Promote a Healthy and Safe Environment Action Plan - Evidence-based programs, policies and practices

Focus Area 1 - Outdoor Air Quality.

• Goal #1: Reduce exposure to outdoor air pollutants with a particular focus on burdened communities.

Focus Area 2: Water Quality

• Goal #1: Increase the percentage of State residents that receive fluoridated drinking water.
• Goal #2: Reduce potential public health risks associated with drinking water and recreational water

Focus Area 3: Built Environment

• Goal #1: Improve the design and maintenance of the built environment to promote healthy lifestyles, sustainability and adaption to climate change
• Goal #2: Improve the design and maintenance of home environments to promote health and reduce related illness

Focus Area 4: Injuries, Violence and Occupational Health

• Goal #1: Reduce fall risks among vulnerable populations.
• Goal #2: Reduce violence by targeting prevention programs particularly to highest risk populations.
• Goal #3: Reduce occupational injuries and illnesses.

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Focus Area 1 - Outdoor Air Quality

Goal #1 (Action Plan) (Dashboard): Reduce exposure to outdoor air pollutants with a particular focus on burdened communities.

1. Provide guidance to the public on potential health effects of criteria air pollutants and actions individuals can take to reduce exposures when levels are forecast to exceed National Ambient Air Quality Standards. Explore the use of electronic and social media, and partner with meteorologists and local health departments to raise awareness.
   1. AirNow
      Website and text/email alert system that provides easy public access to national air quality information. Site offers daily Air Quality Index (AQI) forecasts as well as real-time AQI conditions for more than 300 American cities, and provides links to more detailed state and local air quality web sites. Also explains what actions people can take to protect their health at different AQI levels, such as "code orange."
   2. Clean Air NY
      Initiative sponsored by the NYS Department of Transportation in support of downstate air-quality efforts which educates the public on simple, everyday changes that reduce driving. Provides real-time updates on Air Quality Action Days via text messaging, email and media notifications.
   3. New York City Air Quality
      Information pertaining to outdoor and indoor air quality, including neighborhood-scale air quality studies and how to protect one's health during poor quality days.
2. Consider implementing EPA's School Flag program at schools and other community organizations.
   1. Resources for Implementing the School Flag Program
      School Flag Program helps children, parents, school personnel and the community to be aware of daily air quality conditions using brightly colored flags.
3. Assess and reduce emissions from categories of stationary and mobile pollutant sources that may contribute significantly to local air pollutant levels.
   1. New York State Department of Environmental Conservation
      1. Control of air pollution
      2. Reporting an environmental violation
   2. NYS Department Of Health Outdoor Wood Boiler Website
      Provides general information on outdoor wood boilers.
   3. New York City Air Quality Information & Complaint Reporting
      Information on air quality programs and how to report an air quality problem.
   4. US Environmental Protection Agency Near-Source Air Pollution Research
   5. Municipalities can develop their own rules that address local sources of air pollution. Examples include:
      1. New York City regulations for reducing air pollution from heating oil.
      2. Westchester County Anti-Idling Law effective February 10, 2009
      3. Controlling emissions from charbroilers by California's Bay Area Quality Management District.
   6. NYS Energy Research and Development Authority & Northeast States for Coordinated Air Use Management Report - Assessment Of Carbonaceous PM 2.5 For New York And The Region
      • Volume I
      • Volume II
   7. Reducing air pollution from residential burning:
      1. NYS Department of Health Outdoor Wood Boiler Website
         Provides general information on outdoor wood boilers.
      2. NYS DEC has two rules pertaining to residential burning: Outdoor Wood Boilers and Open Burning.
      3. New York State Energy Research and Development Authority has an incentive program, called Renewable Heat NY, for high-efficiency, low emissions wood heating equipment.
      4. Local governments may have their own rules for on-site energy generation, including wood-fired heating systems (e.g., Town of Lyme Renewable Energy Law, Suffolk County Outdoor Furnace Law)
      5. US Environmental Protection Agency's Strategies for Reducing Residential Wood Smoke
4. Urge all agencies to consider toxic and GHG emissions in SEQRA reviews.
   1. NYS Environmental Quality Review Act
      Requires all state and local government agencies to consider environmental impacts equally with social and economic factors during discretionary decision-making.
   2. NYSDEC Climate Change
      Provides links to forms and guidance publications, technical information and support.
   3. NYSDOH Climate Change and Health
      Information how climate impacts raise health risks and describes NYS actions to increase community resilience.
   4. New York City's plan for growth, equity, sustainability, and resiliency (OneNYC)
5. Develop State Implementation Plans (SIPs) that rely on and credit, in part, interventions that support the transition to cleaner-burning fuels and clean energy sources, including renewable power and energy efficiency, in the transportation, buildings and electricity sectors to sustain air pollution reductions over time.
   1. NYSDEC State Implementation Plans
      Control strategies to reduce air pollution in non-attainment areas which can benefit from local and state clean-energy policies.
   2. NYSERDA Responding to Climate Change in New York State (ClimAID)
   3. Climate Smart Community Program
      NYSDEC program is a state-local partnership to reduce greenhouse gas emissions, save taxpayer dollars and advance community goals for health and safety, economic vitality, energy independence and quality of life.
6. Support transportation options that reduce air pollution from mobile sources.
   1. CDC's Transportation Recommendations
   2. US EPA's Smart Growth and Transportation
   3. NYSERDA Transportation Technology
   4. NYSDEC's Controlling Air Pollution from Motor Vehicles
   5. US Department of Energy's sustainable transportation
   6. International Council on Clean Transportation
   7. Association of State and Territorial Health Officials (ASTHO) Transportation Policy Guides
7. Incorporate information on vulnerability to climate change in identification of environmental justice communities for targeting climate adaptation measures.
   1. Facing the Climate Gap: How Environmental Justice Communities are Leading the War to a More Sustainable and Equitable California
      Report includes examples of community-based efforts to address climate impacts.
   2. New York City's plan for growth, equity, sustainability, and resiliency (OneNYC)
   3. NYSERDA Responding to Climate Change in New York State (ClimAID)
8. Coordinate activities addressing climate change mitigation through reduction of GHG emissions with regulatory activities intended to reduce emissions of other harmful co-pollutants, particularly in communities meeting the definition of environmental justice areas.
   1. Facing the Climate Gap: How Environmental Justice Communities are Leading the Way to a More Sustainable and Equitable California
      Examples of interventions that partners can use in community-based efforts to address climate impacts.
   2. National Climate Assessment explores expected impacts of global warming on the US and options for responding.
   3. NYSDOH Building Resilience Against Climate Effects (BRACE) in New York State
   4. World Health Organization climate change and health
   5. New York City's plan for growth, equity, sustainability, and resiliency (OneNYC)
   6. Responding to Climate Change in NYS (ClimAID)
      See Climate Adapation Guidebook (Annex II).

