EPID 600 - Introduction to Public Health Practice - Summer 2017

Community Assessment Presentation
Jeff Stover, Kim Buttery

Data Sources

In the mid 1970s (revs. 1995) Ivan Illich's book "Medical Nemesis" sub-titled "The Expropriation of Health" was published, read the introduction (4 pages), feel free to scan more and consider how this relates to the US medical/health system. His thesis was to decry the tendency to name every symptom as a discrete disease and develop an ICDA code for it, thus increasing the complexity of medical care unnecessarily, as well as making health assessment difficult, This study is brought up to date with this report from the BMJ. We see this materialization at present with the over diagnosis of PTSD, ADHD and Autism. Also read this recent article from the BMJ. Look at the CDC Web Page overview on on Public Health performance standards, then review Community Health Solutions. Also look at this comment from the IOM about the importance of social determinants of health. Read this viewpoint from JAMA, The Community Guide provides a number of tools to assist in assessment. Also scan this report from the IOM and this report from the WHO showing that public health is more than the medical & public health agencies,

In 1973, Marc Lalonde, then Minister of Health for Canada proposed the "Health Field Effect"at the APHA meeting in Detroit. Noting that up to 75% of a community's health was affected by behaviors, rather than medically treatable diseases, he initiated an impetus to look carefully at the whole community environment, including behavior/mental health, not just obvious treatable entities. This publication led to the 1983 Forward Plan for Health from the HHS and eventually to the decennial Healthy People 2020 etc. Also part of any assessment should be ana lysing how the community of interest encompasses the 10 Essentials of public health

10 essentials

Review Hans Rosling's video of a global assessment of health status and use of data. Think about the how this could be applied to your community or state.

Dr. Buttery introduces the use of geographic communities (slides). Dr. Bradford's presentation focuses on assessment of communities where the community is defined by a population with shared characteristics such as AIDS, sexual preference or Lung Cancer. 

A new report from the Institute of medicine focuses on data needed for community assessments from the local to the global levels and shows how data presenters maps are described below by Jeff Stover can be valuable. Scan this report

The1998 Geographic Assessment for 17 counties in Southside Virginia was performed by computer analysis using data downloaded from the Virginia Center for Health Statistics, then analyzing a combination of spreadsheets, databases and GIS (geographic Information Systems) projections.  Those of you who viewed the "RX for Survival" on PBS (the last session) should review this article on GIS and control of tropical diseases (starts at lower right corner.)

Assessments should consider the following issues:

How long does the population live?
How well do they live?
How much disability do they have for how long?
What are the extremes of health and disability in the community?
What seem to be the underlying causes of ill health?
How do you define 'ill health'?
What can be done to change health status?
Whose health status are you going to affect?
What are the costs and the benefits?
How long will change take?
Are these change medical or social?
Is there a difference?
What is measurable?
Are you sure it is measurable?
What role does the environment play?
Who will pay for it?

Once you believe you have answered these questions:

How are you going to plan interventions to change health status?
Whose permission do you need?
What are the constraints to your actions?
Who must be involved in the change?
What can enable the changes?

For an example of a community assessment,  scan the AHEC summary of the community assessment Dr. Buttery performed in 1998, from which several of the slides in the 1998 slide show were chosen.  Consider why the recommendations might be unexpected. Also look at this annual review from the Richmond City Health Department.

Finally, look at the following annual reports written to a city manager more than 25 years ago.  This was the director's first position after completing his MPH.  Which issues still remain important public health issues today?  Why?.  How do you think we could resolve them before another 25 years pass by?    Consider how useful these annual assessments of policy accomplishment were for the health of the city's residents?   What contributes to these assessments? Examine what happened with the grant programs over this 6 year period.

Annual report for 1970
Annual report for 1973
Annual Report for 1974

'Then look at a recent report from the Richmond City Health Department.

Note: One can even perform a global assessment (From the BMJ)

Look again at the Website for Current County Health Rankings. Identify the health status for your home county. Make sure to click on the "Move forward with action" link and then click on the "Action Center" click on at least the "Public Health" link. Consider how far we have come since I developed my first Annual reports 30+ years ago. Also, get a feel for the validity of the Healthy People Goals and Objectives by looking at this progress report This is important as Healthy People is an important resource for developing your own community health Goals & Objectivists. This JAMA viewpoint identifies one state's increased focus on making health data available to all communities for assessment. Also consider this viewpoint on Community Assessment outside the hospital as well as this recent JAMA Viewpoint. CDC has developed a Navigator to help hospitals perform community analyses. Such analyses should not be performed in a vacuum but coordinated by Local Health Departments. Click on each of the assessment tools.

Finally scan the following publications which together summarize he concepts of community assessment.

UK proposal on ensuring equity in health care (p 8-13).
Scan this Summary on community approaches from the IOM.(Focus on tables & boxes on pages 12 through 33, , rather than the text)
Scan the short assessment discussion from the WHO

Review Jeff Stover's Objectives and recommended readings on the previous web page. Intro to GIS

Readings for this session, Essays 3 & 6 (scan only)
Europe 2008 Atlas of Health Facts (skim to get a feel of what is available outside the U.S. (look at pages 10 & 16)
Also worth reading are these recent reports:
An interim report on Health & Social Care in the UK (Pages 10-12)
Comparative Review of Health and Social Care in 9 Countries. (Pages 7 & 9

Community Assessment Bookmarks


GIS Map of smoking deaths in Corpus Christi, TX, Written with Graphics Basic in 1985

Introduction to Mapping Resources