A “Grounded in Health” Fair: Applying Environmental Health Approaches in a Cross-Specialty Community-Based Initiative

Abstract

Individual and community wellness are shaped not only by clinical medicine but also by environmental and social drivers of health. Yet, preventive services addressing these factors often operate in isolation. To offer a useful integrated perspective, we describe a community health fair in New Haven, Connecticut, that combined health insurance coverage assistance, stroke prevention outreach, environmental exposure assessment, and consumer product safety education to address these intersecting drivers of health. The event was developed through community partnerships and provided free services including blood pressure screening, stroke awareness materials, soil lead testing, pocketbook audits for chemical hazards, and health and dental coverage enrollment support. Implementation required cross-specialty collaboration among neurology, primary care, and emergency medicine, as well as cross-sector collaboration with trusted local organizations. In this article, we elaborate on the event’s structure, implementation process, and the practical considerations that shaped its delivery. Rather than evaluating outcomes, our goal was to document lessons learned from this pilot effort and highlight considerations for others interested in developing similar community-based preventive health programming. Future work, including formal assessment of acceptability, feasibility, and impact, will be essential to determine whether this model can be scaled or adapted to other settings.

Introduction

Chronic diseases such as hypertension, diabetes, coronary heart disease, and cancer remain leading contributors to disability and mortality worldwide and in the United States (U.S.).^1,2 For example, a 2023 National Health and Nutrition Examination Survey (NHANES) study reported that 47.7% of U.S. adults (~120 million people) have hypertension. ³ Hypertension is the primary risk factor for stroke, which ranks as the second leading cause of mortality globally and the third most common cause of disability. ⁴ Given this immense public health impact, identifying effective strategies to reduce this burden remains a critical priority.

Clinical medicine is a cornerstone of treatment and prevention, yet health fairs have emerged as a valuable complement to traditional care. ⁵ By meeting people where they live and work, health fairs can identify individuals who are not connected to the healthcare system and provide preventive services in accessible settings. This community-based approach also allows healthcare providers to better understand the environments in which patients live, an important consideration given the growing influence of environmental drivers on health. ⁶

Environmental exposures increasingly affect population quality of life and contribute to chronic disease risk, yet they are often poorly addressed during routine clinical encounters. ⁷ Globally, an estimated 12 million deaths each year are attributable to residence or occupation in unhealthy environments, and environmental hazards account for 16.3% of disability adjusted life years lost.^8,9 Recognizing that community members are not only patients but also consumers underscores the complexity of daily exposures, as the average person in the U.S. encounters more than 100 chemicals through personal care products such as hair care, soaps, lotions, and perfumes. ¹⁰ However, access to screening and education about these risks remains limited. In many urban communities, residents face overlapping risks from many sources including soil contaminants and harmful chemicals in consumer products. Soil lead exposure, even at blood lead levels below 5 µg/dL, has been associated with hypertension. ¹¹ Exposure to volatile organic compounds and chemicals in personal care and cosmetic products has been linked to elevated systolic blood pressure and increased cancer risk.^12,13

Despite the interconnectedness of chronic disease and environmental exposures, clinical care and environmental health prevention efforts largely operate in isolation.^{14 -16} This gap perpetuates underdiagnosis of environmental risk factors and misses opportunities for early intervention and holistic care. To address this need for integrated and accessible strategies, we piloted the “Grounded in Health” Fair on December 4, 2025. Partnering with “Access Health CT,” Connecticut’s (CT) official health insurance marketplace, the event combined health coverage enrollment assistance with blood pressure screening, stroke education, soil lead testing, and personal care product assessments in a single community setting. The goal was to provide residents with an opportunity to address multiple health risks through an integrated and accessible approach. The objective of this perspective is to describe how the “Grounded in Health” event was implemented as a community-based model for integrating environmental and preventive health services, and to share lessons learned from the process.