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Focus Area 2: Water Quality

Goal #1 (Action Plan) (Dashboard): Increase the percentage of State residents that receive fluoridated drinking water.

1. Provide communities interested in implementing fluoridation with outreach materials and resources to promote fluoridation as a significant health intervention.
   1. Best Practice Approach: Community Water Fluoridation
      Best Practice Approach Report describes the use of community water fluoridation as a public health benefit, describes program activity steps, lists and describes guidelines and recommendations, and uses practice examples to illustrate innovative and/or successful implementation.
   2. Centers for Disease Control and Prevention. Community Water Fluoridation
      Web site provides information on community water fluoridation: safety, benefits, data, statistics, engineering and operations, as well as guidelines and recommendations.
   3. Fluoride & Fluoridation
      Web site contains recent fluoridation news, policy statements, resources and scientific reports, as well as links to fluoridation materials and policy statements on web sites from 33 professional organizations.
   4. Fluoridation Facts
      American Dental Association's premier resource on community water fluoridation. This 71-page booklet is an encyclopedia of fluoridation facts taken from more than 350 scientific references. Fluoridation Facts includes information from scientific research in an easy-to-use, question-and-answer format on the effectiveness, safety, practice and cost-effectiveness of fluoridation.
   5. Campaign for Dental Health: Fluoridation
      Website contains fluoridation materials and resources for the general public about how fluoride works, what the opponents say, fluoride myths and facts, and cost savings from fluoridation.
   6. Water Fluoridation in NYS
      Materials, resources, fact sheets, articles, and official policy statements on the topic of water fluoridation. Addresses benefits, safety concerns, cost and savings, operational/engineering aspects, and training. A copy of the Water Fluoridation in NYS Manual can be obtained by emailing oralhealth@health.ny.gov.
   7. Oral Health New York. Why Fluoride?
      Web site contains fluoridation resources and news pieces. Also contains an electronic copy of the NYS Department of Health's Water Fluoridation in NYS binder and the NYS Regulations and Laws applicable to water fluoridation.
2. Develop and promote existing strategies that provide benefits of fluoridation fluoride to people with private drinking water wells (e.g., fluoride tablets). Obstetricians, pediatricians, WIC programs and others are likely partners.
   1. Center for Fluoride Research Analysis: Fluoride Science
      Web site provides an unbiased review of key fluoride-related studies. Purpose is to communicate the strengths and weaknesses of studies discussed in the public arena to educate practitioners and policy makers. Can also help scientists identify gaps in research studies and improve quality. Web site features summaries on a variety of fluoride topics, appraisals of fluoride research, and videos of fluoride researchers discussing their research and areas of expertise.
   2. Prevention and Control of Early Childhood Tooth Decay
      A Best Practice Approach that describes what tooth decay is, the disease process and burden, components of the strategic framework to prevent and control early childhood tooth decay, and steps stakeholders can take to reduce the burden.
   3. Use of Fluoride: School-based Fluoride Mouthrinse and Supplement Programs
      A Best Practice Approach Report that describes the use of supplemental fluoride (mouthrinse, tablets and drops) as a public health strategy, assesses the strength of evidence on the effectiveness of the strategy, and uses practice examples to illustrate successful/innovative implementation.
   4. Rozier RG, Adair S, Graham F, et al. Evidence-based clinical recommendations on the prescription of dietary fluoride supplements for caries prevention: a report of the American Dental Association Council on Scientific Affairs. JADA. 2010;141(12):1480-9. Available through NYS Library.
      Article presents evidence-based clinical recommendations for the prescription of dietary fluoride supplements. Developed by an expert panel convened by the American Dental Association Council on Scientific Affairs. The recommendations are a resource for practitioners to consider in their clinical decision-making process.
   5. Weyant RJ, Tracy SL, Anselmo T, et al. for the American Dental Association Council on Scientific Affairs Expert Panel on Topical Fluoride Caries Preventive Agents. Topical fluoride for caries prevention Executive summary of the updated clinical recommendations and supporting systematic review. JADA 2013;144(11):1279-1291.
      An expert panel report presents evidence-based clinical recommendations regarding professionally applied and prescription-strength, home-use topical fluoride agents for caries prevention.
      Available through http://jada.ada.org/article/S0002-8177(14)60659-0/pdf.
3. Ensure NYSDOH and partners provide best available public information regarding fluoridation.
   1. Center for Fluoride Research Analysis: Fluoride Science
      Website that provides an unbiased review of key fluoride-related studies. Purpose is to communicate the strengths and weaknesses of key studies discussed in the public arena with an aim to educate practitioners and policy makers. Assists scientists to identify gaps in research studies and improve the quality. Features summaries on a variety of fluoride topics, appraisals of fluoride research, and videos of fluoride researchers discussing their research and areas of expertise.
   2. Guide to Community Preventive Services: Preventing Dental Caries
      The Community Preventive Services Task Force recommends community water fluoridation based on strong evidence of effectiveness in reducing dental caries across populations.
   3. Task Force on Community Preventive Services. Recommendations on selected interventions to prevent dental caries, oral and pharyngeal cancers, and sports-related craniofacial injuries. Am J Prev Med. 2002;23(1S):16-20.
      Available through Dickerman Library and NYS Library.
   4. Use of Fluoride: Community Water Fluoridation
      A Best Practice Approach Report describes the use of community water fluoridation as a public health approach, describes program activity steps, lists and describes guidelines and recommendations, and uses practice examples to illustrate successful and/or innovative implementation.
   5. Centers for Disease Control and Prevention. Community Water Fluoridation
      Website provides information on community water fluoridation including safety, benefits, data, statistics, engineering, and operations, as well as guidelines and recommendations on the subject.
   6. Fluoridation Facts
      Valuable resource on community water fluoridation from the American Dental Association including fluoridation facts taken from more than 350 scientific references. Includes information in an easy-to-use, question-and-answer format on effectiveness, safety, practice and cost-effectiveness of fluoridation.
   7. Campaign for Dental Health: Fluoridation
      Web site contains fluoridation materials and resources for the general public on numerous topics including how fluoride works, fluoride myths and facts, and cost savings from fluoridation.
   8. Griffin SO, Jones K, Tomar SL. An economic evaluation of community water fluoridation. JPH Dent. 2001;61(2):78-86.
      Assessed the local cost savings resulting from community water fluoridation, given current exposure levels to other fluoride sources. The annual per-person cost savings resulting from fluoridation ranged from $15.95 in very small communities to $18.62 in large communities. For every $1 invested in fluoridation, $38 was saved in treatment costs. Available through Dickerman Library and NYS Library.
   9. Kumar JV, Adekugbe O, Melnik TA. Geographic variation in Medicaid claims for dental procedures in NYS: role of fluoridation under contemporary conditions. Pub Health Rep. 2010;125(5):647-54.
      Study examined whether the number of claims reimbursed for caries-related procedures for children in the NYS Medicaid program varied by county fluoridation coverage. Discovered that Medicaid enrollees in less-fluoridated counties needed 33 percent more fillings, root canals, and extractions than those in counties where fluoridated water was more prevalent. As a result, the treatment costs per Medicaid recipient were $23.65 higher for those living in less-fluoridated counties. Available through Dickerman Library and NYS Library.
   10. Water Fluoridation in NYS Manual
       Materials, resources, fact sheets, articles, and official policy statements on the topic of water fluoridation. Addresses benefits, safety concerns, cost and savings, operational/engineering aspects, and training. A copy of the Water Fluoridation in NYS Manual can be obtained by emailing oralhealth@health.ny.gov.

