Assessing Community Health

By Bernice Bennett, MPH, CHES; George Weiner, PhD; and Daniel Mueller, PhD

The Voluntary Hospital Association (VHA) defines community health assessment as a dynamic process undertaken to identify the health problems and goals of the community, enable community-wide establishment of health priorities, and facilitate collaborative action planning directed at improving community health status and quality of life. Involving multiple sectors of the community, the assessment draws on both quantitative and qualitative data on health status and use of health services. With a strong emphasis on community ownership of the process, the assessment supports developing community competence and consensus in the identification and response to health problems and goals.

Community health assessment establishes baseline measures of health status, health practice and health-related perceptions of a population. It provides the community with knowledge and significant information to prioritize needs, resources and negotiate for change.

Political, social and economic factors must be examined to determine their impact on the health of the community. Lifestyle factors such as smoking, exercise and nutrition also require careful review. The availability and access to health and social services must be analyzed to determine if the resources are adequate for the community. In addition, environmental factors, such as exposure to dangerous substances in the air, water or workplace, must be examined. Finally, hereditary and physiological makeup of the population require assessment.

Community involvement and empowerment is the key to making change. For example, in Slovakia, the Turcianske Teplice healthy community project assembled a community task force. The multi-faceted group is comprised of the town's mayor, several town deputies, the town's environmental engineer, a teacher, a priest, a coach, a social worker and interested community residents. Together with their American partners, they systematically compiled a list of problems, issues and resources. Group leaders engaged residents in an open dialogue on their perspectives of community problems. This type of process--called a focus group--allows a variety of opinions to be heard.

In addition to individual perceptions of problems, objective data must also be collected. Statistical information needs to be gathered and extrapolated from existing data for Turcianske Teplice. The Institute for Preventive and Clinical Medicine in Bratislava is preparing a survey to help compile information on Turcianske Teplice and surrounding villages, to compare local health status with nearby cities, other regions, Slovakia as a whole and other central and eastern European countries.

Another method of assessing community health uses a more formal process developed and implemented by the Missouri Department of Health. The Community Health Assessment Resource Team (CHART) is now used throughout Missouri and is being adapted for use in the partnership with Petrzalka. Specially trained teams guide the community through the assessment process.

CHART's mission is to assist communities in examining existing health care services, developing community health care plans, improving community health status and developing effective links among local health care providers. Such strategies provide a community with information to shift its focus from responding to acute crises to designing systems that plan for health, promote healthy behaviors and provide health services that are appropriate for its needs. A community-based coalition gathers community data, identifies gaps in available information, conducts community surveys and analyzes the data to best redesign the community's health care system. In this way, health care remains local, and the community can redesign health care interventions that respond directly to the issues faced by its citizens.

George Weiner, PhD is the director of Planning and Institutional Research with Cleveland's MetroHealth System. Daniel Mueller, PhD is the CHART project director with the Missouri Department of Health.

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