Multnomah County Health Department

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

• Multnomah County population 650,000 1/3 of
  Oregons residents
• Primarily urban with 79 population in the City
  of Portland
• Majority of diverse population resides in
  Multnomah County

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Oregons 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

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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

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Vision of Success

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

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

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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.

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Definition of Success

• Goal I. Develop Functioning Coalition
• Diverse Representation (organization,
  individuals, under represented communities)
• Create Steering Committee
• Functional Work Groups
• Relationship Building
• Develop Action Plan for Assessment
• Advocate for Implementation of Action Plan

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Definition of Success Continued

• Goal II. Complete Environmental
  Health Assessment
• Define Geographic Area of Focus
• Define Goals, Objectives and Scope
• Identify EH Issues
• Analyze EH Issues
• Prioritize EH Issues

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How do you get to community?
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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

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People of Color
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People of Color
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People in Poverty
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Exposure to multiple environmental problems
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Exposure to multiple environmental problems
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Availability of existing data on that area
Existing GIS data considered

• 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

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PACE-EH support is welcomed by the community
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Active Neighborhood Coalitions
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Passion and Storytelling
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Core Functions of Public Health

• Assessment
• Assurance
• Policy Development
• Passion

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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

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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

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Next Steps

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

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