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Goal #2 (Action Plan) (Dashboard): Reduce potential public health risks associated with drinking water and recreational water.

1. Utilize tools to conduct sanitary surveys and monitor water quality at regulated beaches.
   1. Beach Sanitary Survey Guidance
      EPA developed a beach sanitary survey tool — one each for marine and Great Lakes beach — to help beach managers evaluate all contributing beach and watershed information, including data on water quality, pollution source and land use. The tool consists of three types of beach sanitary surveys in paper and electronic form.
2. Distribute outreach materials for proper maintenance and operation of waste disposal systems for protection of recreational water from contamination.
   1. Septic System Operations and Maintenance
      Overview of how septic systems operate and how they should be maintained.
3. Enforce standards for proper design, location and operation of sewage disposal systems.
   1. Wastewater Treatment Standards for Individual Residential Onsite Systems
      Lists the NYS standards.
4. Identify resources to support beach assessments and a water quality monitoring program by State district offices and local health departments.
   1. Federal Clearinghouse for Grants
      Includes grants available to support beach assessments and water quality monitoring.
5. Provide NYSDOH with sanitary survey and water quality monitoring data for regulated beaches to inform decision-making.
   1. US EPA. BEACH Act
      Requires sanitary survey and water quality monitoring be submitted to the State.
6. Develop and/or disseminate outreach materials for families, private well owners, preschools and others about importance of well testing, to target at-risk populations.
   1. Best Management Practices for Private Water Systems
      Brochure summarizes the proper maintenance of private water wells.
   2. Drinking Water from Household Wells
      General information about drinking water from home wells (also considered private drinking water sources). Describes types of activities that can create threats to a water supply, as well as problems to look for and offers maintenance suggestions. Sources for more information and help are listed.
7. Provide education to elected officials on the importance and need for asset management at community water systems to ensure the long-term sustainability of the systems infrastructure.
   1. The Value of Water
      NYSDOH brochure designed to increase awareness about issues associated with aging water infrastructure.
   2. Asset Management Best Practice Guide
      Intended for owners, managers and operators of water systems, local officials, technical assistance providers, and State personnel about how to best manage local water systems.
   3. Bridging the Gap: An Educational Primer on Sustainable Water Infrastructure Asset Management
      Web site synthesizes initiatives to develop an educational primer for water and wastewater utility infrastructure asset management.
   4. Asset Management for Local Officials
      Fact sheet provides information for local officials on the basics of asset management and the vital role local officials have in successfully implementing an asset management program.
8. Develop or enhance scientific curricula for primary and secondary school science classes on long-term impacts of, and adaptation to, climate change.
   1. Global Climate Change Resources (Subscription required)
      Listings of the best available student and educators resources related to global climate change, including NASA products.
   2. Stanford University Climate Change Education Curriculum
      Integrates concepts from the earth, life, and physical sciences as well as the most current data on climate systems to help students understand the phenomena of climate change, the justification for these phenomena, and why they are scientifically and socially important.
9. Support infrastructure upgrades through funding mechanisms, such as the Drinking Water State Revolving Fund, and identify additional mechanisms to create fiscal incentives for local governments to update aging infrastructure.
   1. How to Upgrade and Maintain Our Nation's Wastewater and Drinking-Water Infrastructure
      Report details water infrastructure problems, explains the authority structure for these systems, and argues why projected funding levels are insufficient. Commonsense reforms to help address the systems' failures are promoted.
   2. Drinking Water State Revolving Fund
      The Safe Drinking Water Act, as amended in 1996, established the Drinking Water State Revolving Fund to make funds available to drinking water systems to finance infrastructure improvements. Website contains implementation guidance and a tool to compare financing alternatives.
10. Promote better land use practices across all sectors.
    1. Smart Growth
       State Department of Environmental Conservation web site that describes tools to promote the principles of Smart Growth and initiatives underway in the state.
    2. Source Water Protection Publications Database
       Publications focus on source water protection, e.g., management of agricultural fertilizer applications, management of highway deicing operations, managing pet and wildlife waste.
    3. Watershed Management for Potable Water Supply: Assessing the New York City Strategy (Free electronic download with site registration)
       Lays out how and why New York City's watershed agreement can be a good template for proactive watershed management that, if properly implemented, will maintain high water quality.

