This final series installment highlights the development of a set of community-derived public health indicators associated with land reuse and redevelopment created using the Agency for Toxic Substances and Disease Registry’s (ATSDR) Action Model (ATSDR, 2019). We designed the Action Model to engage communities in land reuse and redevelopment plans with a goal to measure changes in overall community health status. To track these changes, the Action Model promotes the development of community-derived health measures across a broad range of public health categories, from physical and mental health to environmental and economic health.

ATSDR introduced the first three Action Model pilot communities in a publication in the July/August 2013 issue of the Journal of Environmental Health (Berman & Forrester, 2013). By 2018, over 45 different communities across the U.S. have used the Action Model in redevelopment planning. Our objective was to create a data set of types of community-derived public health indicators associated with land reuse and redevelopment. Our secondary objective for creating the set of indicators was to provide a resource to accompany the Action Model that communities can use for measuring outcomes of land reuse and redevelopment activities that can lead to improved overall community health status.

Communities who used the Action Model were community partnership pilot communities (i.e., communities in which we provided technical assistance on land reuse) or grantees from a past funding program (i.e., ATSDR community health projects related to contamination at brownfield/land reuse sites). Collaborative relations with over 45 Action Model communities provided us access to these Action Models and an opportunity to consolidate the models with the intention of developing a set of community-derived public health indicators associated with land reuse and redevelopment. We ultimately consolidated 40 Action Models to a set of 69 public health indicators through an iterative process of data consolidation and assessment:

After the final consolidation, we had a set of 69 public health indicators associated with land reuse and redevelopment that are commonly being tracked by at least 20% of the 40 Action Model communities. The final grouping of indicators selected by communities fell under 9 community health categories:

Built Environment: 17 indicators

For communities considering ways to track implementation of activities and changes over the course of revitalization, the indicators provide a variety of measures to contemplate. Ideally, communities may wish to select a handful of indicators from categories that best resonate with their particular community concerns, redevelopment activities, intended outcomes, and stakeholders.

The 69 indicators are provided, organized by health categories, under the ATSDR Build Your Own Community Health and Land Reuse Scorecard Toolkit at www.atsdr.cdc.gov/sites/brownfields/model.html. An example highlighting environmental improvement and community involvement indicators is provided in Tables 1 and 2.

We created the Action Model to help communities measure overall changes in community health over the course of redevelopment. By consolidating the indicators derived by 40 communities to track such changes, we aim to provide additional guidance to assist communities in selecting indicators that might help them address redevelopment concerns and improve health outcomes. While we limited our 69 indicators to those collected by at least 20% of 40 different communities, we recognize that communities may be interested in indicators that are not part of ATSDR’s community-derived set of indicators.

Our indicators can be used for guidance but communities can also consider measurement and evaluation in the context of their own stakeholders and intervention design. Communities may wish to create their own indicators that demonstrate their unique concerns. For example, one community was concerned about how odor from a waste transfer facility affected residents’ quality of life. This indicator was very specific to one community but it was still very important to that community and its intervention design. One resident ultimately conducted a survey of residents and businesses near the waste transfer facility and quantified quality of life impacts from waste odor, which helped move forward the eventual relocation of that facility to a more compatible area.

To provide additional Action Model indicator development guidance from a real community, we provide an example from Baraboo, Wisconsin, a community highlighted in Berman and Forrester (2013). Table 3 highlights the various measures the Baraboo Development Community derived and tracked over time. The full set of Baraboo’s indicators is available and described in the report, Community Health Monitoring: The Baraboo Ringling Riverfront Redevelopment (www.atsdr.cdc.gov/sites/brownfields/docs/Final_Baraboo_032911.pdf). Ultimately, within a few short years, Baraboo began to measure positive outcomes by tracking their indicators, including a 40% reduction in potentially hazardous sites and exposures to contaminants (indicators related to pollution of the river and sites) and increases in new jobs and contribution to the tax base (indicators related to community-wide employment, business, and economic issues). Highlights are provided in the sidebar above.

The community-derived public health indicators associated with land reuse and redevelopment provide a useful accompaniment to the Action Model and serve as a promising tool for communities to track the delivery of activities and changes in overall health status over the course of redevelopment. Indicators mark progress and can support performance measurement and evaluation, increasing the opportunities for continuous program improvement and measuring change in environmental and general health outcomes. ATSDR’s compilation of public health indicators will provide a helpful resource for communities to track their progress.