Community Risk Profiles:

Summary

Synopsis

Compartmentalized bureaucratic structures have obstructed the integration of understanding and management of the numerous elements that contribute to public health and environmental quality. This lack of integration has also prevented joint consideration of issues at the interface of health and environment. To meet the health and environmental needs of a large and diverse population in dissimilar circumstances calls for addressing them where they connect, at the community level.

We define a Community Risk Profile (CRP) as a resource, continuously updated with new data, that makes conveniently available to a range of users the spectrum of information that characterizes the environmental and health status of a community. The CRP offers a vehicle for understanding and acting upon the spectrum of local health and environmental concerns. It is both a management information system and the process that creates it. In general, CRPs should aim toward comprehensiveness, consistency, and integration in assembling and analyzing data on health and environmental risks at the local level.

New information technologies can handle large quantities of environmental, health, and demographic data efficiently and thus offer greater analytic power for researchers and improved access to knowledge and services for communities. Antecedent efforts at creating CRPs reveal the scarcity of adequate and accurate data at the community level and emphasize the need to improve the knowledge base to interpret them. A case study of Allegheny County, Pennsylvania, demonstrates the possibility--as well as the difficulty--of developing CRPs given the current availability of data at the local level.

Participation of community representatives and stakeholders provides local knowledge and is essential for sound and credible CRPs. A case study of Silicon Valley, California, demonstrates the importance of community participation and offers a framework for community participation in the development of CRPs.

Federal, state, and local governments have shown interest over the last decade in comparative risk assessment at finer spatial scales. CRPs build on experience in comparative risk assessment but avoid the divisive and sometimes questionable emphasis it places on ranking risks. Government can advance the development and utility of CRPs through policy levers that promote an integrated view of risks, encourage and facilitate more local analysis, and enhance local authority for reducing risk.

By enabling communities to understand better the problems facing them, CRPs can help provide more cost effective services to satisfy local needs. To clarify their problems and promise, and to spur their establishment as a standard practice and their subsequent diffusion, we recommend the development of four to six thorough and ambitious experimental community risk profiles in diverse locations in the United States.

SUMMARY REPORT

COMMUNITY RISK PROFILES

Each [bureaucracy and committee] views my city through a soda straw. They only look at one thing at a time, for instance, underground storage tanks, or stormwater runoff, drinking water, trucker safety. . . . No one considers the cumulative effect at the local level. . . ." --Gregory S. Lashutka, Mayor, Columbus, Ohio

ENVIRONMENT AND COMMUNITY HEALTH:
PROBLEM STATEMENT

"The patient is the only generalist in a hospital," it is often said. Our guts and limbs, skin and bones, and nerves all connect, often painfully, as the parade of physicians perform their specialized tasks. Health care at the level of the

community is often as fragmented as for the individual. Heart disease, cancer, infectious disease, injuries, aging--each invokes a separate world of experts.

As for health, so for environment. An individual breathes, drinks, eats, gardens. Human exposures to environmental pollutants integrate within and across air, water, food, and soil. And, the rain that falls through the local sky fills the community streams and suffuses its earth. Yet, for the most part we study and manage environmental risks as if they existed in independent, parallel universes. Moreover, although environment and health intersect in the actual life of the individual and community, the organizations that understand and provide environmental and health services rarely mesh.

In this compartmentalized context, society loses its ability to appreciate the interactions of problems, their cumulative effects, and how they compare. Not surprisingly, we find it hard to act efficiently and fairly upon the common roots of environmental and health problems in lifestyle and behavior. Indeed, we find it hard even to know what we should do, and we find local resistance against the strategies and priorities that flow out from the political center through numerous well-insulated channels.

Federal jurisdiction over sources of ionizing radiation provides an example. Congress assigned setting of environmental radiation standards to the U.S. Environmental Protection Agency (EPA) at its inception. Health care facilities dealing with ionizing radiation are administered by the Department of Defense (DOD), the Veterans Administration, and the Department of Health and Human Services, although the Nuclear Regulatory Commission (NRC) licenses radioisotopes for medical applications and the Food and Drug Administration (FDA) for radiation-related medical devices. The NRC, Department of Transportation, and Postal Service oversee transport of radioactive materials. Finally, the FDA, NRC, and Consumer Product Safety Commission share control of consumer products that are sources of ionizing radiation. A further cadre of agencies govern occupational exposures.

This highly organized yet unwieldy situation does not result from ill will. Rather, it comes from decades of well-meaning efforts, and considerable success, at controlling one problem at a time. However, achieving further advances, especially cost effectively, in reducing mortality and morbidity and improving other measures of health and environmental quality will require new strategies that can address the more subtle, intricate, and interlinked problems that face us.

A brief history of the EPA and its functions illustrates the problematic evolution. In 1970, an executive branch reorganization created the EPA with the authority to regulate air and water quality, radiation, pesticides, and solid- waste disposal. In the decade of its birth, a series of legislative acts set down the laws for EPA to enforce. These include the Clean Air Act (CAA, 1970), Water Pollution Control Act (1972), Federal Insecticide, Fungicide, and Rodenticide Act (FIFRA, 1972), Safe Drinking Water Act (SDWA, 1974), Resource Conservation and Recovery Act (RCRA, 1976), Toxic Substances Control Act (TSCA, 1976), Clean Water Act (CWA, 1977), and Comprehensive Environmental Response Compensation and Liability Act (CERCLA or "Superfund," 1980). From its inception, EPA approached solving problems primarily by individual environmental media (1). The decade of intense legislative activity reinforced the previous isolation of problems by emphasizing a regulatory structure focused on individual problems while neglecting more integrated views.