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Focus Area 3: Built Environment

Goal #1 (Action Plan) (Dashboard): Improve the design and maintenance of the built environment to promote healthy lifestyles, sustainability and adaption to climate change.

1. Implement the Smart Growth Public Infrastructure Policy Act and the Complete Streets Law.
   1. Smart Growth Public Infrastructure Policy Act
      Smart Growth is sensible, planned growth that integrates economic development and job creation with community quality-of-life by preserving the built and natural environments.
   2. Information on NYS Complete Streets Law
      Law presents an opportunity to expand programs and collaborate with bicyclists, pedestrians, people with disabilities and others to identify best practices and designs for transportation facilities. Website includes resources for planning, funding, and design.
   3. US EPA Smart Growth program - EPA provides resources and case studies to help communities grow in ways that expand economic opportunities and protect the health and environment.
   4. CDC's Built Environment and Health Initiative - CDC provides informational resources on the relationship between the built environment and public health.
   5. Smart Growth Self-Assessment for Rural Communities: Madison County, New York Developed in collaboration with EPA, this tool helps local governments evaluate how well their policies and regulations support the type of development they want and identify strategies for improvement.
2. Seek opportunities to promote compliance with and enforcement of existing laws and ordinances, such as NYS Smart Growth Infrastructure Act and NYS Complete Streets.
   1. New York State's Smart Growth Public Infrastructure Policy Act of 2010:
      Implementation through 2014 and Significance for Local Government.
   2. NYS Department of State's Office of Planning and Development advances progressive land use solutions, community-based development and building standards to increase resilience and sustainable growth. Through partnerships, grants and other tools, OPD provides assistance for Brownfield redevelopment, waterfront and downtown revitalization efforts, and Regional Economic Development Councils.
   3. Association of State and Territorial Health Officials (ASTHO) Transportation Policy Guides
      Series of transportation, land use, and community design cross-sectoral, evidence-based policy guides.
3. Seek opportunities to incorporate guidance and recommendations from other existing programs and guidelines to consider the effects of climate change on infrastructure and critical resources/facilities.
   1. NYSERDA ClimAID 2011
      ClimAID, the Integrated Assessment for Effective Climate Change Adaptation Strategies in NYS, was undertaken to provide decision-makers with cutting-edge information on the state's vulnerability to climate change and to facilitate the development of adaptation strategies informed by both local experience and scientific knowledge.
   2. NYS Rising Community Reconstruction Program.
      Program facilitates community redevelopment planning and their resilience. It allocated $25 million for planning in communities affected by Hurricanes Sandy and Irene and Tropical Storm Lee.
4. Promote progressive codes and incentives for 'green buildings.'
   1. NYSERDA Community Resources for Energy Efficiency and Renewable Programs & Services
      Community resources on energy efficiency and renewable programs from NYSERDA.
   2. ASHRAE (American Society of Heating, Refrigeration, and air-conditioning Engineers) Standard for the Design of High-Performance Buildings (Standard 189.1)
   3. New York State Green Building Construction Act (2009)
   4. NYC OneNYC Green Buildings
5. Expand tracking and surveillance to promote better land use planning and respond to local needs.
   1. NYSERDA ClimAID 2011
      ClimAID, the Integrated Assessment for Effective Climate Change Adaptation Strategies in NY, was undertaken to provide decision-makers with cutting-edge information on the state's vulnerability to climate change and to facilitate the development of adaptation strategies informed by both local experience and scientific knowledge.
   2. NYC Office of Emergency Management: Emergency Planning
      Contingency plans and protocols that guide New York City's response to natural and man-made emergencies, from extreme weather to power outages. The plans focus on three components of a disaster: preparedness, initial response and recovery. These plans can be used to prepare for emergencies in other areas of the state.
6. Provide accessible, neighborhood cooling centers.
   1. New York City Cooling Centers
      A cooling center is a facility, such as a senior center or community center, where people may go for air-conditioned comfort during a heat emergency.
   2. New York State Cooling Centers
      Cooling centers are facilities where you can go to cool off during extreme heat. The New York State Department of Health collected information about seasonal cooling centers from local health departments and emergency management offices.
7. Conduct school, workplace and community-based physical education programs.
   1. Communities Putting Prevention to Work
      Locally driven initiative supporting 50 communities to tackle obesity and tobacco use — two leading preventable causes of death and disability in the United States.
   2. School Health Guidelines to Promote Healthy Eating and Physical Activity
      CDC-synthesized research and best practices related to promoting healthy eating and physical activity in schools, culminating in nine guidelines. Each one is accompanied by implementation strategies to help schools implement each guideline.
   3. CDC cross-cutting programs to prevent and control chronic diseases and improve community health
8. Develop targeted education and outreach materials to key audiences, such as clinicians, teachers, employers, property owners, local planning and zoning boards on the impact of the built environment on health. Materials should include intensive strategies for vulnerable populations (e.g., poor, elderly, and children).
   1. CDC's Division of Community Health programs fund community-based activities to prevent and control chronic diseases.
   2. CDC's Healthy Places website provides informational resources and tools for promoting health though healthy community design.
9. Broadly support efforts to mitigate and adapt to climate change by reducing carbon-based energy use.
   1. NYSERDA Community Resources for Energy Efficiency and Renewable Programs
      Community resources on energy efficiency and renewable programs.
   2. NYS Rideshare
      511NY Rideshare is New York's home for ride-matching, commuter and traveler services for individuals who are seeking enhanced mobility options. It works with commuters, travelers and employers to make ridesharing an easy, affordable and appealing alternative to driving alone.
   3. Climate Smart Community Program
      NYSDEC program is an state-local partnership to reduce greenhouse gas emissions, save taxpayer dollars and advance community goals for health and safety, economic vitality, energy independence and quality of life.
10. Make space available for and support the development of community gardens, especially in low income urban communities.
    1. Starting a Community Garden
       Fact sheet designed to give groups basic information to get a gardening project off the ground.
    2. NYS Department of Agriculture and Markets - Community Gardens Program Resources
       Resources include Gardening on State Land, Joining or Starting a Community Garden, Soil Testing for Nutrients and Other Properties, General Resources and School Gardening.
    3. NYSDOH Healthy Gardening: Tips for New and Experienced Gardeners
    4. NYC Parks GreenThumb and other local community garden organizations (e.g., Capital Roots, Capital District Community Gardens, Rochester Community Garden, Grassroots Garden of Buffalo, etc.
    5. Cornell's Integrated Pest Management develops sustainable ways to manage pests in ways to minimize environmental and health effects.
11. Construct and maintain safe sidewalks, bike lanes, recreational facilities, parks and other amenities, especially in low-income communities.
    1. Information on NYS Complete Streets Law
       Law presents an opportunity to expand programs and collaborate with bicyclists, pedestrians, people with disabilities and others to identify best practices and designs for transportation facilities. Website includes resources for planning, funding, and design.
    2. USEPA Our Build and Natural Environments - Review of the interactions between land use, transportation, and environmental quality (2nd ed.)
    3. Portland, Oregon Climate Smart Strategy
       Downloadable fact sheets, reports and presentations that can be used as examples for programs in NYS.
    4. The Built Environment and Health: 11 Profiles of Neighborhood Transformation
       Highlights neighborhood-level changes to the built environment that can have a positive influence on the health of community residents, especially in low-income communities. These profiles demonstrate how health practitioners, community members and many others can work together to improve community well-being by making changes to the built environment.
    5. Designing and Building Healthy Places
       Web site lays out several ways public health personnel and community design decision makers can collaborate to improve the health of a community.
    6. Surgeon General's 2015 Call to Action to promote walkable communities.
12. Incorporate smart growth into land use planning and SEQR process.
    1. New York's State Environmental Quality Review Act
       Requires all state and local government agencies to consider environmental impacts equally with social and economic factors during discretionary decision-making. Site also provides links to technical information and support.
    2. Smart Growth Self-Assessment for Rural Communities: Madison County, New York Developed in collaboration with EPA, this tool helps local governments evaluate how well their policies and regulations support the type of development they want and identify strategies for improvement.
13. Provide incentives for Brownfield Opportunity Areas.
    1. Brownfield Redevelopment Toolbox: A Guide to Assist Communities in Redeveloping NYS's Brownfields
       Toolbox designed to explain the cleanup and redevelopment of brownfields in straightforward terms and provide a systematic, start-to-finish guide to cleanup and redevelopment.
    2. Agency for Toxic Substances and Disease Registry funds community health projects related to contamination at Brownfield/land reuse sites.

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Goal #2 (Action Plan) (Dashboard): Improve the design and maintenance of home environments to promote health and reduce related illness.

