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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. Multnomah County . Multnomah County population 650,000 1/3 of Oregon’s residents Primarily urban with 79% population in the City of Portland
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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
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 • 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
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
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
Availability of existing data on that area • Income • Diversity • Waste transfer stations • Landfills • Illegal dump sites • Air quality • Age of housing Existing GIS data considered: • Lead poisoning cases • Benzene • Diesel particulate matter • Brownfields • Automobile accidents • Cancer incidence • Pesticide exposures
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