Digging into community health problems

1. Digging into community health problems A tale of three communities Carol L. Ireson RN PhD University of Kentucky College of Public Health

2. Traditional approach to community health improvement • Conduct random digit dial telephone survey • Analyze the findings • Pull other sources of data together • Publish a report • Put it on a shelf

3. Involving Citizens in Community Health Improvement Efforts • Town hall meetings • Deliberative forums using the Kettering process of naming and framing issues • Focus groups • Issues briefs • Use of public media

4. Informing citizens with local data • Demographic data, i.e., age, race, sex, income, other • Specific data about • Disease burden, i.e. , mortality and morbidity • Health status • Health access • Behavioral Risk Factors

5. Primary Data telephone surveys mailed surveys stakeholder interviews focus groups county fairs homemakers clubs senior centers Where do you get it?

6. Where do you get it? • Secondary Data from • state and national data bases • bureau of vital statistics • disease registries • census bureau • law enforcement agencies

7. How do you make it meaningful? • Transform data to information • Use issue booklets to communicate in lay terms • Use the local media to inform the public

8. How do you make it relevant? • Reach out to local citizens • Convene public forums • Engage the citizens in deliberating about what the data means to them • Engage different groups in different settings

9. Owensboro • Conducted a random digit dial survey of over 2000 people • Developed a discussion guide from findings about 7 major issues • Convened 52 public forums to deliberate issues • Participants made choices about top issues and potential solutions

10. Owensboro- what happened • Additional forums, honest & open deliberation • Emergence of the Citizens Health Care Advocates (CHCA) • Tough issues brought to resolution through citizen action • Deliberation spillover into arenas besides health

11. Morgan County • Surveys conducted at the county fair found issues with: • Disease burden • Heart disease, cancer, diabetes, injury, depression • Health behaviors • Poor nutrition, lack of exercise • Access to health care • No insurance, no money, not enough doctors

12. Engaged the voices of citizens in naming the issues • Parents of school age children • Senior citizens • Homemakers • High school students • Faith community

13. Interpreting their voices • Deliberations transcribed by a recorder • Transcriptions analyzed line for line for meaning • Themes identified across all of the forums

14. What did the people say? • Dominant themes • the community is transitioning from an agricultural base to an unknown • family life has changed • the traditional family doctor is disappearing • the community has assets that would improve health • the economy affects health

15. Moving to Community Action • What has happened County Judge Exec has become engaged Faith community developing plans to focus on youth Increase in social capital • What is next • Create a citizens health council • Engage other local stakeholders

16. Lincoln County • Health assessment at the county fair • Beginning the process of community engagement in defining the issues

17. "I've seen that there is not a more powerful way to initiate significant change than to convene a conversation. When a community of people discover that they share a concern, change begins. There is no power equal to a community discovering what it cares about." Margaret Wheatley, Turning to One Another