“Grounded in Health” Fair

Community-Centered Model

To bridge existing public health and clinical gaps, we adopted a multi-specialty, community-engaged environmental health approach aligning preventive care, environmental exposure screening, and health education within a single, trusted community space. This integrated framework acknowledges that environmental exposures do not occur in siloes; rather, they act concurrently with social, behavioral, structural, and genetic drivers to influence disease risk across the life course. Our approach also expands environmental health from a purely regulatory or academic endeavor into a directly actionable public health service that can be integrated in community-based healthcare delivery.

Figure 1 details steps of our proposed model where understanding the community member and their environment is the core of the approach. For each community member, the goal was to provide knowledge and education about relevant environmental exposures and harms and the importance of regular screening for health measures such as blood pressure, which are important indicators for overall well-being. Following providing knowledge and education, risk screening occurred implementing both clinical care techniques and utilizing tools such as the Environmental Working Group (EWG) Skin Deep Database to provide standardized and evidence-informed hazard scores for personal care products brought by community members. Results from all assessments were discussed with community members individually followed by a plan for each finding. For soil testing results that were not immediately available, community members received clear instructions on how and when to access their results. Dedicated time was provided for community members to ask questions, which could conclude the care session or lead to an additional round of information sharing to further empower participants with knowledge and resources.

Figure 1.

Community-centered model. Figure highlights the steps of the iterative “Grounded in Health” approach, which combines education, clinical screening, and environmental risk assessment to provide personalized plans for community members.

Location, Partner Organizations, and Services

The health fair occurred in the gymnasium of the Dixwell Community House (Q House) in New Haven, CT (4-8 pm EST). The health fair was a free event and located in a community-based building which curated trust by fostering accessibility and eliminating financial and psychological barriers (such as discomfort from unfamiliarity of the space). By addressing such barriers, this helped to bypass factors that often limit participation in preventive health services. ¹⁷ Through integrating clinical screening, environmental testing, and consumer product assessments within a safe space, the event provided an entry point for community members who may otherwise hesitate to engage with traditional healthcare systems.

Organizationally, members of Access Health CT, Yale New Haven Hospital Stamp Out Stroke, ELND, and Planted Pores partnered through an informal, opportunistic collaboration to address overlapping health and environmental risks within a single community setting. Access Health CT, Connecticut’s official health insurance marketplace, helps residents compare plans, enroll in coverage, and determine eligibility for financial assistance. Through health and enrollment fair style events, Access Health CT Enrollment Specialists can provide community members with concentrated assistance to understand terminology surrounding health and dental coverage options and complete an enrollment application. The complex nature of health insurance can be a barrier to access, especially for those with limited English proficiency. ¹⁸ Access Health CT provides support in multiple languages to increase access to coverage. The in-person model adds an additional layer of trust since community members can talk to a real person and feel like they have a partner in their health and well-being. Moreover, all standard Access Health CT plans provide 10 Essential Health Benefits, which include preventative services, at no additional cost. Enrollment Specialists explain these included benefits at the time of enrollment and encourage people to find a primary care provider. This increases routine clinical encounters for community members, increasing early detection and decreasing morbidity and mortality.

Stamp Out Stroke is a Yale New Haven Hospital community engagement program that promotes stroke prevention through education, risk screening, and linkage to care. Members from the Stamp Out Stroke team provided blood pressure screenings, free electronic blood pressure monitors, and stroke risk factor education. ELND (elnd.org) is an organization that funds, supports, and connects community-level environmental health and improvement initiatives through education, advocacy, and cross-sector collaboration. Planted Pores is a science-driven organization promoting skin health through research, education, and safer cosmetic solutions that address environmental exposure impacts. Volunteers from ELND and Planted Pores provided community members with environmental health education as well as soil lead testing and “pocketbook audits” of participants’ personal care products to assess chemical hazards. Each modality addressed a different layer of risk, giving attendees a multidimensional look at their health and environment. Incentives such as free information pamphlets and flyers, resource magnets, free at-home blood pressure monitors, and refreshments were also available at the event. The collaborative presence of clinicians, environmental health experts, community advocates, and student volunteers further reinforced credibility and encouraged open dialog around sensitive health and exposure concerns. Jointly, these components portray how intentional community engagement strategies can fortify trust, broaden impact and reach, and promote more equitable access to preventive care that addresses social and environmental drivers of health. Figure 2 presents a panel of images from the event, including flyers shared on social networking platforms prior to the event day (Figure 2A and B), free home blood pressure monitors and stroke/cardiovascular risk information materials (Figure 2C), and the environmental screening and education station with an ongoing pocketbook audit (Figure 2D).

