Community Health Needs Assessments

1. CHELAN-DOUGLAS HEALTH DISTRICT Community Health Needs Assessments Barry Kling, MSPH Administrator Chelan-Douglas Health District October 26, 2012

2. CHELAN-DOUGLAS HEALTH DISTRICT Main Topics:Some Practical Issues in Community Health Assessment • How can you tell how healthy a community is? • Indicators – especially for sub-populations. • Small numbers and over interpretation. • Health priority setting. • So what? Implementation plans.

3. CHELAN-DOUGLAS HEALTH DISTRICT How can you tell how healthy a community is? • Population characteristics (demographics) • Health care resources, utilization and access • Illness/death statistics • Social determinants (including built environment) • Environmental factors • Community opinion/input • Prevalence of unhealthy behaviors/health risks • Standards and benchmarks • State/national comparisons • Healthy People 2020 goals • Local history/trends

4. CHELAN-DOUGLAS HEALTH DISTRICT Indicators • You can’t always measure exactly what you want. • Especially for sub-populations. • An indicator is a factor that you can count and provides good information about what you really want to know. • Example: Infant Health • A complicated subject. Infant mortality too crude a measure. • Birth weight strongly correlated with good infancy outcomes. • Birth weight readily available in health records. • Used as an indicator of overall infant health.

5. CHELAN-DOUGLAS HEALTH DISTRICT Small Numbers • Our population is already relatively small. • Example: If exposure to a given level of arsenic increases lifetime bladder cancer risk from 3 per million to 9 per million, that’s a 300% increase! But it’s unlikely we’d ever see that in local statistics (though it would make a great headline…) • Example: When you usually have 6 bad events annually (such as infant deaths) three more is a 50% increase, but does that indicate a community health problem to be solved or random variation? • When you cut populations up into service areas, age groups or ethnicities, the problem gets even worse. • So the take-away point is, don’t rely only on rates, but also look at the actual numbers to see if they’re big enough to be meaningful. • For the statisticians in the audience, look at the confidence interval, not the point estimate of likelihood.

6. CHELAN-DOUGLAS HEALTH DISTRICT Setting Health Priorities • There is an unavoidably arbitrary aspect to this. • Is it better to prevent three cases of infant mortality or 10 cases of premature cardiac death among balding portly middle aged males? • There are systematic tools such as Years of Healthy Life Lost, which are used to rank the impact of health problems. • But personal values are also involved. • So it is important to be clear and transparent about this, and to address a set of good questions.

7. CHELAN-DOUGLAS HEALTH DISTRICT Some Good Questions on Health Priorities • Number of people affected. • Severity of the effects. • Historical trends. • Alignment with organizational priorities/strengths. • Impact on vulnerable populations. • Level of concern in the community. • Existing resources/efforts to address the problem. • Relationship of problem to other community issues. • Feasibility of change, availability of evidence-based approaches. • Urgency – is it critical to intervene soon? Source: Assessing and Addressing Community Health Needs, Catholic Health Association of the United States

8. CHELAN-DOUGLAS HEALTH DISTRICT So What? Implementation • Of course doing something about it is the whole point. • Non-profit hospitals must develop implementation plans. • Health Departments are preparing to develop Community Health Improvement Plans. • This is just the beginning of a longer process. • But the collaborations that support a good community health assessment are usually the basis for effective interventions later on.

9. CHELAN-DOUGLAS HEALTH DISTRICT Thanks for Listening Contact Information Barry Kling, Administrator Chelan-Douglas Health District Phone: 509-886-6480 Cell: 509-264-7045 barry.kling@cdhd.wa.gov