1. Disseminate (or develop, if needed) targeted educational programs and materials about exposures, health risks and effective control strategies for hazards in homes, schools and other indoor environments.
   1. Seven Tips for a Healthy Home
      Tips for ensuring a safe and healthy home.
   2. NYS Environmental Health Information
      Numerous topics related to health and safety in the home, workplace and outdoors.
   3. ATSDR Health Effects of Chemical Exposure
      Explains possible health effects of exposure to chemicals and other harmful substances.
   4. CDC Environmental Health
      Information on healthy homes, air quality, asthma, lead, fire prevention and more.
   5. National Center for Healthy Housing
      Report describes housing interventions and their impact on health status.
   6. Managing Asthma in the School Environment
      Materials for schools on creating and maintaining an asthma-friendly environment.
2. Support educational efforts aimed at primary care providers to assess risks, screen patients, take environmental histories and provide follow-up treatment, using relevant guidelines (e.g., from NYS, NHLBI, CDC) for building-related exposures and illnesses.
   1. NYSDOH Lead Screening Program
      Information for health care providers on lead poisoning prevention and management.
   2. ATSDR: Taking Exposure Histories
      Educational case study is one in a series of self-instructional publications designed to increase primary care providers' knowledge about hazardous substances in the environment and to promote the adoption of medical practices that aid in the evaluation and care of potentially exposed patients.
   3. Diagnosing CO Poisoning
      Issue of Emergency Medicine Practice covers the epidemiology, pathophysiology, diagnosis and management of carbon monoxide poisoning in the general population and special groups.
   4. NHLBI Guidelines for Asthma
      Clinical guidelines for diagnosis and management of asthma.
3. Enhance mechanisms, and increase resources for, referrals to support services.
   1. NYS Healthy Neighborhoods Program
      Program seeks to reduce the burden of housing-related illness and injury through a holistic approach. Provides in-home assessments and interventions for asthma, tobacco cessation, indoor air quality, lead, fire safety and other environmental health hazards in selected communities throughout NYS.
   2. Breathe Easy at Home
      Boston-based model program developed to ensure that initial and follow-up inspections are performed quickly to resolve substandard conditions. A related link is How the referral program works.
4. Incorporate 'Healthy Homes' education and inspections into other (non-health) 'opportunity points.'
   1. Healthy Home Standard
      In partnership with the American Public Health Association, the National Center for Healthy Homes is developing the National Healthy Housing Standard to inform and deliver housing policies that reflect the latest understanding of the connections between housing conditions and health.
   2. CDC Healthy Housing Inspection Protocol
      Model reference tool for local jurisdictions or others to use that can improve the effectiveness and efficiency of the public health and housing management workforces that identify, prevent and control health problems associated with housing.
5. Implement the Medicaid Redesign Team recommendations to provide home assessments (e.g., for children with asthma in at-risk housing).
   1. Healthy Homes University: A Home-Based Environmental Intervention and Education Program for Families with Pediatric Asthma in Michigan
      In-home environmental public health program where program staff assessed homes for asthma triggers and subsequently provided products and services to reduce exposures to cockroaches, dust mites, mold, tobacco smoke and other triggers.
   2. Investing in Best Practices for Asthma: A Business Case
      Identifies best practices and policies in asthma funding and reimbursement which foster excellence in environmental and clinical asthma management.
   3. Boston Children's Hospital Community Asthma Initiative
      Initiative developed to help improve the health and quality of life of children with asthma and their families and can serve as a model.
   4. EPA Asthma Program
      EPA provides resources and information for physicians and healthcare plan administrators to establish home visit programs. The programs are proven to be effective in improving overall quality of life and productivity by improving asthma symptoms and reducing the number of school days missed due to asthma.
   5. EPA Implementing an Asthma Home Visit Program: 10 Steps to Help Health Plans Get Started
      This guide should be used primarily by health plans that have established asthma management programs. It offers step-by-step instructions on how to implement an asthma home visit program with a particular emphasis on environmental risk factor management.
   6. NYS Healthy Neighborhoods Program
      Seeks to reduce the burden of housing-related illness and injury through a holistic approach. Program provides in-home assessments and interventions for asthma, tobacco cessation, indoor air quality, lead, fire safety and other environmental health hazards in selected communities throughout NYS.
6. Encourage safe home and building renovations and modifications such as weatherization, carbon monoxide alarms, smoke detectors, fire alarms, and other safety mechanisms.
   1. NYS Weatherization Assistance Program helps reduce heating and cooling costs for income-eligible families.
   2. NYSERDA tips and resources for reducing home home energy use.
