BY: PATSY MATHENY, PAUL LIPKE and JULIE TROCCHIO, M.S.
In the last few decades, the science linking environmental conditions and effects on health has grown considerably stronger. We have learned, for example, that early chemical exposure may contribute to diseases both early and later in life, and early eating patterns contribute to both pediatric obesity and diabetes. Poor air quality, exposure to pesticides, soil and water contamination, lack of access to fruits and vegetables, along with other environmental risks, have direct correlation to congenital and other chronic diseases, reproductive complications and premature death.
Many health care organizations already are taking steps to provide healthier environments for patients and staff. Many also seek to be better stewards of natural and other resources by reducing both their use of energy and their environmental impact. Staff members form "green teams," and sustainability gains importance as an organizational goal.
But these kinds of activities also can reach outside the organization's walls to have a favorable impact on community health. A health system's "green team," for example, can help with community benefit assessment, planning and activities to address the community's environmental health issues. Doing so can greatly increase the knowledge, resources and effectiveness of efforts to tackle preventable health problems.
Some activities to improve a community's environmental health may be applicable for reporting on the IRS Form 990, Schedule H. To examine this issue, CHA has been working with Health Care Without Harm, an international coalition of health care providers and others committed to a health sector that does no harm but, instead, promotes the health of people and the environment. CHA and Health Care Without Harm organizations have developed draft guidelines on whether and how to report these activities. You can download "Guidelines for Reporting Environmental Improvement Activities as Community Benefit and Community Building to the Internal Revenue Service."
Environmental initiatives and community benefit programs share a common interest: improving community health. By integrating these two, we can expand our impact. This can be done by building attention to environmental factors into the community benefit process, assessing community health needs, developing a strategy for addressing community health needs and telling the community benefit story.
ASSESSMENT
Select environmental factors to be included in a community assessment. These can include information about air, soil and water quality, access to fresh fruits and vegetables and any barriers to physical activity. In addition, when analyzing the root cause of identified health problems, look for whether environmental factors may be at play, such as mold in public housing triggering asthma.
Start the assessment process by identifying internal staff who are knowledgeable and committed to environmental and community health. For example:
- "Green team" members can provide knowledge of environmental issues and internal green efforts.
- Procurement department and material managers can identify healthier product or service alternatives and examine the cost competitiveness for those alternatives.
- Facility management staff such as engineering, energy, housekeeping and environmental services can provide expertise on infrastructure improvements, waste management, cleaning and pest control.
- Quality staff can be useful in developing effective metrics and linking efforts to health outcomes of importance to the organization as a whole.
- Clinicians with interest in environmental health connections or public health degrees can identify links between environmental health programs and clinical concerns.
Outside the organization, involve and partner with knowledgeable and committed individuals and groups in the community. For example, public health departments, as part of their accreditation process, must conduct a community assessment every five years. Reach out to them; they may include physical and socioeconomic environmental factors on their assessments, along with other health and risk indicators. They also may have staff dedicated to environmental concerns.
Other public and nonprofit organizations such as maternal and child health grantees, Head Start programs, United Way and disease-specific societies also assess community needs as part of their resource allocation process, and they can be a part of the community-wide assessment.
Representatives from organizations with interests in environmental health, environmental justice or sustainable economic development can provide expertise, time and possible funding. Local groups and agencies can document environmental health needs that may not surface in more formal community assessments.
Colleges and universities in the area can provide expertise from among researchers, faculty and students who are concentrating on public and environmental health. Also, consider including regional representatives from the Environmental Protection Agency, Department of Housing and Urban Development and local and state planning and transportation departments.
PLANNING
Planning for community health improvement requires developing partnerships, building on existing programs and efforts, looking for evidence-based programming and building evaluation into plans.
Community partners participating in the assessment also can be involved in planning activities and measures to address needs. For example, Bon Secours Health System, based in Marriottsville, Md., requires each of its regions to participate in "healthy community" efforts that engage local residents. Through this process, a neighborhood transformation took place in Richmond, Va.'s East End district, an inner-city neighborhood with high rates of infant mortality, obesity, cardiac disease and diabetes. The partnership resulted in new housing, installation of sidewalks and the opening of a wellness center in one of the housing projects. The neighborhood, which had no supermarket, gained a farm stand to improve access to fresh local produce.
Investigate what enhancements can be added to existing community benefit programs. For example, can a hospital's school health program addressing asthma be expanded to include assessing home environments, or addressing causes of pollution? Can new-parent education classes add a component on hazardous materials, recycling and safe chemicals in the home?
Also consider whether existing expertise in the organization can be expanded or "exported" into the community. A health care facility's program to use safer chemicals for cleaning or grounds maintenance could be included in a community education component for homes, schools and multi-family housing entities. Sustainability staff might be able to help community members identify and replace cleaning, pesticide or other products with healthier alternatives, such as those the health care organization has researched and uses.
Once priorities have been set for community needs, including environmental health issues, look for programs that have proven effective in addressing the relevant environmental factor or the health of relevant populations. For example, advocacy has proven to be a successful strategy for addressing community and environment heath issues. Environmentally focused community health improvement programs can work with stakeholders to support environmental health-related organizational and public policy changes such as:
- Promoting policies friendly to employee and community carpooling, bike riding and use of mass transit, which increases physical activity and reduces the number of car trips
- Advocating for government action on safer chemicals and climate policy and action
- Educating lawmakers and policy leaders on the relationship between environmental health and public health
- Building evaluation into plans. This means each program needs goals, objectives and a defined plan for measuring results. Using benchmarks set by national and other evidence-based initiatives can help establish realistic goals.
TELL THE STORY
Including environmental improvement initiatives in the organization's overall community benefit communication strategy demonstrates commitment to improving the environment and community health.
Since the health of the community's environment is relevant to community residents, the message can both educate readers on the connection between environmental risk factors, lifestyle and poor health, and offer residents ways to help and get involved. Within the health care organization, communication can help make the connection between environmental improvement and quality of care. Communicating opportunities for employees and physicians to become involved contributes to enhancing an environmental sustainability culture.
There is a growing recognition that the current acute care model is not addressing the social and environmental conditions that are creating the epidemic of chronic disease in America. The imperative to conduct community needs assessments and to align community benefit programming with those needs create an unprecedented opportunity to address the root cause of many community health problems and to improve community health.
A copy of "Healing Communities and the Environment Opportunities for Community Benefit
Programs" can be downloaded from www.chausa.org/environment/resources/environmental-
responsibility-resources.
PATSY MATHENY is a community benefit consultant with Patsy Matheny LLC, Columbus, Ohio.
PAUL LIPKE is senior adviser, energy and buildings, Health Care Without Harm, Montague, Mass.
JULIE TROCCHIO is senior director, community benefit and continuing care, Catholic Health Association, Washington, D.C.
Copyright © 2013 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.