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					 Introduction to Public Health
      September 18, 2000
     Community Assessment:
The Healthy People 2010 Connection
           Judith Bradford, Ph.D.
   Survey and Evaluation Research Lab
 Ph.D. in Public Policy and Administration
       (Health Policy Concentration)
             jbbradfo@vcu.edu
           Communities

• Of geography, such as a group of
  Census tracts, or a county or city
• Of individuals with shared
  characteristics, such as demographic
  and/or other personal characteristics
• Of affiliation, such as faith
  communities
         Critical Concepts

• Community health is profoundly
  affected by the collective behaviors,
  attitudes, and beliefs of everyone
  who lives in/belongs to the
  community.
• Partnerships are effective tools for
  improving health in communities.
    Core Issues and Challenges
• Definition of community members -- who is
  in the community?
• Trustworthy understanding of their
  characteristics and needs.
• Feasible methods of gathering needed
  information about them.
• Effective methods for involving community
  members in assessment and interpretation.
   Healthy People Movement

• 1979: The Surgeon General’s Report
  on Health Promotion and Disease
  Prevention
• 1980: Promoting Health/Preventing
  Disease
• HP2000: National Health Promotion
  and Disease Prevention Objectives
      Healthy People 2010

Overarching purpose: promoting
 health and preventing illness,
 disability, and premature death

... grounded in science, built through
   public consensus, and designed to
   measure progress
      Healthy People 2010

Two overarching goals:
• Increase quality and years of life
• Eliminate health disparities

Format: 467 objectives to improve
 health, organized into 28 focus areas.
        HP2010 Perspective
• …increase life expectancy and quality of life
  over the next 10 years by helping individuals
  gain the knowledge, motivation, and
  opportunities they need to make informed
  decisions about their health
• …encourages local and state health leaders
  to develop community-wide and statewide
  efforts that promote healthy behaviors, create
  healthy environments, and increase access to
  high-quality health care.
 Goal 1: Increase Quality and
        Years of Life

• life expectancy (average # of years
  people born in a given year are
  expected to live based on a set of
  age-specific death rates.
• quality of life -- reflects a general
  sense of happiness and satisfaction
  with our lives and environment
   Subgroups of Concern for
    Eliminating Disparities
Differences that occur by….
• gender
• race or ethnicity
• education or income
• disability
• living in rural localities
• sexual orientation
      Major HP2010 Data Sources
•   National Health Interview Survey (NHIS)
•   National Health and Nutrition Examination Survey (NHANES)
•   National Vital Statistics System - Mortality (NVSS-M)
•   School Health Policies and Programs Study (SHPPS)
•   National Survey of Family Growth
•   National Vital Statistics System - Natality (NVSS-N)
•   National Hospital Discharge Survey
•   National Household Survey on Drug Abuse (NHDA)
•   National Profile of Local Health Departments (NPLHD)
•   Behavioral Risk Factor Surveillance System (BRFSS)
•   HIV/AIDS Case Surveillance System
•   Youth Risk Behavior Surveillance System (YRBSS)
•   Medical Expenditure Panel Survey (MEPS)
    10 Leading Health Indicators
•   Physical activity
•   Overweight and obesity
•   Tobacco use
•   Substance abuse
•   Responsible sexual behavior
•   Mental health
•   Injury and violence
•   Environmental quality (social)
•   Immunization
•   Access to health care
    Public Health Infrastructure
HP2010 Goal: Ensure that ... health agencies
  have the infrastructure to provide essential
  public health services effectively
• Data and information systems
• Workforce
• Public health organizations
• Resources
• Prevention research
     Essential Public Health Services
•   Monitor heath status
•   Diagnose and investigate
•   Inform, educate, and empower
•   Mobilize community partnerships
•   Develop policies and plans
•   Enforce laws and regulations
•   Link people to personal health services
•   Assure a competent health care workforce
•   Evaluate effectiveness, accessibility, and quality
•   Research for new insights and solutions
                 Focus Areas
• Access to quality          • Disability and
  health services              secondary conditions
• Arthritis, osteoporosis,   • Educational and
  and chronic back             community-based
  conditions                   programs
• Cancer                     • Environmental health
• Chronic kidney             • Family planning
  disease                    • Food safety
• Diabetes                   • Health communication
                Focus Areas
• Heart disease and       • Medical product safety
  stroke                  • Mental health and
• HIV                       mental disorders
• Immunization and        • Nutrition and
  infectious diseases       overweight
• Injury and violence     • Occupational safety
  prevention                and health
• Maternal, infant, and   • Oral health
  child health
                Focus Areas
• Physical activity and   • Substance abuse
  fitness                 • Tobacco use
• Public health           • Vision and hearing
  infrastructure
• Respiratory diseases
• Sexually transmitted
  diseases
 Limitations of Current System for
 HP2010 Community Assessment
“Disparities populations” ….
• are not always easy to find
• are sometimes difficult to define (and
  therefore to count)
• may be poorly understood by the “system”
• may have low political/social priority
• may even be considered less valuable or
  otherwise inconvenient
 For example, sampling for HIV
        assessment……..
What’s the question?
What’s the community of concern?

On a scale of 1 - 10….
How complete are available data?
How difficult to obtain currently unavailable data?
Which sampling strategies are most effective?
 For example, sampling for HIV
        assessment……..
How to determine the distribution of identified
  cases in a geographic area defined by Census
  tracts?
• HARS
• Difficulty: 1-2, depending on time of year and
  subject to limitations of case finding
• Additional data: not needed
How to capture reliable data on HIV
risks from Latino non-resident workers?


No existing federal data system contains directly
 relevant data.
• Successful example: Latino rural men’s study
• Difficulty of additional data collection: 5
• Strategies: cooperation from worksite and
  community gatekeeper
How to determine the HIV risks and
prevention needs of Caucasian, African
American, and Latino men who have sex
with men?
No existing federal data system will do this.
• Successful example: Virginia MSM Survey
• Difficulty of additional data collection: 8
• Strategies: set up field study, with regional
  managers and gatekeepers from all three
  race/ethnic groups; careful translation of
  concepts.
How to assess the feasibility of engaging
faith communities in HIV prevention and
care?
No existing federal data system contains relevant
 data.
• Successful Example: Clergy Survey of
  Predominantly White Congregations and
  African American Faith Initiative: Eastern
  Virginia Pilot Study
• Strategies: listed samples (difficulty: 2); multi-
  stage targeted recruitment (difficulty:7)
                Conclusions
• Current public health data systems are inadequate
  for comprehensive community assessment.
• There is a “disconnect” between HP2010 goals and
  readiness of public health infrastructure to fully
  respond.
• Additional assessment methods must be carefully
  chosen to fit the community of interest and
  challenges it presents.
• Effective participation by community of interest is
  critical.

				
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