National summit on pace eh pace eh in rural settings march 29 2006 louisville kentucky
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National Summit on PACE EH “PACE EH in Rural Settings” March 29, 2006 Louisville, Kentucky

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National summit on pace eh pace eh in rural settings march 29 2006 louisville kentucky

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National Summit on PACE EH“PACE EH in Rural Settings”March 29, 2006Louisville, Kentucky

National summit on pace eh pace eh in rural settings march 29 2006 louisville kentucky


  • Ricky Elliott, Environmental Supervisor, Escambia County Health Department, Brewton, Alabama

  • Tom Struzick, Project Director, Southeast Regional Academic Center for Environmental Public Health, UAB School of Public Health, Birmingham, Alabama

Pace eh in alabama partners


  • Alabama Department of Public Health, Bureau of Environmental Services

  • Eight County Health Departments

  • School of Public Health, University of Alabama at Birmingham – Department of Environmental Sciences and Center for Community Health Resource Development

National summit on pace eh pace eh in rural settings march 29 2006 louisville kentucky

The Alabama PACE EH experience has been supported with two grants:

  • Developing Communities of Excellence in Environmental Health, 2001-2004 funded by the Association of Schools of Public Health

  • Southeast Regional Academic Center for Environmental Public Health,2004-2007 funded by the National Center for Environmental Health at the Centers for Disease Control and Prevention

National summit on pace eh pace eh in rural settings march 29 2006 louisville kentucky

In Memory of our Friend and Colleague

H. Kenneth Dillon, Ph.D.

September 2, 1947 – May 9, 2004

Present project team members

Present Project Team Members

  • Kent R. Oestenstad, Ph.D., CIH, CSP; Principal Investigator

  • Linda Goodson, R.N. Co-Principal Investigator

  • Elizabeth Maples, Ph.D.

  • Katrina Wright, Research Assistant

  • Patricia A. Burchfield, B.A., Administrative Coordinator

  • Cheryl Johnson, Website Manager

  • Sherry Bradley, M.P.A., Bureau of Environmental Services, Alabama Department of Public Health

  • Plus, 7 other PACE EH Project Developers

Developing communities of excellence in environmental health 2001 2004

Developing Communities of Excellence in Environmental Health, 2001 - 2004

  • Building partnership between the Alabama Department of Public Health and the UAB School of Public Health

  • Alabama Public Health Environmentalists’ Training Needs Assessment

  • Field-testing a New Curriculum

  • Launching PACE EH

National summit on pace eh pace eh in rural settings march 29 2006 louisville kentucky

Building the Partnership between the

Alabama Department of Public Health’s Bureau of Environmental Services and the UAB School of Public Health

Training needs assessment

Training Needs Assessment

  • Multiple kinds of data

  • Field tested with PHA Area Environmental Directors – March,2002

  • Revised completed May/June 2002 with Environmental Directors’ support

  • 89% response rate

  • Findings relating to PACE EH

National summit on pace eh pace eh in rural settings march 29 2006 louisville kentucky

The assessment consisted of six sections:

  • Demographic information,

  • Experiences with the Ten Essential Services for Environmental Health,

  • Abilities in the Fourteen Core Competencies,

  • Experiences working with the community

  • Attitudes about environmental health work,

  • Training experiences and training needs.

Experiences working with the community

Experiences working with the Community

  • When asked how often they work with community agencies, leaders, and lay people, one-third of the participants reported working with community agencies at least once a month, one-fourth reported working with community leaders once a month, and about one-third of the participants reported working with lay people at least weekly

  • County and city agencies were the agencies with which the participants reported having the most contact. County commissioners were the community leaders that they reported having contact most often. They worked with other community leaders mostly on garbage and illegal dumping issues and with community lay people mostly on sewage problems.

The curriculum

The Curriculum

Communities Working for Environmental Health:A Community-focused Training Curriculum for Environmental Public Health Practitioners

[ A Primer for PACE EH ]

Curriculum design challenges

Curriculum Design Challenges

  • Cover content required by ASPH/CDC

  • Provide background for understanding community EPH work

  • Establish foundation for conducting PACE EH

  • Minimize trainee/agency travel expenses

  • Minimize trainee absence from work station



  • Training began May and ended November, 2003

  • Began with 11 (one from each of the state’s Public Health Areas); ended with 10

  • All participants were experienced EPH workers with between 10 and 31 years experience; average 15 years

  • Participants valued their curriculum experience and made one recommendation – move the PACE EH material to the first day.