   3. USDA grant to improve rural housing conditions
      The Very Low-Income Housing Repair Program provides loans and grants to very low-income homeowners to repair, improve or modernize their dwellings, or to remove health and safety hazards.
   4. North Carolina program for home rehabilitation
      Example of a program that helps low-income homeowners who need urgent repairs, accessibility modifications, comprehensive rehabilitation or energy-related home improvements by providing funds to local governments and nonprofit organizations which provide these services.
   5. HUD Programs available in NYS
      Programs and resources to help homeowners with home repairs and improvements.
   6. NYSERDA Energy and Weatherization Assistance for Low and Moderate Income Households
      Income-qualified families are particularly susceptible to high and fluctuating energy costs, based on the earnings-to-expenditure ratio. To reduce the energy burden on these households, NYSERDA offers programs that provide cost-effective home improvements.
   7. Safe School Renovation from Healthy Schools Network, Inc.
      Guide details the NYS regulations that schools must follow during renovation and construction to protect children and adults from hazards. Parents or others who care about the health and safety of children must be informed about the law and vigilant about its implementation.
   8. EPA lead resources
   9. EPA lead safe renovations
      Describes requirements of EPA's Lead-Based Paint Renovation, Repair and Painting Program Rule for contractors. Provides guidance to homeowners and occupants so that each may learn to properly address lead-based paint hazards associated with renovation, repair and painting activities.
   10. NYSDOH lead-safe renovation, repair and painting tips for contractors and homeowners.
   11. Maryland renovation guidelines
       Information can help project managers and site inspectors identify construction hazards and facilitate inter-departmental communications.
   12. Providence, R.I. provides free smoke and CO alarms to eligible residents
       Providence Fire Department used grant funds to offer free smoke detectors (and carbon monoxide detectors when available) to low-income and handicapped residents of one-, two- and three-family houses.
   13. NYSDOH information about carbon monoxide including sources, health effects and Amanda's Law, which requires CO detectors to be installed in all dwellings.
   14. NFPA Fire Fact Sheets
       Fire statistics from Fire Analysis and Research Division reports are formatted to be used as handouts to answer frequently asked questions. Fact sheets or individual points on the fact sheets may be used with attribution.
7. Conduct activities and programs that provide clean energy sources in homes, schools and other buildings (e.g., ultra-low sulfur heating oil).
   1. NYSERDA Cleaner, Greener Communities
      This program empowers regions to create more sustainable communities by funding smart growth practices.
   2. NYSERDA provides resources for improving energy efficiency, clean energy and financing options for homes, businesses, and schools.
   3. Financing Guide for NYC Clean Heat Resources
      Resources that offer financing products in New York City to help convert buildings from oil to cleaner fuels.
   4. NYS Solar Power Initiative (NY-Sun)
      This initiative brings together and expands existing programs administered by the NY-Sun facilitates installation of solar systems to support clean energy in our communities and create a robust solar industry in New York.
   5. NYSERDA Wind Energy
      NYSERDA has incentives to encourage the installation of end-use wind energy systems for residential, commercial, institutional or government sectors.
   6. NYC Rules Governing Emissions in #4 and #6 Fuel Oil in Boilers and Burners
      Rule governing the use of #4 and #6 fuel oil in heat and hot water boilers and burners in New York City which can also be used in developing similar  legislation in other communities.
   7. DEC Fuel Composition and Sulfur Limitations
      Outlines the State law regulating sulfur limitations in fuel composition and use.
   8. NYS Collaborative for High Performance Schools
      Provides a framework that helps school districts and their design teams build sustainable school buildings that enhance the educational environment and facilitate learning. Other school resources from NYS Education Department are available and include links to school solar energy program and requirements for carbon monoxide detection.
8. Conduct activities and programs that enhance building inspection and maintenance.
   1. CDC IPM Urban Rodent Surveys
      Manual for classroom use and for field training of program managers, environmental health practitioners, inspectors, outreach workers and others who work in community-based rodent integrated pest management programs.
   2. NYSDOH Lead Paint Abatement
      What people who live in or own an older home need to know about protecting themselves and others from exposure to lead-paint dust or chips, which can cause serious health problems.
   3. NYS DOH Mold and Your Home - a factsheet about preventing mold growth and how to get rid of mold
   4. EPA Mold Remediation
      Document can help individuals with little or no experience with mold remediation decide whether a situation can be handled in-house.
   5. NYS Department of Labor program for mold remediation professionals
   6. Surgeon General's 2009 Report on Promoting Healthy Homes
      Website includes facts and actions to implement as part of the Surgeon General's call to promote healthy homes.

