1. Introduction to Public Health September 18, 2000 Community Assessment: The Healthy People 2010 Connection Judith Bradford, Ph.D. Survey and Evaluation Research Lab Ph.D. in Public Policy and Administration (Health Policy Concentration) jbbradfo@vcu.edu

2. Communities Of geography, such as a group of Census tracts, or a county or city Of individuals with shared characteristics, such as demographic and/or other personal characteristics Of affiliation, such as faith communities

3. Critical Concepts Community health is profoundly affected by the collective behaviors, attitudes, and beliefs of everyone who lives in/belongs to the community. Partnerships are effective tools for improving health in communities.

4. Core Issues and Challenges Definition of community members -- who is in the community? Trustworthy understanding of their characteristics and needs. Feasible methods of gathering needed information about them. Effective methods for involving community members in assessment and interpretation.

5. Healthy People Movement 1979: The Surgeon General’s Report on Health Promotion and Disease Prevention 1980: Promoting Health/Preventing Disease HP2000: National Health Promotion and Disease Prevention Objectives

6. Healthy People 2010 Overarching purpose: promoting health and preventing illness, disability, and premature death... grounded in science, built through public consensus, and designed to measure progress

7. Healthy People 2010 Two overarching goals: Increase quality and years of life Eliminate health disparities Format: 467 objectives to improve health, organized into 28 focus areas.

8. HP2010 Perspective …increase life expectancy and quality of life over the next 10 years by helping individuals gain the knowledge, motivation, and opportunities they need to make informed decisions about their health …encourages local and state health leaders to develop community-wide and statewide efforts that promote healthy behaviors, create healthy environments, and increase access to high-quality health care.

9. Goal 1: Increase Quality and Years of Life life expectancy (average # of years people born in a given year are expected to live based on a set of age-specific death rates. quality of life -- reflects a general sense of happiness and satisfaction with our lives and environment

10. Subgroups of Concern for Eliminating Disparities Differences that occur by…. gender race or ethnicity education or income disability living in rural localities sexual orientation

11. Major HP2010 Data Sources National Health Interview Survey (NHIS) National Health and Nutrition Examination Survey (NHANES) National Vital Statistics System - Mortality (NVSS-M) School Health Policies and Programs Study (SHPPS) National Survey of Family Growth National Vital Statistics System - Natality (NVSS-N) National Hospital Discharge Survey National Household Survey on Drug Abuse (NHDA) National Profile of Local Health Departments (NPLHD) Behavioral Risk Factor Surveillance System (BRFSS) HIV/AIDS Case Surveillance System Youth Risk Behavior Surveillance System (YRBSS) Medical Expenditure Panel Survey (MEPS)

12. 10 Leading Health Indicators Physical activity Overweight and obesity Tobacco use Substance abuse Responsible sexual behavior Mental health Injury and violence Environmental quality (social) Immunization Access to health care

13. Public Health Infrastructure HP2010 Goal: Ensure that... health agencies have the infrastructure to provide essential public health services effectively Data and information systems Workforce Public health organizations Resources Prevention research

14. Essential Public Health Services Monitor heath status Diagnose and investigate Inform, educate, and empower Mobilize community partnerships Develop policies and plans Enforce laws and regulations Link people to personal health services Assure a competent health care workforce Evaluate effectiveness, accessibility, and quality Research for new insights and solutions

15. Focus Areas Access to quality health services Arthritis, osteoporosis, and chronic back conditions Cancer Chronic kidney disease Diabetes Disability and secondary conditions Educational and community-based programs Environmental health Family planning Food safety Health communication

16. Focus Areas Heart disease and stroke HIV Immunization and infectious diseases Injury and violence prevention Maternal, infant, and child health Medical product safety Mental health and mental disorders Nutrition and overweight Occupational safety and health Oral health

17. Focus Areas Physical activity and fitness Public health infrastructure Respiratory diseases Sexually transmitted diseases Substance abuse Tobacco use Vision and hearing

18. Limitations of Current System for HP2010 Community Assessment “Disparities populations” …. are not always easy to find are sometimes difficult to define (and therefore to count) may be poorly understood by the “system” may have low political/social priority may even be considered less valuable or otherwise inconvenient

19. For example, sampling for HIV assessment…….. What’s the question? What’s the community of concern? On a scale of 1 - 10…. How complete are available data? How difficult to obtain currently unavailable data? Which sampling strategies are most effective?

20. For example, sampling for HIV assessment…….. How to determine the distribution of identified cases in a geographic area defined by Census tracts? HARS Difficulty: 1-2, depending on time of year and subject to limitations of case finding Additional data: not needed

21. How to capture reliable data on HIV risks from Latino non-resident workers? No existing federal data system contains directly relevant data. Successful example: Latino rural men’s study Difficulty of additional data collection: 5 Strategies: cooperation from worksite and community gatekeeper

22. How to determine the HIV risks and prevention needs of Caucasian, African American, and Latino men who have sex with men? No existing federal data system will do this. Successful example: Virginia MSM Survey Difficulty of additional data collection: 8 Strategies: set up field study, with regional managers and gatekeepers from all three race/ethnic groups; careful translation of concepts.

23. How to assess the feasibility of engaging faith communities in HIV prevention and care? No existing federal data system contains relevant data. Successful Example: Clergy Survey of Predominantly White Congregations and African American Faith Initiative: Eastern Virginia Pilot Study Strategies: listed samples (difficulty: 2); multi- stage targeted recruitment (difficulty:7)

24. Conclusions Current public health data systems are inadequate for comprehensive community assessment. There is a “disconnect” between HP2010 goals and readiness of public health infrastructure to fully respond. Additional assessment methods must be carefully chosen to fit the community of interest and challenges it presents. Effective participation by community of interest is critical.