Understanding the Community

The relationship you build with the community influences how much community members trust you and ultimately how they react to your public health messages and recommendations. To effectively engage with the community, you need to first understand the characteristics of your community.

Community Profile

An important first step is doing research to understand more about the community, including:

• Community demographics, leaders, and information sources
• Current contamination and contamination history
• Other organizations working on health and environmental issues in the community

Several tools in the ATSDR Communications Toolkit can guide you to developing a basic understanding of the community before you even visit, including the Community Data Worksheet [PDF – 64 KB] and the Rapid Community Assessment guide. Also see the types of community information to collect in the Getting Familiar with the Site section.

Research up front will help ensure you are able to start off relationships “on the right foot” when you do begin to reach out in the community.

Community Concerns

A good way to identify community concerns at your site is through using ATSDR’s Stakeholder Interview Guides [PDF – 73.9 KB]. You will summarize the findings of the community concerns in your documents (e.g., PHAs, HCs) and address the following:

• Community concerns including potential exposure and health effects expressed by the community.
• Actions ATSDR has taken to learn about the community’s health concerns.
• How community health concerns may relate to site-specific contaminants and exposure pathways.

Consider the following approaches when addressing community health concerns in your documents:

• If there are numerous community health concerns, provide information about common topics or issues where possible.
• If there are few community concerns received for a site, you can state that a small number of community concerns were found and then present the information by exposure pathway.
• Generally, provide information about a health-related concern even if the contaminant was not detected at the site or was present but was not found to pose a health hazard.
• If the health concern relates to a potential non-site-related source, note that the contaminant does not relate to the site ATSDR is investigating. When there is a high level of community concern about non-site-related sources, provide more detail about the issue and references to other agencies that may have more information.
• For non-health issues, such as environmental, property, or liability concerns, acknowledge the issues but explain they are beyond the scope of the document (e.g., PHA, HC). Consider directing the concern to an appropriate local, state, or federal agency.

Trust and Credibility

Every interaction ATSDR has with community members influences its relationship with the community. ATSDR should maximize opportunities to listen to community concerns and help community members better understand how ATSDR will address their concerns. This will help facilitate trust between the community and ATSDR. Trust lays the foundation for community cooperation during the PHA process and for the community’s willingness to accept your conclusions and respond to your recommendations. For all these reasons, building trust is essential to working with community members.

Cultural Sensitivity

In many communities, concerned or potentially impacted groups will include different ethnic or minority groups or members of tribal nations. Your community engagement activities and tools will need to be sensitive to each group’s culture and language.

During the initial engagement, identify all groups within the local community to establish contacts and determine their needs (e.g., language interpreters). Work with local organizations and community leaders to identify appropriate cultural contacts (see box on the right). Your community involvement specialist or health communication specialist can help identify skilled and reliable language interpreters and translators who can provide unbiased oral and written translations.

When tribal members are part of the site community, you may need to consult tribal leaders and other government agencies, such as the Indian Health Service, which may also be able to identify cultural contacts. The cultural contact may also act as a language interpreter, depending on his or her skills and experience.

Environmental Justice

It is important to recognize whether an exposed or potentially exposed population is already experiencing economic or environmental burdens or social vulnerability.

Environmental justice refers to efforts to ensure that all populations, regardless of their economic status or political power, are treated equally with respect to the development, implementation, and enforcement of environmental laws, regulations, and policies. These efforts help ensure that no population unfairly shoulders the negative human health and environmental impacts of pollution. Social vulnerability includes a number of factors, such as poverty, lack of access to transportation, and crowded housing. Such factors may weaken a community’s ability to prevent human suffering and financial loss in the event of a disaster, or harmful exposure in the environment.

To evaluate a community’s environmental and health burden, health assessors may use the factors identified in CDC’s social vulnerability index (SVI) and EPA’s Environmental Justice Screen (EJ Screen). Examples of criteria to consider for a community include lower income, poor public health indicators, limited access to healthcare, limited access to healthy food choices, and the presence of major environmental pollution sources (e.g., a power plant, waste incinerator, sewage-treatment plant, landfill, or other major source of air pollution). This information can help you plan your community engagement strategies.

Community Stress

For some community members, learning about local environmental contamination can contribute to psychological stress. Environmental contamination can also cause intra-family and community-wide social stress (e.g., conflict). For most people, these stress reactions are normal, not an indication of mental health problems. But, chronic stress poses health risks on top of those associated with potential environmental contamination. For these reasons, the site team should seek to prevent and reduce stress throughout the PHA process. There are ways to help community members cope with environmental contamination that do not require special training in behavioral or mental health. Review ATSDR’s tips for supporting community members who may experience stress related to environmental contamination. ATSDR has tip sheets for public health professionals, clinicians, and community-based organizations. Depending on the situation, one or more of the following actions may be appropriate:

• Discuss with community leaders whether (and why) residents are experiencing stress.
• Validate and acknowledge community members’ experiences related to contamination.
• Consider stress when preparing health/risk communication messages and materials. Focus on addressing the issues causing stress, not stress itself.
• If requested, facilitate stress-related learning opportunities for community members and/or other organizations and agencies that work with the community. Refer to ATSDR’s Community Stress Resource Center for more information.
• If community members are concerned about stress, address it in applicable sections of your documents (e.g., community health concerns, public health action plan).
• Identify the need for stress-focused interventions beyond what the PHA process addresses, either by partnering with or referring to services provided by another institution.

Environmental Odors

Sometimes communities are affected by environmental odors. Environmental odors can come from various sources, including human activities, animals, nature, vehicles, and industries. In general, most contaminants that cause odors in outdoor air are not present at concentrations that can cause serious injury or long-term health effects. However, odors may cause stress and physical symptoms, such as watery eyes and throat irritation, and can affect the quality of life for individuals in affected communities. Health assessors can refer to ATSDR resources to help address environmental odors in communities.

Confidentiality and Privacy

During the community engagement process, community members may provide you with information about their health that is considered confidential or sensitive containing personal identifiable information (PII). It is highly recommended that you consult with ATSDR program leaders, privacy experts, and/or legal counsel before handling any data in which confidentiality may be an issue. ATSDR can only use and share PII and confidential information such as medical records and other personal identifiers that are used in exposure investigations, health studies, etc. for approved purposes. We must ensure there is no disclosure of sensitive information in written products and other communications that could identify individual data subjects without consent. Further guidance is provided under Confidentiality and Privacy Issues in the Getting Familiar with the Site section.

Accessibility

Health assessors producing materials for the public must meet the requirements in Section 508 of the Rehabilitation Act (29 U.S.C. 794d), also referred to as “Section 508” standards. This federal law requires agencies to provide individuals with disabilities equal access to electronic information and data comparable to those who do not have disabilities, unless an undue burden would be imposed on the agency.