Figure 2.

Event images. Figure presents images from the “Grounded in Health” Fair. Panel (A and B) show event flyers, Panel (C) displays stroke and cardiovascular disease education materials along with free electronic blood pressure cuffs that community members received, and Panel (D) depicts the environmental exposure education, soil testing, and pocketbook audit screening station.

Population Served and Observed Anecdotal Impact

Over 50 community members attended the health fair, with over 30 community members visiting the blood pressure screening, soil lead testing, and pocketbook audit table. Services were delivered in a coordinated way by strategically placing the soil lead testing, pocketbook audit, and blood pressure screening at a shared table. Given that this was not a research study, we did not collect data on the attendees; however, it was noted that several health fair attendees identified as racial/ethnic minorities, predominantly Black American and non-White Hispanic. Notably, community members attended as individuals and as family units.

Reactions and responses by community members affirmed not only the value of health education, exposure screening, and immediate feedback but also the demand for this integrated model. Several community members expressed gratitude but also deep concern when presented with new knowledge about the hazard levels of their favorite lip balms and fragrant lotions that they used daily. Some community members were surprised by their blood pressure readings and expressed interest in learning more about the connection between environmental exposures and chronic disease risk. These reactions ultimately suggest that a multi-specialty healthcare approach is relevant, and environmental discussions are often under-addressed issues in community health. Table 1 highlights the targeted risk domains of the pilot along with community member broader impact and takeaways. These takeaways were developed following a debriefing meeting with the health fair volunteers and organizers.

Table 1.

“Grounded in Health” Targeted Risks Approach and Takeaways.

Targeted risk domain	Provided service/screening	Community member impact and takeaway
General knowledge gaps	Informational flyers and pamphlets about importance of blood pressure management, stroke risk factors, and cardiovascular health. Informational flyer providing information about how to check hazards in personal care products.	Aware of and empowered with information on how to engage in improved health behavior and consumer decision-making.
High blood pressure screening	Blood pressure screening and discussion of normal and abnormal results through Stamp Out Stroke.	Awareness and discussion of next steps for concerning results, including scheduling appointments with primary care providers or visiting the emergency department for extreme findings. Offered at-home monitor to engage in regular monitoring of blood pressure.
Soil lead testing	Free of charge soil lead testing was offered with easy to access results.	Educated on lead exposure mediums and health risks.
Hazardous personal care products/cosmetics assessment	1:1 Pocketbook audit with review of product ingredient lists and evaluation of community member hazard scores for personal care products using the EWG Skin Deep database.	Consulted about safety of daily use products and real-time discussion of safer alternatives.
Health insurance enrollment	On-site assistance for health insurance enrollment through Access Health CT, helping attendees review plan options, complete applications, and get answers to coverage-related questions.	Received personalized guidance on selecting and enrolling in health insurance plans, learn about available financial assistance, and gain clarity on benefits and coverage options.

Challenges, Limitations, and Lessons Learned

Although this pilot event was successfully executed, some challenges emerged that provide useful lessons for future implementation and for others interested in organizing comparable community programs. First, resource and funding constraints shaped what was possible. This event relied on a small institutional community service grant as well as in-kind time. As such, incentives such as home blood pressure monitors, which were distributed to support health self-monitoring, were limited and depleted before the event ended. Additional material support or expanded partnerships will be needed in the future to ensure that core supplies remain available throughout an event. Staffing was another important limitation. The event relied heavily on volunteer clinicians, students, and community partners. This approach was workable for a single pilot, but dependable staffing for subsequent efforts would likely require modest funding for dedicated personnel who can manage logistics, deliver education, and assist with community engagement. One approach to addressing staffing needs without direct financial support would be to offer participation in the health fair as a means for health professional students to fulfill elective requirements or for practicing clinicians to obtain continuing medical education credit.

