1. A Definition of Health
Health is an individual’s capacity, relative to his or her aspirations and potential, for living fully in the social, economic, and political environment.
This definition is also applicable to populations.

2. The Social Determinants of Health
The environmental, social, behavioral, and psychological factors -- such as income, employment, housing, and education -- that influence the health status of individuals and populations.

3. The LaLonde Model Factors Influencing Health Status
Lifestyle/Behavior
Medical Care
Environment
Human Biology

4. Health Status

5. A Popular Population/Community Health Status Improvement Model
Community Capacity for Health Status Improvement
Ecological Factors
Access to Care
Health Status + + =
Policies
Social Capital
Supporting Functions
Social Determinants
Community Characteristics
Population Characteristics

6. Poor Maternal Nutrition
Infant Mortality
Low Birth Weight
Genetic Problems
Lack of Prenatal Care
Poor Maternal Nutrition
Maternal Smoking
Lack of Knowledge
Accessibility
Don’t Value
Cultural Values
Transportation
Language
Money
Location
Don’t Read

7. Factors Influencing Community Health Status
Demographics/Social Determinants of Health
Pooled Risk for Disease/
Opportunities for Prevention
Prevalence of Diseases &
Disabilities
Current Health Status
Consumption of Medical,
Health & Human Services
Factors Influencing Access to &
Quality of Care
Availability & Application of Social Capital

8. Methods For Understanding Community Health
Qualitative Methods
Quantitative Methods
Community
Discussion
Groups;
Individual Interviews
Secondary
Data
Collection
and
Analysis
General
Population
Survey
On-Site
Observation

9. Secondary Data
Data from existing sources (local and state) are examined to incorporate the insights gathered by others.
Sources include:
Various web-based data sources
Data on key health indicators
Economic, political, social and cultural information for the area of interest
Comparisons of the local area of interest to the state, for indicators such as disease or health risks

10. Community Discussion Groups
Meetings are scheduled with a wide variety of audiences to try and hear from all segments of the community:
Youth, middle aged, and the elderly
Racial and ethnic minorities
People with different income levels
Community leaders, and
Health and human service providers
Meetings are scheduled with a wide variety of audiences to try and hear from all segments of the community:
Youth, middle aged, and the elderly
Racial and ethnic minorities
People with different income levels
Community leaders, and
Health and human service providers

11. Agenda Describe your community
What are the issues and challenges facing your community?
What are local resources for addressing these issues and challenges?
What are examples of local collaboration to solve problems?
What advice do you have for us?

12. Instrument Components of a Comprehensive Community Survey
Demographics
Functional health status (SF-12)
Chronic conditions and disabilities
Risks to poor health from behaviors
Preventive screening
Presence of, and characteristics of “regular provider”
Challenges to accessing services
Insurance (coverage, history of lack of insurance)
Social capital measures
Places for regular care
Use of emergency room for care
Readiness to change and counseling received from regular provider
Need for supportive community services
Community issues of concern

13. Application Of Community Health Information
Planning and Evaluation
Program/Service Planning
Program/Service Evaluation
Strategic Planning
Market Planning
Estimation of Risk Pooling
Capitation (or other Financing) Contracting (especially Medicaid and Medicare)
Grant Writing
Meeting Requirements
Community Benefits Documentation
HEDIS Reporting
JCAHO Requirements
Physician (and other staff) recruitment

14. Why Use Community Data To Drive Improvement Efforts?
Understanding the factors influencing community health allows us to allocate resources more effectively and evaluate results more accurately.
A community health data focus requires that we engage the community in the process; this increases the resources available and the options for approaching solutions.

15. Why Use Community Data To Drive Improvement Efforts?
A community-health focus meets mission and values, along with bottom-line concerns.
If our goal is to improve the health of the community we serve, while or with the objective of reducing costs of care and improving viability of the institution, then community data is essential.

16. Why Community Strategies Fail (WHO)
Failed to encourage people to think and act for themselves.
Let people depend on external resources for answers.
Have not paid attention to the question of sustainability.
Inadequate training.
Reluctance to base programs and services on local resources and knowledge.
No involvement in the design and implementation of programs.
Medically directed needs conflict with health related needs of people.
Lack of community accountability for health improvement.

17. Best Community Health Practices
Operate from a broader definition/understanding of “health”
Focus on many levels of social functioning: individual, family, neighborhood, institutions
Citizen involvement strategies
Utilization of existing resources
Truly collaborate: exchange ideas, information and resources
Skills building
Health education/health promotion
Implementation focus
Multiple, simultaneous interventions
Process/outcome evaluation
Commitments for the long-term (no quick fixes)
Understand differences in service utilization/perceptions of services within a culture (e.g., within the Hispanic population there may be differences)

18. Best Community Health Practices Have These Focus Areas on the Radar Screen
Resources
Education and Communication
Training and Technical Assistance
Information and Resource Exchange
Evaluation and Monitoring

19. Best Community Health Practices
Organize
Prioritize
Implement
Evaluate
Sustain

20. Organize And Prioritize
Develop a purpose
Size of the problem
Seriousness of the problem
Effectiveness of interventions
Community involvement and contribution
Support of leadership
Model mutual respect
Encourage people to think and act for themselves

21. Organize And Prioritize
Utilize local (existing) resources and knowledge
Incorporate elements of education and training
Incorporate policy level changes
Able to be evaluated
Attention to sustainability
Demonstrate the exchange of information and resources
Demonstrate benefit to the entire population
Increase capacity in the community for health status improvement activities
Impact on health status

22. Implement
People
Process
Practices
Policies
Resources

23. Evaluate And Sustain Information and resource exchange
Training and technical assistance
Resource development
Monitoring and evaluation
Multiple community demonstration sites

24. Southern Delaware Health Partnership
Community
Guiding Community Principles
Inviting & inclusive
Community oriented
Strengthen & enhance
Doable
Partnership
Coordinates Partnership Activities
Implementation Team
Access to Health Care
Youth Development
Communication
& Education
Primary care
Mental & dental health
Transportation
Physician recruitment
Provider network/system
Community participation
Recreational activities
Peer/mentoring programs
Youth boards
Volunteer Fair
Managed care
Medicaid & Medicare
Broader determinants of health
Discussion groups
Prevention education
Insurance education
Community health resources
Community