Combination Advance Worksheet

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					Community Assessment and Priority Setting Workbook

Instructions for “issue importance” worksheet
This worksheet is for local public health department use.

The issue importance worksheet is designed to evaluate the relative importance of community health issues.

This worksheet may be used with staff and with advisory groups or others as part of a priority-setting process. The background work (preparing estimates, calculating
years of potential life lost and the potential economic burden, summarizing community concern, and listing community resources) may, or even should be done in
advance of group discussions: with the background information in place, the group can focus their efforts on scoring and ranking.

The worksheet uses items for which a score of 1, 2, 3 (1 is low, 3 is high) is assigned. The scores are automatically tallied for an overall score.

Column 1: Size of the population potentially affected by the issue (“persons at risk”)

Enter 1, 2, or 3. “At risk” means that some combination of behavior, heredity, and/or environment increases the odds that they will eventually experience the
problem/issue. This is an estimate only, but it should be based on knowledge of the community, health data, and the epidemiology of the issue. It may be helpful to
think in terms of which groups are at-risk and how large those groups are. To put this number in perspective, calculate what percent this is of your total community
population (divide the estimated number at risk by the total population).

Column 2: Size of the population at risk who are actually affected by the issue

Enter 1, 2, or 3. The estimated number of those affected will likely be smaller than the number at risk.

Column 3: Level of premature death (potential life lost)

Enter 1, 2, or 3. Premature death is often defined as death before age 65 (sometimes before 75). Because mortality rates are so much higher for older than younger
people, looking at mortality data alone presents a biased picture of the most serious issues (i.e., it emphasizes those issues that primarily affect the elderly). Considering
"premature death" balances that by highlighting the loss of life among younger persons, a loss which creates a significant cost to families and represents a large
economic loss to the community. To assign this score, think about whether the issue affects mostly older people (fewer years of potential life lost) or younger people
(more potential life lost). (The formal statisticial measure of premature death is called YPLL, or "years of potential life lost". For assistance in calculating this statistic,
please contact the Minnesota Center for Health Statistics at MDH.)

Column 4: Severity

Enter 1, 2, or 3. Severity measures the extent to which the issue limits a person's ability to live their life in the way they want (i.e., “quality of life”). The issue may require
nursing home care, cause physical disabilities, keep people from drinking their own water, or prevent them from getting necessary health or emergency care.

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Column 5: Potential economic burden to the community

Enter 1, 2, or 3. As you consider this issue think about all the economic factors involved (for example, lost productivity and taxes because of premature death, the costs
of health care, and the costs of providing other services). Evaluating the potential economic loss to the community can be a powerful argument for addressing an issue

Column 6: Extent of public concern

Enter 1, 2, or 3. Because it is the public that ultimately sanctions and funds public health, their views on community health issues must be solicited and considered. The
views of the public should not necessarily reverse the results of a systematic and rational planning process, but the public's perception of the seriousness of the issue
cannot be ignored.

Column 7: Ability of public health to prevent the issue from occurring (primary prevention)

Enter 1, 2, or 3. Issues that can be prevented should score higher than issues that cannot be prevented. An issue is preventable if it has an: a) Identifiable agent or
cause (biologic, lifestyle, physical or social environment); b) identifiable host (a person or group of persons suffering from the cause); or c) effective means to break the
link between the cause and the host.

Column 8: Size of the gap between existing community resources currently addressing the issue and need

Enter 1, 2, or 3. Consider whether there are aspects of the issue that are not being addressed by anyone in the community, and how significant these aspects are.

Column 9: Other criteria

Enter 1, 2, or 3. Feel free to include additional criteria specific to the community.

Column 10: TOTAL importance score.

This column is automatically tallied in the spreadsheet.
NOTE: This sum is automatically entered into the Feasibility Worksheet , column 1.
A WORD OF CAUTION: A “score” is merely a starting point for discussion. This is not an exact science, so it may NOT be assumed that an
issue with a score of 20 is twice as important as an issue with a score of 10!


Space is provided to allow for further clarification of any of the preceding information.

Instructions for strategies worksheet

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This worksheet is for local public health department use.

The strategies worksheet can provide additional information for prioritizing community health issues. It gives an “at a glance” overview of the number and types of
strategies available to address a particular issue. Strategies are sorted by the three levels of intervention— individual, community, and systems—and the three levels of
prevention—primary, secondary, and tertiary. Completing this worksheet can help to ensure that primary prevention is given priority over secondary and tertiary
prevention and that consideration is given first to interventions that provide the greatest good for the greatest number of people.

Columns 1 through 6:

Put "Yes" or "Y" in the boxes corresponding to the types of strategies available for each community health issue.

NOTE: You may want to list available strategies for each community health issue somewhere else. You do not have to type the strategies onto this

After you fill in the boxes, look at each issues and consider the following:

    1. Are public health strategies available to address the issue? Having many strategies available increases the chance for identifying an appropriate strategy to meet
    your community’s unique needs and strengths.

    2.   Do the strategies emphasize prevention of the issue? Prevention strategies focus on preventing disease before it occurs by stopping the cause(s) of the issue.

    3. Are strategies available on the individual, community and systems levels? Strategies that occur at different levels usually result in greater and more long-lasting

    4. Is there any evidence that the strategies are effective? Whether a strategy is successful is determined by its ability to produce the desired results. Past
    effectiveness of a strategy is obtained from the research of others and through experience with evaluating current and past programs.