Another important challenge involved the structure of the clinical and environmental assessments. Many of the health-related screenings offered at the event provided immediate results (eg, blood pressure screening, pocketbook audit). This allowed participants to receive real-time information and counseling during the visit. In contrast, lead testing required external processing, and results were not available at the event itself. This difference highlights the potential value of environmental screening approaches that can provide rapid results similar to point-of-care clinical diagnostics. Tools such as handheld X-ray fluorescence devices may offer promise for on-site environmental assessment of heavy metals, although their performance and feasibility in integrated community settings require further study. The experience from this pilot event suggests that continued development of accurate, accessible, and immediate environmental screening tools would substantially strengthen future community-based preventive health initiatives.

Finally, because this was designed as an implementation effort rather than a research study, we did not collect participant-level outcomes. As a result, we cannot draw conclusions about acceptability, trust, empowerment, or changes in service use. This distinction emphasizes that the primary goal of this manuscript is to describe how the event was developed and carried out, along with the practical lessons learned during the process. Future iterations will require structured feedback tools, process measures, and follow up to assess feasibility and impact. Relatedly, this pilot was conducted within a single community setting. Although health fairs are widely used across the United States and internationally, additional implementations with systematic data collection will be needed to understand how well this model translates to communities with different social, demographic, and environmental characteristics.

Overall, the lessons from this initial effort may be informative for others, but they should be interpreted as practical guidance rather than as generalizable conclusions about effectiveness. Still, based on our experience, a basic version of this model could be replicated with relatively minimal resources. At minimum, this would include: (1) a community-accessible venue, (2) a small team of health educators and/or clinicians able to provide preventive health counseling, (3) simple environmental exposure screening tools, (4) modest incentives or health-related supplies when feasible, and (5) a local partner able to assist with outreach and community engagement. This pared-down model could allow communities to implement the core components even without extensive staffing or specialty representation.

Future Directions and Conclusions

Tackling environmental health risks is challenging because lasting impact often requires broader legislation and policy changes.^{19 -21} However, the timelines for such systemic reforms can be long, creating a need for more immediate, actionable strategies. Some of these include practical interventions such as installing air or water filters in homes.^22,23 Relevant to our health fair, emerging evidence suggests that health insurance may play a complementary role in reducing risk, although current findings are preliminary, and the mechanisms remain unclear. ²⁴ Education continues to be one of the most powerful tools for improving health outcomes. ²⁵ By informing individuals and communities, education can not only promote healthier behaviors but also motivate advocacy, influence voting patterns, and drive collective actions that support upstream public health solutions.

We believe that initiatives like the “Grounded in Health” Fair can support many of these efforts. To strengthen this model, we recommend incorporating environmental health assessments into all community health outreach events where possible and fostering partnerships among clinical providers, environmental scientists, and community organizations. Connections with health systems are particularly important for ensuring follow-up on concerning findings and helping community members establish primary care. These partnerships, along with support from nonprofits and the private sector, can also provide the funding needed to sustain programs. Stamp Out Stroke is one example of an established health system partnership that may serve as a useful model for similar initiatives. As previously mentioned, Stamp Out Stroke is a Yale New Haven Hospital initiative focused on stroke prevention through community engagement. It provides education, risk factor screening, and linkage to care, aiming to reduce stroke incidence by increasing awareness and connecting individuals to appropriate health resources.

Finally, robust studies evaluating long-term health outcomes and cost-effectiveness of integrated prevention strategies are essential to demonstrate impact and establish best practices. Overall, this pilot, implemented in a trusted and accessible community space, shows that an integrated, cross-sector approach can serve as a model for advancing environmental health through multi-specialty engagement. By merging clinical screening with environmental risk assessment, community-based initiatives like the “Grounded in Health” Fair offer a powerful prevention framework that aims to address the full context of people’s lives, including daily environmental exposures. These efforts represent an important step toward comprehensive, upstream public health strategies that protect and empower communities while strengthening preventive care based on evidence of the environment’s role in health.