Community Environmental Health Assessment
Silva, Hilton P., Rosile, Paul A., Journal of Environmental Health
The Delaware City-County Health Department Experience, Phase I-Issues Identification
Environmental health traditionally has been a subject that fosters ironies. One of the paradoxes is that while nearly everyone agrees government must intervene, there is no consensus on the methodology of intervention. It is an area ideally suited for prevention, yet most often crisis management and reactive approaches often have prevailed (1). The past two decades have seen dramatic changes in the management of environmental health, such as increased citizen awareness and demands, increased complexity of environmental issues, reduction or dispersion of funding, and the fragmentation of traditional environmental health programs and services from public health agencies. These changes increase the stress on environmental health divisions and have made it difficult to deal with the increasing number of environmental challenges (2). For smaller counties with fewer resources, environmental health management can be a daunting task.
Delaware County, in central Ohio, has an estimated population of 98,000. The county has a mix of lifestyles: suburban areas, agricultural areas, and small midwestern college towns. Because of its proximity to the City of Columbus/Franklin County metropolitan area, Delaware is the fastest growing county in Ohio and one of the fastest growing counties in the United States. The growth results from an increase in a high-income, well-educated suburban population in the county's southern townships. The majority of these citizens have little familiarity with Delaware County and have retained their identification with Columbus and its northern suburbs. To effectively manage this growth, Delaware County must face the challenge of a growing and ever more demanding population, fast environmental changes brought about by development, and the limitations of existing community infrastructures. For the Delaware City-County Health Department the potential environmental impacts associated with the rapid demographic changes and the changes in community expectations are of great concern.
The Protocol for Assessing Community Excellence in Environmental Health (PACEEH) is a pioneer protocol developed in the last three years under the leadership of the National Association of County and City Health Officials (NACCHO), with support from the National Center for Environmental Health (NCEH) of the Centers for Disease Control and Prevention (CDC) (3). The protocol is designed to assess environmental health priorities by involving community members in a process that identifies and compares environmental problems (4-6). PACE-EH evolved as a way to include environmental health issues in the existing Assessment Protocol for Excellence in Public Health (APEX-PH), also developed through a cooperative agreement with NACCHO (7).
The Delaware City-County Health Department has been chosen as one of 10 sites in the United States to pilot PACE-EH. The objectives are to collect environmental health data, assess and evaluate local environmental conditions, identify populations at higher risk, and prioritize local environmental health programs and policies (3). In Delaware County, PACEEH is part of a larger community project called "Healthy Delaware," also managed by the health department. A "Healthy Delaware" advisory committee directs and coordinates the actions of both the PACE-EH committee and the APEX-PH committee.
In 1995, the Delaware City-County Health Department made community assessment a priority. A commitment was made to enhance the department's internal and external capacities in this area. The health department completed an internal agency assessment in 1996, using the APEX-PH model. This model describes eight planning steps used to institutionalize organizational capacity by assessing nine capacity indicators:
1. authority to operate,