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Focus Area 4: Injuries, Violence and Occupational Health

Goal #1 (Action Plan) (Dashboard):
Reduce fall risks among vulnerable populations.

1. Utilize STEADI (Stopping Elderly Accidents, Deaths, and Injuries) Toolkit to aid primary care providers in older adult fall risk assessment and referrals/treatment.
   1. STEADI
      CDC's Injury Center created the STEADI Tool Kit for health care providers who see older adults in their practice who are at risk of falling or who may have fallen in the past. The kit gives health care providers information and tools to assess and address their older patients' risk of falling.
2. Train community workers in evidence-based intervention programs for older adults such as Tai Chi: Moving for Better Balance, Stepping On and A Matter of Balance.
   1. Tai Chi
      Information from CDC describes a study that compared a 15-week program of Tai Chi classes that used 10 simplified movements, with a balance training program that reduced the risk of falls, and includes information on how to implement.
   2. Tai Chi Simplified program derived from the Simplified 24-form Tai Ji Quan routine which consists of an eight-form routine core with a variety of built-in practice variations and a subroutine of Tai Ji Quan - Mini Therapeutic Movements which, collectively, comprise a set of simple yet functional Tai Ji Quan exercises.
   3. Tai Chi Productions
      Dr. Paul Lam's instructional and empowering DVDs and books to improve health and wellness including the learner-friendly beginner and health series, or the intermediate and advanced series to develop skills further.
   4. Stepping On
      Program proven to reduce falls and build confidence in older people using a community-based, small-group workshop. Stepping On was developed in Australia and tested in a randomized trial where it demonstrated a 31 percent reduction in falls.
   5. A Matter of Balance
      Nationally-recognized program developed at the Roybal Center at Boston University that includes eight two-hour sessions for a small group led by a trained facilitator.
3. Train physical therapists to deliver the Otago Exercise Program or other equivalent programs.
   1. Otago Exercise Program
      Information provided by CDC on a program tested in four randomized controlled trials and one controlled multi-center trial that consists of individually tailored muscle strengthening and balance-retraining exercises of increasing difficulty, combined with a walking program.
   2. The Health Professional's Online Learning Connection
      Periodically offers courses on the Otago Exercise Program.
4. Promote community-based programs for fall prevention.
   1. STEADI
      CDC's Injury Center created the STEADI Tool Kit for health care providers who see older adults in their practice who are at risk of falling or who may have fallen in the past. The STEADI Tool Kit gives health care providers the information and tools they need to assess and address their older patients' risk of falling.
   2. Tai Chi
      The CDC Compendium of Effective Fall Interventions: What works for Community-Dwelling Older Adults includes a description of 'Tai Chi: Moving for Better Balance' program on page 22.
   3. Simplified Tai Chi
      Program is derived from the Simplified 24-form Tai Ji Quan routine which consists of an 8-form routine core with a variety of built-in practice variations and a subroutine of Tai Ji Quan - Mini Therapeutic Movements which, collectively, comprise a set of simple yet functional Tai Ji Quan exercises.
   4. Stepping On - Program Summary
      Stepping On is a program proven to reduce falls and build confidence in older people. A community-based, small-group workshop, Stepping On was developed in Australia and tested in a randomized trial where it demonstrated a 31% reduction in falls. This CDC website summarizes the study and provides information for implementation.  It also includes links to CDC's full falls compendium.
   5. Stepping On - Organizing a Program in Your Area
      Stepping On is a program proven to reduce falls and build confidence in older people. The Wisconsin Institute for Healthy Again developed an American version with support from CDC that has been tested in the United States and shown to achieve results similar to the original.  This website provides information about becoming a workshop leader and organizing a workshop.
   6. A Matter of Balance
      A Matter of Balance includes eight two-hour sessions for a small group led by a trained facilitator. This nationally recognized program was developed at the Roybal Center at Boston University.
   7. CDC-Otago Exercise Program
      A program tested in four randomized controlled trials and one controlled multi-center trial is a program of muscle strengthening and balance-retraining exercises of increasing difficulty, combined with a walking program.
5. Educate parents and healthcare providers on common fall risk and prevention strategies for infants and toddlers.
   1. Child Fall Prevention Guide
      Information provided by CDC on falls and associated risks among children details prevention tips and offers free materials to download.
   2. CPSC Safety Handbook
      Handbook presents safety guidelines for public playground equipment. This handbook is expected to promote greater safety awareness among those who purchase, install and maintain public playground equipment.
6. Careful assessment for fall risks and fall prevention education and referrals for older adults, such as using 'Timed Up and Go.'
   1. 'Timed Up and Go' Fall Risk Assessment in Older Adults>
      Test that can be used to assess a patient's mobility to see whether they are at risk for a fall..

