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Conduct Research to Build an Evidence-Base of Effective Community Health Assessment Practice

  • Date: Nov 08 2006
  • Policy Number: 20066

Key Words: Community Health Programs, Future of Public Health, Health Planning and Administration, Health Services

Community health assessment is defined as: Collecting, analyzing and using data to educate and mobilize communities, develop priorities, garner resources, and plan actions to improve public health.18 Many governmental and private organizations have conducted community health assessments across a broad array of public health issues. 19-32 Assessment is the first phase in planning and policy development.

By better understanding and documenting evidence of effective community health assessments, practitioners will: (1) avoid costly mistakes; (2) demonstrate success; (3) distinguish between real success and apparent success; (4) answer questions important to social policy decisions; (5) provide timely information; and (6) apply lessons in diverse fields.33

The Future of Public Health, the landmark 1988 Institute of Medicine report, identified assessment as one of three core public health functions that every public health agency should perform, and is an essential public health service.1 While this statement has been widely accepted in the public health community, there is little published literature on evaluations of community health assessments.2 There are a lot of planning models, and guides on how to do community health assessments.3-15 Lacking, however, is rigorous research that links effective community health assessments factors to the results.

The Government Accountability Office studied 29 comprehensive key indicator systems which use information from government statistical databases and a variety of private sources to provide quantitative data of social well-being including health and found evidence of positive influences in four areas: enhanced collaboration to address public issues; provided tools to encourage progress; helped inform decision-making and improve research; and increased public knowledge about key economic, environmental, social and cultural issues. However, it was difficult to attribute action directly to the indicator system.16

American Public Health Association (APHA) has approved several policy resolutions related to the assessment process such as "protecting essential public health functions" (20034); "supporting the National Public Health Performance Standards Program" (200022); "supporting community-based participatory research" (2004-12); and "strengthening the public health workforce" (2005-12). 17

Therefore the American Public Health Association:

1. Urges the CDC to take initiative on issues related to evaluations of community health assessments.

2. Urges CDC to identify an office within the organization that can oversee evaluation of community health assessments and health impact assessment. 

3. Encourages the allocation of sufficient financial and human resources at federal, state and local levels to set up a workgroup in collaboration with professional organizations including, but not limited to, APHA, Association of State and Territorial Health Officials (ASTHO), Council of State and Territorial Epidemiologists (CSTE), and the National Association of County and City Health Officials (NACCHO) to develop a plan and recommendations for developing and evidence-base of effective community health assessment practice. Among the questions this workgroup should study are: - What are the criteria for good research in evaluation of community health assessments? - What are factors that need to be in place to evaluate community health assessment practice consistent with standards used by the Task Force on Community Preventive Services34 in the health sector and the Campbell Collaboration35 in the educational, social and behavioral sectors? - What changes in policy will make it feasible to study community health assessment practice? - What aspect of community health assessment practice (e.g. methods of data disseminations, community involvement frameworks) should take priority? - What methodologies and evaluation frameworks (e.g. logic model36, Friedman Framework37) can be used to study community health assessment practice? - What are the specific roles of assessment practitioners at the federal, state and local levels in community health assessment practice research? - What are the technical, training and resource needs for evaluating community health assessment practice? 

4. Encourages incorporating evaluation of community health assessment practice in the 2006-2015 Research Guide. In the CDC Research Guide,38 the study of community health assessment practice would fit within the scope of crosscutting research. One suggestion is to incorporate it within Chapter IXC4 subtitle to "Public Health Assessment, Planning, Evaluation and Translational Research" (in italics are suggested changes). The crosscutting aspect of community health assessment practice is easily demonstrated. Detailed comments were submitted during the draft review phase for the Research Guide.  