Column 7: Strategy Score

Finally, assign a score or rating to the issue based on the number and type of effective strategies available (for example, Lo/Med/High).
 NOTE: This score will automatically carry over into the Feasibility Worksheet , column 2.


Space is provided to allow for further clarification of any of the preceding information.

Instructions for feasibility worksheet

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This worksheet is for local public health department use.

The feasibility (also known as “do-ability”) worksheet is a summary of multiple criteria both to help determine which issues to address in the community health
improvement plan, and to help explain why some issues are and some are not included in the community health improvement planning part of the action plan.
NOTE: Some of the columns in this worksheet are designed to be automatically filled in using the values from the previous worksheets.

Column 1: Issue importance score

This column contains the score that you calculated in the issue importance worksheet. This number is automatically filled in.

Column 2: Strategy score

This column indicates whether community-based, primary prevention strategies are available to address this issue; using the score from the strategy worksheet. This
score is automatically filled in.

Column 3: Community ready?

(Y/N) Based on your knowledge of the community, and through your efforts at community engagement, determine whether this is an issue that the community is ready to

Column 4: Legal issues?

(Y/N) Indicate whether there are legal issues to consider, such as the authority to act, regulatory requirements, etc.

Column 5: Resource rating

(Y/N or Lo/Med/High) With this rating, you indicate the ability of your own department to address the problem, including the availability of staff, staff skill sets or other
workforce issues, and funding/budget issues. You can use Y/N (resources are/are not available) or give a rank (Lo/Med/High) to reflect resource availability.

Column 6: Designated funding

(Y/N) Many times, local public health departments undertake activities or programs because they receive funding specifically designated for those programs. These
activities, however, may not always be directed toward problems of high importance. The purpose of this column is to clarify why a department might be involved in an
activity for a problem that ranked low in importance and/or low in strategies.

Column 7: Feasible?

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(Y/N) In this column you may include any additional criteria that affect the feasibility of taking on this particular community health issue, including political support, county
board issues, etc. Use the comments section to explain more, if desired.

Column 8: Develop a community health improvement plan?

(Y/N) Consider all the factors listed, and indicate whether the problem will be addressed in a community health improvement plan.
NOTE: This conclusion is subjective, not a "sum" of all the preceding columns. However, each of those columns helps to provide a clear rationalization for
the decision to address the issue or not.


Space is provided to allow for further clarification of any of the preceding information.

Instructions for "summary of issues" worksheet

This worksheet is submitted to MDH once every five years.

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The purpose of this worksheet is to provide a summary of whether the public health issues identified through the community assessment process will be addressed, and
if they will be addressed by the local public health department or by others in the community ("who will address community health issues?").

Column 1: Is this a new issue?

(Y/N) Indicate whether this issue is new to the community or whether it is an ongonig issue.

Column 2: Will local public health address at this time?

(Y/N) The reason/s for not addressing any particular community health issue are worked out through the Feasibility Worksheet.

Column 3: Local public health will provide ongoing services or activities.

(Y/N) If Column 2 is yes, use this column to indicate if the LPH department is providing ongoing services or activites. Ongoing services or activities include those for
which there is designated funding, or programs that are an established part of the local public health department's structure (e.g., WIC clinics).

Column 4: Local public health will provide a new program or service.

(Y/N) If Column 3 is Yes, use this column to indicate whether the local public health department will develop a new program or service to address the issuse.

Column 5: Another organization will be, or is addressing this issue.

(Y/N) Please note that, whether Column 2 is Yes or NO, other community organizations may be addressing the issue. If desired, list the organization or organizations in
the Comments box.

Column 6: This issue will be addressed on a regional level.

(Y/N) Please note that, whether Column 2 is Yes or No, the issue may also be addressed at a regional level. If desired, provide additional information in the Comments


Provide more explanation of programs, organizations, or other information.

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Issue Importance Worksheet                                 For LPHD use

Local Public Health Department:                            Enter LPHD name here on the Issue Importance Worksheet


                                                               1            2              3             4          5           6             7             8             9           10
                                                             Size of      Size of     Amount of                             Extent of                   Gap between                 TOTAL
 Area of public health
                                  Community health issue   population   population   potential life              Economic    public                    resources and    Other     importance
                                                             at risk     affected        lost         Severity    burden    concern     Preventability     need        criteria      score












Strategies Worksheet                                       For LPHD use

Local Public Health Department:

                                                                    Types of strategies            Levels of prevention         Strategy Score
                                                                1            2            3       4          5            6           7
  Area of public health
                                  Community health Issue    Individual   Community   Systems   Primary   Secondary   Tertiary    High/Med/Low

Feasibility ("do-ability") Worksheet                                                  For LPHD use

Local Public Health Department:

                                                      1           2           3          4         5           6            7            8
                                                    Issue                                                                             Write an
 Area of public health                                         Strategy   Community    Legal    Resource   Designated
                         Community health Issue   importance                                                            Feasible?   improvement
    responsibility                                              score       ready?    issues?    rating     funding?
                                                    score                                                                              plan?

Summary of Issues Worksheet                                        Submit to MDH

Local Public Health Department:

                                                        1                 2                   3                     4                 5                   6
                                                                   LPH will write an  LPH will provide     LPH will provide a      Another        This issue will be
  Area of public health                            Is this a new
                          Community health Issue                    improvement      ongoing services or    new program or      organization is      addressed
     responsibility                                    issue?
                                                                       plan?              activities           service            addressing         regionally


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