Legislation protecting water and air quality illustrates the state of affairs. By focusing on a short list of National Ambient Air Quality Standards (NAAQS), CAA effectively excluded certain hazardous air pollutants from consideration (2). Only the presence of associated nitrogen oxide and particulate discharges constrained emission of these pollutants by hazardous waste incinerators.+ In the area of water quality, even the complex federal regulatory framework does not comprehensively deal with groundwater contamination. SDWA covers only aquifers supplying public water systems. RCRA and CERCLA protect only groundwater affected by waste disposal facilities, and CWA addresses only nonpoint discharges to groundwater. For a community, to whose members groundwater appears a single resource, the result is confusing and often costly and ineffective water management.

From addressing the blatant sources of air and water pollution in the 1970s, the EPA shifted focus in the 1980s to toxic pollutants, primarily cancer-causing chemicals. Accompanying this shift was the popularizing of "risk assessment" as a tool to inform decision-making in environmental policy. According to former EPA administrator William Ruckelshaus, risk assessment is "the scientific evaluation of the human health impacts posed by a particular substance or mixture of substances," and more generally, "the quantitative approach to analyzing environmental problems."

Besides encouraging greater objectivity about individual risks, the risk assessment process appeared to offer a common currency for evaluating environmental hazards in its expanded form, "comparative" risk assessment. Effort went into ranking risks according to several criteria, including carcinogenicity, and assigning budget priorities according to "worst risks first." The EPA and its Science Advisory Board authored two landmark studies on risk at the national level, Unfinished Business: A Comparative Assessment of Environmental Problems (1987) and Reducing Risks: Setting Priorities and Strategies for Environmental Protection (1990).

The attempt at rationalizing risk did not bring consensus about the seriousness of the risks themselves or how to act. Controversy raged about methods and interpretations of results and whether rankings should serve to set priorities. The debate still rages. But, by the early 1990s, experiments using comparative risk assessment to measure environmental hazards became widespread.

In public health, efforts to identify national priorities have a long tradition. The problem is that at the national level either the priorities tend to be general or the list of priorities lengthy. In 1980 the U.S. Public Health Service report Promoting Health, Preventing Disease: Objectives for the Nation detailed numerous national health objectives. The 1990 sequel, Healthy People 2000, emphasized broad goals of increasing the span of healthy life, reducing health disparities among sub-populations, and improving access to preventive services for all Americans. In all, it listed 22 priority areas, encompassing over 500 objectives and sub-objectives defined to measure progress toward the goals. Priorities were established in nutrition, clinical preventive services, drug abuse, immunization, and family planning.

Environmental health was also one of the priorities. However, the report employed a rather narrow definition of environmental health, dwelling on public exposure to toxic chemicals, and was perhaps misleading in suggesting that environmental effects on health are limited to chemical exposures that are easily isolated.

The sameness of our basic biology makes health care amenable to common goals for a variety of populations. Nonetheless, the actual conditions experienced by populations differ dramatically, and even where outcomes may be similar the paths to meet public health goals may need to be as diverse as the communities for which they are meant. What is new in the past decade in public health is the emphasis on how national strategies can be realized at the local level. The federal government has tried to help communities tailor their programs to meet federal standards by directly providing tools for local planning. However, in general, the public sector at the state level echoes the federal compartmentalization.

The private sector has its own partitions. For example, in universities and other research institutions, academic disciplines and subdisciplines have proliferated. Many study environment and health, but they talk little with one another and rarely develop joint views. Indeed, dependency on funding from federal agencies and subagencies each with its particular mission has tended to create within the research community a pattern of organized isolation.

American reality is a range of landscapes and ecosystems overlain with a social structure varied in history, culture, population density, income, age, and occupations. Inevitably, the environmental and health problems that face communities differ. In older cities such as Pittsburgh, lead paint flakes in the aging housing stock pose risk to children who ingest them. In western states such as Colorado, mining wastes contaminate water supplies and disturb local ecosystems through acid runoff. In sparsely populated New Mexico, isolated communities lack timely access to health care. In the smog-ridden Los Angeles Basin, urgency attaches to achieving mobility without emissions.

Yet, specialization has produced analytic frameworks for forming policies and regulatory structures for implementing them that appear insensitive to the needs of actual individuals and communities who possess a host of concerns not so neatly defined as the duties of our hierarchical organizations. From an administrative standpoint, the effect of specialization has been growing legislative mandates to state and local governments that often go unfunded due to budgetary pressures. States and localities struggle to comply with these mandates, but rarely do they have credible alternatives for deciding how to spend scarce resources.

COMMUNITY RISK PROFILES: A PROMISING WAY FORWARD

Communities provide the smallest political unit in society responsible for defusing political conflicts and capable of meting out solutions to local problems. They also provide a reference point for defining the needs of the individuals included within them and determining sound use of resources to meet those needs. Geography usually defines community but other factors can distinguish a community as well. Economic status, ethnicity, language, and reliance on common resources are among the other characteristics that may be used for definition.

Understanding better the health and environmental characteristics and needs of communities can surely lower the obstacles to improving their welfare. Yet, if we consider the information about environment and health available to community service providers about their communities, the reality is shocking. In contrast, consider the information immediately available to a bank teller or customer about financial transactions. Consider the information immediately available to a travel agent or a user of on-line travel information services. Then think of the access to information on health and environment of a local public manager, or health care worker, or community group, or entrepreneur. The reality is a morass of federal, state, and local data covering inconsistently defined geographical areas, often available only two or three years after the fact, not all on-line, and hardly ever cross-referenced.

We define a Community Risk Profile as a resource, continuously updated with new data, that makes conveniently available to a range of users the spectrum of information that characterizes the environmental and health status of a community. A CRP is both a management information system and the process that creates it. The topics a CRP encompasses will vary by locality. In general, CRPs should aim toward comprehensiveness, consistency, and integration in assembling and analyzing data on environmental and health risks at the local level.

Unlike comparative risk assessment, a CRP does not rank risks. Although useful for comparing issues and suggesting possible interventions, a CRP would be developed with a more fundamental objective in mind. As an information base, it provides means for a variety of individuals and groups concerned with the needs of a community to help determine how best to serve them. The purpose is not restricted to giving a one-time evaluation of a particular location; a CRP is not a one-time study. It requires creating an active database, and a management system to access and analyze its contents. A CRP should thus establish the continuing context for informing public managers, community groups, and private citizens in evaluating local situations and making decisions. A CRP can help reveal spatial correlations between problems, "hot spots" of greatest need in environment and health, and opportunities to deliver services in a more concentrated and effective way. It can also reveal inefficient allocations of resources and discrepancies between community needs and the national and state programs serving them. A CRP should enhance the skill, timeliness, and productivity of community service providers.

Determining the content of a CRP is, however, not a simple matter. To achieve credibility and acceptance, a CRP must be the product of community effort. There will be considerable public disagreement about what should be included and how. Experts will disagree with one another. Experts will disagree with the general public. A central benefit of the development of a CRP is that it creates a forum for social learning about environmental and health risks.

In the remainder of this report, we look at antecedent efforts bearing on the creation of CRPs, their potential for helping a community come to grips with its problems, and blocks to their widespread use.

ANTECEDENT STUDIES

In this section, we survey past and current efforts in the United States to perform comparative risk assessments and other risk studies akin to risk profiles. Risk studies geographically limited to municipal or other local boundaries have a thin history. More activity has occurred at the state level. The efforts vary in their aims, breadth, and impact. Yet, collectively they document a movement toward more localized, geographically-based understanding and management of risks. The surfacing of similar concerns in disparate projects helps identify features deserving attention in developing CRPs. Quantitative risk assessment was introduced as a tool for environmental management in the 1970s and diffused widely in the 1980s. Many early assessments addressed health, safety, and environmental risks of nuclear energy and in turn compared nuclear energy with other forms of energy supply. Energy risks were in turn compared with non-energy risks such as tobacco smoke and driving without a seatbelt. Because energy systems tend to have a national and global character, the assessments tended to be national and global in scope, although risks were often measured in terms of the probability of death to the individual.

Studies also addressed risk perception, risk acceptance, and distribution of risks, especially between rich and poor. At the conclusion of Unfinished Business, the EPA's first attempt at a comprehensive national environmental risk assessment, the Agency expressed concerns about the relevance, perceived or otherwise, of the report to the communities potentially affected by its findings. This observation was partly responsible for EPA's subsequent interest in more local assessments.

The report also noted that expert evaluation contrasted with a parallel listing and ranking of environmental problems based on a public survey conducted by the Roper Organization. The risk posed by hazardous waste sites exemplifies the disparity between expert and public rankings of environmental hazards. Experts regarded this top public concern (fueled by disturbing images of hazardous waste sites at Love Canal and Times Beach) as a fairly low national priority. High levels of funding in recent EPA budgets for the Superfund program to clean up hazardous sites show how government eventually responded to this divergence of opinion. Air pollution, ranked first by the experts, placed a still prominent fourth in the public poll but was followed by oil spills, a very low listing for the experts. Near its conclusion, the EPA report quietly observed, "National rankings do not necessarily reflect local situations-local analyses are needed." On the one hand, local concern about a particular issue, such as spilt oil, may differ significantly from national concerns. On the other hand, local understanding of the set of issues may incorporate quite different information from more macroscopic assessments. Of course, a parochial view can also be poorly informed.

The difficulties of the EPA, Department of Energy (DOE), and DOD in implementing policies at the local level on such issues as incineration, landfills, and hazardous waste cleanup increase appreciation that risk studies should involve the public in the assessment process and that local analyses offer a promising means for articulating environmental needs.

In fact, national interest in local risk predates the release of Unfinished Business. In the early 1980s, EPA financed experimental risk studies in Philadelphia, Baltimore, and Santa Clara Valley. The studies emphasized methods for determining the worst environmental assaults facing the areas. Local residents wore radiation badges and other devices to assess exposures, but in general the process of assessment involved little community participation. The studies did not achieve widespread local acceptance and, in the case of Santa Clara, met with some hostility and ridicule. Beginning about 1990, EPA initiated a new round of risk assessment projects on the regional, then the state, and eventually the local level (3). The EPA has gradually inclined to a more geographic or "place-based" approach to risk assessment rather than by media such as air and water. The newer studies also emphasize community involvement. With assistance and stimulation from the Office of Strategic Planning and Environmental Data (Regional and State Planning Branch) and regional comparative risk centers established in Vermont and Colorado, at least seven states have completed or made substantial progress in conducting state risk assessments in recent years. More are underway.

To date, the Washington state study released in 1990 has had the greatest impact in stimulating environmental legislation and effecting changes in the budget of the state. The project was characterized by broad scope and public participation. The study participants included the leaders of 19 state agencies and representatives of two federal agencies as well as a Technical Committee composed of 26 state employees and several outside consultants. A Public Advisory Committee of 34 citizens, representing a range of public interest groups and occupations, reviewed the technical reports and ranked the problems listed in conjunction with the state legislature. Following the review, town meetings were held across the state to discuss the findings. The final product of the project not only listed the problems and their rankings but outlined possible action strategies and included a summary of the public attitudes toward the contents of the report. As a result of the report, eight new pieces of environmental legislation were enacted and $23 million dollars were either newly appropriated or reallocated pursuant to the report's recommendations. Links between previously isolated state agencies were established. Additional successes of the project included better understanding of environmental issues among the many individuals and groups that contributed to the report development and the identification of benchmarks to measure progress in the state's environmental quality.

The Colorado study (CE2000), also released in 1990, was originally structured around a technical group consisting mostly of government employees and a public committee. In the initial stages, the technical group included representatives from the Department of Health as well as the Department of Natural Resources. As the study unfolded, its nontechnical component, the Public Advisory Committee (later renamed the Citizens Action Council), never crystallized. The citizen group and the Technical Committee worked essentially independently of one another. The lack of interaction was in large part responsible for the minor impact CE2000 had on Colorado, according to the Northeast Center for Comparative Risk. One encouraging action (and possible precedent) did result from the development of CE2000. Approximately five percent of EPA funding to Colorado has been redirected to reducing some of the risks identified in the report.

The Louisiana venture, still ongoing, is significant for bringing together environmental groups and representatives of the petrochemical industry. Time will tell whether the process of working together toward the shared goal of a sound assessment of risk at the state level will lead to substantially increased mutual understanding as well as a useful product. The Michigan report stands out as the only state project conceived and driven by academic scientists rather than state government employees. The products of the study were directed to the Governor's office and high-ranking state officials. The top-down research approach relied on generating public consensus at the final stages of development rather than including public participation throughout. The success of this project remains to be seen and will provide a control case for projects that stress public participation as an essential feature of state comparative risk assessment.

The Vermont study design included representatives from a host of state agencies and initially stressed public involvement. Although the project was considered successful in improving understanding of the state's environmental needs, it fell short on conveying information to and from the public and effecting change at the political level. One criticism of the study was that the public participants were weighted too heavily toward an environmentalist agenda. The Vermont experience suggests the difficulty in finding individuals willing to participate in what can be a demanding process with little or no financial compensation who are informed on environmental or health issues and yet provide a balanced picture of the views and concerns of the community.

The authors of the recently released California study consider it to be ground breaking in better incorporating considerations of economics, environmental justice, education, and pollution prevention in its analysis and findings. Public participation was stressed throughout by way of the Statewide Community Advisory Committee. The effect of the study on state environmental policy remains to be seen. The expansive framework used in the study has generated controversy, with some observers praising its comprehensiveness and others criticizing the reliance on criteria such as "social welfare" and "peace of mind." The report may help define the appropriate balance between the qualitative judgement needed to make risk assessment relevant for most people and the quantitative precision that motivates much risk assessment in the first place.

At the municipal level, EPA-sponsored comparative risk projects are underway in Atlanta, Georgia; Jackson, Mississippi; Cleveland, Ohio; Houston, Texas; Charlottesville, Virginia; Elizabeth River, Virginia; Allegheny County, Pennsylvania; and Guam. Like the state projects, local programs range widely in design and the concerns they address. Some have broadened their scope to include issues (such as crime) outside the traditional definitions of environment and health. The Atlanta study is part of the larger Atlanta Project preparing that city to host the 1996 Olympic games. In 1994, Columbus, Ohio, began a two-year community-wide program of environmental risk assessment. The city formed a committee of both technical experts and members of the general public to identify risks, rank them in order of severity, and determine a comprehensive strategy to address them.

The federal government has a large degree of control over environmental funding and programs within states. Similarly, state laws, agencies, and policies often control local environmental and health budgets. The inability to effect required changes outside their local jurisdictions complicate and constrain risk assessments conducted by municipalities. The experience of the city of Seattle shows how the context must be considered at the outset. Seattle, which produced an acclaimed comparative risk assessment study in 1991, declared early in the process that the recommendations addressed only those risks for which the authority of local government mattered strongly. Local risk assessment must consider not only state and municipal authority but also water and school districts, county government, and other boundaries and jurisdictions.

All the antecedents mentioned so far are comparative risk assessments and none was conceived as an ongoing management tool rather than a one-time study.

Environmental cleanup efforts at federal facilities also offer lessons for the development of CRPs. Such efforts demand a concerted effort on the part of government and the community to make environmental decisions. Both the DOD and DOE have endeavored to include "stakeholders" from the community in their efforts to identify and remediate risks from contaminated sites. Moffett Field in Santa Clara County, California, and the DOE's Hanford facility in Washington state are prominent examples of the attempt to include input from the surrounding community in cleanup operations.

In the public health sphere, several recent efforts help define appropriate local goals and standards in a national context. The 1991 American Public Health Association guidebook, Healthy Communities 2000: Model Standard, helps communities meet national objectives at the local level. In the same spirit, the Centers for Disease Control and Prevention (CDC) in association with the National Association of County and City Health Officials (NACCHO) and other national public health organizations developed the Assessment Protocol for Excellence in Public Health (APEX/PH) to help local health departments improve their own organizations and implement national public health objectives. Although APEX/PH was developed to help localities, it has been tested at the state level in Michigan, Kansas, and Illinois.

The CDC also developed the Planned Approach to Community Health (PATCH) model to assist community health organizations to develop comprehensive health promotion programs tailored to community needs. PATCH encourages communities to document, for example, the number and percentage of deaths and years of potential life lost by major disease and injury categories. PATCH seeks strong local support and participation, with community members recommending goals using the local health data, ranking health problems and setting objectives, and evaluating programs. PATCH has been implemented in local health departments in 46 states. The impact on incidence of disease and mortality will not be known for a long time, but PATCH should visibly help at an early point to ensure a network of trained health professionals and communities prepared to make effective interventions.

Because of limited resources for the overall PATCH effort, persons with little or no experience and marginal interest often carry out the data collection. Moreover, resources spent on data collection cannot be used to implement the program. PATCH already makes clear that communities need better systems that can routinely and efficiently gather data relevant to the status of health promotion. Such systems would help establish standard databases and enable collection of comparable small-area data across divergent populations.

The rising share of health care costs borne by the states has caused many to seek approaches to contain costs. The state of Oregon has pioneered efforts at the state level to rationalize health care provision for individuals, cutting across traditional health care specialties. Under the Oregon plan, 709 medical procedures were ranked according to costs and benefits. Those items falling below item 587 would no longer be covered by state-funded Medicaid programs. Preventive treatments such as childhood vaccinations and prenatal care exemplify treatments that received high rankings. More exotic treatments such as strenuous AIDS therapies for patients with less than six months to live and liver transplants for unrepentant alcoholics received low rankings. Some treatments received low rankings not due to their relative contribution to quality of life, but because of a history of clinical ineffectiveness. The Bush administration rejected the Oregon approach because it appeared biased against certain groups, notably persons with disabilities. Despite its current questionable status, the Oregon plan opened the Pandora's box containing the issue of heath care rationing and stimulated much debate about medical ethics and social justice in relation to community choice.

Compartmentalization, specialization, expense, and other factors are creating problems in environment and health and a widening search for ways to achieve better outcomes. Current pressure from states for receiving a larger fraction of federal expenditures in the form of block grants indicates the scope of concern and the heterogeneity of conditions that exist. But it is also clear that the articulation of local needs and the information base to enable ongoing implementation of programs at the community level are weak. Many communities lack a politically acceptable yet scientific system to express what their needs are.

CONTRASTING CASES: PITTSBURGH AND SILICON VALLEY

In this section, we summarize two contrasting case studies to understand better the content of a sound and useful Community Risk Profile and the process for achieving it. The study of the city of Pittsburgh and the surrounding area of Allegheny County, Pennsylvania (pages 35-62), illustrates the challenge, opportunities, tools for technical analysis, and the environmental and health issues that might be illuminated by a CRP. The study of Silicon Valley, California (pages 63-79), suggests ways to develop a CRP that will be credible and widely accepted.

Researchers at RFF, an environmental research institute in Washington DC, developed and carried out the Pittsburgh study with local collaborators. The initial plan was to study comprehensively the environmental hazards within the geographical limits of the city of Pittsburgh. Use of a personal computer*-based GIS formed an innovative element of the plan. The spatial dimensions of risk were taken very seriously, with large amounts of information mapped onto the city. The main question to be explored was the distribution of environmental risks among poor and minority populations. Attempts to implement the initial plan revealed several constraints. To represent accurately the local situation, existing geographical data needed extensive refinement. The difficulty of obtaining the relevant demographic data consistent with the spatial grid also became clear. Confining the study to Pittsburgh proved to be a rather contrived choice, because the city boundaries do not naturally isolate the surrounding population. In addition, the researchers found more complete demographic data at the county level. Thus, the study group decided to look at all of Allegheny County.

The difficulties of a comprehensive environmental review also quickly emerged. The analysis in such a broad study would necessarily be shallow, given the time and resources available. A narrower focus would permit greater analytic depth. The study organizers chose the latter, limiting their concern to chronic or acute exposures to airborne toxic and hazardous substances.

To represent sources of chronic risk, the group identified all the Toxics Release Inventory (TRI) facilities in the county, whereas all storage facilities for EPA-designated Extremely Hazardous Substances served as the proxy for acute risks. The two types of facilities were mapped separately into the GIS. In practice, locating the facilities on the electronic grid proved laborious, ultimately requiring direct communication with each facility. The researchers then analyzed the composition of the population within a half-mile radius of each facility for its ethnic and economic makeup and compared it with that of the general population elsewhere in the county.

For chronic hazards, minorities formed 15 percent of the population inside the circles compared with 12 percent in the area outside. Poor residents accounted for 16 percent of the total inside and 11 percent outside. The findings were similar for the case of acute hazards. Adjusting for the day and night populations in the area, the study found that the resident proportion of poor and minority populations was actually smaller within the affected area than outside.

The main point of the case study is not these results but rather the feasibility of the analysis and methodological issues it raised. Among the important questions raised for CRPs were as follows: Is proximity alone a good indicator? If so, what radius should be used? How sensitive are results to assumptions about spatial vulnerability to exposure? What databases would be useful for the analysis but are currently unavailable? How could existing databases be improved? Even given meticulous handling, are the initial data reliable? What are the best local indicators of environmental risk? How can cumulative or interacting risks be represented? Notwithstanding its preliminary character, the Allegheny County study shows the potential power of new information technologies for assembling and analyzing information about community risk.

The Silicon Valley case study concerns the deliberative processes that bring to bear local knowledge and sentiment, and contribute to greater legitimacy and acceptance for a CRP. The Pacific Studies Center, a community-based organization in Santa Clara County, prepared the study. The Santa Clara Valley, once renowned for orchard crops, is now known for Apple Computers and other high-tech industry, which has grown rapidly in the past two decades. The population of the Valley is ethnically diverse and boasts a higher than average education. Minority groups with incomes lower than the average population comprise the majority of production workers in the manufacturing enterprises that dot the Valley and supply the hardware for the data industry. The absence of traditional "smokestack" industries led many to believe that the risks posed by environmental hazards would not be very consequential.

Initially, the environmental alarm bells rang as a result of health concerns voiced by production workers. Seepage from a nearby semiconductor manufacturing plant in San Jose contaminated a well used for local water supply. Neighbor and worker complaints about plant operations eventually led to a shutdown of the plant. State-run epidemiological studies tentatively indicated a relationship between the relatively high rate of birth defects and miscarriages in the area and the activities of the plant. As local interest coalesced into general public concern, the more affluent and better-educated sectors of the population took up the issue, presaging the widespread, high environmental awareness that now characterizes the Valley.

The Santa Clara Center on Occupational Safety and Health, formed in 1977, provided the first community voice for environmental concerns. Increased participation by organized labor and the environmental community led in 1982 to the formation of the Silicon Valley Toxics Coalition. These community-based groups, which often opposed government and disagreed with the expert scientific establishment, have proven effective in publicizing risks and organizing efforts to reduce them.

The government has increasingly recognized and accepted the crucial role of community organizations. The clean-up of Moffett Field provides an example of their constructive engagement. A military base located in the heart of the Valley, Moffett Field was slated for environmental cleanup operations by DOD prior to its conversion to new uses. The Moffett Technical Review Committee established by DOD included representatives from each constituency that would be affected by its findings. The Committee's success owed in part to the public confidence generated by an open and inclusive process.

The successful experience with Moffett and other projects involving community participation suggests a two-dimensional matrix for communities considering drawing risk profiles. One dimension of the matrix is the risks to be considered; these must be agreed by the participants (a sample list is provided on page 71). Of course, some environmental concerns, such as acid rain, are regional and others are global. Depending on the community, these larger scale concerns might also figure in CRPs.

The other dimension of the matrix includes the information essential for assessment, for example, geographical range, economic impact on local communities, quality of life considerations, jurisdictional issues, and the cost of cleanup. Such a matrix or protocol is not unusual in formal risk assessment but emphasizes the spatial nature of many risks and the needs of the communities affected. The matrix is also open to the addition of new ideas and the accumulation of information through time. If promptly filled and maintained, it is an information and management resource enabling a range of insights and actions.

Of course, one can argue that a process that works in Silicon Valley may not apply to the Rio Grande Valley or old industrial towns of the Northeast. In the next two sections, we seek to expand on the generic substantive and procedural challenges to effective CRPs.

IMPLEMENTING COMMUNITY RISK PROFILES: TECHNICAL ISSUES

Implementing sound community risk profiles will require an array of methods, facilitating technologies, and data. Empirical data as well as model-based estimates have been used for diagnosing local risks. Here, we touch on a few major challenges, with an emphasis on data.

The availability and reliability of data both challenge and constrain. From Queens, New York, to Allegheny County, Pennsylvania, to Silicon Valley, California, the citadel of the data industry, community-level databases are nonexistent or inadequate. Environmental data at the national level are often too aggregated to use, and local databases, if available, generally offer an ill-matching patchwork of information. CRPs require both better organized data collection and better database managements systems to become a reality. Much local information is not yet digitized nor readily accessible if it is. At the same time, some data are wastefully entered over and over in slightly different formats, but the data structures do not allow efficient searching for, or combining of, information.

Methods for managing and analyzing large volumes of data are crucial factors. As shown by the Allegheny County case study, geographical information systems offer enormous potential. These systems can, for example, overlay demographic data on data about health, emissions, and locations of industrial facilities. National geographic databases [such as the Topographically Integrated Geographical Encoding & Reference (TIGER) files] and the Census of Population's summary files can now be accessed quite easily and provide local detail.

Spatial boundaries and resolution are of course major issues, directly related to the question of what defines a community (see pages 52*-62). Community-level studies have typically been determined by census tracts, primarily due to their availability. These tracts are artificial from the standpoints of environment and health. GIS offers flexibility in this regard. GIS can integrate data from satellite maps whose logical boundaries may be physical terrain or population density with meteorological models that, for example, analyze paths of air emissions. Information on hydrology and groundwater can also be integrated. Thus, definitions of "community" can be reasonably organic and complete and keyed to particular issues.

Underlying the availability of data and suitable data structures is the accuracy of the data itself. "Dirty" or unreliable data are one of the banes of risk assessment. For some questions, data may simply not have been collected, or collected for the needed area, or for a long enough time.

Time matters equally as space. Knowing whether the toxics in question are released in a short period posing a possible acute danger to neighboring communities or whether they are released gradually implying chronic effects is essential to understanding and eventually reducing their risk. Annual data do not contain this information. Chronic environmental effects require long-term studies to determine properly their influence on health.

Time implies also that money matters. A Harvard University air pollution study considered data gathered over a 16 year period using over 8,000 subjects to analyze relations reasonably definitively between urban air pollution and mortality in six U.S. cities. The Harvard researchers concluded that fine-particulate air pollution does contribute to excess mortality in the U.S. cities studied. However, they cautioned that they could not exclude other contributing risk factors unequivocally. Such studies require stable funding over many years, which is rarely available, especially at the community level.

Time and space combine. Not only risks migrate in time, but the people exposed to them also migrate. The population of a community by day is not necessarily the same as by night. Similarly, in America's highly mobile society, the residents of communities change as people migrate from place to place even seasonally.

Choosing and isolating environmental and health indicators are further challenges. For example, simple proximity to storage facilities is often insufficient. Groundwater can flow in sharply divided patterns, depending on subterranean geology unrelated to surface boundaries. Airborne transport of pollutants can span entire regions and even cross national borders. We know little about actual human exposure to most environmental hazards. CRPs need to reflect people's actual behavior. For example, people spend most of their time indoors (only approximately 1½ hours each day outside), but analyses rarely take into account actual daily time budgets.

Incompleteness of data is also an issue. For example, the TRI, the most comprehensive database on industrial chemical releases available, represents only a small fraction (5 percent) of the chemicals used in industry and is almost entirely self-reported. The qualifications that must be applied to many environmental and health databases combine with accessibility to generate worries that the information will be either used naively, leading to inaccurate results, or exploited to advance narrow policy agendas.

In turn, interpreting juxtapositions of possible cause-and-effect depends on knowledge of exposure pathways, the etiology of disease, and epidemiological methods. Uncertainty remains throughout and must be communicated honestly. We can try to distinguish better the known from both the unknown and the unknowable.

Notwithstanding the many difficulties to which we have referred, we conclude that a great opportunity exists. The current environmental and health information resources available to communities are so poor that a substantial enrichment seems almost sure to result from a focused effort. Again, we stress that a CRP is not a one-time study but a management information system that can flexibly grow, accommodating new and better information as it becomes available and indeed helping communities to recognize and articulate their needs.

IMPLEMENTING COMMUNITY RISK PROFILES: PROCEDURAL ISSUES

No single formula will likely succeed for development and maintenance of risk profiles in all communities. Here, we mention four important dimensions of the process. First, the individuals and groups who are the stakeholders in the community need to determine appropriate means for representing themselves. Communities and their sub-populations are sometimes ill-defined entities. Their amorphous and overlapping nature can make it hard for them to offer clear and coherent voices. In any case, consideration needs to be given to several ways in which a community defines itself, for example, by income level, ethnicity, and proximity to factories and military facilities. Some affected groups may lack the educational and organizational base necessary to represent themselves effectively in a technical process without some assistance. In addition to community groups, other possible participants include representatives from local industry, labor, and environmental groups. The potential "end-users" of the Community Risk Profile, which can include both public (governmental) and private (nonprofit and for-profit) groups must participate in the design of the CRP from the outset, assuring relevance to customers.

Second, the responsibilities for developing and maintaining the CRP must be agreed and assigned. Authority, funding, and accountability must be established. Over the long term, maintaining a CRP could logically prove to be a governmental function, as much of the data will likely come from governmental sources and government will be a major user. However, the flexibility of nongovernmental groups, including universities, think-tanks, and community-based organizations, might prove them effective in the initial experimental design and development of a CRP. In the cities where the EPA now sponsors comparative risk assessment, nongovernmental organizations play major roles, for example, the Houston Area Research Council and Case Western University in Cleveland. Some cities have independent sector entities that might capably take the job on a continuing basis. For-profit entities could also play an active role, inasmuch as they directly benefit from better community information and enhance their credibility within the local community by participating. A CRP could prove to be an economically self-sustainable information service. In all cases, issues of access and financing (including use fees) would need to be faced.

Third, the range of risks to be addressed must be delineated in a serious, thoughtful, participatory way. The selection of risks considered is itself a crucial step in profiling a community. It provides a good way to initiate and check mechanisms for public feedback in the entire risk profiling process. Communities are faced with risks ranging from dirty smokestacks to earthquakes to poverty. If the process of developing a CRP is open to the public, hardly any issue regarded as important by the public may be ruled out a priori from consideration. Although researchers may have preconceptions about what belongs in a CRP of environment and health, the community's own conception must weigh heavily. The city of Jackson, Mississippi, included crime in the list of risks to be addressed in an EPA-sponsored program.

Fourth, a wide range of professional abilities should be brought to bear. Civil and environmental engineers, geographers, physicians, epidemiologists, biologists, chemists, meteorologists, economists, information scientists, and community organizers all contribute. Practical decisions will need to be made to keep the CRP from being a vast, inachievable, and inaffordable dream. However, from the outset a strong effort should be made to integrate diverse disciplinary and professional perspectives in the design. The central goal, after all, is a utility that helps overcome problems of segmentation and specialization.

VISION AND RECOMMENDATION

Electronic networks already cheaply offer community service providers instant access to information. An example of public access to environmental data is the Right To Know Network (RTKNET). Established in 1989 by "OMB Watch," a group that tracks decisions of the White House Office of Management and Budget, RTKNET furnishes TRI and related data on-line and encourages communication about environmental issues among interested parties. The network has also sought to assist EPA's understanding of the environmental data needs of the public and ways for meeting those needs. Med-Line, Health, and the Bibliographic Abstract Service which provide access to the information resources of the National Library of Medicine, exemplify on-line access to current information in the health area.

Computer networks can also open new channels of communication between community professionals and the people they serve. United Neighborhood Houses of New York (UNH), an umbrella organization for the 37 settlement houses scattered throughout New York City, has embarked on an ambitious program to modernize these important community resources. By establishing an electronic network among the houses, the UNH project will improve information sharing between sites and allow records to be passed along and collected centrally as well. From the internal network a link to the Internet will provide access to the global network for the many individuals scattered throughout different sites. The increased capability benefits not only the professionals working for the Houses but the thousands of community members they serve as well, inviting the community to go "on line." Greater access alone is insufficient for improving the quality and effectiveness of community services. The available data must be relevant and applied appropriately. The human factor remains crucial.

"Community empowerment" is a consistent theme in American political culture. The CRP can both benefit from and contribute to this movement. Although rhetorically popular, the concept of federal (or state) block grants to localities, a symbol of empowerment, often meets with resistance in part due to the absence of coherent or convincing plans at the local level for allocating funds. Communities that have developed a CRP could be well prepared to respond to the question of distribution of blocks of funds. The EPA currently administers 18 separate programs of grants that are allocated to states and localities. Complaining about such fragmented and distant management is easy, but few communities in fact have alternative views that serve to integrate their concerns. The purpose of the CRP is to frame such views and improve and inform the local decision-making process.

The movement toward comparative risk assessment at the national level has usefully stimulated debate about the efficiency and equity of investment and regulation in environment and health. Comparative risk assessment has also mired analysts in controversy. Concern about the outcome of the ranking exercise often overwhelms other aspects of the process and relegates the information collected to the shelf.

The CRP retains and enhances the benefits of comparative risk assessment while finessing the question of which risk is worst. By being less goal-oriented, the CRP can provide a community with information resources sensitive to local concerns and suitable for multiple and continuing uses. For example, the CRP could be helpful in determining where to site community services or how to lower the risk posed to the population from a new industrial facility. In particular situations, it may be used to help a community reach consensus on risk priorities. But this is not the justification for its existence. It is a more general tool for both diagnosis and prognosis.

Moreover, the process of creating the CRP can itself be salutary. It can help a range of organizations and agencies normally concerned with narrow outcomes to understand the context of their work. By combining and evaluating a host of concerns, the CRP should raise appreciation of the general and collective interests of the community and place specialized concerns in perspective. By designing the CRP to be current and widely accessible on-line, it should diminish the isolation in which many groups and specialists operate.

The next step for judging and ultimately implementing CRPs is experimental practice. To clarify their problems and promise, and to spur their establishment as a standard practice and their subsequent diffusion, we recommend the conduct of four to six thorough and ambitious experimental community risk profiles in diverse locations in the United States. We believe four to six experiments would permit a reliable evaluation of the concept and costs with respect to communities that differ in culture, ready availability of data, and other factors. Also, this range would allow experimentation with respect to the lead performer in the conduct of the CRP. For example, in one community the local government might take the lead directly, while in others, the conduct of the CRP might center in a community group, a university, or a company.

The Community Risk Profile can be a practical means to achieve the reintegration of knowledge and services whose fragmentation has become increasingly problematic. The confluence of the development of risk assessment, new information technologies and networks, and community need makes it timely to try.

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END NOTES

1. The origins of the segmentation can be traced in some cases to legislation dating back to early in the century which was previously overseen by other federal departments such as Agriculture and Interior.

2. CAA, in fact did include requirements for EPA to establish standards for hazardous air pollutants, but these were never realized. The 1990 amendments to CAA contains more detailed language intended to correct this situation.

3. For more information on state comparative risk projects see State Comparative Risk Projects: A Force for Change, Northeast Center for Comparative Risk.