Curriculum content seven modules 4 training days

Curriculum ContentSeven Modules – 4 Training Days

  • Fundamentals of EPH


  • EPH Community Leadership

  • Working with Communities for EPH

  • Community Outreach

  • Community-based Participatory Research

  • Strategic Planning for Community-focused EPH Projects

Setting the stage for the alabama pace eh experiment

Setting the Stage for theAlabama PACE EH “Experiment”

Pace eh in alabama pragmatics

PACE EH in Alabama: Pragmatics

  • CDC/NCEH interest in PACE EH

  • University’s buy-in: The Spirit of PACE EH captured our attention; Engaging community members in planning, implementing and evaluating EPH services/programs

  • University project staff trained on PACE EH

  • Working with the PACE EH Project in Anniston, AL

  • Earlier project experiences led us to focus on a “modified” version of PACE EH - getting through Tasks 1-5 and beginning to address some of the concerns

Alabama pace eh target communities

Alabama Pace EH Target Communities

  • At least 30 minutes from any urban area; include high percentages of ethnic minority populations with large numbers of people living in poverty; and have slight community resources (e.g., a church or a school)

  • Population demographics not always available

  • Few EPH practitioners are available to serve these widely dispersed communities; sometimes one worker does all the EPH work for one county

  • EPH practitioners who do serve communities in these counties must travel to remote locations which are far from their base of operations

Alabama pace eh target communities1


Launching pace eh february 2004

Launching PACE EH – February, 2004

  • Project Roles – Developer and Facilitator

  • PACE EH Task #1 – Checklist and Resource List

  • PACE EH Task #2 – Community Description

    (begun during training)

  • PACE EH Task #3 – Assembling the CEHA Teams

National summit on pace eh pace eh in rural settings march 29 2006 louisville kentucky

PACE EH Task #4

(Summer, ’04)

Planning for the Community Surveys

University IRB Approval

Project Start Up Funds

National summit on pace eh pace eh in rural settings march 29 2006 louisville kentucky

PACE EH Task #5

(July – December, ’04)

  • Conducting the assessments; survey form selection

  • Data entry and analysis

Pace eh task 5 environmental health issues of concern

PACE EH Task #5Environmental Health Issues of Concern

  • 415 total surveys from the 8 target communities

  • All of the environmental issues on the survey forms were checked; though numbers were small

  • Majority of respondents felt safe at work, in their own homes, and at outdoor recreation areas

  • Top five concerns were similar across all communities

National summit on pace eh pace eh in rural settings march 29 2006 louisville kentucky

PACE EH Task #10

Top Five Concerns

  • Safe Drinking Water

  • Vector Control – Mosquitoes

  • Abandoned Buildings

  • Septic Systems

  • Waste Management

Where are we now

Where Are We Now?

PACE EH Tasks 11, 12, and 13

  • Several teams have had some success in resolving some issues

  • All of the teams are loosing momentum

  • Running up against the reality of limited resources for “major” problem resolution

Alabama pace eh successes

Alabama PACE EH Successes

  • New players involved in EPH program planning

  • Lower connection fees for public water access

  • Waived fees for private well testing

  • Distribution of mosquito larvicide briquettes

  • Public education and awareness campaigns:

    • Drinking water

    • Mosquito control

  • Engaging public water authorities in community education

  • Formation of 501(c) (3) for community sewer system

National summit on pace eh pace eh in rural settings march 29 2006 louisville kentucky

  • Joining forces with county commission to support community water survey

  • “Doggy” roundup

  • Cleaning up abandoned buildings and lots

  • Reduced numbers of illegal solid waste dumps

  • Local Ordinances:

    - noise control (Jake Brakes)

    - licenses for selling food at alternate locations

  • Engaging local media in food safety campaign

Work yet to be done

Work Yet to be Done

Most of the target communities identified two critical EPH issues which remain to be tackled:

  • Safe Drinking Water Systems and Resources

    EPA Environmental Priority grant application

  • Septic Tanks and other systems

    Symposium on Rural Waste Water Treatment

    Both requiring major multiple agency support and large amounts of funding.

Lessons learned

Lessons Learned

  • The University/Community Partnership can work

  • Resources (especially peoples’ time and effort) make or break the PACE EH process

  • University – working with state and county health departments was surprising, frustrating, and challenging

  • County – working with university was …

In closing

In Closing …

With an appreciation for the spirit of PACE EH, a comfort with modifying the PACE EH agenda, the right mix of resources, some serious determination, and a whole lot of luck …

The voices of community leaders and lay people can be heard and brought into consideration for community-focused environmental public health planning, implementation, and evaluation

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