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Goal #2 (Action Plan) (Dashboard): Reduce violence by targeting prevention programs particularly to highest risk populations.

1. Develop multi-sector violence prevention programs such as SNUG or Cure Violence and work with businesses and schools to improve safety.
   1. Cure Violence
      Initiative founded in 1995 by epidemiologist Dr. Gary Slutkin, who maintains that violence should be treated like an epidemic and can be prevented by stopping the behavior at its source.
   2. Gun Violence Reduction in Small U.S. Cities
      Examples of U.S. cities similar in population to New Haven, Connecticut (pop. 129,779) that have reduced gun violence and their methods for achieving that reduction.
2. Provide referrals in emergency departments and hospitals for victims of violence.
   1. Youth Violence
      The Rochester Youth Violence Partnership is a hospital-based violence intervention program that targets trauma victims under the age of 18 when they present for medical care following a knife or gun injury.
   2. Intimate Partner Violence and Sexual Violence Assessment Instruments
      Guide to aid in the selection of assessment instruments for use in health care settings to identify victims requiring additional services.
3. Raise community awareness of violence prevention strategies.
   1. Shaken Baby Syndrome
      Toolkit provides information to educate people about Shaken Baby Syndrome.
4. Improve safety in school and workplace environments with cameras, better lighting, safes, and more than one person on duty.
   1. FBI Publication on Workplace Violence
      Guidelines for reducing various types of violence within the workplace.
   2. "Protect Your Workplace"
      FBI developed this campaign with posters and brochures dealing with physical and non-physical violence.
   3. FBI Resources on School Violence
      Includes reports and prevention initiatives.

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Goal #3 (Action Plan) (Dashboard): Reduce occupational injuries and illnesses.

1. Develop respiratory protection programs that include written policies and procedures for fit testing, employee training, medical clearance, appropriate selection of respirators, training in the use and maintenance of respirators, recordkeeping and program evaluation.
   1. Prevention Strategies for Seasonal Influenza in Healthcare Settings
      Updated guidance continues to emphasize the importance of a comprehensive influenza prevention strategy that can be applied across the entire spectrum of healthcare settings.
   2. Respiratory Protection in the Workplace-General Resources
      Trusted source of respirator information to verify which respirators are approved by NIOSH, how to get them and how to use them.
2. Train providers in recognizing signs and symptoms associated with weather-related outcomes, such as heat and cold stress and arboviral infections.
   1. Heat stress
      CDC overview on types of heat stress offers recommendations for employers and workers with links to resources by the CDC and other entities.
   2. Cold Stress
      CDC overview about types of cold stress offers recommendations for employers and workers with links to resources by the CDC and other entities.
   3. Arboviral Infections
      NYSDOH addresses common questions about arboviral infections and ways to prevent them.
3. Educate teens about their rights and applicable regulations, targeting vocational schools and industries hiring large numbers of young workers.
   1. Talking Safety. Teaching Young Workers about Job Safety and Health
      CDC poster educating youth about job safety and health.
   2. Passport to Safety New York
      Online health and safety training course designed to train teens about workplace safety and health and labor laws.
4. Consider requiring flu vaccine for workers who interact with high-risk populations.
   1. Prevention Strategies for Seasonal Influenza in Healthcare Settings
      Updated guidance emphasizes the importance of a comprehensive influenza prevention strategy that can be applied across the spectrum of healthcare settings, including steps to prevent the spread of influenza.
5. Remove disincentives to reporting occupational hazards, injuries and illness.
   1. OSHA memo re: Employer Safety Incentive and Disincentive Policies and Practices
      Direct notice to employers of whistleblower protections.
   2. J.J. Keller's Safety Management Today
      Article provides guidance on employer safety incentive and disincentive policies and practices that are believed to discourage employee reports of injuries (see p. 1-2).
   3. How To Create a Safety Program
      OSHA document describes the model for creating a safety program that includes rewarding compliance with program rules.
   4. On-Site Consultation Program
      Resource for safety and health issues that is free to businesses.
   5. OSHA - Public Sector Safety & Health Fundamentals Certificate Program
      Certificate program supports OSHA's mission by training public sector employees in occupational safety and health to reduce incident rates for workers in state and local governments.

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