Multnomah County Health Department Environmental Health PACE EH A Tool for Overcoming Health Disparities Lila Wickham, RN MS November 15, 2003

Multnomah County Multnomah County population 650,000 1/3 of Oregon’s residents Primarily urban with 79% population in the City of Portland Majority of diverse population resides in Multnomah County

Oregon’s Inequities Oregon is one of two states in the nation in which the gap between the wealthy and the poor grew the fastest The median household income for African Americans is the lowest of any group and 33% lower than the county median income

Why PACE ? Dealing with “Hazard of the Week” Lack of “community” involvement in environmental health Disparity between science and public perception Limited data at the local level Seeking available resources rather than community desired resources

Vision of Success Facilitate an inclusive community process that identifies, analyzes and prioritizes environmental health concerns and builds community capacity

Reach out into the community to engage collaboratively in research not perform research on a community Biggest ongoing ethical issue remains allocation of resources

Eisenhower 1953 “Every gun that is fired, every warship launched, every rocket fired, signifies, in the final sense, a theft from those who hunger and are not fed, those who are cold and are not clothed. The world in arms is not spending money alone. It is spending the sweat of its labourers, the genius of its scientists, the hopes of its children”.

Definition of Success Goal I. – Develop Functioning Coalition 1. Diverse Representation (organization, individuals, under represented communities) 2. Create Steering Committee 3. Functional Work Groups 4. Relationship Building 5. Develop Action Plan for Assessment 6. Advocate for Implementation of Action Plan

Definition of Success – Continued Goal II. – Complete Environmental Health Assessment 1. Define Geographic Area of Focus 2. Define Goals, Objectives and Scope 3. Identify EH Issues 4. Analyze EH Issues 5. Prioritize EH Issues

How do you get to “community”?

Select a Geographic Area Environmental justice area – large % of people of color – low-income – disproportionately affected by environmental and health threats – people with historically limited access to political & decision- making power Exposure to multiple environmental problems Availability of existing data on that area PACE-EH support is welcomed by the community

People of Color

People in Poverty

Exposure to multiple environmental problems

Availability of existing data on that area Income Diversity Waste transfer stations Landfills Illegal dump sites Air quality Age of housing Lead poisoning cases Benzene Diesel particulate matter Brownfields Automobile accidents Cancer incidence Pesticide exposures Existing GIS data considered:

PACE-EH support is welcomed by the community

Active Neighborhood Coalitions

Passion and Storytelling

Core Functions of Public Health Assessment Assurance Policy Development Passion

Immediate issues identified by community See EH screening as a regular medical visit Neighborhood clean-ups Education on peeling paint and lead paint Landlord inspection of property on a regular basis Mold in basements Disease carrying rodents

Immediate issues identified by community (cont) Manage traffic so that children can walk safely to school Change policy around diesel exhaust, trains, trucks Stinky garbage cans

Next Steps Complete community based assessment Identify and prioritize issues Create solutions Change public policy