5. Urges organizing an Action Learning Lab in partnership with selected states to study evaluation of community health assessments as done in the maternal child health field.39 

6. Encourages Congress to recognize the need for health assessments in legislation as exemplified in S.2506/H.R.5088 which calls for assessing the health impact of the built environment on children's health.40

References

  1. Institute of Medicine. The Future of Public Health. Washington, D.C.: National Academies Press; 1988:7. Available at: http://fermat.nap.edu/books/030908704X/html/. Accessed March 4, 2006.
  2. Myers SS, Stoto MA. Useful Community Health Assessments: A Literature Review. RAND Health; 2005. Technical Report 314. Available at htpp://www.health.state.ny.us/nysdoh/chac/usefulcha/index.htm. Accessed March 4, 2006.
  3. New York State Department of Health. 10 Steps in the Community Health Development Process. Available at http://www.health.state.ny.us/nysdoh/chac/10steps.htm. Accessed October 11, 2005.
  4. Public Health Foundation. Healthy People 2010 Toolkit - A Field Guide to Health Planning. Available at http://www.healthypeople.gov/state/toolkit/. Accessed October 11, 2005.
  5. Centers for Disease Control and Prevention. Framework for Program Evaluation in Public Health. MMWR, 1999; 48(RR11) :1-40. Also available at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr4811a1.htm. Accessed October 11, 2005. 
  6. National Association of County and City Officials. Mobilizing for Action through Planning and Partnerships (MAPP). The Four MAPP Assessments. Available at http://mapp.naccho.org/4_mapp_assessments.asp. Accessed October 11, 2005.
  7. School Improvement in Maryland. Using MSDE's 10-step process. Available at http://www.mdk12.org/process/index.html. Accessed October 11, 2005.
  8. Healthy Carolinians. North Carolina Community Health Assessment. Available at http://www.healthycarolinians.org/assess.htm. Accessed October 11, 2005.
  9. CDC National Center for Chronic Disease Prevention and Promotion. Planned Approach to Community Health (PATCH). Available at http://www.cdc.gov/nccdphp/patch/index.htm. Accessed October 11, 2005.
  10. SAMHSA's Prevention Platform. Available at http://www.preventiondss.org/ . Accessed October 11, 2005.
  11. University of Kansas Workgroup on Health Promotion and Community Development. Community Tool Box- Identification of Best Processes from Representative Resources (n=17). Available at http://ctb.ku.edu/tools/bp/en/IdentificationTable.jsp. Accessed October 11, 2005.
  12. Illinois Department of Public Health. Illinois Project for Local Assessment of Needs (IPLAN). Available at http://app.idph.state.il.us/. Accessed October 11, 2005.
  13. Kansas Department of Health and Environment. Kansas Community Health Asessment Process Workbook. Topeka, KS: Division of Printing, 1995.
  14. Steen, John. Validating plans through collaborative health improvement initiatives. American Health Planning Association Articles on Health Policy. March 1996. http://www.ahpanet.org/Health_policies.html#Plans
  15. Recommendations on Community Health Assessment and the Roles of State Health Agencies and the Federal Government. National Committee on Vital and Health Statistics, Subcommittee on State and Community Health Statistics. Available at http://www.ncvhs.hhs.gov/commrec1.htm. Accessed March 14, 2006.
  16. Government Accountability Office (GAO). Informing Our Nation. Improving how to understand the USA's position and Progress. November 2004. Available at http://www.gao.gov/new.items/d051.pdf. Accessed March 14, 2006.
  17. American Public Health Association. Search the APHA Policy Database. Available at http://www.apha.org/legislative/policy/policysearch/ . Accessed March 4, 2006.
  18. AssessNow, a collaboration of Washington State Department of Health, the Northwest Center for Public Health, the Northwest Center for Public Health Practice, and local health jurisdictions. What is assessment. Available at: http://www.assessmnow.info/assessment.htm. Accessed March 4, 2006.
  19. National Association of City and County Health Officials (NACCHO). Local Health Agency Infrastructure: A Chartbook. Community Health Assessments; 1999: 74-78. Available at http://archive.naccho.org/documents/chartbook_community74-78.pdf. Entire report available at http://archive.naccho.org/documents/chartbook.html. Accessed March 4, 2006.
