Countering the conventional practice of top-down planning, Multnomah County Health Department is taking on environmental justice and health equity by partnering with communities that suffer the brunt of outdoor and indoor air pollution.
Environmental programs often attempt to address issues that funding sources define as priorities, said Lila Wickham, manager of Multnomah County Health Department’s Environmental Health program. The community is often not involved in the assessment of its needs. “And as a result of that you often have to go out into the community and engage them, that this is a problem, then the money goes away and then you’re left with a community that you’ve engaged with that you can no longer support.”
In order to avoid this problem, the Health Department adopted a tool developed by Centers for Disease Control called Protocol for Assessing Community Excellence in Environmental Health (PACE-EH).
“We wanted to use a model where we actually go work in the community and find out what their issues are, and as a result of those issues seek resources, policy change, long-term solutions,” Wickham said.
The PACE-EH coalition was made up of more than 45 citizen advocates, community-based organizations and agencies. Its initial work, when the coalition was formed three years ago, involved data collection that showed which neighborhoods in Portland are exposed to the most environmental health risks.
“We looked at a variety of indicators,” said Stephanie Farquhar, chair of the PACE-EH assessment team, and assistant professor of community health at Portland State. With the help of Portland State students Farquhar compiled data relating to various health risks, including levels of diesel particulate matter and proximity to solid waste facilities.
The assessment revealed a heavy concentration of environmental and health problems in five communities in Portland: inner North and Northeast Portland, East County/Rockwood, North Portland-St. Johns and Portsmouth, outer Northeast Cully, and outer Southeast Lents.
The inner North/Northeast affordable housing community showed the most interest in participating in the PACE-EH assessment. Through methods such as focus groups, photo essays and surveys, several areas of concern were identified, including trash, lead and “feeling like an ‘ignored community.'” Mold was identified as a major concern due to its negative health effects, including allergies, headaches and the exacerbation of asthma.
Household mold is a pervasive problem, said Andrea Greiling, public health prevention specialist at the Health Department. “I know that it’s a common household asthma trigger but there are a lot of things in houses that may be triggering asthma, cockroaches, bed bugs, animal dander.”
“Oftentimes landlords are suggesting that you open your window if your fan doesn’t work or if you don’t have a fan,” Greiling said. “Well, I wouldn’t open the window right now when it’s pouring down rain if I don’t have very much money to pay my heating bills.”
“It [mold] is visible in particular in the master bedroom,” said Jen, a sociology major at Portland State who rents an apartment in the Gresham area and wishes to be anonymous due to the risk of retaliation by her apartment manager. “It’s black and grainy, it looks like mold, and I’m allergic to mold.”
“I had bronchitis for 21 days and a full course of antibiotics,” Jen said, who lives in the apartment with her two young sons.
This week she went to the student health center and the nurse’s initial question was “‘have you checked your apartment for mold?'”
The entire 20-unit apartment complex has mold problems, Jen said. City inspectors have visited several times and fined the property owner but the problems have not improved, she added.
“Sometimes I think being homeless would have been better,” she said. “We’d be cold but we’d be healthy.”
An asthma map with data collected by the Health Department showed that the same five areas of Portland that have the greatest percentage of minority residents, the worst pollution, and the most poverty, also have a disproportionate number of children under six years old who have asthma.
With input from the PACE-EH coalition, the Health Department applied to Housing and Urban Development for a Healthy Homes Demonstration grant aimed at providing services to low-income families with children under six years old who have asthma. The grant would provide the county with close to $1 million to address home health issues in Multnomah County.
The fruit of the three-year PACE-EH assessment arrived in late September 2005 when the Health Department was awarded a grant of $998,874. “It’s rare,” Farquhar said. “Only happened because leadership and commitment of the county.”
The Healthy Homes project will focus on assisting 200 low-income families who have children less than six years of age who are diagnosed with asthma. An environmental health specialist and community health nurse will go into homes of families who volunteer to participate, and help to remediate or prevent household hazards. Enrollment is planned to begin in spring 2006.
The Health Department staff will provide education regarding home health practices and also provide “incentives” such as vacuum cleaners and “green cleaning” supplies, said Wickham, director of the Healthy Homes Demonstration grant.
Sometimes household hazards need to be addressed by landlords, said Greiling, who is also the Healthy Homes program manager. If a property manager is unresponsive to requests for repairs, Healthy Homes staff will refer families to community organizations that can offer help, such as the Community Alliance of Tenants. Numerous partnering organizations will be available to assist families with “structural” household issues such as leaky pipes or inadequate weatherproofing.
“We know that 200 households is just a drop in the bucket,” Greiling said. “That is one of the reasons why we are also focusing not just on these 200 household but on other programs in the county that we can kind of leverage so we can maximize the outreach.”
Future projects relating to Healthy Homes will include free presentations, open to the public, on indoor air quality, renters’ rights and communication with landlords regarding repairs.
For more information about Healthy Homes contact Andrea Greiling, program manager, at 503-988-3663, or e-mail [email protected]