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

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.

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 o State/national comparisons o Healthy People 2020 goals o Local history/trends

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.

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.

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.

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

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.

CHELAN-DOUGLAS HEALTH DISTRICT Thanks for Listening Contact Information Barry Kling, Administrator Chelan-Douglas Health District Phone: Cell: