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PACE EH Post Project Assessment
of Quality of Life Changes
in a Florida Community Related
to Infrastructure Improvements
The Indian River county health department, environmen-
tal health division (IRCHD EH) in Florida implemented the
Protocol for Assessing Community Excellence in Environmental Health (PACE EH) in the
low-income community of West Wabasso, Florida. Over two and a half years, IRCHD EH
worked with the community and various governmental agencies to bring much-needed im-
provements to the area. At the end of the two and a half years, a survey was conducted to
discover if the residents’ quality of life had increased due to the community’s improvements.
The survey results yielded high satisfaction rates among residents. The general response was
that their feelings of safety and overall well-being-attributed to infrastructure improvements
in their community-had increased significantly. An unforeseen benefit realized by all parties
involved was a renewed trust in government. The majority of surveyed residents (91%) felt
that governmental agencies were better able to respond to their issues.
Redefining public health and urban planning is
an especially important issue in Florida, where
continued and unprecedented growth is adding
pressure to its schools, highways, water sup-
plies, communities, natural environments, and
open space. While urban planners work to sup-
port the community and infrastructural needs
of a growing population of over 18 million,
public health officials have worked to offset
rising healthcare costs and reported increases
in cases of asthma, obesity, diabetes, and men-
tal illness. An emerging movement focuses on
public health reengaging with its urban plan-
ning roots to highlight and understand the links
between land use and health. Public health of-
ficials and urban planners are responsible for
more than just ensuring that communities are
habitable; they need to ensure communities are
well designed, well built, attractive, and func-
tional for all people who live, work, learn, and
play in them (Frumkin, 2005).
Working from its historical involvement
in both land use and health through drink-
ing water protection and on-site sewage
oversight, the Florida Department of Health’s
division of environmental health began a
process in 2002 to adopt and use the Na-
tional Association of County and City Health
Official's (NACCHO) Protocol for Assess-
ing Community Excellence in Environmen-
tal Health (PACE EH) (NACCHO & CDC,
Laurel Harduar-Morano, M.P.H.
Julianne R. Price, R.S.
Daniel Parker, M.S.P.
Carina Blackmore, D.V.M., Ph.D.
2000). Results from the pilot projects sup-
ported a strong need to refocus public health
and assess the relationship to the built envi-
ronment. The process addressed community
needs not captured through divergent pro-
grammatic and funding structures of state
and local health and planning agencies.
In January 2004, Florida Department of
Health’s Indian River County Health Depart-
ment, environmental health division (IRCHD
EH) began implementing the PACE EH in the
community of West Wabasso (NACCHO &
CDC, 2000; NACCHO & CDC, 2002). This
neighborhood of approximately 350 low-in-
come minority residents is an island of pov-
erty located in a very affluent county. Prior to
implementation of PACE EH, Henry Stephens
of the Vero Beach Press Journal described the
community as “being off the beaten path,
where the roads are not paved, don’t even fol-
low grids, and instead meander among the
houses. There are no sidewalks or streetlights.
There are no county water connections, so
residents have wells, many of which flow with
rust-colored water (Stephens, 2004).”
As part of the PACE EH process, an en-
vironmental health assessment was con-
ducted in March and April 2004 by IRCHD
EH to discover what issues West Wabasso
residents identified within their community.
The results of the assessment, including all
quantitative and qualitative evidence regard-
ing community issues, the current status of
these issues, and suggested solutions were
presented to the residents. Over a series of
40 Volume 70 Number 10
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