  20. New York Presbyterian Hospital 2004 Community Service Plan Comprehensive Report. Available at http://www.nyp.org/pdf/communityserviceplan2004.pdf. Accessed March 5, 2006. and Franklin County 2003 Community Health Assessment by the Franklin County Health Network in Maine. Available at http://www.fchn.org/HCC/healthassessment.asp. Accessed March 5, 2006.
  21. Center for Rural Health Practice at the University of Pittsburgh at Bradford, PA. McKean County Community Health Needs Assessment 2005. Available at http://www.upb.pitt.edu/crhp/CHA%20Final.pdf. Accessed March 5, 2006.
  22. United Way of King County, WA. United Way of King County Community Assessment. Available at http://www.uwkc.org/ourcommunity/researchreports/commassess/toc.asp, April 2005. Accessed March 5, 2006.
  23. The Boston Public Health Commission. The Health of Boston 2002. Available at http://www.bphc.org/reports/pdfs/report_146.pdf. Accessed March 5, 2006.
  24. Community Health Assessment and Improvement Report, MI ; 2001-2002. Available at http://www.michigan.gov/documents/PartI-2_37390_7.PDF. Accessed March 5, 2006.
  25. US Department of Health and Human Services. Healthy People 2010, November 2000. Available at http://www.healthypeople.gov/Publications/. Accessed March 6, 2006.
  26. City and County of San Francisco Department of Public Health Occupational and Environmental Health Eastern Neighborhood Community Health Impact Assessment: Profile Public Infrastructure. Available at http://www.sfdph.org/phes/enchia_mtngs/mtng_archives/2005_08_17_PublicInfrastructureWorkingDraft.pdf. Accessed March 5, 2006.
  27. Seven Valleys Health Coalition. 2004 Cortland Counts. Available at http://www.sevenvalleyshealth.org/report04/1_3.htm. Accessed March 5, 2006.
  28. Communities Count Initiative Partners. Communities Count: Social and Health Indicators from King County, WA. Where do we go from here? 2005. Available at http://www.communitiescount.org/tableofcontents.htm. Accessed March 5, 2006.
  29. Multnomah County. Multnomah PACE-EH Assessment Report, 2004 and 2005 Action Plan. Available at http://www.pace-eh.org/. Accessed March 5, 2006
  30. Florida Department of Health, PACE-EH. Available at http://www.doh.state.fl.us/environment/programs/PACE-EH/PACE-EH.htm, 2005. Accessed March 5, 2006.
  31. Health Action Steering Committee, Monroe County, NY. Health Action- Report Cards. Available at http://www.healthaction.org/ReportCards.html . Accessed March 5, 2006.
  32. US House of Representatives. Select Partisan Committee Report To Investigate the Preparation for and Response to Hurricane Katrina, 2006. Available at http://katrina.house.gov/full_katrina_report.htm. Accessed March 9, 2006.
  33. Center for Global Health. When will we learn? Improving lives through impact evaluation. May, 2006. Available at http://www.cgdev.org/content/publications/detail/7973. Accessed July 18, 2006.
  34. Guide to Community Prevention Services. About Us. http://www.thecommunityguide.org/about/. Accessed March 9, 2006
  35. The Campbell Collaboration Information - Frequently Asked Questions (FAQs). Available at http://www.campbellcollaboration.org/faqs/faq.asp. Accessed March 9, 2006.
  36. W.W.Kellog Foundation Logic Model Development Guide. Available at http://www.wkkf.org/Pubs/Tools/Evaluation/Pub3669.pdf. Accessed June 12, 2006.
  37. Friedman, Mark. A Guide to Developing and Using Performance Measures in Results-based Budgeting by Mark- Friedman, Prepared for the Finance Project, May 1997. http://www.financeprojectinfo.org/Publications/measures.html
  38. Centers for Disease Control and Agency for Toxic Substances and Disease Registry. CDC Health Protection and Research Guide, 2006-2015, Public Comment Draft, Release November 18, 2005. Available at http://www.cdc.gov/od/ophr/hpr_guide.pdf. Accessed March 4, 2006.
  39. Building State Partnerships to Improve Birth Outcomes. AMCHP Perinatal Disparities Action Learning Lab Report. January 2005. Available at http://www.amchp.org/policy/disparities-all-report.pdf. Accessed June 14, 2006.
  40. American Public Health Association. During National Public Health Week Sen. Obama and Rep. Solis introduced a bill to address the built environment and children's health. Tell your Senators and Representative to cosponsor S.2506/H.R.5088 The Healthy Places Act of 2006! Available at http://www.capwiz.com/apha/issues/alert/?alertid=8638786&type=CO. Accessed July 18, 2006.

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