing facilities, and
service area competition grants. Expansion grants are available to construct or update facilities, expand the
medical capacity of facilities by adding or increasing primary health services (e.g., additional medical providers,
additional services, expanded hours of operation, etc.), and through the expansion of services such as mental
health/substance abuse, oral health, pharmacy and enabling services.
There is much federal funding for health amenities. Cataloguing those resources is beyond the scope of this
document, but the interested reader could start with the following:
HUD Community Development Block Grants. http://portal.hud.gov/hudportal/HUD?src=/program_
offices/comm_planning/communitydevelopment/programs
HUD Fair Housing and Equity Assessment. http://portal.hud.gov/hudportal/HUD?src=/program_offices/
sustainable_housing_communities/regional_fairhsg_equityassesmt
USDA Rural Health and Safety Education Grants Program, http://www.csrees.usda.gov/fo/
ruralhealthandsafetyeducation.cfm
Affordable Care Act (ACA) Funding and Grants Listed on HHS Website
There are several potential health center grant opportunities identified on the U.S. Department of Health and
Human Services grant forecast website. Based on the potential for future rounds of funding and the estimated
application due dates, several funding opportunities might offer opportunities for increasing access to primary
health care for Health Zone #1 (HZ#1); these are marked in bold font below. Based on the health center program
collaborative relationship requirement (see Health Center Program Requirements, page 6), any new access point
sites in HZ#1 would need support from Agape Community Health Center, the FQHC facility serving HZ#1.
(Note: for grants listed as "application deadline ended," it is unclear whether there will be another round of
funding.)
1. ACA - Health Center New Access Points Funded Under the Affordable Care Act of 2010.
Program goal: to establish new full-time service delivery sites that provide comprehensive primary
and preventive health care services. In fiscal year (FY) 2010, HRSA announced the opportunity for
organizations interested in becoming health centers to apply for up to $250 million to be awarded in FY
2011. These have already been awarded for FY 2013.
2. ACA - School-Based Health Centers (SBHCs). In FY 2013, HRSA announced $50 million for the
construction and renovation of school-based health centers. These grants have been awarded already
37
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Chapter 6. Resources
during FY 2013. From information on www.nasbhc.org/, Florida was awarded a total of $2.6 million for
SBHCs (eight awards given), http://www.grants.gov/search/search.do?mode=VIEW&oppId=58278
3. ACA - Capital Development in Health Centers Program. This program will award approximately
$600 million, through competitive one-time grants, to existing health centers receiving grants under the
Health Center Program (section 330 of the PHS Act, 42 USC 254b, as amended). This announcement
details the competitive ACA funding opportunity available for existing Health Center Program grantees
to improve their capacity to provide primary and preventative health services to medically underserved
populations. Grants awarded through this opportunity can include alteration/renovation, expansion,
or the construction of a facility. http://www.acf.hhs.gov/hhsgrantsforecast/index.cfm7switclFgrant.
view&gff_grants_forecastInfoID=35981, and http://www07.grants.gov/search/search.do;jsessionid=Cv
plTMqYplcpHyM4TY 011 qgTnKRdGW 1 pnMv6gYqL5 GP JP2vvvN2q! -1697423112?oppId= 121493 &
mode=VIEW
4. Health Care Controlled Networks Technical Assistance. This grant is intended to support the
adoption and implementation of electronic health records and technology enabled quality improvement
strategies in health centers. http://www.hrsa.gov/grants/apply/assistance/HCCN
5. Health Center Outreach and Enrollment Assistance. This funding is available to " support health
centers in raising awareness of insurance options and providing eligibility and enrollment assistance to
uninsured patients of health centers and residents in their approved service areas." http://bphc.hrsa.gov/
outreachandenrollment
6. Health Center Base Adjustments. This award is intended to "support ongoing operations and quality
improvement." http://www.hrsa.gov/about/news/2013tables/baseadjustments
For more information on application requirements, visit HRSA's How to Apply website.
Funding Sources for Health Impact Assessments
Foundations and other funding sources that may have funding available to support health impact assessments
include:
Active Living Research, http://activelivingresearch.org
Health Impact Assessment to Help Foster Healthy Design, a grant opportunity offered by the Centers
for Disease Control. http://www.grants.gov/custom/viewOppDetails.jsp?oppId=66533
The Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew
Charitable Trust, http://www.healthimpactproject.org
Robert Wood Johnson Foundation, http://www.rwjf.org
Additional Funding Networks
Additional funding networks that may have grants related to health and wellness include:
Environmental Funders Network, http://www.greenfunders.org
Environmental Grantmakers Association, http://ega.org
Funders Network for Smart Growth and Liveable Communities, http://www.fundersnetwork.org
Health and Environmental Funders Network, http://www.hefn.org
38
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Chapter 6. Resources
REFERENCES
The following resources were included in the literature review to identify a range of approaches that evaluate
relationships between public health and the design of the built environment.
Planning and Health Frameworks
Change Lab Solutions. 2012. "Toolkit: General Plans and Zoning". Retrieved November 29, 2012.
Clean Air, Cool Planet. 2012. "Community Solutions to Global Warming". Retrieved November 29, 2012.
Dannenberg, Andrew L., Rajiv Bhatia, Brian L. Cole, Sarah K. Keaton, Jason D. Feldman, and Candace D.
Rutt. 2008. American Journal of Preventative Medicine. "Use ofHealth Impact Assessment in the U.S.:
27 Case Studies, 1999-2007/'Retrieved November 29, 2012.
Flournoy, Rebecca. 2010. "Healthy Food, Healthy Communities''. Policy Link. Retrieved November 29, 2012.
< http://www.policylink.org/atf/cf/%7B97c6d565-bb43-406d-a6d5-eca3bbf35af0%7D/HFHC_SHORT_
FINAL.PDF>
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November 29, 2012.
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cdph.ca.gov/pubsforms/Guidelines/Documents/HIA%20Guide%20FINAL%2010-19-10.pdf>
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General Resources on Health, Planning and the Environment
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Chapter 6. Resources
Design, Community and the Environment, Dr. Reid Ewing, Lawrence Frank and Company, Inc., and Dr.
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Environment: A Report Prepared for the LEED-ND Core Community/' Retrieved November 20, 2012. <
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EPA. 2001. "Reuse Assessments: A Tool to Implement the SF Land Use Directive"'. Retrieved November 2012.
NACCHO. "Land Use Planning 101 Resources". Retrieved November 27, 2012
NACCHO. 2000. "Protocol for Assessing Community Excellence in Environmental Health". Retrieved
November 27, 2012.
NACCHO. "Public Health in Land Use Planning and Design." Retrieved November 20, 2012. < http://www.
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Interventions to Improve Public Health." Retreived November 6, 2012. < http://www.nursingcenter.com/
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EPA OSWER. 2008. "Improving Public Health in Brownfields Communities".
LISC. 2011. "New Market Tax Credit Profiles".
Partnership for the Public's Health. "Health Eating Active Communities",
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