1. The Value of the National Environmental Health Performance Standards to EH Programs Volusia County Florida

2. Existing Tools MAPP MAPP State/Programmatic Audits State/Programmatic Audits Internal Reviews Internal Reviews

3. EH Renaissance 10 Essential Services 10 Essential Services National EH Performance Standards National EH Performance Standards Geographic Information Systems Geographic Information Systems Assessment, Monitoring Assessment, Monitoring Smart Growth Smart Growth Health Impact Assessment Health Impact Assessment Cause/Effect Exposure/Disease Outcomes Cause/Effect Exposure/Disease Outcomes

4. Population Based EH Requires a strategic focus on the societal causes of ill health Requires a strategic focus on the societal causes of ill health Societal or “Social Determinants of Health” are broad Societal or “Social Determinants of Health” are broad Changes in structural conditions can affect many individuals simultaneously and have broad and diverse impacts on multiple health outcomes Changes in structural conditions can affect many individuals simultaneously and have broad and diverse impacts on multiple health outcomes Cost effective Cost effective

5. Levels of Determinants of Behavior & Disease Individual Family Neighborhood Community Society

6. How this tool is used… Build agency capacity for essential services Build agency capacity for essential services Build community accountability Build community accountability Consistent services Consistent services Provide support for GR programs Provide support for GR programs Teach EH, local BOH, Health department directors, state level program, & stakeholders Teach EH, local BOH, Health department directors, state level program, & stakeholders

7. Future of EH Funding Scenarios Figure EHF-1a 50%25%150% Vulnerable – Possible scenario Tanning – Privatized Mobile Home Parks – gone or to other agency Small wells – gone S/T - Privatized or building dept. Pools – Privatized SDWA – Other agency All in column 1 out In: Rabies Consulting SLE Consulting FBI Investigation Infectious disease investigation Adding PH Priority Programs: Safety/Injury Sanitary Nuisance Public Relations & Marketing Tox risk assessment and OH Minimum Housing Health Assessment Reuse water regulation Surface water Future of Volusia County EH Financial Disaster Plan

8. Social Conscience / Fiduciary Outbreak Response + Health Assessment Community Assessment Toxicological Risk Assessment Figure EHF 1-b

9. Addition to Health Department Director Assistant Director for Public Health Programs Office of Assessment

10. Staff Comments “Since I was a young man of 19 I was attending EH classes. If you asked me back then what I would have been doing in an EH HD setting, I would have responded with #1 and #2. My response now would be #6.” “Since I was a young man of 19 I was attending EH classes. If you asked me back then what I would have been doing in an EH HD setting, I would have responded with #1 and #2. My response now would be #6.” “I find #3 particularly important. The public should be made to be EH professionals.” “I find #3 particularly important. The public should be made to be EH professionals.” “We do #8 very well.” “We do #8 very well.”